# Why is Adderall NOT approved for social anxiety?



## Raptors (Aug 3, 2009)

Me among others on this thread have found it to be simply.

Yet, time and time again doctors refuse to accept it as a treatment option and it is one of the hardest drugs to be prescribed for SA. 

I've heard supposedly, it has possibility to increase anxiety, but this cannot true to the the sheer amount of anecdotal evidence.


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## Ash09 (Apr 27, 2009)

It's not approved because there are no clinical trials showing it's efficacy, the FDA requires at least two trials showing it's effective.


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## Upekkha (Dec 10, 2009)

I think there should be a distinction between anxiety and social anxiety. Adderall can cause anxiety during its effective period and as it is wearing off. Yet during its effective period, the type of anxiety that is produced (if it does produce anxiety at all) is usually a more generalized unsettled feeling not related to any stimulus. The specific anxiety induced by the social stimulus is in many cases eliminated, or greatly reduced. I have found this to be the case for myself.

So while the doctor may be right the medication can cause anxiety, it is usually not very severe and it is unrelated to any stimulus. In other words, it just seems a byproduct of CNS stimulation. Yet while it may do this, it also seems to make people insensitive to anxiety from the social stimulus. So it is very useful, since the social stimulus usually causes more anxiety and is far more debilitating in social phobia sufferers than the possible mild generalized anxiety caused by the medicine. 

So it seems like there are two types of anxiety in this equation, and if you have social phobia it seems like the medicine may add a little and but also take away a whole lot in this department. So for a doctor to say it is not useful for social anxiety because it can cause anxiety, this seems to be a misunderstanding of the problem. He may just be reluctant to prescribe a highly controlled substance off-label.

Also, some doctors are just conservative period regarding controlled substances. If you have a very conservative doctor, then it may very well be futile to attempt to get this treatment from them. The best way to get this treatment without a specific ADD diagnosis would probably be to exhaust (or have exhausted) the alternatives. If you have found all other treatments unsatisfactory, and your doctor will still not prescribe them, then he is probably too conservative. There definitely exist doctors who will prescribe them for SA, though very few who will do so as a first-line treatment without a comorbid ADD diagnosis.


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## mike8803 (Feb 21, 2010)

Adderall isnt for SA, you might think it would be because it gives you energy/movitation, but thats not what SA lacks.


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## wantotalk (May 4, 2009)

Initially, I found stimulants to be great for social anxiety (Vyvanse and now Adderall). However, over time, the pro-social/feel good aspect starts to diminish. The only way I know to get effects back is buy taking a week or so off....or by increasing the dosage (which my Pdoc did, but we've agreed to stop going any higher).

I suppose there is some risk that individuals will abuse the drug by increasing the dose (without dr. approval) to get that initial feeling back, but, who knows...


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## Raptors (Aug 3, 2009)

Upekkha said:


> I think there should be a distinction between anxiety and social anxiety. Adderall can cause anxiety during its effective period and as it is wearing off. Yet during its effective period, the type of anxiety that is produced (if it does produce anxiety at all) is usually a more generalized unsettled feeling not related to any stimulus. The specific anxiety induced by the social stimulus is in many cases eliminated, or greatly reduced. I have found this to be the case for myself.
> 
> So while the doctor may be right the medication can cause anxiety, it is usually not very severe and it is unrelated to any stimulus. In other words, it just seems a byproduct of CNS stimulation. Yet while it may do this, it also seems to make people insensitive to anxiety from the social stimulus. So it is very useful, since the social stimulus usually causes more anxiety and is far more debilitating in social phobia sufferers than the possible mild generalized anxiety caused by the medicine.
> 
> ...


How long did it take for the pro-social effects to go away? (assuming you were taking it daily) What was your initial dose?


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## crayzyMed (Nov 2, 2006)

mike8803 said:


> Adderall isnt for SA, you might think it would be because it gives you energy/movitation, but thats not what SA lacks.


Actually its one of the best meds for social anxiety, and it doesnt work because it gives you energie and motivation, look at ritalin, most ppl dont like it here wile it gives you those 2.

Its a shame amphetamines arent prescribed more often for differend conditions then ADHD since they have potential for a lot of differend disorders, i think a big reason why they arent prescribed more often is also the tolerance problem, wich can be overcome once understanding the mechanisms behind it.


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## UltraShy (Nov 8, 2003)

Ash09 said:


> It's not approved because there are no clinical trials showing it's efficacy, the FDA requires at least two trials showing it's effective.


1. Adderall went generic years ago, thus there is nobody to pay to test generic mixed amphetamine salts for the treatment of SA. No economic incentive = no clinical trial.

2. It's a C-II drug. No way in (non-existent) hell is the DEA going to put up with amphetamines being commonly used to treat SA. The DEA doesn't give a damn if it works -- their only objective is to keep junkies from having fun with it and there is less out there for potential diversion to such junkies if you and & I & all other legitimate patients can't get it.

3. If you're not happy with the DEA please feel free to write your federal elected officials (I sure have).


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## mike8803 (Feb 21, 2010)

Ash09 said:


> It's not approved because there are no clinical trials showing it's efficacy, the FDA requires at least two trials showing it's effective.


+1


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## korey (Apr 25, 2006)

What makes AD/HD more deserving of stimulant treatment than SA? Stimulants are commonly accepted as the best treatment for AD/HD, and psychiatrists usually don't have a problem writing monthly prescriptions for C-II stimulants if a patient has officially been diagnosed with AD/HD. But if you mention using stimulants for anything else, they go crazy. Really, does the DEA routinely check to make sure the medications prescribed are approved for the diagnosed condition(s)? And so what if they aren't? Doctors are allowed to use their own discretion and prescribe off-label if necessary. I seriously don't understand how a doctor can choose to decrease treatment options and tell a patient that they're s.hit out of luck when other traditional treatments fail. Their idiocy is supposed to keep them safe from the DEA's scrutiny/bullying so they can continue practicing medicine. But what's the point in treating patients if you're not willing to go the distance and make sure they are getting relief of their symptoms? I guess it's all about job security and money. But if they're not knowledgeable and confident enough to back up their prescribing practices, then they shouldn't be practicing in the first place. It's so frustrating to think about because there's literally nothing we can do.


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## meyaj (Sep 5, 2009)

korey said:


> What makes AD/HD more deserving of stimulant treatment than SA?


The fact that it can be used to treat ADHD effectively for years/indefinitely, but SA without comorbid ADHD generally has you developing tolerance to the helpful effects really quickly?


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## UltraShy (Nov 8, 2003)

korey said:


> What makes AD/HD more deserving of stimulant treatment than SA?


I suspect the standard excuse would be that we have a s***load of non-controlled SA treatments, like every SSRI/SNRI under the sun (ignoring the fact that many of them don't work for many SA patients).

When it comes to ADD drug treatments there really isn't anything other than stimulants, with Wellbutrin be the only non-controlled one and being too weak to really work.

Clearly, those of us who can't function socially need treatment at least as much as little Timmy who drives teachers insane because he acts like a kid and won't sit down and shut up in class. We all know that magically rich white kids "suffer" from ADD at vastly higher rates than do poor kids. This means that doctors & lawyers want their Timmy to bring home straight "A"s and they're going to drug him if that's what it takes to get an "A+" out of him. At 36 I have a harder time getting drugs than Timmy at age 8 -- ironic given that I'm college educated and as an adult for over half my life can give informed consent that little Timmy can't.



korey said:


> Stimulants are commonly accepted as the best treatment for AD/HD, and psychiatrists usually don't have a problem writing monthly prescriptions for C-II stimulants if a patient has officially been diagnosed with AD/HD. But if you mention using stimulants for anything else, they go crazy.


Agree. Just do a Google search for amphetamine use in the treatment of depression. You'll get so few hits that it seems like you just typed in the most exotic & esoteric thing possible.



korey said:


> Doctors are allowed to use their own discretion and prescribe off-label if necessary.


Off-label prescribing is very common. In fact, I'm confident most folks on antipsychotics don't have any psychotic symptoms at all. But when docs play with C-IIs they're putting their career in the balance if they can't 100% fully justify its use to all who look over their shoulder and can yank their license to practice medicine. They get to enjoy the government second guessing their medical decisions.



> I seriously don't understand how a doctor can choose to decrease treatment options and tell a patient that they're s.hit out of luck when other traditional treatments fail.


If you earned $300,000 a year would you risk your job as an MD? Saying you're "s*** out of luck" is a whole lot cheaper than losing a career worth many millions over a lifetime. It's a disgrace the way we treat legitimate patients in desperate need. We regularly deny amphetamines to most depression patients even if the other option could well be suicide in some cases. This is part of the DEA's "Better Dead Than Addicted" program that show such great compassion for human life and suffering.



> Their idiocy is supposed to keep them safe from the DEA's scrutiny/bullying so they can continue practicing medicine.


Yup. Don't forget state regulators as well who issue their license to practice medicine.



> But what's the point in treating patients if you're not willing to go the distance and make sure they are getting relief of their symptoms?


The point has six figures and puts them in the highest tax bracket.



> It's so frustrating to think about because there's literally nothing we can do.


Yes, I feel very frustrated about this issue as well as you've surely noticed. You can relentlessly phone, e-mail, and snail mail your elected officials about how their asinine War On Drugs leaves many legitimate patients as collateral damage.


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## SilverNova (Mar 19, 2010)

UltraShy said:


> *1. Adderall went generic years ago, thus there is nobody to pay to test generic mixed amphetamine salts for the treatment of SA. No economic incentive = no clinical trial.*
> 
> *2. It's a C-II drug. No way in (non-existent) hell is the DEA going to put up with amphetamines being commonly used to treat SA. The DEA doesn't give a damn if it works -- their only objective is to keep junkies from having fun with it and there is less out there for potential diversion to such junkies if you and & I & all other legitimate patients can't get it.*
> 
> 3. If you're not happy with the DEA please feel free to write your federal elected officials (I sure have).


I've tried both Rx adderall and generic. Rx is much better. It didn't do anything but sorta help me focus, have a good workout and stay up for 24+hrs. 
In the bold there....and big box Pharma wins again. They will help you but only if they can profit from it.


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## KurtG85 (Sep 19, 2008)

meyaj said:


> The fact that it can be used to treat ADHD effectively for years/indefinitely, but SA without comorbid ADHD generally has you developing tolerance to the helpful effects really quickly?


All depends on the person. Definitely not universal as I have been on it for many years and developed 0 tolerance whatsoever.

As for whether adderall helps or worsens my anxiety, that all depends on the exact kind of anxiety you are describing. Adderall helps my anxiety in some situations and worsens it in others.


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## UltraShy (Nov 8, 2003)

SilverNova said:


> I've tried both Rx adderall and generic. Rx is much better.


It's my understanding that both immediate release generic adderall and dextroamphetamine currently only have one US maker: Teva, a huge generic drug maker based in Israel (which I once noticed I own stock in through an emerging markets index fund).

It seems Teva bought out Barr's dex IR operation, and still sells it with the "B" emblem on one side.


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## SilverNova (Mar 19, 2010)

UltraShy said:


> It's my understanding that both immediate release generic adderall and dextroamphetamine currently only have one US maker: Teva, a huge generic drug maker based in Israel (which I once noticed I own stock in through an emerging markets index fund).
> 
> It seems Teva bought out Barr's dex IR operation, and still sells it with the "B" emblem on one side.


Interesting. I love reading about who makes what now. The Rx kind I had was the 30mgXR in those little balls. The generic was this one. Both different doses though and felt different when I took them. 
Sorry threadjack..

Lots of off label uses for all kinds of drugs. It's just that now that it's a schedule II drug they just aren't dispensing it like they did before.


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## korey (Apr 25, 2006)

I think generic Adderall IR as well as generic Dexedrine IR have three or more manufacturers: http://www.drugs.com/imprints.php?action=search&drugname=Amphetamine+dextroamphetamine http://www.drugs.com/imprints.php?action=search&drugname=Dextroamphetamine

Sandoz, Ranbaxy, Mallinckrodt, Barr (or Teva if that is who you say owns Barr)


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## mark555666 (May 1, 2008)

Because it's legal speed. The FDA probably think people ends like amphetamine addicts or something. How many people drink alcohol without becoming an alcoholic? The FDA doesn't like drugs that works too good, end of story. More than 50% percent of the worlds criminality is drugs related. http://www.wodc.nl/images/1790B_summary_tcm44-201188.pdf
I never believe that drug legalization will happen because too much is earned by lots of people on combating drugs.How many jobs would get lost?? I wonder how many people earn money to fight drugs(war on drugs???). I think if legalization will happen the economy collapses. I think America doesn't want to make it legal for that reason.
It's a cycle. Mexico and other countries make drugs to live, while other countries fight against drugs (without success) for jobs. Sorry for my English


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## crayzyMed (Nov 2, 2006)

Asking amphetamine for SA is a waste of time, go into the ADD route, tell your psychiatrist your ADD symptons and say that you think that is the cause. If you would make it possible for him to give a ADD diagnosis he wont have to risk losing he's license as he just prescribes a normal treatment.
Everyone wins.


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## inVis420 (Jul 15, 2009)

crayzyMed said:


> Asking amphetamine for SA is a waste of time, go into the ADD route, tell your psychiatrist your ADD symptons and say that you think that is the cause. If you would make it possible for him to give a ADD diagnosis he wont have to risk losing he's license as he just prescribes a normal treatment.
> Everyone wins.


This is what I did and my doc immediately gave me adderall (no ritalin or strattera first...just got the addy right away). I really do have ADD though so I didn't feel like I was making anything up and it also helps my SA alot.


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## Raptors (Aug 3, 2009)

inVis420 said:


> This is what I did and my doc immediately gave me adderall (no ritalin or strattera first...just got the addy right away). I really do have ADD though so I didn't feel like I was making anything up and it also helps my SA alot.


How long have you been taking it? How effective is it? Did it 'poop-out' for you?


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## nothing to fear (Mar 23, 2005)

it can worsen the physical aspects of anxiety.. it certainly has for me and given me some of the worst episodes of anxiety i've had. but it can help social anxiety in its ability to clear up the mind, make thoughts flow much faster, builds confidence, increases talkativeness, etc. those effects diminish overtime, probably unless you constantly increase the dosage. 
many people with SA who want to take medication surely aren't addicts wanting to get high, but there's no question that a drug that increases confidence and all that awesome stuff for SAers as well as amphetamine does would have a very high potential for addiction among social anxiety sufferers. 

if it was approved for social anxiety, there should be specifics on how it's used. i really don't believe it's good to take long-term, in regards to the benefits on SA and other physical and mental health effects it could have. ideally, i think it would work best being given out for use in moderation when there's a very socially demanding situation, in the way that some people use benzos. in the beginning it was good for giving me that extra push in getting out, but those effects fade over time and it is detrimental to always depend on it (which tends to be a problem with substances, alcohol most often, for a lot of SAers).

anyway, i really think dopamine's role in social anxiety really should be considered and there should be more focus on that rather than just serotonin. i don't know how medication is really made but it'd be very beneficial to alter a drug that increases dopamine well enough that it has the positive effects on socializing similar to adderall but doesn't have the dependancy/addiction potential and other possible negative effects.

benzos work on just the physical symptoms of anxiety but it can be seriously blunting to social skills and conversing well. it's a bit bothersome that the few drugs approved for SA are benzos and SSRIs. it seems that for pharma companies, as long as there's enough meds approved that will bring in the big bucks for them then there's no use to try to find others even if they are more beneficial.


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## meyaj (Sep 5, 2009)

nothing to fear said:


> it's a bit bothersome that the few drugs approved for SA are benzos and SSRIs.


Which benzo is approved for social anxiety disorder? I don't think there are actually any...


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## UltraShy (Nov 8, 2003)

> Which benzo is approved for social anxiety disorder? I don't think there are actually any...


No benzo is FDA approved for SA. As far as I know, the only meds FDA approved for SA treatment are Paxil, Zoloft, and Effexor. No benzos, no MAOIs -- despite general agreement they are the most effective.

Given that all benzos are now generic I can't imagine any ever being approved for SA as there is no company holding a patent ready to pay for clinical trials and reap the financial benefit of being approved for SA.

FDA approval really means next to nothing. Either something works or it doesn't. What works works even without FDA approval and the FDA stamp of approval still doesn't make Paxil or Zoloft work for me.

Since no company is going to pay to study generic drugs like benzos it would have to be paid for by the govenment, but is the NIH really going to study an "evil" controlled substance? Not likely IMO.


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## meyaj (Sep 5, 2009)

UltraShy said:


> No benzo is FDA approved for SA. As far as I know, the only meds FDA approved for SA treatment are Paxil, Zoloft, and Effexor. No benzos, no MAOIs -- despite general agreement they are the most effective.
> 
> Given that all benzos are now generic I can't imagine any ever being approved for SA as there is no company holding a patent ready to pay for clinical trials and reap the financial benefit of being approved for SA.
> 
> ...


Oh I totally agree, I just thought maybe he was aware of something I wasn't.


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## fredericmoreau (Dec 1, 2009)

nothing to fear said:


> anyway, i really think dopamine's role in social anxiety really should be considered and there should be more focus on that rather than just serotonin. i don't know how medication is really made but it'd be very beneficial to alter a drug that increases dopamine well enough that it has the positive effects on socializing similar to adderall but doesn't have the dependancy/addiction potential and other possible negative effects.


Unfortunately tolerance and dependence are part and parcel of the hedonic and motivational effects of Adderall/psychostimulants. You'll often hear on this forum that the use of memantine and other NMDAR antagonists will prevent or attenuate amphetamine tolerance, however the evidence for this is equivocal at best and the use of these agents long-term has not been studied enough for me to feel confident using them.

I have no doubt that the most efficacious and quickest acting anxiolytics and antidepressants are opioids and stimulants. Hell, that's why people abuse them! However to prescribe them indiscriminately for social anxiety or depression would be a mistake, as a Bayesian analysis would reveal that the potential drawbacks of long-term usage of these agents would supersede the immediate benefits. Of course, there are those few of us who are so treatment resistant and adversely affected by our mood issues that the benefits these medications provide outweigh the risks. I've been in multiple inpatient psychiatric facilities long-term and suffered bouts of pretty much the worst kind of melancholic depression imaginable for my whole life, and I am still wary about using Dexedrine, which I take now in combination with Parnate and nortriptyline. There are some serious risks involved with my drug combination, but it is worth it for me. Really though, 4 or 5 safer combos should be attempted before someone gets to MAOI+TCA+stimulant. So should Adderall be indicated for SA? No it should not, but it should remain part of the good psychiatrist's pharmaceutical arsenal for the highly treatment refractory and functionally disabled patient.


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## korey (Apr 25, 2006)

I think Luvox CR is approved for SA, but regular Luvox like I take somehow isn't. Ha, imagine that.


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## korey (Apr 25, 2006)

fredericmoreau said:


> Unfortunately tolerance and dependence are part and parcel of the hedonic and motivational effects of Adderall/psychostimulants. You'll often hear on this forum that the use of memantine and other NMDAR antagonists will prevent or attenuate amphetamine tolerance, however the evidence for this is equivocal at best and the use of these agents long-term has not been studied enough for me to feel confident using them.
> 
> I have no doubt that the most efficacious and quickest acting anxiolytics and antidepressants are opioids and stimulants. Hell, that's why people abuse them! However to prescribe them indiscriminately for social anxiety or depression would be a mistake, as a Bayesian analysis would reveal that the potential drawbacks of long-term usage of these agents would supersede the immediate benefits. Of course, there are those few of us who are so treatment resistant and adversely affected by our mood issues that the benefits these medications provide outweigh the risks. I've been in multiple inpatient psychiatric facilities long-term and suffered bouts of pretty much the worst kind of melancholic depression imaginable for my whole life, and I am still wary about using Dexedrine, which I take now in combination with Parnate and nortriptyline. There are some serious risks involved with my drug combination, but it is worth it for me. Really though, 4 or 5 safer combos should be attempted before someone gets to MAOI+TCA+stimulant. So should Adderall be indicated for SA? No it should not, *but it should remain part of the good psychiatrist's pharmaceutical arsenal for the highly treatment refractory and functionally disabled patient*.


Don't forget the kids with ADD! :wink :mum


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## fredericmoreau (Dec 1, 2009)

korey said:


> Don't forget the kids with ADD! :wink :mum


Haha, don't even get me started on that! Narcissistic parents can't understand why poor Jimmy is getting B's and C's when he is so gifted! Must be ADHD, let's get him on a stimulant! Forget that all psychometric testing he has ever taken reveals he is of decidedly average intelligence, all of those tests are biased! Unless, of course, they reveal him to be gifted, in which case they are infallible. My sister works as a school psychologist at a very wealthy suburban public school and she has some great/scary stories of helicopter parents and their distorted view of their child's ability/importance.


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## inVis420 (Jul 15, 2009)

Raptors said:


> How long have you been taking it? How effective is it? Did it 'poop-out' for you?


I've been taking it for 6 months now (30mg 3 or 4 days a week) and it still works well most of the time. I've avoided dependency/tolerance issues by having self-control and always taking days off (though my tolerance has started to rise a bit so I began to take memantine). The most effective part of it has been the increased motivation and self-esteem. I've been getting things accomplished on time for the first time in my life on adderall and those accomplishments include former social problems that have gotten better. It does increase physical anxiety though but inderal and benzos get rid of that problem. I know I take alot of meds but i'm confident about my self-control and i've done plenty of research on all of them.


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## meyaj (Sep 5, 2009)

fredericmoreau said:


> Haha, don't even get me started on that! Narcissistic parents can't understand why poor Jimmy is getting B's and C's when he is so gifted! Must be ADHD, let's get him on a stimulant! Forget that all psychometric testing he has ever taken reveals he is of decidedly average intelligence, all of those tests are biased! Unless, of course, they reveal him to be gifted, in which case they are infallible. My sister works as a school psychologist at a very wealthy suburban public school and she has some great/scary stories of helicopter parents and their distorted view of their child's ability/importance.


My parents were the opposite of helicopter parents and I WAS identified as gifted and even had the highest standardized test scores out of my gifted class. My work ethic and focus in school was absolutely abominable, but unfortunately, the fact that I was so "gifted" totally obscured the fact that I could also have a disorder like ADHD, especially since it's the inattentive type and I didn't have any serious behavioral problems, so I wasn't enough of a pain in the *** for adults to care.

I got diagnosed last summer at the age of 23. I WISH adults had stepped in and done something earlier, a teacher, my parents, whatever. I've heard from some of the foremost experts in the area that they strongly believe the net result is UNDERdiagnosis, even despite the fact that a lot of obsessive parents think their kid needs drugs because he's not the studious little genius they somehow KNOW he/she should be. Yeah, there are definitely parents that push their kids into the diagnosis, but there are tons of times in general when people shouldn't be medicated and they aren't be. It in no way makes it an invalid diagnosis, and stimulant treatment is heavily evidence supported, is very often the only realistic treatment, and has been continually demonstrated to be beneficial even with long term use.

Yes, we know amphetamines can help with depression and possibly a few other things as well, but the difference is that for these, there are also a whole host of other viable treatments available, and the medical literature strongly points to the conclusion that stimulant treatment in these cases rapidly loses any effectiveness. Because of this, simply being refractory is not enough... if the depression or whatever has lasted long enough to determine that the disorder IS treatment resistant, you're clearly not dealing with a short-term problem anyways, so you have a very limited benefit because all you're really doing is delaying. The SEVERITY is a much more useful criterion because even a brief delay can possibly buy you enough time to say a life. I don't think any psychiatrist should outright exclude it from their arsenal, but at the same time the evidence just doesn't justify its use on the scale that a lot of people seem to be hoping for.


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