Huberman Lab #126
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Adderall, Stimulants & Modafinil for ADHD: Short- & Long-Term Effects
Short Summary 🏎️
Professor Andrew Huberman discusses the use of drugs to treat ADHD, such as Adderall, Ritalin, and Vivance.
These drugs work by increasing the transmission of dopamine and norepinephrine, which are neuromodulators that increase motivation, focus, and alertness.
Huberman also addresses common questions about the addictive nature of these drugs and their potential dangers.
He also discusses the role of ADHD medications in children, emphasizing the importance of accurate diagnosis and appropriate treatment.
Finally, he cautions against using these drugs recreationally or for performance enhancement, as they can lead to addiction and other negative effects.
Key Learnings 🎯
Attention is a powerful resource that requires metabolic resources to maintain.
ADHD is not necessarily a deficit in prefrontal cortical function, but rather the prefrontal cortex's ability to communicate with other brain areas in the proper ways.
Adderall is a combination of D and L amphetamine salts that increases dopamine and norepinephrine transmission.
Vivants is a timed-release Dexadrine that increases dopamine and norepinephrine.
Ritalin mainly increases dopamine and to a lesser extent norepinephrine at synapses.
Adderall and other sympathomimetics trigger the release of neurochemicals and activate the sympathetic arm of the autonomic nervous system.
Children with ADHD who are treated with medication tend to perform better in school and have better outcomes later in life.
Guanfacine is a non-stimulant medication that works on the norepinephrine system and can help individuals learn how to focus and attend to certain things.
It is important to find the right dosage and type of sympathomimetic and to work closely with a board-certified psychiatrist to determine the appropriate dosage and to monitor any potential side effects.
Stimulants should not be used recreationally or for performance enhancement, as they can lead to addiction and other negative effects.
If you have 6 more minutes 🏖️
In the latest episode of the Huberman Lab podcast, Professor Andrew Huberman discusses attention deficit hyperactivity disorder (ADHD) and how drugs like Adderall, Ritalin, and Vivance can help alleviate its symptoms. He explains that attention is a powerful resource that allows us to navigate through life with efficiency and adaptability, but it is also expensive and takes metabolic resources. The prefrontal cortex is responsible for orchestrating the activity of other brain networks and controlling active suppression, which is why ADHD is not necessarily a deficit in prefrontal cortical function, but rather the prefrontal cortex's ability to communicate with other brain areas in the proper ways. In people with ADHD, the background chatter becomes very loud, and the default mode network is often still active at a robust level even while trying to attend to things. The drugs used to treat ADHD work by creating a certain set of conditions that allow the prefrontal cortex to be a better conductor, enhancing the activity of particular circuits to create a sort of learning so that the prefrontal cortex is much more efficient at doing its job of conducting.
The drugs used to treat ADHD fall under the category of sympathomimetics, which trigger the release of neurochemicals and activate the sympathetic arm of the autonomic nervous system, responsible for increasing attention and arousal. The most commonly prescribed stimulant for ADHD is Adderall, which is a combination of D and L amphetamine salts. D-amphetamine is more potent in increasing certain neurochemicals in the brain, while L-amphetamine tends to increase peripheral effects like heart rate and blood pressure. The major effect of Adderall and other sympathetic stimulants is to increase the transmission of dopamine and norepinephrine, which are neuromodulators that increase the firing patterns of particular brain circuits. Dopamine increases motivation and pursuit, while norepinephrine increases attention and focus. Vivants is time-release Dexadrine, which is effective in treating ADHD due to its slow, long-lasting increase in dopamine and norepinephrine. Ritalin, on the other hand, mainly increases dopamine and to a lesser extent norepinephrine at synapses.
Understanding the biology of how these drugs work and their potential benefits and risks is crucial in making informed decisions about their use. The major effect of Adderall is an increase in dopamine, making it an attractive drug for treating ADHD and for recreational use. Huberman also briefly discusses Vivants, a drug that is a pro-drug of D-M-Fetamine and is timed-release. The episode ends with a sponsor message for Athletic Greens, a vitamin mineral probiotic drink that covers all foundational nutritional needs.
Huberman also addresses common questions about the addictive nature of these drugs and their potential dangers. He explains that dopamine and norepinephrine are closely related and work together to increase motivation, focus, and alertness. Adderall increases the levels of these neurotransmitters by disrupting the activity of transporters and vesicle packaging in the presynaptic neuron. This leads to a buildup of dopamine and norepinephrine in the synapse, resulting in increased release and transmission.
Huberman also discusses the different mechanisms by which these drugs increase dopamine and norepinephrine transmission, and how they impact the prefrontal cortex and executive function. He notes that there is no way to predict how quickly someone will metabolize these drugs, and that finding the right dosage and type of sympathomimetic can be a process of trial and error.
Huberman also discusses the role of ADHD medications in children. He emphasizes the importance of accurate diagnosis and appropriate treatment, which may include a combination of medication and behavioral interventions. Huberman notes that children with ADHD who are treated with medication tend to perform better in school and have better outcomes later in life. He also addresses concerns about the potential for addiction or drug abuse later in life, citing studies that suggest early treatment with ADHD medication can actually lead to normalization of brain circuits over time. Huberman stresses the importance of ongoing assessment and adjustment of treatment as a child matures and their needs change. He also discusses the role of nutrition and supplementation in ADHD treatment.
Huberman emphasizes the importance of working closely with a board-certified psychiatrist to determine the appropriate dosage and to monitor any potential side effects. He also notes that there is no simple test to predict how someone will respond to these drugs, and that the most effective approach is to start with the lowest possible effective dose and increase only as necessary. Huberman also addresses concerns about the long-term effects of these drugs on growth and development, and explains that there is no evidence to suggest that they limit overall height when used appropriately. Overall, the episode provides valuable insights into the complex and individualized nature of ADHD medication use.
Professor Andrew Huberman discusses the use of drugs to treat ADHD. He explains that while ADHD medications have been shown to increase BMI in children, they do not appear to stunt development or impair growth. However, long-term use of these medications can increase sympathetic nervous system activity, which carries some cardiovascular risk. It is important to arrive at the minimal effective dosage and to avoid alcohol and benzodiazepines while taking these medications. Huberman also addresses concerns about addiction and psychosis, stating that appropriate dosage of medication under the supervision of a qualified psychiatrist can actually reduce the risk of addiction to other substances in adulthood.
Huberman also discusses the potential for ADHD medications to induce psychotic episodes in individuals with a predisposition to psychosis. He explains that drugs such as amphetamine, methylphenidate, and ritalin can increase the likelihood of psychotic episodes, but there is a divide in the literature regarding whether these symptoms will cease after the person stops taking the drug. Huberman also highlights the dangers of methamphetamine, which is considered an illicit drug and has all sorts of negative effects on health, including neurotoxicity to serotonergic and dopaminergic neurons. He emphasizes that the kinetics or time course of dopamine and norepinephrine release caused by a given drug is strongly correlated with its abuse potential, addictive potential, and potential to induce psychotic episodes.
Huberman also discusses the effects of ADHD medication on the immune and endocrine systems. He explains that while the immune system is always active, medication can amplify or mobilize the release of anti-inflammatory molecules to combat infections. However, chronic elevations in cortisol, a hormone released in response to stress, can disrupt other hormones in the endocrine system, leading to reductions in testosterone and estrogen levels. Huberman emphasizes that the treatment of ADHD with medication should never be done at the expense of these critical biological systems.
Huberman cautions against using these drugs recreationally or for performance enhancement, as they can lead to addiction and other negative effects. However, he notes that children and adults with ADHD who are prescribed these drugs and take them as directed are at lower risk for negative effects. He also discusses the importance of dosing patterns, noting that many of these drugs were originally designed to be taken during the school week with weekends off, but this pattern has fallen away in recent years. Huberman also discusses non-amphetamine treatments for ADHD, such as modafinil and armodafinil, which are becoming more commonly used. He notes that there is little difference between these drugs, but that consumers may have preferences for brand name or generic versions.
Finally, Huberman discusses guanfacine, a non-stimulant medication that works on the norepinephrine system. He notes that guanfacine can activate prefrontal cortical networks, improving executive function and increasing the coordinated firing of locus ceruleus neurons with the prefrontal cortex. This can help individuals learn how to focus and attend to certain things, limiting impulsivity and hyperactivity. However, guanfacine should only be taken under prescription, as it can have serious side effects when taken off-label.
Some thought-provoking questions 🤔
1. What are the potential risks associated with stimulant drugs for treating ADHD?
There are potential risks associated with stimulant drugs for treating ADHD, such as addiction, abuse, and potential to cause psychotic symptoms. Long-term use of these medications can also lead to an increase in sympathetic nervous system activity, which carries some cardiovascular risk and can disrupt other hormones in the endocrine system. Additionally, there is a risk of experiencing negative side effects such as decreased appetite, runny nose, headache, and skin rashes, as well as rare but potentially fatal skin conditions such as Stevens Johnson syndrome.
2. How does guanfacine work to treat ADHD?
Guanfacine works by stimulating alpha-2 receptors in various parts of the brain, including the locus ceruleus, which releases norepinephrine at other sites in the brain. This activation of prefrontal cortical networks can help individuals learn how to focus and attend to certain things, limiting impulsivity and hyperactivity. Guanfacine can be prescribed alongside other drug treatments and behavioral protocols as part of an individualized treatment plan for ADHD.
3. What are the different types of drugs used to treat ADHD?
The different types of drugs used to treat ADHD include Adderall, Ritalin, Vivance, modafinil, armodafinil, and guanfacine. Adderall is a combination of D and L-amphetamine salts and works mainly by increasing dopamine and norepinephrine transmission. Ritalin is methylphenidate, which mainly increases dopamine transmission. Vivance is a long-release DM-Fetamine, while modafinil and armodafinil are stimulants used to treat daytime sleepiness issues. Finally, guanfacine is a non-stimulant medication that works on the norepinephrine system.