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Adderall, Stimulants & Modafinil for ADHD: Short- & Long-Term Effects | Huberman Lab Podcast

Andrew Huberman・106 minutes read

The Huberman Lab podcast delves into the science behind ADHD treatments with a focus on amphetamines like Adderall, Ritalin, and Vyvanse, discussing their mechanisms of action and potential risks. It emphasizes the importance of combining drug treatments with behavioral protocols and consulting board-certified psychiatrists for effective ADHD management.

Insights

  • Stimulants like Adderall, Ritalin, and Vyvanse are commonly used to treat ADHD by enhancing dopamine and norepinephrine levels, improving focus and attention while reducing distractions.
  • ADHD medications like Adderall and Ritalin can positively impact children's school performance and long-term outcomes, emphasizing the importance of early treatment for ADHD.
  • Properly managed ADHD treatment with medications and behavioral protocols can reduce the risk of addiction to other substances and minimize the likelihood of addiction to the ADHD medications themselves.
  • Consulting a board-certified psychiatrist knowledgeable about the latest scientific literature on ADHD is crucial for effective treatment, which may involve a combination of drug treatments and behavioral interventions tailored to each individual's needs.

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Recent questions

  • How do ADHD medications work?

    ADHD medications like Adderall, Ritalin, and Vyvanse increase dopamine and norepinephrine levels in the brain, enhancing focus and attention by targeting neurotransmitter transporters.

  • What are the risks of using ADHD drugs?

    Using ADHD drugs without a prescription poses serious risks, including potential contamination with harmful substances like fentanyl from black market sources. Additionally, excessive dopamine or norepinephrine levels can lead to euphoria, anxiety, or other adverse effects.

  • Are there long-term consequences of ADHD drug use?

    Long-term use of ADHD medications does not seem to impact height or growth in children, but it may subtly raise cardiovascular risk. Properly managed treatment reduces the risk of addiction to other substances and minimizes the likelihood of addiction to the ADHD medications themselves.

  • How can ADHD medications affect hormone levels?

    ADHD medications can impact cortisol levels, which in turn influence focus, alertness, immune system activation, mood, and interactions with other hormones like testosterone and estrogen. Chronic elevation of cortisol from these drugs can potentially disrupt sleep patterns and hormonal balance.

  • What is the importance of consulting a psychiatrist for ADHD treatment?

    Consulting a board-certified psychiatrist who is knowledgeable about the latest scientific and clinical literature on ADHD is crucial for effective treatment. Combining drug treatments with behavioral protocols tailored to individual needs is essential for optimal results in managing ADHD symptoms.

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Summary

00:00

"ADHD Stimulants: Science, Risks, and Benefits"

  • The Huberman Lab podcast discusses science and science-based tools for everyday life, hosted by Andrew Huberman, a professor of neurobiology and Ophthalmology at Stanford School of Medicine.
  • The focus of today's discussion is stimulants for treating ADHD, including popular drugs like Adderall, Ritalin, Vyvanse, modafinil, and guanfacine.
  • Huberman delves into how these compounds work to improve ADHD symptoms, addressing common questions about their addictive potential and impact on psychotic symptoms.
  • He explores the scientific literature on the long-term consequences of using these drugs in childhood or adulthood.
  • Many individuals use these prescription drugs without a prescription, with surveys showing high usage rates among college-age young adults.
  • Obtaining these drugs without a prescription poses serious risks, including potential contamination with fentanyl in black market sources.
  • Huberman explains the mechanisms through which these drugs work at the neuronal and brain network levels to enhance focus in individuals with ADHD.
  • He addresses common questions about the use of stimulants, including their impact on sleep, hormone health, reproductive health, and height.
  • Huberman discusses the data on whether these drugs predispose individuals to addiction to other substances, even after ceasing or continuing stimulant use for ADHD.
  • The podcast is separate from Huberman's teaching and research roles at Stanford, aiming to provide free science-related information to the public.

14:37

ADHD Drugs: Enhancing Prefrontal Cortex Function

  • The discussion focuses on alleviating ADHD symptoms by understanding the prefrontal cortex's role in enhancing and suppressing brain networks.
  • The primary focus is on the drugs used to treat ADHD, how they work at the neuronal level, and their impact on the prefrontal cortex's function.
  • These drugs aim to improve brain function by enhancing specific circuits to aid learning and efficiency in the prefrontal cortex.
  • Common questions about drugs like Adderall, Vyvanse, and Ritalin are addressed, including their addictive potential and usage in children.
  • Understanding the biology of these drugs is crucial to assess their benefits and risks for oneself or children.
  • Stimulants like amphetamines improve ADHD symptoms by increasing activity in the prefrontal cortex, enhancing focus and attention.
  • ADHD drugs fall under the category of sympathomimetics, triggering the sympathetic nervous system to increase alertness and arousal.
  • Adderall, a common ADHD medication, contains a ratio of D-amphetamine to L-amphetamine, affecting neurotransmitters like dopamine and norepinephrine.
  • Dopamine and norepinephrine play crucial roles in motivation, focus, and attention, working together to achieve a state of alertness and focus.
  • Adderall increases dopamine and norepinephrine levels by disrupting presynaptic transporters and vesicle packaging, leading to enhanced neurotransmitter release and activity.

29:46

ADHD Medications Enhance Dopamine for Improved Focus

  • Adderall increases dopamine and norepinephrine in synapses through disruption of protein networks.
  • Adderall's effectiveness in increasing dopamine compared to other ADHD treatments is due to its ability to enhance dopamine release and transmission.
  • Adderall's major effects stem from its significant increase in dopamine levels, making it popular for ADHD treatment and recreational use.
  • Vyvanse, a prodrug of D-amphetamine, provides timed-release effects by attaching lysine to D-amphetamine.
  • Vyvanse's slow release mechanism prevents abuse by ensuring a gradual increase in dopamine and norepinephrine levels.
  • Ritalin, or methylphenidate, increases dopamine transmission by inhibiting dopamine transporters, with a focus on dopamine over norepinephrine.
  • Ritalin's effects last about 4-6 hours, with a shorter half-life compared to Adderall.
  • Ritalin's mechanism differs from Adderall and Vyvanse, primarily targeting dopamine and norepinephrine transporters.
  • Dopamine and norepinephrine impact executive functions in the prefrontal cortex, enhancing attention and reducing distractions.
  • Dopamine aids in noise reduction by suppressing distracting signals, while norepinephrine from the Locus ceruleus enhances focus by sprinkling norepinephrine at various brain locations.

44:05

"ADHD drugs enhance focus and reduce distractions"

  • Norepinephrine can be released widely or focally in the brain.
  • Dopamine reduces noise while norepinephrine boosts signals at synapses.
  • Drugs like Adderall increase dopamine and norepinephrine levels.
  • Increased dopamine and norepinephrine reduce noise and amplify signals.
  • ADHD drugs aim to increase focus and reduce hyperactivity.
  • Excessive dopamine can lead to euphoria, mania, or psychosis.
  • Excessive norepinephrine can cause anxiety, panic attacks, and physical symptoms.
  • ADHD drugs aim to balance neural circuits and improve focus.
  • ADHD drugs stimulate brain networks to enhance focus and reduce distractions.
  • ADHD drugs promote neuroplasticity by strengthening synapses for long-term benefits.

59:29

ADHD Treatment: Drugs, Dosages, and Outcomes

  • Children diagnosed with ADHD benefit significantly from appropriate doses of drugs like Adderall, Ritalin, or Vyvanse in terms of school performance, focus, and general outcomes.
  • Studies indicate that untreated children with ADHD have a higher tendency towards illicit drug use and addiction in adulthood, emphasizing the importance of early treatment.
  • Treatment with sympathomimetic drugs like Adderall or Ritalin in childhood does not predispose individuals to drug abuse later in life, as shown by neuroimaging studies.
  • Accurate diagnosis of ADHD is crucial, involving a comprehensive evaluation by a qualified psychiatrist who may recommend a combination of drug and behavioral treatments.
  • Behavioral treatments, nutritional guidelines, and supplementation are essential components of ADHD treatment, alongside prescription drugs, tailored to each child's developmental stage.
  • Tapering off ADHD medications should be done under the guidance of a psychiatrist to assess the need for continued treatment based on individual neuroplasticity and circuit function.
  • Dosage ranges for ADHD medications vary widely, with Adderall ranging from 10 to 40 mg per day, Ritalin from 10 to 60 mg per day, and Vyvanse in higher doses due to its slow-release mechanism.
  • Individual responses to ADHD medication dosages are highly variable, influenced by genetic differences in enzyme metabolism, necessitating careful monitoring by a psychiatrist.
  • Long-term use of ADHD medications does not appear to impact height or growth in children, with treated individuals potentially having slightly higher body mass indexes compared to peers.
  • Starting with the lowest effective dose and adjusting based on symptom relief and side effects is the safest approach to determining the optimal dosage for ADHD medication.

01:15:08

ADHD Medications and Cardiovascular Health Risks

  • ADHD medications do not stunt overall development but may elevate sympathetic nervous system activity, potentially increasing cardiovascular risk.
  • Long-term use of sympathomimetics like Adderall or Ritalin may subtly raise cardiovascular risk, but not to a degree that warrants discontinuation if prescribed appropriately.
  • Maintaining a minimal effective dosage of ADHD meds is crucial to mitigate risks, emphasizing the need for additional cardiovascular health measures like exercise and avoiding smoking.
  • Combining alcohol with ADHD medications, even though they affect different brain pathways, can be more harmful than taking the drugs alone, leading to brain and body detriment.
  • Alcohol consumption should be limited, with most adults advised to stay under two drinks per week to avoid negative health impacts, especially when taking ADHD medications.
  • Cortisol levels, influenced by ADHD meds, can impact focus, alertness, immune system activation, mood, and interactions with other hormones like testosterone and estrogen.
  • Timing and dosage of ADHD medications are vital due to their effects on cortisol levels, which can disrupt sleep patterns and potentially affect hormone balance.
  • Chronic elevation of cortisol from ADHD meds can impact testosterone and estrogen production, potentially leading to reduced libido, muscle mass, and other hormonal imbalances.
  • Properly managed ADHD treatment with appropriate medications and dosages under supervision reduces the risk of addiction to other substances and minimizes the likelihood of addiction to the ADHD medications themselves.
  • Withdrawal effects from tapering off ADHD medications can be mistaken for symptoms of not having the brain systems activated as before, emphasizing the need for careful management during dosage adjustments.

01:29:56

ADHD Drugs and Psychosis: Risks and Effects

  • Amphetamines like D amphetamine, L amphetamine, and methylphenidate (Ritalin) can induce psychosis.
  • Predisposing factors to psychosis include a family history of schizophrenia or bipolar disorder.
  • Stopping methylphenidate can often cease psychotic episodes induced by the drug.
  • Adderall, a mix of D and L amphetamine, can lead to long-lasting psychotic episodes even after drug cessation.
  • Methamphetamine is a highly dangerous drug, causing various health issues and neurotoxicity.
  • Vyvanse, a long-release D-amphetamine, has lower potential for inducing psychosis and abuse.
  • Drugs that rapidly increase and decrease dopamine levels have higher potential for addiction and psychosis.
  • Recreational use of ADHD drugs can lead to addiction and heightened risk of psychotic episodes.
  • Regular use of ADHD drugs by diagnosed individuals leads to reduced dopamine peaks over time.
  • Original clinical literature suggested drug holidays for children with ADHD, but this practice has diminished.

01:45:11

ADHD Drugs: Effects, Side Effects, and Alternatives

  • Studies on long-term effects of ADHD drugs vary in duration, with a focus on methylphenidate.
  • Modafinil and armodafinil are non-amphetamine drugs used for ADHD treatment, with modafinil being more expensive.
  • Experts note no significant difference between modafinil and armodafinil, despite consumer perceptions.
  • Generic versions of drugs may differ in binders, impacting release rates and metabolism.
  • Modafinil and armodafinil are prescribed for various daytime sleepiness issues, including post-surgery recovery.
  • Personal experience with armodafinil led to heightened alertness but an uncomfortable, prolonged state.
  • Side effects of modafinil and armodafinil include decreased appetite, runny nose, headaches, and skin rashes.
  • Stevens-Johnson syndrome, a severe skin condition, is a rare risk associated with modafinil and armodafinil.
  • Guanfacine, a non-stimulant ADHD medication, primarily targets the noradrenergic system.
  • Guanfacine can improve executive function by fine-tuning brain circuits, particularly in children with ADHD.

01:59:04

ADHD Treatment: Amphetamines, Supplements, and More

  • The text discusses the risks and benefits associated with using amphetamines to treat ADHD, emphasizing the importance of combining drug treatments with behavioral protocols for optimal results. It also highlights the necessity of consulting a board-certified psychiatrist well-versed in the latest scientific and clinical literature on ADHD for effective treatment.
  • It mentions the partnership with Momentous Supplements for those interested in supplements to improve sleep, hormone support, and focus, directing listeners to livemomentous.com/huberman. Additionally, it encourages following Huberman Lab on social media platforms for science-related content and subscribing to the Neural Network Newsletter for distilled essential points from podcasts and toolkits on various topics like sleep and neuroplasticity.
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