I was aware of ADHD medication in the past. Friends and acquaintances have told me that they take it, some of whom were self-medicating in an attempt to get an edge academically, and there was also the occasional weird kid around in school that was on all kinds of meds. However, I find difficult to square my own experience with methylphenidate with my perception of others on this or similar drugs.

Methylphenidate and other ADHD medications are often used in an attempt to “boost intellectual performance”. They do not make you smarter, though. Instead, they allow you to use your intellectual facility much more effectively. There is probably a sweet spot in terms of the dose. For instance, the dose I am currently on is quite likely not the optimum yet, but the effect is quite profound already. Probably you should not take more than you need, if you suffer from ADHD, and if not then you probably want to be very careful about self-medication.

The previous paragraph leads to my experience with people on ADHD meds. A fair number — we are still obviously in the range of anecdotes — talk excessively. There are people I knew, one actually a “PUA” from back in the days, who seemingly cannot stop talking. That particular guy was able to motor-mouth an entire group, shifting his focus from person to person, looking at you very intently, before talking to someone else, and this went on an on. I found this quite uncanny and I wondered how this person was able to function in society. Motor mouthing is a very apt metaphor as these people cannot stop talking. If you have never witnessed it you probably cannot even imagine what it is like. I find this incredibly off-putting. Most interestingly is that these people are not always like that but only when they are on their meds. Excessive talking is thus a side effect. There are other side effects people report, or bystanders observe. Similarly, I have met people in the working world who very aggressively chew gum. As Pickernanny pointed out to me, grinding one’s teeth is a common side effect of methylphenidate and other ADHD meds. However, grinding your teeth is a lot less socially acceptable than chewing gum, so this is what people do in order to mask this particular side effect.

I wonder, though, if people experience such side effects because they either take ADHD medications without suffering from ADHD or because their dose is too high. I am not a medical expert, but to me it seems reasonable to assume that side effects scale with the dose, i.e. if you experience mild headache as a side effect of a particular medication, you may experience stronger headache with a higher dose. In my case, for instance, the side effects from methylphenidate are quite minimal. I experience mild headache that is transitory, lasting just moments, and some of the effects I experienced during the first time of taking this medication I no longer experience at all. Mouth dryness is also much reduced. However, I am on the lowest possible dose, and I do not even take this medication daily. My psychiatrist recommended I take 10 mg in the morning, during the week, and if I think a second pill would help, I could consider taking another pill one during lunch. I am fine with 10 mg for now, taking it when I think I could benefit from an increased ability to focus.

From speaking to some people in real life about ADHD, I got the impression that my moderate approach is perhaps not typical. Of the few people I spoke to, without having outed myself as also taking meds, all take their pills daily, even though a common recommendation is to take breaks on the weekends and/or on vacation. I also learned that some people were put on surprisingly high starting doses by their psychiatrist. I know of one guy who started with 30mg and who has been taking it daily from the get-go. I was also quite surprised that people seem to either have little awareness of side effects or downplay them. One guy told me that ADHD meds are only addictive to people who do not have ADHD. Otherwise, they merely fix a deficit. I found this approach a bit naive. There is a good reason why amphtetamine and methylphenidate are regulated substances. In the United States it is a “Schedule II substance” under the Controlled Substances Act.

Thinking back at my interactions with people who self-medicated, without a prescription, in order to boost study results, I am even more concerned. I met students at university who took Adderall so that they could cram for hours on end, often pulling all-nighters before an exam. There was even an infamous subset of students who spent the night before an exam at the library, studying. From what I could tell, Adderall seems to have helped them, but partly this drug was seen as a panacea for a lifestyle not suited for studying, i.e. they were quite lazy during the term and partied a lot, and in order to catch up, they crammed before the exam. This approach is probably not suitable for technical degree programs such as Engineering or Computer Science. For Law or Medicine, though, it seems to work reasonably well. These people complained about side effects such as headaches and “feeling sick”. Surely, taking medication they did not need, and at a does that was likely far beyond the recommended does even for people with ADHD, only made it worse.

Overall, though, I wonder if the frequency and intensity of side effects of ADHD medication would be a lot lower if people were more conservative in their usage, i.e. pick the lowest dose at which you notice an obvious improvement, instead of following a somewhat odd narrative of “working your way up” to a higher does. Yes, this is a verbatim quote of someone who told me that he is currently taking 40 mg of methylphenidate. He wants to go up to 80mg, which is the maximum his psychiatrist would prescribe him, as there is a guideline of not going beyond 1 mg per kg per day and if your weight is about 80 kg, then 80 mg is the maximum. He thought the side effects where a good trade-off. I was not so certain, and in fact, I wondered if this guy had an addiction problem and should not even be on that drug.