Definitive answer about ADHD meds needed
February 9, 2014 12:35 PM   Subscribe

Here's an assertion one hears frequently in discussions of ADHD: "It seems people with ADHD get a calming, clear headed effect from stimulants, as opposed to the speedy, euphoric type of high 'normal' people get from them." My question is: where can I find *good* information about the truth or falseness of this type of statement?

I am looking for reliable sources that address this issue from a scientific, non-anecdotal standpoint. I'm not looking for stories from individuals about their ADHD and what happens to them on stimulants; I'm looking for studies, review articles, and/or expert opinions with scientific backup -- sources that one could cite if one were writing a paper for college, for example.

(Obviously behind this issue is a greater question: does ADHD as a disorder actually exist? I'm not expecting an answer to that question here; and I'm well aware of the controversies surrounding it.)
posted by DMelanogaster to Science & Nature (10 answers total) 5 users marked this as a favorite
Do you have access to an online database like WorldCat? You could search for articles in psych journals by keyword.
posted by sevensnowflakes at 12:56 PM on February 9, 2014 [1 favorite]

This seems unanswerably broad. Where you would find this information is academic research journals, generally, but you aren't going to find, like, three articles that provide a definitive answer to the question of what ADHD/ADD are, how they impact the brain, and how medication impacts those who are diagnosed with these disorders, or there'd be a consensus already. But the first seems less the sort of thing you see people saying in research papers than the sort of thing you see people saying at cocktail parties. I do have anecdotal evidence here but I spent a lot of time using my university's research databases to do reading after I got diagnosed--there really are a lot of interesting questions involved, but I have no idea how one would possibly boil everything down into an AskMe answer.
posted by Sequence at 1:04 PM on February 9, 2014

Cognitive effects of methylphenidate in healthy volunteers: a review of single dose studies.
Linssen AM, Sambeth A, Vuurman EF, Riedel WJ.

Int J Neuropsychopharmacol. 2014 Jan 15:1-17. [Epub ahead of print]

Methylphenidate (MPH), a stimulant drug with dopamine and noradrenaline reuptake inhibition properties, is mainly prescribed in attention deficit hyperactivity disorder, is increasingly used by the general population, intending to enhance their cognitive function. In this literature review, we aim to answer whether this is effective. We present a novel way to determine the extent to which MPH enhances cognitive performance in a certain domain. Namely, we quantify this by a percentage that reflects the number of studies showing performance enhancing effects of MPH. To evaluate whether the dose-response relationship follows an inverted-U-shaped curve, MPH effects on cognition are also quantified for low, medium and high doses, respectively. The studies reviewed here show that single doses of MPH improve cognitive performance in the healthy population in the domains of working memory (65% of included studies) and speed of processing (48%), and to a lesser extent may also improve verbal learning and memory (31%), attention and vigilance (29%) and reasoning and problem solving (18%), but does not have an effect on visual learning and memory. MPH effects are dose-dependent and the dose-response relationship differs between cognitive domains. MPH use is associated with side effects and other adverse consequences, such as potential abuse. Future studies should focus on MPH specifically to adequately asses its benefits in relation to the risks specific to this drug.

Psychostimulants and cognition: a continuum of behavioral and cognitive activation.
Wood S, Sage JR, Shuman T, Anagnostaras SG.

Pharmacol Rev. 2013 Dec 16;66(1):193-221. doi: 10.1124/pr.112.007054. Print 2014 Jan.

Psychostimulants such as cocaine have been used as performance enhancers throughout recorded history. Although psychostimulants are commonly prescribed to improve attention and cognition, a great deal of literature has described their ability to induce cognitive deficits, as well as addiction. How can a single drug class be known to produce both cognitive enhancement and impairment? Properties of the particular stimulant drug itself and individual differences between users have both been suggested to dictate the outcome of stimulant use. A more parsimonious alternative, which we endorse, is that dose is the critical determining factor in cognitive effects of stimulant drugs. Herein, we review several popular stimulants (cocaine, amphetamine, methylphenidate, modafinil, and caffeine), outlining their history of use, mechanism of action, and use and abuse today. One common graphic depiction of the cognitive effects of psychostimulants is an inverted U-shaped dose-effect curve. Moderate arousal is beneficial to cognition, whereas too much activation leads to cognitive impairment. In parallel to this schematic, we propose a continuum of psychostimulant activation that covers the transition from one drug effect to another as stimulant intake is increased. Low doses of stimulants effect increased arousal, attention, and cognitive enhancement; moderate doses can lead to feelings of euphoria and power, as well as addiction and cognitive impairment; and very high doses lead to psychosis and circulatory collapse. This continuum helps account for the seemingly disparate effects of stimulant drugs, with the same drug being associated with cognitive enhancement and impairment.
posted by jaguar at 1:09 PM on February 9, 2014 [3 favorites]

Best answer: (What those two abstracts indicate to me is that abusing ADHD medications in an effort to get high will indeed induce euphoria, because people abusing the medications are taking enough to attain that specific state. Lower doses increase attention, concentration, and memory. You can think of it regarding your morning coffee, assuming you drink coffee. A cup or two increases your focus and concentration. Too many cups has you jumping off the walls. That's pretty true for any stimulant.)
posted by jaguar at 1:13 PM on February 9, 2014 [2 favorites]

Response by poster: And yet those studies don't address the differential effects of stimulants on ADHD-diagnosed people vs. non-ADHD-diagnosed people. I would really like to see the difference in the inverted-U-shaped curves for the ADHD group vs a non-ADHD group (if available). In other words, is the dose-response curve pretty much the same in the two populations?

I would also like to see subjective reports: "gee I can focus now! it's a miracle!" (which is something you hear from both the ADHD-diagnosed and the non-diagnosed), vs. "I feel so much *calmer* when I take my Adderrall,"( which you tend to hear from the diagnosed but not from the non-diagnosed (of course, that response from the diagnosed is polluted by the very quote I started my question with -- the diagnosed has been trained to think that the pill focuses him *and* calms him down (i.e., is Good), whereas the diagnosed has been trained to think that taking the pill focuses him but might make him "wired" because he "doesn't have" the correct diagnosis, and therefore is Bad for taking a pill that is prescribed for "disordered" people)).

[ Presumably the non-diagnosed college student is taking the same dose as the diagnosed (1 pill of whatever's in the diagnosed's bottle -- that the diagnosed gave or sold to his non-diagnosed friend).]

(Of course, non-ADHD-diagnosed people might possibly be diagnosed with ADHD if they went to a doctor who does that sort of thing, so the categories themselves are spurious. Non-diagnosed in X% of cases might really be pre-diagnosed.)

and so on.
posted by DMelanogaster at 2:51 PM on February 9, 2014

Response by poster: whereas the diagnosed has been trained to think that taking the pill focuses him but might make him "wired"

sorry, I meant "non" diagnosed in that sentence
posted by DMelanogaster at 2:57 PM on February 9, 2014

Best answer: Ok, here we go:

Stimulants: Therapeutic Actions in ADHD

Amy F T Arnsten

Neuropsychopharmacology (2006) 31, 2376–2383. doi:10.1038/sj.npp.1301164; published online 19 July 2006

...In contrast to these basic studies in rats, humans given stimulant medications for the treatment of attention deficit hyperactivity disorder (ADHD) display reduced locomotor activity and improved attentional focus. For years, it was presumed that stimulant medications had paradoxical effects in ADHD. However, it is now established that the focusing effects of stimulants in ADHD are not paradoxical; these agents have the same effect in 'normal' human subjects (albeit a more subtle response given ceiling effects) (Rapoport and Inoff-Germain, 2002). ...

The cited study abstract:

Responses to methylphenidate in Attention-Deficit/Hyperactivity Disorder and normal children: update 2002.
Rapoport JL, Inoff-Germain G.

J Atten Disord. 2002;6 Suppl 1:S57-60.

Since the positive effects of stimulants on disruptive behavior were described (Bradley & Bowen, 1941), further pediatric studyhas been limited almost exclusively to samples of hyperkinetic school-age children. Because these agents normally were viewed as arousing in their effects on the central nervous system, but were calming in their therapeutic effects on these children, stimulant effects on Attention Deficit Disorder (ADD) were interpreted as being 'paradoxical.' Investigation of effects in normal children and adolescents and in those with disorders unrelated to Attention-Deficit/Hyperactivity Disorder (ADHD), as well as in young adult samples, however, indicate that stimulants appear to have similar behavioral effects in normal and in hyperactive children. This brief report is an update (as of August 2002) on studies of stimulants in ADHD and normal children, with particular focus on MPH.

Which is saying that prior to 2002, researchers assumed there was a "paradoxical effect" because the ways in which researchers were conducting rat studies on the medications didn't line up to how people were being prescribed the medications (which is interesting to know -- I hadn't realized there was any scientific basis for that claim). The 2002 study disproved the "paradoxical effect." The 2006 study claims that the actions of ADHD stimulant medications have a slightly more subtle effect on healthy populations, but that the effects are pretty much the same.

As for anecdotes, googling Ritalin College Students will get you a ton.
posted by jaguar at 3:31 PM on February 9, 2014 [7 favorites]

Thanks, jaguar. Now I know exactly where to link people who argue with me about this.
posted by Justinian at 9:12 PM on February 9, 2014 [1 favorite]

I'm pretty sure those statements are false. I've been doing some research on ADHD medication recently. They used to think there was a thing called a "paradoxical effect," where kids with ADHD would respond differently to stimulants ("paradoxically," i.e. they'd become calmer) than kids without ADHD. Now experts seem to accept that stimulant medications affect all kids (and all people) in the same general way. It's just that in kids with ADHD, those effects are considered therapeutic.

Rapoport is an expert on all this and the 2002 study you were recommended above is key.
posted by toomuchkatherine at 3:24 PM on February 10, 2014 [2 favorites]

Response by poster: YAY. This is fantastic, exactly what I wanted. Thank you very much!!
posted by DMelanogaster at 4:41 PM on February 11, 2014 [1 favorite]

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