In a recent comment, Yarara raised a philosophical question about taking methylphenidate (MPH), namely the position of not wanting to expose oneself to anything artificial, such as processed foods. The extreme position is to not consume anything that is not naturally occurring in nature, which is not a position he holds. MPH is an artificial product, manufactured on an industrial scale by pharmaceutical companies. So, if it does not exist in nature, can it be good for you? Related is the consideration whether relying on a such a potent artificially created drug undermines your humanity as you are no longer your true self with it.
Let me quote Yarara more fully. He wrote,
I have always tried to avoid putting anything artificially produced in my body, unless absolutely necessary. Of course I am not some sort of gaia-worshipping eco-loon, I just came to the conclusion a few years ago that it is healthier to try to live closer to the way that evolution intended for our bodies. That means ditching processed foods as far as possible, avoiding uhealthy habits, exercising more….. and stimulants have long been on my suspicious list. I do not smoke or drink coffee, but I will confess to the occasional energy drink (RedBull and such) when I have a deadline, or a long drive at the end of the working week. I am working to cut down on those as well, but alternatives look tempting.
I know where he is coming from. In fact, I hold a very similar view. The vast majority of the food I eat we prepare ourselves at home. My wife is fully aligned on this issue. On very rare occasions, my wife throws a frozen pizza in the oven and she also likes to sometimes prepare a pack of instant noodles for herself. We also have some condiments at home, of course. The most artificial product in our fridge right now is some mustard. As much as possible, we use fresh, natural ingredients. I believe that this is healthier for your body. In a supermarket, easily 95% of the products have no appeal at all to me. In fact, a good rule of thumb is that if you buy industrially produced food, it is garbage.
Regarding psychoactive substances, I am a hardliner. I do not drink, nor do I smoke. I took a puff of a cigarette in my teens and I have a vague memory of possibly trying weed. There was a group of guys I briefly hung out with, and sometimes they smoked a joint. I do not recall whether I tried it myself. The last time I tasted alcohol was years ago, taking a sip of red wine. It is quite likely that I have consumed only about one to two liters of alcoholic beverages in my life. During my partying years, I had ample opportunity to take drugs, but I was never tempted by it. I have always turned down pills, and even cocaine I did not care about.
The brain is arguably your most important organ. Of course, none of your organs is superfluous, but I hope I do not need to elaborate on why you should not damage your brain. I have seen what alcohol does to people. This includes witnessing alcoholics, some high-functioning ones and others who were less so, in my village community. There are even alcoholics in my extended family. I want to have nothing to do with that. Regarding synthetic drugs, my big concern has always been quality control. You simply do not know what the pills that are being sold by a shady drug dealer in a club contain. The same is true for cocaine. Yes, it is a natural substance, but that white powder could contain a lot of other substances such as rat poison.
When my psychiatrist suggested MPH, after issuing a surprise ADHD diagnosis, I did not quite know how to react. However, I did tell him that I had a lot of respect for psychoactive drugs, which was a very polite way of saying that I am rather skeptical of taking psychotropic medication. He did not push the pills at all on me. Instead, he first just mentioned the name of the drug, described use cases and effects, and suggested that I should read up on it. If I wanted to try it out, I was welcome to return and get a prescription. It took me weeks to make it back to this guy’s office and even after I got the prescription, I waited many more weeks before I finally tried it out.
Initially, I was very skeptical of taking psychotropic medication. The objections I had regarding illicit drugs did not hold because MPH is an established product. I read quite a few studies and skimmed many more. On top, I was prescribed a very low dose of just 10 mg. Thus, the risk/reward ratio seemed favorable. At worst, I would try it once or twice and then just stop taking it. As the side effects I experience are very minor, I do not even have any health concerns anymore. A major reason why I decided to try MPH was that I framed it as being comparable to getting glasses. I do have an ADHD diagnosis and I have a history of engaging in masking behavior to help me get through the day. Thus, after reflecting on my life, in the wake of getting the ADHD diagnosis, I came to accept that I am deficient in some regards. In fact, viewed from an ADHD perspective, I was able to better understand parts of my life history. This is similar to not seeing well. Would you decline getting glasses if you were myopic? I hope not. Granted, you can always remove your glasses, so the analogy is not perfect. However, MPH does not lead to a build-up in your body either, based on what we know, so it is somewhat comparable to putting on reading glasses for a few hours to help you with getting your work done. Arguably, wearing glasses does not erode your humanity either, even though you could easily argue that you are not really being your true self if have to rely on such an object for your survival.
I also thought a lot about the issue of MPH being a crutch. There is some truth to that. However, if you suffer from ADHD and engage in various masking behaviors to help you with organizing your day, then you are also using crutches. Your to-do list is a crutch. You putting your keys in the same place every time is a crutch. You modifying your phone and router to block the Internet connection between midnight and 8 a.m. is also a crutch. If you get distracted easily, for whatever reason, and you can fix this problem by taking a pill from which you may experience hardly any side effects then this looks like a pretty good trade to me. Of course, after I had experienced how much more productive I am on MPH, this objection completely went away.
Given my starting position in life, I think I am quite successful. I achieved this without MPH. However, my ADHD has made my life a lot more difficult than it would have needed to be. With MPH, on the other hand, I simply function a lot better in society. Had I gotten a prescription early in my life, I am certain that I would be a much different person today. I could likely have gone into any field and be happy with it. Instead, I embarked on a long journey, trying out different careers, moving around a lot, meeting a lot of women. In the end, it all worked out well but I could probably easily pull up any number of success metrics and argue that I would be better off in an alternative universe had I started taking MPH in early adulthood already.
MPH is obviously an artificial product and I can understand if people have reservations against taking it. I read that up to 50% of adults who receive an ADHD diagnosis refuse to take any medication for it, albeit it was not quite clear how reliable the data was. Even if it was largely anecdotal, the takeaway is nonetheless that there is skepticism regarding such drugs. I have been there myself. However, if you have received an ADHD diagnosis, it probably happened for a good reason. You can of course get a second or a third opinion. There are plenty of psychiatrists out there, after all. Assuming that your ADHD diagnosis was correct, then why not see if MPH will help you? There is a good chance that only after you have experienced the effect of MPH you will understand how much of an impairment ADHD is for you.
Thanks for the detailed answer. You did your due diligence, as expected, looking up papers on the drug you were about to take. I would add one caveat there, that the research may not be trustworthy.
One thing that I neglected to mention in my original comment, one of the reasons I distrust drugs, particularly more recent ones, is the questionable integrity of the current research regarding drugs, especially psychiatric ones.
I have not researched MPH so I cant speak specifically about it, but I am generally persuaded that medical research is deeply flawed by the influence of the pharma industry, and psychiatric drugs may be even more so. Look up talks by Peter Gotzsche on youtube, without being a specialist I found him quite persuasive. Here is one to get you started (I think I have posted this same video here a couple years back):
He argues mostly against antipsychotics and antidepressants, but the root of his criticisms does apply to any range of medications. For example, since clinical research is so expensive, its almost always being carried out by the pharma industry, and they can easily fund a dozen experiments on a certain drug and only publish the ones that show positive results, even if this is an artifact of statistical chance.
I suspect drugs that are considered cash cows, like those prescribed for chronic conditions, will be subject to greater pressures to fudge the research. We got a nakedly cynical example of this with everything related to Covid.
ADHD, like depression, is one condition where there are good reasons to believe is widely overdiagnosed, particularly in boys, so it would not surprise me if we found out it was subject to systematic research malpractice. Therefore, hearing of your experiences firsthand is a valuable data point for the rest of us.
I am quite skeptical about academia and I am also well aware of how imperfect the peer review process is. I think we spoke about the reproducibility crisis in psychology before, which also affects many other disciplines. However, as much as drug manufacturers may be able to push the scales in their favor, they cannot do so indefinitely. The push-back against the vaxx is a good example. Similarly, Ozempic, the weight-loss wonder drug, is increasingly viewed critically. Methylphenidate has been around for 80 years, and it has been used to treat what we know refer to as ADHD for about 60 to 70 years. Given that it is also a widely used drug, there is surprisingly little to be found in terms of harmful side effects. Yes, some people abuse their drugs, for instance by snorting it, or taking a multiple of their prescribed dose, but these people are outliers. You would expect more people to die or develop severe medical issues with such a history of abuse, but this does not happen.
I only have two concerns remaining. One is that little is known about using MPH in old age. I think you can still get it as off-label use but it is not recommended. However, in old age, I do not think I could derive nearly as much benefit from this drug as I do now. More generally, after retirement there is a less clear benefit of MPH. Of course you can take it to be more productive while being engaged in your hobbies, but this seems a bit frivolous. I would not be surprised if some long-term studies will have been published by the time I am in old age. This is decades away, so I am not overly concerned about this. The other concern is about addiction. I do not know how I would view MPH if it made me experience euphoria. As this is not the case, I am not really at risk of becoming addicted to MPH. My psychiatrist also spent some time exploring my non-existent history with substance abuse, which is one reason he prescribed MPH instead of an alternative drug. Just last week, I took five days off MPH, just to see if I would experience cravings. This was not the case at all.
I do agree that ADHD seems overdiagnosed, largely because boys do not fit into the feminized educational system. They want to use their body and be physically active, but Teacher Karen does not like this as it makes her day more difficult. She feels a lot more confident about herself if she can lord it over a classroom full of docile girls and sedated boys. Speaking more abstractly, I do not think that modern society is particularly natural. Some people can adopt to it, but plenty of people struggle psychologically with it. This is expressed not only in record-numbers of people, often women, being on anti-depressants but also in substance abuse patters, with alcohol, nicotine, weed, and cocaine all being highly popular. Probably a significant fraction of people would drink a lot less if they had an MPH prescription. I mentioned before that after a draining day at work, I used to veg out, often watching YouTube videos for an hour or so. Others drink a beer or two. As I also wrote earlier, with MPH, this is not a problem for me.
I had my ADHD evaluation this morning. I’ll have to wait until tomorrow or so to discuss the results with the psychiatrist. It basically went like this: handed in my pre-assessments followed by a short interview, did a series of cognitive tests which took about an hour, and finally he had me stare at a black screen with some orange rectangles in the middle and click the mouse once every time the number 1 (vs the no. 2) was verbalized or shown in the rectangles. The final portion took 20 straight minutes.
Interesting. Was the final test a variation of a Stroop test? I do not want to sound flippant, but it seems safe to assume that such tests have much less validity for people who are used to playing demanding video games. I surely do not go out of a limb by saying that, ceteris paribus, people whose biggest gaming achievement are a few rounds of Candy Crush will fare a lot worse than anybody who has ever sat down and dedicated hours on getting better at a skill-based game. For someone who has spent dozens of hours in the training mode of a fighting game, practicing the execution of various special movies, even a 20-minute test like the one you describe should not very demanding.
Got my results back. I was diagnosed with ADHD (moderate). The series of cognitive tests were apparently part of the WAIS-5. Verbal comprehension and processing speed were found to be average, while visual spatial and working memory were above average, with fluid reasoning considered to be very high. Overall: above average intelligence bracket.
The psychiatrist also noted in his summary that even though I exhibited the ability to sustain effort, that doing so leads to fatigue and carelessness in my work which results in errors. I was given a list of referrals. One for a psychiatrist that could prescribe medication, one for a CBT specialist, and one for an executive function coach. I’m guessing these are all his buddies lol. Oh, and a book referral for something called Driven to Distraction. Technically, I could take this report to my PCP and discuss medication options immediately.
“Was the final test a variation of a Stroop test?”
This test that I mentioned was actually called the IVA-2. My response control was apparently rated as average, while my full scale attention was above average.
I do agree with your sentiments. Clicking the mouse whenever prompted is much easier than getting parries in Dark Souls. I knew the test would only last 20 mins as well, so I could will myself to stay locked in and correct myself whenever I wavered.