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Adderall, Stimulants & Modafinil for ADHD: Short- & Long-Term Effects

Episode 126 May 29, 2023 1h 58m 16 insights
In this episode, I explain how medications such as Adderall, Ritalin, Vyvanse and other stimulants work to increase focus and treat attention-deficit/hyperactivity disorder (ADHD). I explain the brain circuits involved in focus and the key roles dopamine and norepinephrine play in their regulation. Then I explain how stimulants such as Adderall and Vyvanse can increase focus and reduce hyperactivity in kids or adults with ADHD, and how and why Ritalin and other medications (e.g., Modafinil, Guanfacine) may work better for some. I explain the long-term effects of ADHD medications on height, cardiovascular health, hormones, predisposition to addiction and psychosis, and whether these treatments can be used and then stopped. I also discuss the immense individual variation in dosage sensitivity for these medications and the negative side-effects that occur from recreational use. This episode ought to benefit anyone with ADHD, their parents, those on ADHD medications or anyone curious about how these medications work. For the full show notes, visit hubermanlab.com.
Actionable Insights

1. Treat Diagnosed Childhood ADHD

For children with diagnosed ADHD, pursue appropriate treatment combining medication and behavioral therapies, as untreated ADHD significantly increases the risk of illicit drug use and addiction in adulthood, while treated children fare better in life outcomes.

2. Seek Comprehensive ADHD Treatment

Obtain an accurate ADHD diagnosis from a well-qualified psychiatrist who can prescribe a comprehensive treatment plan including appropriate medication, behavioral therapies, nutritional guidelines, and supplementation, updating these as the individual matures.

3. Avoid Non-Prescribed Stimulants

Do not use stimulant compounds like methylphenidate, Ritalin, Adderall, Vyvanse, Dexedrine, or methamphetamine unless prescribed by a physician specifically for ADHD. Recreational or off-prescription use carries a high risk of addiction and psychotic episodes.

4. Avoid Recreational Stimulant Use

Refrain from using stimulant medications like Adderall or Ritalin recreationally or for performance enhancement without a prescription. This significantly increases the risk of addiction and psychotic episodes due to the rapid and intense dopamine response in individuals without ADHD.

5. Combine ADHD Treatments

For optimal ADHD treatment, combine drug therapies with behavioral protocols under the guidance of a board-certified psychiatrist. This approach is more effective than either method alone.

6. Tailor ADHD Medication Regimen

Work with a qualified psychiatrist to carefully adjust the dosage, timing, and duration of ADHD medication use over a person’s lifespan. This optimizes the function of neural circuits for focus and reduces hyperactivity/impulsivity.

7. Use Minimal Effective Dosage

When starting or adjusting ADHD medication, begin with the lowest possible effective dose and increase only as necessary to achieve benefits. Always carefully monitor for any side effects that might arise.

8. Consult Psychiatrist for Tapering

If considering reducing or stopping ADHD medication, especially if under 25, consult a board-certified psychiatrist to discuss a tapering plan. Abrupt cessation can lead to withdrawal symptoms like lethargy, depressed mood, and difficulty focusing.

9. Consider ADHD Medication Breaks

Discuss with a psychiatrist the potential benefits of taking ‘drug holidays’ (e.g., weekends off, summer vacations) from ADHD medication. This was an original recommended dosing pattern and may lead to different biological and neuroplastic responses compared to continuous daily use.

10. Avoid Alcohol with Stimulants

If taking ADHD stimulant medications, strictly avoid alcohol and benzodiazepines (unless prescribed by a physician). Combining them is detrimental to brain and body health and can exacerbate negative effects.

11. Avoid Alcohol with Guanfacine

If taking guanfacine, strictly avoid alcohol, as it profoundly lowers alcohol tolerance. Even small amounts can lead to serious problems and potentially death.

12. Support Cardiovascular Health

If taking ADHD medication, actively support cardiovascular health by avoiding smoking/vaping nicotine and engaging in regular exercise. These drugs can increase sympathetic nervous system activity, warranting proactive health measures.

13. Manage Evening Alertness/Cortisol

Limit overall alertness and stress levels in the late day and evening, even if needing to focus. This prevents chronic late-day cortisol elevations that can disrupt the endocrine system and contribute to depressive symptoms.

14. Understand Dopamine Kinetics

Be aware that drugs or behaviors causing rapid, high peaks in dopamine followed by quick crashes carry a higher risk for addiction and psychotic episodes. Slower, more sustained dopamine increases reduce this risk.

15. Utilize Meditation and NSDR

Engage in meditation, yoga nidra, or non-sleep deep rest (NSDR) sessions, even short ones (e.g., 10 minutes). These practices can restore cognitive and physical energy and help explore different brain-body states.

16. Prioritize Hydration, Electrolytes

To ensure proper hydration and adequate electrolytes (sodium, magnesium, potassium), dissolve one packet of Element in 16-32 ounces of water first thing in the morning and during physical exercise. These are vital for optimal brain and body function.