how does ADHD medication work?
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I highly recommend watching the seminars with Dr. Russell Barkley, as that totally clicked with me and my understanding of my own diagnosis. He does go into the different medications and the effect they have, however, one of the greatest takeaways from his lectures is that ADHD had been misnamed and minimised because of that label, as we are not deficient in attention, nor are we actually hyperactive, what we are, is deficient in our ability to “regulate” our own minds; this can relate to emotional or physical impulsivity, working memory, organisational skills, time keeping, motivation, etc.
We dont have any actual issues with focus itself, as I’m absolutely sure ADHD folks here can attest to spending wayyyyy to may hours zoned into a game/series/book/project that we found stimulating, beyond the average capability of our neurotypical peers. The issue is our brains inability to regulate this focus as a part of our executive function, and so we are totally unable to divert it like a neurotypical brain can to other matters we find less rewarding in the “now”. In regards to our regulation issues, there are a wide range that those of us with ADHD may have issues with, and typically it relates to a lack of past/future functionality, so we can only experience that deficiency as a present moment issue ans impulse (look at emotional impulsivity as the most visible example), with this severely impacting our ability to problem solve the aspect we are deficient in regulating. The same is true for task management and focus on the mundane tasks, as we cannot function on these aspects nornally, due to this regulation deficiency, but when our brains are receiving an appropriate level of stimulation on medication, we have a reduction on focal impulsivity and can then explore that task on a wider time scale (past and future) to take action on it, where we were completely unable to before that.
The medications on offer have a wide range of effects, with the exact actions still being the subject of study, and with each ADHD brain being different, so some react in different but now predictable ways to each one. Stimulant medication, for instance, has a suppressive effect on the frontal cortex, suppressing emotive capacity. While this is a benefit for quite a few people whose ability to regulate that is deficient, and so by suppressing the range they need to manage increases their capacity to emote, but there are just as many folks who are described as emotional zombies on stimulants, because that suppression is too great for them. These folks usually benefit from the non stimulant re-uptake meds, which help to fine tune that area rather than suppress it.
A previous Dr had an interesting story (I thought so anywho) about stimulant use by pilot’s, during WW2. During the war, pilot’s were such an in demand resource that they were made to fly for crazy hours, with little downtime, just to try and keep up. Stimulants were already widely used, and their use in war predated the blitzkrieg, but there ended up being a bit of a stimulant development sub war between the axis and allies, to give their respective pilot’s the edge over the other. Speaking in an objective sense and purely about if the goal was to make the efficacy of a stimulant in being able to keep the person awake and alert for a long time, and remain focused throughout, then the Germans won the race! The Germans developed a stimulant with a much more potent effect that allowed their pilot’s to fly for longer and focus like laser beams, however, this actually worked against the Luftwaffe in the most schadenfreude way possible, as their pilot’s became so over focused on a specific element of their flying, that they were physically unable to assimilate new peripheral information, or divert from a course of action when the surrounding circumstances changed. This led to allied tactics such as engaging German pilots in 1v1 dog fights, which would cause the German pilots to hyper-focus on the aerial fight and not see the other planes either flanking them, or engaging the bombers they were supposed to protect. The allies, on the other hand, developed one that not only allowed their pilot’s to fly long hours, but that was just “inefficient” enough to allow them to take in new information and break away from the their focused state when needed. The same can be said for a neurotypical brain taking a stimulant in that they would experience over focus, emotional blunting, impulse reduction and difficulty (from their baseline) at processing peripheral information; this is pretty much the desired effect for kids using ADHD meds as an academic crutch though, where as the ADHD brain on the right dose will just function on a “normal” level.
I’d also recommend Dr. Andrew Huberman as a great source of info, especially on dopamine.
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