A case for ADD/ADHD diagnosis

I recently informed my friend Miles that I started taking Adderall to treat my ADHD. His response was strong opposition:

“Read that article on Adderall.  ADD and ADHD didn’t even exist 20 years ago.  They created a diagnosis so they could sell pills, PERIOD.” 

Unfortunately, this seems to be a common response among my friends who feel that at 32, I sold out to Big Pharma to coast through life on a blue pill called Adderall. This was my response.

Dear Miles;

Okay, I am going to very polemic here and tell you I disagree with your assessment that ADD/ADHD should be discarded as a fictitious condition. But first, I am going to poke holes in your argument because when it comes to discussions about science, sweeping statements that lack sound scientific evidence hold no ground for me.  Just because a condition wasn’t given a name until 20 years ago, doesn’t mean that it’s non-existent and not worth study and treatment. Second, it’s been over 20 years! The condition has had classification since the 1980’s which makes it 36 years old. Alcoholism wasn’t considered a disease until 1956, before then, it didn’t exist either, but just because the disorder lacked semantic categorization does not mean that its effect was any less destructive than it is today. The spirit of scientific research and the scientific method is to move our body of knowledge forward – although I completely agree with you that monetary interests can shape the course of treatment and research.

In the last 20 years, important technological advancements in neuroimaging and genetic testing have resulted in a prolific body of research on the brain.  Moore’s Law holds in the field of neuroscience where electronic equipment like PET and MRI scans have seen drastic improvements in brain imaging, and new technologies in electrophysiology even allow scientists to look at individual neurons as they are firing! May I remind you that 36 years ago, this is what a computer looked like:

Image result for 1980 computer

We’ve come a long way from pack-man era technology of and I can assure you that some things known about the brain today might not hold true tomorrow, but there is without a doubt far more to discover.

Now, you remember when I moved to my studio how I agonized about picking the right bed sheets that combined with my sofa? I read hundreds of Amazon reviews over three weeks. You are also well aware that I am very reticent about medication and mind altering substances. Please trust me when I say that giving Adderall a try was not a decision I made lightly. I spoke to users, I read blogs, I read drug reviews and I read lots and LOTS of scientific literature while weighing the pros and cons.

I’m not talking about having read generic primers meant to be best-sellers, I’m talking about studies published in medical journals by reputable institutions and known experts showing that the brains of people with attention deficit are structurally different than those of normal subjects. SPECT scans repeatedly show that someone with ADD/ADHD has reduced blood flow to certain parts of the brain that include the prefrontal cortex – which is associated with attention, memory, and impulse control. Genetic markers have been found in people with ADD/ADHD that show poor expression of dopamine receptor gene, which is why a person with ADD/ADHD gets easily bored – they crave more dopamine and are more likely to engage in novel and risky ventures to get a fix. Other receptor genes and neurotransmitters like serotonin also are involved which explains why some with attention deficit manage their symptoms better with anti-depressants like serotonin-reuptake inhibitors. The scientific evidence – showing that an inability to regulate attention can be detrimental to learning, memory, and managing mood is so insurmountable and undeniable – that it would be like rebuffing climate change. Large sample sizes, timeliness, strong positive correlations, and a mix of qualitative and quantitative data of in vivo and in vitro studies make the case for attention deficit too compelling to ignore.

Attention deficit is correlated with other cognitive impairments.  The same neurotransmitters that are associated with alcoholism and other addictions (dopamine, serotonin), are associated with attention modulation which is why many ADD/ADHDers self-medicate with drugs and are more likely to develop drug habits.  The thoughts and ideas of an ADD/ADHDers jump around so quickly, that it’s hard to get one coherent thought before then next random one interrupts it. Drugs like alcohol slow thinking down so the thoughts aren’t as fast and intrusive. Do you think that if someone has a problem with alcoholism related to poor impulse control and anxiety that they don’t need treatment? In the same vein, don’t you think that is possible that the brain’s ability to modulate attention and motivation can be impaired enough to pose serious problems to learning which can translate to depression or anxiety?  If you are interested in reading more about the topic, try to find articles by Dr. Daniel Amen.  He’s got a repository of over 83,000 brain scans and writes extensively about depression, ADD/ADHD, and addiction.

While it is common for children to have problems with attention modulation as their young brains are developing, for some this issue persists well into adulthood due to a strong genetic component in conjunction with environmental conditions (such as sedentary office jobs) that are debilitating to an ADD/ADHDers way of thinking and learning. Yes, if I change my environment, my “symptoms” of attention deficit might disappear. I don’t doubt that! But for now, I have to pay the bills and need to be productive enough to keep my job while focusing on hobbies and side-projects that DO bring me satisfaction and a sense of personal growth.

I am very scared of becoming addicted and will be as mindful of the side-effects as possible. The man in the Times article you sent who wrote about his addiction to Adderall already had an unhealthy relationship with drugs. He experimented freely for the sake of partying. His callous and immature approach to drugs was bound to make him an addict. I can tell you right now, that I don’t know a SINGLE person that approached drugs for kicks in college that today doesn’t have some kind of addiction – even if it’s mild – to alcohol, weed or pharmaceuticals.  Right NOW my fear of being intellectually stagnant is greater than my fear of Adderall leading to a life on the streets sucking dick for crack – the latter is very unlikely. However, I do appreciate the heartfelt concern of friends like you, but accept that the ADHD is as part of me as my left arm. It’s why I’m quirky, ditsy, funny and spontaneous, but it’s a source of great distress for learning and project realization which I need to feel content and whole. You get it! This is where I have to end this long soapbox sermon. I’ve decided to make this my next blog entry and double my productivity for the day. Bang! Bang!

Get well soon so we can have dinner before you go off to Hollywood or Chile, or God knows where your projects will take you. Big hug Miles,

Sandra

(Thank you for your support dear reader! Please feel free to leave a comment or press LIKE at the top of the page. This way it looks like you care, which might or might not be true, but I’m insecure and I would like it if you pretended to care.)

 

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