I had my first visit to the psychiatrist this morning, and ended up being prescribed 30mg Vyvanse. But I'm really writing because of a comment he made on the ethics of stimulant prescriptions. To paraphrase:

Everybody, whether they have ADD or not, benefits cognitively from taking stimulants. You can observe this on college campuses during finals. When taken in a controlled manner, they are extremely safe, from a purely medical perspective. But there is an ethical concern in the psychiatric community about why we don't just hand out these stimulants to everybody. The medication helps people with ADD function more "normally" in society. If we gave stimulants to everyone, those with ADD would once again be "under performing" in this cognitively elevated society. I don't prescribe stimulants to someone without ADD just because they think they would function at a higher level with it - even though it's probably true that they would, and would do so safely.I guess the big picture question is whether or not it's ethical to withhold a substance that is basically beneficial to everybody just to promote more equality with those who are "under performing" due to ADD. On the flip side, if equality isn't a concern, what would the world be like if everyone took stimulants in a controlled manner, as if it were just another part of the food pyramid, or FDA recommendation on exercise?

To be painfully honest, I feel like my ADD (I was told I present an atypical set of symptoms, but ADD nonetheless) was completely manageable before being prescribed Vyvance. So I feel a little guilty because I could very well be the exact ethical dilemma he presented. I was plenty productive before Vyvanse. But I am extremely productive with it.

Is this a valid ethical concern? If so, should I stop taking a stimulant and return to the perfectly acceptable cognitive level I was before?

If your symptoms are entirely managable without treatment or intervention, why go through all the work of getting diagnosed and treated?

Are you experiencing any difficulties at...

- work
- school
- socially
- in your relationships

Do you have ongoing difficulties with...

- distractibility
- disorganization
- inconsistant performance
- too much energy (or too little)
- frequent mood swings
- tendency to over react
- saying or doing things before thinking
- difficulty with transitions, in other words difficulty with starting and stopping tasks
- difficulty staying on task when doing things you don't want to do

Do you have any other conditions that would help you cope with your AD/HD, OCD perhaps?

Have you always felt like everyone else? Or have you always felt different?

I'm curious...

grandma lise

I don't think there can be one definitive answer to a question like this. There is a lot of precedent for notable people who didn't "need" stimulants taking them anyway, though. My favorite example is the delightfully eccentric mathematician Paul Erdős. From his Wikipedia article (http://en.wikipedia.org/wiki/Paul_Erdos):

After 1971 he also took amphetamines, despite the concern of his friends, one of whom bet him $500 that he could not stop taking the drug for a month. Erdős won the bet, but complained that during his abstinence mathematics had been set back by a month: "Before, when I looked at a piece of blank paper my mind was filled with ideas. Now all I see is a blank piece of paper." After he won the bet, he promptly resumed his amphetamine use.

It's a little difficult to discuss it in such broad terms, I think: "If we gave stimulants to everyone, those with ADD would once again be 'under performing' in this cognitively elevated society..." It's important to remember that no one is really suggesting that. I feel like one has to take each individual situation and evaluate it with respect to its details and context. What would it even mean to "give stimulants to everyone"? Would everyone get the same dose of the same chemicals? Who would pay for it? How would it be distributed? Bringing the debate down to specifics gives us more relevant and bite-sized problems to realistically explore.

For your specific situation, I would take the stuff for a while. See how you feel on it. Don't sweat the oceanic ethical quandaries--you're making a complex decision that involves a lot of fuzzy emotions and vague socio-political concepts. I would say, it's a good sign that you're thinking about it, but it would be counterproductive to let it completely stop you from exploring a tangible way to test your own potential.

Actually, there is no reliable or consistent evidence that "stimulants" are neuro-enhancers. Your doc has it all wrong. I could give you a bunch of links, but, you can research it yourself. There is only one study that shows any "neuroenhancement" for "normal brains," and that was recently debunked at the NIMH. There is no advantage to above normal neurotransmitters -- as such, they introduce confusion, reset nerve cells, and have been shown to time and time again DECREASE performance in high-performing individuals who don't fit the criteria for add.

You can research it yourself, you don't have to rely on your doc.

How did you get it prescribed on the first day?


today It was my first time visiting one and I said something like " This is why I think i have Adhd" He quickly said that it wasn't my job to diagnose myself..

How did you get it prescribed on the first day?


today It was my first time visiting one and I said something like " This is why I think i have Adhd" He quickly said that it wasn't my job to diagnose myself..

Your doc sounds like an ***.

I've only had one *** pdoc before. After I walked out I went straight to the front desk and told them to never schedule me with him again (he was not my usual pdoc). Then, I went to my car and cried for about 10 minutes.

Actually, there is no reliable or consistent evidence that "stimulants" are neuro-enhancers. Your doc has it all wrong. I could give you a bunch of links, but, you can research it yourself. There is only one study that shows any "neuroenhancement" for "normal brains," and that was recently debunked at the NIMH. There is no advantage to above normal neurotransmitters -- as such, they introduce confusion, reset nerve cells, and have been shown to time and time again DECREASE performance in high-performing individuals who don't fit the criteria for add.

You can research it yourself, you don't have to rely on your doc.

Somehow, this information does not surprise me at all, although I have seen people authoritatively state otherwise. I have also seen neurotypical people on stimulants and they seem a lot like me when I am typically unmedicated. And sometimes more extreme.

that was my psychiatrist.

he thought that i was a drug seeker, like every college student is. He gave me a pep talk everytime about a year ago i saw him.

Now, he prescribes me adderall. But he's still wary... sad

Wow. I believe that's called an 'inverse error' in formal arguments.

So...ADHD people shouldn't be given stimulants because if everyone had stimulants, there would be no benefit to the ADHD sufferers?

If we had some bacon, we could have bacon and eggs, if we had eggs.

Personally, I find that to be an absurdly rhetorical theory. Even my ADHD brain tossed that one out as ridiculous, and my brain likes to ponder some really dumb things.

First of all, not everyone is trying to get stimulants by falsely claiming ADHD.

Second, is your doctor aware of the social stigma most people face when they're on something like Adderall? From families, friends, coworkers - a lot of people don't want to admit to taking them, because of the bias against them.

Third, the medical community isn't exactly handing them out like candy canes at Christmas.

And last, ADHD people deal with a hundred different kinds of discrimination, from mild disbelief to accusations of lying to cover up for laziness. If the medical community was really that concerned about leveling the playing field for ADHD people, they'd be stressing ADHD awareness as a means to bring attention to the problems we deal with. And Big Pharma would be throwing millions into a 'Adderall for Everyone! It's good for you!' campaign.

I'm sort of sputtering mentally over this one.

But at least you did get your prescription. I'm curious about your definition of 'manageable' though. Do you mean that you outwardly appeared to be completely functional, but internally it was chaotic scrambling to stay on top of everything? Really well-developed coping skills? I'm not suggesting that you shouldn't be taking Vyvanse, or feel guilty about it, just wondering.

There were a number of years that I took no medication at all, ever. That included aspirin. I refused to even deal with anyone with a prescription pad. There were a whole lot of reasons for that, all good in my opinion.

I was told that I was managing myself well. I was working a high stress job. I was "successful" by the definitions of my peers. I was losing it.

Outside, I looked great. I congratulated myself on having learned all the things that the outside world considered important. I did what was expected of me. When I wasn't "performing", I was toast. Exhausted with the effort and wondering daily how to keep going.

You may think that you are holding it all together. My question is, "at what price?"

I get that the pdoc wanted you to understand that taking stimulant medication isn't trivial. I also think that is a non-issue where you are concerned.

No one "volunteers" to have ADHD. NO reasonable person WANTS to be told that they have a non-curable mental health issue that they will have to manage properly for the rest of their life. No one asks for a brain that spins wildly out of control.

When you went to that doc, you were saying, "I need some help with this". That's pretty serious. Choosing to make yourself that vulnerable wasn't easy. It wasn't trivial.

It isn't uncommon for people to want to question the diagnosis. It isn't uncommon to fall back on the idea that you just need to "try harder". After all, you've been hearing that all your life. Everyone who has said that to you was probably right. Thinking that there is an organic and functional issue that needs to be dealt with is just another example of your laziness... am I right?

This isn't an ethical issue. This is an acceptance issue. You have ADHD. Around here, that's okay.

Hang in there.

I think many without ADHD can benefit from stimulants, but the key here is the dose and the corresponding nature of the benefits. There's likely a threshold in terms of dose where when crossed, the drug starts to have effects that are the opposite of what was intended. That threshold may be lower for those without ADHD. The level of improvement of abilities may not be anywhere near the level of improvement that someone with ADHD experiences. Also, I don't think the main desired benefit is increased concentration for all of those non ADHDers in college taking the drug. In some cases, it could be used simply to stay awake at unusual times of the day for the purposes of studying.

Someone who I work with was having a conversation about illegal drugs and mentioned that he tried (meth?)amphetamine in the 1970's as some were using it as a study aid. He didn't think it really helped him in this respect. It certainly made him alert, but otherwise, he was less than impressed. I know that this doesn't prove anything, but it certainly leads me to believe that the benefits vary from person to person.

Thank you all for these great replies! To respond to a few questions...

I assumed the pdoc (that's your insider term for psychiatrist, right?) knew what he was talking about when stating everyone benefits from stimulants, but I will certainly do more research into that claim. The whole reason I felt compelled to post on the issue of ethics may be based on an incorrect assumption.

Broadening the topic of this thread, here's more about my particular situation: The pdoc is in the same practice as my therapist. I've been seeing my therapist for over a year now, so she's been able to catalog my life pretty well. I agreed to let her consult and share notes with her pdoc colleague, and I think that's why I got a prescription on the very first day.

Work performance isn't the only measure of things, but it's a very big part of my life, so it's always been the measuring stick I use. All of school and even into starting my job, concentration was never a problem. I'm a high performer at work, and over the last 2 years, I have been granted more and more freedom to choose the projects that I work on, and that's really when the ADD started coming out. My boss has enormous trust that what I decide upon is best for the group, and I suspect this freedom, or to rephrase, this lack of forced structure, is when I first realized I have some ADD tendencies.

Some insight into me in general: I'm a computer programmer who hates math and loves crafting beautiful user experiences with the software. In my spare time, I'm always trying to invent the next big thing. I consider myself a very creative person who just happened to grow up as a child writing computer code (I've seriously been coding since elementary school just because, weirdly, that's what my best friend was really into). When I'm with coding people, I'm the zany creative one. When I'm with Englishy people, and I believe that is the technical term :-), I turn more robotic, looking for logical and code solutions to their problems. Socially, even my personality shifts inversely, depending on the company. This was most noticeable with my ex-girlfriend, who was extremely social, bubbly and energetic, which pushed me towards extreme rigidity and calmness. Around my math and science friends, I'm a goofball.

Finally, Paul Erdős sounds like a cool dude to hang out with...

Frankly, the question is kind of interesting, and may be debatable, but I think your psych was way out of line to bring it up in the context of giving you the scrip. I mean, think about it -- he was basically saying 'Here, take these meds, even though I think it may not be ethical for me to give them to you.' It's one thing if you're discussing it over a beer, but how are you supposed to feel in that setting?

I'm still not clear on why you or your psychiatrist believe you're AD/HD. One option that has not been mentioned yet is to see a psychologist who is specialized in AD/HD to be tested. They can tell you what your IQ is, what your learning, memory, and attention abilities are, and also give you a personality inventory.

Because you are so capable, you likely would enjoy learning more about yourself, by that I mean more about your strengths...weaknesses too, if you have any.

Perhaps by doing this you would feel more comfortable with continuing treatment, or perhaps you'll decide that pharmaceutical treatment is not what you need, rather you need something else.

Also important is to get feedback from those around you as to whether they notice any differences in you, good or bad. In doing this, I strongly encourage you to NOT discuss your diagnosis and treatment with co-workers. It's okay to be evasive. This is nobody's business but your own, but I enourage you to get the feedback of those who know you best, and that you trust.

grandma lise

I may have phrased something that made my pdoc look bad, but really his comment about ethics was a brief few sentences made during his overview of the medication and his role as my psychiatrist. I didn't feel that it was in conjunction with my personal diagnosis. If it actually is true that everyone benefits from stimulants, I agree it is an interesting question to consider.

grandma lise: Let me try to clarify why I'm trying to treat what I think is ADD. I assure you I have many weaknesses :-) Some of the behaviors I'm hoping to curtail include: compulsively checking websites looking for new content as a distraction, gluing myself to any TV screen in the room even if I don't care at all about what's on, hyper focus on tasks I find engaging to the point of not sleeping/eating/daily chores, brainstorming new ideas (aka extreme procrastination) instead of doing important but boring tasks.

I am told by both my therapist and psychiatrist that these are a somewhat rare set of ADD symptoms, but ADD nonetheless, so we're trying the chemical route. You are right that I have not seen an AD/HD specialist. Should I be concerned about my diagnosis since it comes doctors with more general backgrounds?

I don't know why your doc thinks that your symptoms are new, rare or different. I will bet that you would hear a whole bunch of folks here reporting the same things.

It's ADHD.

Actually, you sound a bit like me...

The whole programming thing? Me too. I haven't written code in years but I used to. My husband was an Application Architect and we rather enjoyed creating programs at home after work.

The fact that your work has become more unstructured is exactly the kind of thing that can cause decompensation. For some, it takes a new/unique scenario to really clarify just how big the problem really is.

Google DSM ADHD. Read the symptom list. Then tell me if you think the diagnosis is accurate.

The fact that your docs think that your symptoms are rare is an indication of all they don't know about ADHD. The good news is that they are willing to consider the diagnosis and offer treatment.

Hate math, huh? But love programming. That would be a tipoff to me. You probably get lost in math concepts but are a rockstar with english and logic.

The fact that your work has become more unstructured is exactly the kind of thing that can cause decompensation. For some, it takes a new/unique scenario to really clarify just how big the problem really is.

This is is so very, very true.

Hmm . . . those sound like very typical ADHD symptoms to me, at least for inattentive type. Sounds just like the reasons I have problems at work and sought treatment.

Sounds like your pdoc was running off at the mouth or maybe trying to reassure you the meds would be O.K. I don't really know. I have gone through some moments of denial since being diagnosed and thought, "What if I just wanted an energy boost to get my housework done and don't NEED medication?" Then I have one of those totally unproductive procrastination days and realize I really do have a problem.

This could easily describe me:

grandma lise: Let me try to clarify why I'm trying to treat what I think is ADD. I assure you I have many weaknesses :-) Some of the behaviors I'm hoping to curtail include: compulsively checking websites looking for new content as a distraction, gluing myself to any TV screen in the room even if I don't care at all about what's on, hyper focus on tasks I find engaging to the point of not sleeping/eating/daily chores, brainstorming new ideas (aka extreme procrastination) instead of doing important but boring tasks.

The thing is: you CAN perform at an extremely high level, but maintaining that level of performance consistently will take a toll. For one, you'll probably end up devoting more and more time to trying to work (but engaging in some of the distractions) as your life and work demand more and more of you. That's what I did. Eventually ALL I did (and still, most of what I do) is work, chores, and the distractions. I don't do the positive, life-enhancing things that would give me my life more meaning, more balance, etc. You end up with less and less time to devote to those kinds of things, and eventually you realize (at least I did), that you're swimming upstream more than other people.

So the fact that you're high-performing may have masked the ADHD, but what you describe sounds a lot like a lot of the folks on this board.

All of your symptoms scream ADD to me and I share your "unique" set of symptoms as do many other people. I find it odd that your psychiatrist would call these symptoms ... I can't remember the actual word.... rare, or obscure.... because they sound like very common ADD behaviors.

I too am considered successful at my job because I'm naturally good at it, consistency however is not my forte', I'm very creative... too creative to work most jobs without chemical help. When it comes to mundane details I zone out, stimulants allow me to use my creativity in a balanced way.

I don't think anyone would want to have ADD. I can see how stimulants could theoretically help anyone in certain situations but not as an everyday type of thing. I have a very hard time balancing my life, anyone who can balance life and work without feeling like they are constantly wearing themselves out probably wouldn't benefit from regular stimulant use. (At the same time I think if someone wants to experiment with stimulants in a safe way to help them with their work they should be allowed to do so regardless of whether or not they have ADD.)

Besides, just getting rx stimulants can be a huge pain, the last time I picked up my Ritalin at the pharmacy they looked at me like I was there to pick up an ounce of Cocaine or something. They looked at me very suspiciously and said they would have to call my psychiatrist to make sure the script was legitimate, they weren't very nice about it either. When I don't take my meds I'm just like a leaf blowing in the wind, no consistent direction. I don't want to go back to that way of life.

Speaking of meds mine are wearing off, what were we talking about again?

I always thought that Paul Erdos guy sounded fascinating too.

My response to you didn't post, darn it, so here's my brief response...

I agree with the others here. It does sound like you have AD/HD.

Getting tested by a psychologist specialized in AD/HD is helpful in that it can remove feelings of doubt that you may be having. But it's generally not necessary. To get a referral to psychologist who is specialized in providing testing for AD/HD in or near your area, it can be helpful to find an AD/HD education and support group to refer you, either by providing a few names or by referring you to a listing of all treatment providers known to have an interest in working with AD/HD adults, children, and families.

To find a CHADD chapter, go to www.chadd.org (http://www.chadd.org). To find other AD/HD groups, do a search on "ADHD support [your city, state]". Then broaden your search to other cities, particularly the larger ones. Another option is to call 1-211. They often maintain listings of support groups too, not just social service agencies.

It must be so exciting for you to finally have found an explaination for some of the difficulties you've been having. I know it was for me!

Every single response here is wonderful! It's dawning on me how little I really know about ADD and AD/HD, so thank you all for supporting me with information. I really do think I have a great therapist and pdoc, so I'm afraid my clumsy recollection of what they've said is giving them a bad rap...

I've been hitting the Googles, and here's what I've learned - posted here in hopes that the community can steer me back on track if my research wanders into dubious territory.

First, ADD vs ADHD. I gather that in some contexts the acronym "ADD" also covers ADHD, but not vice versa due to the hyperactivity component. (http://add.about.com/od/adhdthebasics/a/ADDvsADHD.htm)

Next, what is the protocol for writing ADHD? AD/HD? ADHD? AC/DC?

My ex has ADHD but in a totally different way, and from what I gather, her's is a more common manifestation of symptoms. Saying "rare" to describe my symptoms probably wasn't the best word choice on my part. Quick aside: I'm still very close with my ex, and she's the only other person outside of the doctors (and now you, the entire Internet :-)) who knows about any of this.

Next, there are six types of ADD: http://www.ehow.com/facts_4967926_symptoms-six-types-add.html

Diagnosing myself, here's my list:

Classic ADD: No
Inattentive ADD: Somewhat
Overfocused ADD: Yes
Temporal ADD: No
Limbic ADD: No
"Ring of Fire" ADD: No

For comparison purposes, here's the list on my ex:

Classic ADD: Yes
Inattentive ADD: Somewhat
Overfocused ADD: Yes, but diagnosed OCD
Temporal ADD: No
Limbic ADD: Yes, I suspect
"Ring of Fire" ADD: No

I found this list of DSM-V symptoms. Are there any significant differences between version 5 and version 4 that you all feel are especially notable as related to ADD? http://www.adhdkid.com/adhd-dsm-v.htm

I'd say I match about half of those DSM symptoms, but the ones I matched were very obviously matches. Symptoms before age 16? Tricky because my parents were very involved and kept my environment very structured, at least when it came to school. Solid evidence of profound impairment? Tricky because "profound" is very subjective, and masked by coping skills and structured environments.

Next I read this: http://en.wikipedia.org/wiki/ADHD_predominantly_inattentive

My childhood experience did not at all match that description, but the adult description did match. As noted in the article, cognitive adjustments and coping skills very likely are in play.

So, that's what I'm filling my head with at the moment. Feel free to chime in with corrections or additions. This place is an awesome community of supportive folks.

Learn more about the 6 Subtypes by reading Daniel Amen's book, Healing ADD. Bad book title - (it's not possible to heal AD/HD) - but good book. It provides medication, diet, and nutritional supplement strategies for each subtype.