ADHD Medication: What If Adderall Isn’t the Right Fit? | Episode #176

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Interestingly enough, these drugs make attention more voluntary.
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Instead of needing really cool shit, compelling shit to get your attention and get you doing on stuff, you could sort of just point your attention at whatever you need to do, and after a few minutes, your body's like, yeah, your mind's like, yeah, we're doing this.
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This is cool.
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We're paying attention to this and we're working and nothing else really much matters.
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That is a big deal.
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Instead of having your attention be like a lantern, it makes it like a flashlight, which is awesome.
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Hey guys, Dr. Mike here for the Making Progress channel.
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This is the fourth video in our ADHD video series.
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The other videos, Dylan, are link in the description, correct?
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Yes, sir.
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What I do have is a super real world, non-technical review,
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of most of the major classes of drugs that help you focus when you need to focus, from caffeine to adamoxetine and a whole bunch of stuff in between.
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You watch this video.
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You get a really good basic description of what all of the drugs are that you could be using.
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And then you go to darkpharmacy.graymarket.net, no.gov, no.xxx, no.xxx.
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Not mom.
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Just kidding.
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You go to your psychologist and or medical doctor and or psychiatrist and you begin to have an open-minded conversation with them about ways that you can help your ADHD.
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Drugs can come up and then they will take over that conversation.
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But now you are an informed participant.
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To the stimulant rocket first, our first contender on this list is a drug called paroxanthine.
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So paroxanthine is the main active substance your body creates when it metabolizes caffeine.
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So it's a downstream metabolite of caffeine.
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Any time you've taken caffeine, paroxanthine is something that's made from that caffeine inside your body and has the same effect.
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So if you've ever taken caffeine, you've actually been on paroxanthine before.
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Like caffeine, it basically works by blocking adenosine signaling.
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Adenosine is one of the brain's accumulating signals of like, you've been awake and you're really tired for long enough signals.
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So it kind of blocks that signal, makes you feel more awake, more alert, more mentally stable, et cetera.
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Paraxanthine is now sold as a supplement ingredient, sometimes marketed as a cleaner or smoother alternative to caffeine.
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The big caveat here is that it's been mostly researched on small groups of people.
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and usually healthy adults and not people diagnosed with ADHD.
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However, it has a decent probability of increasing attentional focus, which is a big deal.
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It might not do this thing where it re-architects your brain entirely to go for better task prioritization, way better impulse control, massive increases in working memory.
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But it absolutely can help keep the lights on if you're unable to drive forward to attentional focus.
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And one of the best things about paroxanthine is that it has substantially less of an anxiogenic effect when you take it compared to caffeine and every other stimulant.
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This is a big deal.
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I have crazy anxiety from stimulants, which is why I basically don't take them.
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Teraxanthine, I'm actually on right now.
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I'm not on it every day.
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I take it like once or twice a week when I sort of need the boost.
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TLDR when I've done edible marijuana the day before and I'm still feeling groggy.
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Holy shit does it work.
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doesn't make me hardly any more anxious than normal.
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It keeps me awake, it keeps me fluid, and it absolutely improves my drive and my attention span.
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The downside with this drug is twofold.
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One, it's just not so well-researched.
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We know it doesn't kill you or some shit like that because you've already been taking it if you've been taking caffeine and we've studied caffeine up the ass.
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We don't know exactly what parazanthes dynamics are by itself.
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And also, it does usual stimulant type stuff, gives you restlessness, sleep disruption, elevated heart rate.
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In very susceptible people, it can cause anxiety, but that's very unlikely because I'm incredibly susceptible and it just doesn't cause hardly any anxiety at all.
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It's claimed that it causes fewer jitters, but that's probably a true claim.
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However, some people also claim that it doesn't build a tolerance like caffeine does.
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I would be very skeptical of that.
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I would expect paroxanthine to be something that you develop a tolerance for.
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So the biggest frustration for this drug class is that just not a lot of good evidence that it improves ADHD things, mostly because we just never looked into it, but it probably can help you.
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And it's real big downside is it's not something you can go to all the time, every day, I take parazanthine, because you'll become dependent on it, it'll work substantially less for you, and then you'll have to take breaks and do all the other stuff that some other attention deficit medications
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not the stimulants, have major upsides in because them you can take all the time and they still keep working.
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If I had to rank it on a 1 to 10 scale of the thing that absolutely works the best to increase your attentional focus, which is Adderall, I would say, well, I would say,
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I would say it gets somewhere between like a two and a three.
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It's effective, but it's low-key effective.
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If you have severe attention deficit disorder, it'll help you a little bit, but probably not take you to the moon.
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Now, last thing, how is your headspace going to feel if you take this truck?
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It's going to probably feel brighter and more awake, kind of less heavy-eyed than the baseline.
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It'll probably feel smoother than caffeine, kind of like an online locked-in feeling, but low-key, probably not a dramatic internal event.
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People who have been taking caffeine might feel almost nothing from paraxanthine, so it's a low-key feeling, but it is nice.
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It does absolutely increase intentional focus.
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It increases that amount of drive that you have.
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People who would respond best to this are people who don't love stimulants because of the anxiety thing and don't have severe enough attention deficit disorder to need it medicated all the time.
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They just like sometimes find that they're not attentive enough and driven enough to get real important tasks done, especially when those tasks are boring and there's lots of work to do in one session and there's lots of distractibility.
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Pop in a parazanthine tab or something, get yourself one of those parazanthine drinks.
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Update is a drink that I consume every now and again for parazanthine.
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It's awesome.
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I have like a sixth of the drink because the shit's 300 milligrams that would send me flying to fucking Mars.
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But if you have one of those before a deep work session, man, you could crank.
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Parazanthine is a pretty slow half-life, so you feel that shit most of the day.
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Then it's an amazing tool.
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But as a serious attention deficit disorder drug drug that you take constantly, it ain't it because it's going to lose potency.
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It is just not that potent to begin with.
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Drug number two, caffeine.
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Caffeine is the world's favorite legal stimulant, and the active ingredient in coffee, tea, energy drinks in approximately 40% of modern civilization is the number of people that are addicted to caffeine and get really weird when you make it obvious that they're addicted to it is incredibly high.
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It does the same thing as parazanthine does.
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It blocks adenosine receptors, so it basically just reduces sleep pressure, absolutely increases wakefulness and attentiveness and focus and concentration, vigilance, reaction time, and even perceived energy.
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So caffeine is kind of that blast that really makes you pay attention whether or not you want to pay attention.
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Now...
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In controlled research in attention deficit disorder, particularly in children, especially in children, caffeine has not shown a reliable clinical benefit compared to actual ADHD medication.
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But for many, it's better than nothing.
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It improves attentional focus in the same way that parazanthine does, so I'm not going to continue laboriously through that.
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The downside of caffeine is it's got all that stuff with tolerance.
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This is a huge problem because you're going to use caffeine one day.
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It's going to be a miracle.
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You're going to use it 12 days later.
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You're going to use it 24 days later, and you're going to be like –
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I don't really feel anything anymore.
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And then you come off of caffeine, you get withdrawal, you get headaches, your attention span goes absolutely down the drain for several days until you ease back in and go through it again.
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I mean, and the withdrawal sucks, causes headaches, fatigue, low alertness, irritability.
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And again, the concentration is just gone.
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And if you have lots of anxiety to begin with, or you're very sensitive to stimulant-based anxiety, holy crap, does caffeine cause anxiety?
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It also makes you pee more often, et cetera, et cetera, et cetera.
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Some people get poopy off of it, et cetera, et cetera.
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Now, the relative focus improvement compared to Adderall for caffeine is like a three or a four.
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Probably more intense than paraxanthine unless you have the anxiety that it works against itself.
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They're definitely quite effective.
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The real big downside of caffeine is that it just isn't dependably something you can use all the time to enhance your attention span.
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If you have attention deficit disorder, you need something more stable.
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How it feels in your head, you guys probably know this, you've had caffeine before, you just feel more awake, quicker, kind of more socially animated in some sense.
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That doesn't make your mind feel super clean and well-sorted, but the thoughts do come quite rapidly, and so there's a lot of good stuff there.
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At a good dose of caffeine, there can be kind of mild optimism and empowerment feeling, and you feel like you're willing to engage.
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Like you're basically like, I'm here, I'm awake.
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And for people that have the drive problem of ADHD plus the attentional focus problem, that drive can really get pushed really hard by caffeine.
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The attentional focus in my experience enhances substantially with a small to moderate dose of caffeine.
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But if you need a high dose of caffeine to give you a ton of drive, attentional focus starts to break down because your internal perception goes from kind of clean and clear to basically feeling skittery, impatient, physically anxious or overclocked at high doses.
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So caffeine is not something you just keep taking more and more of and have a good time, which is going to become really apparent to you if you ever try to take caffeine long term for attention deficit disorder.
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Who is caffeine good for?
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Same people paraxanthine are good for.
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Folks probably that are not clinically diagnosed with ADHD generally can pay attention just fine, just every now and again need more wakefulness because they missed some sleep and need to be focused and concentrated right now on sort of boring tasks.
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Caffeine is a godsend in that department.
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I'd say parazanthin is probably better for almost everything caffeine is good for, but gee whiz, caffeine works great.
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All right, next up, get out your lighters and rolling papers because nicotine is up.
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So you may be surprised to see nicotine on this list, but it is absolutely a real drug in this class.
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Nicotine stimulates nicotinic acetylcholine receptors, which influence attention, learning, arousal, and reward.
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These are core nervous system and brain receptors.
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Nicotine does a lot of stuff.
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Nicotine can rapidly increase dopamine and other neurotransmitter activity in attention-related circuits.
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To that end, small experimental studies have found acute improvements in attention or behavioral inhibition, which is a super big part of ADHD, in some people with ADHD from nicotine.
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Now, nicotine itself doesn't mean you're smoking it.
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Combustion produces most of the physical problems with cigarettes.
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So you can do pouches and they're way, way, way less bad for you, but nicotine remains highly dependent for them.
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You almost certainly will get addicted to it.
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It is not approved or sensible for long-term ADHD treatment.
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Now, nicotine definitely increases attentional focus.
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It can create a rapid feeling of mental sharpening, and that's just a feeling, you're actually mentally sharper.
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It increases your vigilance, it reduces lapses and sustained attention.
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A lot of users report that it can quiet internal restlessness
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But then you need another cigarette.
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If you have a pouch, it can quiet internal restlessness for quite some time.
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A lot of times it enhances the salience of whatever the person is currently doing.
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Basically, it increases your attention span so much that whatever you're working on becomes like, whoa, this is really the thing to work on.
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And your mind tends not to wander or want to wander away from that thing.
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The big problem here, and this is a problem for pretty much every attention deficit disorder drug, is that you don't have to dependably point your nicotine intake at productive work.
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You can take nicotine and do scrolling, gambling, or staring at drywall, and you'll do all those things better.
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It's still up to you to point it in the right direction, which is basically like all of the ADHD meds, but nicotine can be very, very effective.
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It does have some serious downsides.
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Dependence and tolerance, massively like dependable thing that you'll get from nicotine.
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So you will get dependent on it almost certainly, and you will build up a giant tolerance where you just kind of feel normal after a while.
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That's a big deal.
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Once you're dependent on it, the only benefit you're getting out of it is like you just don't get withdrawal anymore.
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And if you start to come off of it or you stop taking it, oh my God, the withdrawal is nuts and nothing good happens.
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It's also a bit of a stimulant.
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So it can raise heart rate, blood pressure.
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It might worsen anxiety.
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It could give you nausea, which I've gotten from nicotine before, dizziness.
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It can impede with sleep.
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It can make you paradoxically really tired.
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Smoking looks cool.
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Don't smoke.
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Taking in your nicotine through pouches is like a trillion times better.
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Now, compared to Adderall...
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Nicotine probably gives you some kind of boost that's like, yo, four or five, maybe three, four or five, depending on who you are, acutely, as far as attention span compared to Adderall.
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So it's pretty intense, but with regular use and dependence, its net benefit can shrink dramatically to like a one or a two.
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And then you're taking this thing which affects your health to a substantial extent, is one hell of an expensive hobby.
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You're addicted to it.
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If you stop doing it, you're completely washed out and going through crazy withdrawal.
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and it only gives you one or two.
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It is not a viable long-term ADHD treatment because of the fact that you get rapidly used to it and get really crazy addicted to it.
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Your headspace is gonna feel cool when the drug is working super well if you use it sparingly.
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You're going to feel kind of a faster mental click into alertness.
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You're going to be simultaneously calmer and sharper if you're most people.
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And you're going to feel kind of slightly rewarded or satisfied or relieving, which is kind of how you get addicted to the shit.
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So it's awesome.
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People who respond the best to it are folks who are under aroused and really need to kind of get going.
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And people who are not prone to addiction and can use something like nicotine sparingly, like once a week or twice a week or once every few weeks, you put in a pouch for a big ass day at work or, you know, big session of deep work, and then you're good to not use it for a while.
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You may think you are one of these people, but you probably aren't.
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If you really are, cool.
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That's awesome.
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But really, really tread lightly here.
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This is not something you take every day to treat attention deficit disorder.
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Next up, the methylphenidates, which include drugs like Ritalin, Concerta, Focalin, Jernay, P.M. Dylan, it's J-O-R-N-A-Y.
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What a name for a drug.
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It's like a black girl saying journey.
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Journey.
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I'm going to name my daughter that.
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Yeah.
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That's oh my God.
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With the A and everything, she's going to be on the pole for sure.
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And Datrana.
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So these are all methylphenidates.
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Methylphenidate is one of the two principal families of prescription ADHD stimulants.
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These are real serious purpose designed drugs for attention deficit disorder.
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Methylphenidate mainly increases dopamine and norepinephrine signaling by blocking their reuptake, meaning those chemicals remain active between your neurons for longer and your neurons talk better to each other.
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These different products use the same general family of drugs, but release it more or less over different timeframes.
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So these drugs are serious and they work.
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How do they improve your attentional focus?
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It basically ends up being that for most people, these drugs reduce the frequency with which irrelevant thoughts and stimuli capture attention, which is a huge deal.
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They can improve working memory, they can improve response inhibition, and sustained attention.
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Many people find it easier to remain with a task after the task novelty wears off.
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Like, they basically just help you lock in for a lack of a better term.
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And it – being on the drugs make your anxiety in some cases reduce because you don't have to manufacture panic or deadline terror or emotional drama before starting work.
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You can just ease in.
199
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And interestingly enough, these drugs make attention more voluntary.
200
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Instead of needing really cool shit, compelling shit to get your attention and get you doing on stuff, you could sort of just point your attention at whatever you need to do.
201
00:17:59.751 --> 00:18:03.034
And after a few minutes, your body's like, yeah, your mind's like, yeah, we're doing this.
202
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This is cool.
203
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We're paying attention to this and we're working and nothing else really much matters.
204
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That is a big deal.
205
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Instead of having your attention be like a lantern, it makes it like a flashlight, which is awesome.
206
00:18:15.045 --> 00:18:17.486
Now, these are serious stimulant drugs.
207
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They have downsides, including lower appetite, which might be cool unless you're underweight, then it's not cool.
208
00:18:25.271 --> 00:18:31.034
Dry mouth, headache, nausea, insomnia, anxiety, irritability, increased heart rate, sweating, and weight loss.
209
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Guys, this is real-world drug time.
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Make no mistake about it.
211
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You do not just recreationally start taking this stuff.
212
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Too much drug, too high of a dose, or just for people that are sensitive, can produce emotional flattening, which South Park made a whole episode about, rigidity, physical tension, or kind of a joyless form of productivity where you kind of feel like a zombie robot.
213
00:18:52.966 --> 00:19:02.513
In a certain course of day of taking it, the medication can wear off abruptly for some users, producing massive fatigue, hunger, irritability, and a return of symptoms.
214
00:19:02.973 --> 00:19:07.957
So like, this is like a superpower ring, but once the ring is inactive, you like fall out of the sky with the shit.
215
00:19:07.977 --> 00:19:08.197
So, yeah.
216
00:19:08.257 --> 00:19:10.539
You better hope you've finished all your work for the day.
217
00:19:11.940 --> 00:19:14.242
It has definite misuse and addiction potential.
218
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It is a Schedule II drug for that reason.
219
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And you know what I'm saying?
220
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If you're trying to snort it, you're off to a really, really bad start.
221
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Good news is that long-term clinical benefit here does not appear to routinely vanish.
222
00:19:26.631 --> 00:19:32.496
Although dosing requirements because of different life demands, side effects, and all that stuff can change.
223
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What also happens to many people is they usually get a kick out of these drugs, like they're, whoa, holy shit, I'm on this drug and I'm doing work.
224
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At some number of months, the kick can leave, but the latent attention span can stay.
225
00:19:45.028 --> 00:19:46.970
And people go, well, I don't need this drug anymore, it doesn't work.
226
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It still works, but more low-key.
227
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That's not a good thing because I wish it worked high-key the entire time.
228
00:19:52.956 --> 00:19:53.437
It does not.
229
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Now, the relative focus improvement of these drugs on a 10 scale, where 10 is Adderall and 0 is taking nothing, is like a 7.5%.
230
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It's intense.
231
00:20:06.493 --> 00:20:08.074
It works really, really well.
232
00:20:08.114 --> 00:20:15.060
Now, there's always, always, always a massive normal distribution, a bell curve about how well it's going to work for you.
233
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I've taken these drugs back when I was taking a break from Adderall in high school, and I felt fucking literally nothing.
234
00:20:21.324 --> 00:20:23.086
It's just nothing for me as far as I could tell.
235
00:20:23.126 --> 00:20:26.388
I felt a little bit different maybe, but even that maybe was a hallucination.
236
00:20:27.109 --> 00:20:28.550
So, you know, that's not going to work.
237
00:20:29.556 --> 00:20:33.238
Other people get a ton out of these drugs and actually get better results than with Adderall.
238
00:20:33.438 --> 00:20:38.041
So it's real close, it's right up there, it's really, really strong, but not for everybody.
239
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Not for everybody.
240
00:20:42.664 --> 00:20:47.387
All right, headspace-wise, I mean, man, it's intense.
241
00:20:47.707 --> 00:20:59.034
Your headspace is likely to feel quieter, cleaner, less crowded, less internal propulsion than Adderall, which is kind of like a screaming rocket, this is more of like an airliner jet sort of feeling.
242
00:21:00.302 --> 00:21:02.782
It's easier for you to choose one thought and keep holding it.
243
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Sometimes you feel emotionally neutral or flattened, which with ADHD can be a good thing because you're too many emotions in your fucking head all the time and you're like, ah, this is too much.
244
00:21:12.164 --> 00:21:13.564
It can actually bring you down to baseline.
245
00:21:13.584 --> 00:21:17.885
If you're not emotionally very up, usually it can absolutely make you a zombie.
246
00:21:18.125 --> 00:21:27.467
But at the correct dose, many users don't feel stimulated as much as like suspiciously normal, which for somebody with ADHD can be a huge, huge welcoming thing.
247
00:21:29.105 --> 00:21:30.366
Who's going to respond best to this?
248
00:21:30.926 --> 00:21:35.709
Probably people with ADHD that tend to respond best just sort of genetically to methylphenidates.
249
00:21:35.849 --> 00:21:43.093
And so you may not know if you are one of these people until you talk to your doctor, talk to a psychiatrist, et cetera, and get into it.
250
00:21:43.634 --> 00:21:45.715
Because there's lots of other stuff they'll ask you.
251
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Do you have tics?
252
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Do you have this and that before they prescribe it to you?
253
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It can worsen tics sometimes.
254
00:21:50.738 --> 00:21:51.578
These drugs can.
255
00:21:52.099 --> 00:21:53.880
But there's lots of considerations.
256
00:21:54.640 --> 00:22:00.487
This is one of those drugs that they used to be a frontline prescription and still is in many cases for attention deficit disorder.
257
00:22:00.667 --> 00:22:08.496
And now time for the king pimp daddy drug of them all, the amphetamine class, which sounds like meth.
258
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And it is.
259
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Examples include Adderall, Dexedrine, Vyvanse, and Avecchio, his new drugs.
260
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Dylan, these new fangled drugs.
261
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Avecchio is a wild name as well.
262
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It's a wild name.
263
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Amphetamines are the other principle family of prescription ADHD stimulants.
264
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They increase dopamine and norepinephrine both by reducing reuptake and by encouraging greater release, more of a dump.
265
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Adderall contains mixed amphetamine salts, Dexedrine and dextroamphetamine.
266
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Vyvanse contains lisdexamphetamine, which is a prodrug that the body gradually converts into dextroamphetamine, which is a really, really cool thing.
267
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In adult ADHD research, amphetamines generally produce the largest average reduction in core symptoms.
268
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If ADHD is a nail, this is a big-ass hammer.
269
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How do they improve attentional focus?
270
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They can substantially reduce distractibility, improve sustained attention.
271
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They often make task initiation easier, which is like you kinda wanna do everything when you're on these drugs, but it's crucial for people who know what to do, but just can't make themselves begin, which is a big thing with attention deficit disorder.
272
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They can massively improve an inhibitory control, reducing the distance between I probably shouldn't do it and not actually doing it.
273
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With attention deficit disorder, sometimes you're just really, really impulsive.
274
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They can make delayed rewards feel sufficiently real to complete whatever is immediately interesting instead of just going for the immediate reward.
275
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And they frequently improve not just concentration, but the ability to mobilize concentration on command, like that flashlight.
276
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That's a humongous deal.
277
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Amphetamines have massive downsides.
278
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Appetite suppression, insomnia, dry mouth, headache, anxiety, agitation, increased heart rate, nausea, weight loss, and sweating.
279
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If you dose excessively, it can create tunnel vision, irritability, compulsive overworking, or intense focus on the wrong tasks.
280
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Some people, many people, report an end-of-day crash, emotional brittleness, pronounced hunger, and really crazy low tension when the medication is off because once you're on these medications, you are absolutely an addict, absolutely.
281
00:24:15.546 --> 00:24:16.848
This is amphetamines.
282
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Everybody gets addicted to amphetamines pretty much, which is why they have substantial misuse dependence and addiction potential in the published literature.
283
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That's a thing.
284
00:24:26.869 --> 00:24:31.591
Now, you get this kind of motivational and euphoric spark at first when taking these drugs.
285
00:24:32.671 --> 00:24:35.993
That may diminish, but the therapeutic effects may still be there.
286
00:24:36.753 --> 00:24:40.835
In my experience, the therapeutic effects absolutely diminish over time.
287
00:24:40.875 --> 00:24:49.918
And for me personally, the side effects got so bad and the main effects got so not great that I had to come off of Adderall because I took this for years in high school.
288
00:24:50.138 --> 00:24:52.179
It was a big deal for me, and here's why.
289
00:24:52.719 --> 00:24:56.081
The relative focus improvement is a 10 out of 10 on its own scale.
290
00:24:56.701 --> 00:25:02.962
But on average, amphetamines are the strongest acute medication class and still are for adult ADHD.
291
00:25:02.982 --> 00:25:13.605
It doesn't mean you get complete symptom elimination, but it absolutely means that you will probably have a really massive improvement in your ability to focus and concentrate.
292
00:25:15.445 --> 00:25:17.266
This is an interesting effect on your headspace.
293
00:25:17.566 --> 00:25:23.287
Your headspace will feel quieter, but like more forward propulsion than with methylphenidates.
294
00:25:24.140 --> 00:25:26.287
I was on Adderall for a long time, tried Ritalin.
295
00:25:26.809 --> 00:25:29.276
I told you guys I basically felt nothing in comparison.
296
00:25:29.437 --> 00:25:30.982
That's just me, some people feel plenty.
297
00:25:32.432 --> 00:25:35.996
Starting a task may feel less negotiable and less emotionally expensive.
298
00:25:36.016 --> 00:25:37.557
You don't have to be like, oh, I got to do this.
299
00:25:37.837 --> 00:25:41.621
When you're at Adderall, whatever you point your mind at, you kind of like going to do it.
300
00:25:42.502 --> 00:25:44.864
And it makes boring work really salient.
301
00:25:45.284 --> 00:25:56.996
You can brush your teeth on Adderall and have the time of your life really focusing on brushing your teeth, doing quizzes, and all of a sudden the boring stuff that they give you in school to do becomes really tractable and in fact sort of fun on Adderall.
302
00:25:57.917 --> 00:25:58.537
That's a thing.
303
00:25:59.058 --> 00:26:06.463
But the anxiety and that rocket ship feeling of can get really, really, really intense.
304
00:26:07.084 --> 00:26:09.365
When you're on Adderall, you don't feel normal.
305
00:26:10.226 --> 00:26:14.829
The people that respond best to this drug are going to be in two classes of people.
306
00:26:15.410 --> 00:26:22.315
One, people with severe ADHD that really demand or really benefit from that quality
307
00:26:22.375 --> 00:26:27.359
quick starter effect that like push motivationally to do stuff, not just be attentive.
308
00:26:27.679 --> 00:26:29.981
Like currently in my life, I don't need any motivation to do anything.
309
00:26:30.001 --> 00:26:30.661
I have plenty of that.
310
00:26:31.082 --> 00:26:36.846
So whatever, I'll tell you guys what attention deficit disorder drug I'm on later in this, but I don't need the push.
311
00:26:36.886 --> 00:26:40.088
If you need the push, and I used to do the push when I was in high school, Adderall's a big deal.
312
00:26:40.589 --> 00:26:46.994
And the second group of people that will benefit from it are people who have tried some of the milder drugs and really just didn't get what they were looking for.
313
00:26:47.594 --> 00:26:53.046
At the end of the day, they can always give you big pimp daddy pain Adderall, and that probably will fry that ass.
314
00:26:54.263 --> 00:26:55.264
Does it have downsides?
315
00:26:55.304 --> 00:26:55.584
Yes.
316
00:26:56.545 --> 00:26:57.686
Is it a real big trade-off?
317
00:26:57.746 --> 00:26:58.066
Yes.
318
00:26:59.067 --> 00:27:02.630
I mean, if you take it through the day, it screws up your sleep.
319
00:27:03.351 --> 00:27:05.613
It can really lead to some nasty downsides.
320
00:27:06.213 --> 00:27:10.157
It's just a thing that you have to use once everything else is like, this ain't it.
321
00:27:10.797 --> 00:27:14.921
So for a lot of people, I personally am not a psychiatrist, don't listen to the following thing.
322
00:27:15.201 --> 00:27:17.443
I would just not recommend you start on Adderall.
323
00:27:18.044 --> 00:27:21.386
I would recommend you start on something else, which brings us to the next section.
324
00:27:22.167 --> 00:27:23.168
This is it for stimulants.
325
00:27:23.888 --> 00:27:26.871
Now we're onto the non-stimulant ADHD drugs, okay?
326
00:27:26.891 --> 00:27:32.515
I was going to say stay tuned for this, but, you know, if you have ADHD, it's going to be tough to stay tuned.
327
00:27:33.135 --> 00:27:34.877
There are some killers in this group.
328
00:27:35.677 --> 00:27:41.001
And this first drug I'm actually currently on right now, and it is called guanfacine.
329
00:27:42.422 --> 00:27:45.605
Guanfacine was originally developed as a blood pressure medication.
330
00:27:46.884 --> 00:27:56.545
In its extended release form, which is called Intuniv, which I'm currently on, guanfacine ER, it's currently used and labeled as a non-stimulant ADHD medication.
331
00:27:57.679 --> 00:28:17.673
What it does is it stimulates the alpha two adrenergic receptors, which strengthens signaling in the prefrontal cortex, which is kind of cool because that's the planning and executive control part of your brain, precisely what is very often underactive in attention deficit disorder.
332
00:28:18.374 --> 00:28:26.400
Rather than pouring just more fuel into the brain and rocket shipping it overall, it might improve the prefrontal cortex's ability to kind of apply brakes
333
00:28:27.040 --> 00:28:28.222
and filter noise.
334
00:28:29.905 --> 00:28:37.075
In the United States, its formally ADHD indication is pediatric, although adult trials and clinical use exist, and you can get it prescribed as an adult, no problem.
335
00:28:37.176 --> 00:28:42.003
Every doctor can just do that for you, and they usually do, because it's not like it's all, it's bad for adults or something like that.
336
00:28:43.568 --> 00:28:48.952
It improves attentional focus by reducing distractibility and improving top-down control.
337
00:28:49.612 --> 00:28:59.299
You basically have this opportunity to pause before acting, and you feel like you're less hyperactive, less impulsive, less excessively emotionally reactive.
338
00:28:59.319 --> 00:29:03.862
So if you see something or feel something that's really emotional, it'll just be like, ah, I could react to that.
339
00:29:04.122 --> 00:29:04.622
I could not.
340
00:29:04.682 --> 00:29:05.283
No big deal.
341
00:29:06.403 --> 00:29:11.306
Some people find that their thought stream feels less noisy because their whole nervous system is less activated.
342
00:29:11.406 --> 00:29:16.149
I absolutely feel that myself right now.
343
00:29:17.630 --> 00:29:25.714
The attentional benefit is usually subtler than that of like a real true stimulant, but it may be more visible in behavior than a dramatic internal feeling.
344
00:29:25.734 --> 00:29:26.595
I'll tell you guys this right now.
345
00:29:27.175 --> 00:29:34.700
You don't feel much from guanfacine, but when you sit down to do focused work, you end up getting into the groove really quick.
346
00:29:35.280 --> 00:29:37.221
And after like an hour and a half, you're like, the fuck?
347
00:29:37.701 --> 00:29:38.962
Oh shit, I'm already done.
348
00:29:39.242 --> 00:29:40.863
Oh shit, where was I for an hour and a half?
349
00:29:41.103 --> 00:29:42.904
Oh my God, I was paying attention to my task.
350
00:29:43.544 --> 00:29:45.665
Whereas usually you'd be like, oh, how much time is it?
351
00:29:45.785 --> 00:29:47.766
Oh, I should go up and get a snack, all this other stuff.
352
00:29:48.527 --> 00:30:00.793
Guanfacine, just like, it chills you out in a way that doesn't put you to sleep, but in a way that makes you feel like relaxed, attentive and focused and able to do work.
353
00:30:01.153 --> 00:30:01.854
It's a big deal.
354
00:30:02.614 --> 00:30:04.235
The problem is it does have some downsides.
355
00:30:05.135 --> 00:30:07.556
Sleepiness and fatigue are among its most common problems.
356
00:30:08.216 --> 00:30:10.197
Me personally, I don't do coffee.
357
00:30:10.397 --> 00:30:11.197
I don't do stimulants.
358
00:30:11.277 --> 00:30:16.599
As soon as I wake up in the morning on almost every day, I'm like way more than awake and I'm way more than enough awake through the whole day.
359
00:30:17.079 --> 00:30:21.360
So for me, it actually vibes me to like something I really like because I'm fucking too awake normally.
360
00:30:21.800 --> 00:30:26.562
But if you need a wakefulness drug in addition to having attention deficit disorder remediated –
361
00:30:27.122 --> 00:30:29.383
This ain't it because it is absolutely going to chill you out.
362
00:30:29.483 --> 00:30:37.526
Now, good news is it actually lowers blood pressure and heart rate, which is cool, but it can cause dizziness, weakness, occasionally fainting if you stand up really fast.
363
00:30:37.546 --> 00:30:38.687
I absolutely deal with that.
364
00:30:38.747 --> 00:30:39.567
That's definitely a thing.
365
00:30:40.527 --> 00:30:44.169
Some people feel mentally slowed or physically heavy or unmotivated on the drug.
366
00:30:44.709 --> 00:30:48.190
So this is for folks that need that push and the attention.
367
00:30:48.450 --> 00:30:49.511
Guanfacine is not it.
368
00:30:49.931 --> 00:30:52.692
There's other drugs on this list that are not stimulants that could do that for you.
369
00:30:53.543 --> 00:30:58.907
Interestingly enough, guanfacine has very little abuse potential, and here's the best thing about it, I think.
370
00:31:00.228 --> 00:31:01.909
So first of all, people just don't get addicted to it.
371
00:31:02.329 --> 00:31:03.710
Second of all, here's probably why.
372
00:31:04.711 --> 00:31:09.975
Guanfacine is something that works the next day after you take it.
373
00:31:11.481 --> 00:31:16.525
But you take it at night typically, and it doesn't give you attentional focus during the night.
374
00:31:16.545 --> 00:31:17.906
It doesn't keep you awake or anything like that.
375
00:31:17.926 --> 00:31:19.307
It works over way longer.
376
00:31:20.227 --> 00:31:21.208
But that's subtle.
377
00:31:21.868 --> 00:31:27.412
What it really does is it re-architects how your prefrontal cortex works over weeks and months.
378
00:31:28.533 --> 00:31:32.996
So it makes you better longer term if you stay on the draw, get paying attention.
379
00:31:33.277 --> 00:31:34.077
And here's the best part.
380
00:31:34.798 --> 00:31:37.860
There is direct evidence across all of the studied literature.
381
00:31:38.792 --> 00:31:42.054
that demonstrates basically nobody gets used to this drug.
382
00:31:43.154 --> 00:31:43.815
And the opposite.
383
00:31:44.695 --> 00:31:47.337
For at least a few months, the longer you take it, the better it gets.
384
00:31:47.477 --> 00:31:50.519
And then it reaches a flat baseline and it just doesn't budge.
385
00:31:51.299 --> 00:31:59.824
The idea that if you take the stimulants, they work really well at first and then they kind of suck and then they kind of suck more and then they kind of get to a flat baseline of suckiness with a shitload of side effects, it's the opposite here.
386
00:32:00.986 --> 00:32:02.468
which sure shit sold me on the drug.
387
00:32:02.628 --> 00:32:06.552
And I'm so, so glad that my doctor was able to prescribe him.
388
00:32:06.673 --> 00:32:11.819
Now, the relative focus improvement here will be a 4, 5, or 6 out of 10.
389
00:32:12.099 --> 00:32:13.841
It is not Adderall.
390
00:32:13.961 --> 00:32:15.182
It will not feel like Adderall.
391
00:32:15.202 --> 00:32:17.245
It will not help you focus as much as Adderall does.
392
00:32:18.415 --> 00:32:27.298
But for impulsivity, emotional explosiveness, or physical overactivation, the effect may be bigger than just the number 5 out of 10 suggests.
393
00:32:27.698 --> 00:32:32.979
This, for many people, will be a very, very powerful drug.
394
00:32:33.780 --> 00:32:40.902
And if you combine it with a drug that has stimulant-like properties or a stimulant, it can be an additive effect.
395
00:32:42.215 --> 00:32:46.618
It can also make a stimulant regimen more tolerable for people because, remember, stimulants keep you up.
396
00:32:47.339 --> 00:32:48.219
This puts you to sleep.
397
00:32:48.260 --> 00:32:49.240
Stimulants jazz you up.
398
00:32:49.260 --> 00:32:50.061
This calms you down.
399
00:32:50.481 --> 00:32:52.363
Both allow you to focus better.
400
00:32:53.383 --> 00:32:54.384
This is really, really cool.
401
00:32:54.984 --> 00:32:55.685
Very, very cool.
402
00:32:58.240 --> 00:32:59.240
Who responds best to it?
403
00:32:59.780 --> 00:33:09.723
Again, it's people who need attentional focus, but probably are not dealing with a crapload of I need to be pushed to do what I need to do.
404
00:33:10.003 --> 00:33:13.804
They have plenty of energy in the brain that's just distracted and is going in a bunch of different directions.
405
00:33:14.364 --> 00:33:17.605
This allows you to focus your attention and be calm enough to do your work.
406
00:33:18.145 --> 00:33:27.507
So if you're very impulsive, if you're very hyperactive, but you've got plenty of motivation to do stuff, this may be very well a concordant drug for you.
407
00:33:28.707 --> 00:33:33.511
Interestingly enough, if you have tics like my eye thing you guys see me do, which is, by the way, it's just a tick.
408
00:33:33.611 --> 00:33:34.192
It just happens.
409
00:33:34.212 --> 00:33:35.232
And I'm like, oh, it's happening.
410
00:33:36.674 --> 00:33:37.554
Had it my entire life.
411
00:33:39.196 --> 00:33:44.600
Guanfacine in many people reduces the magnitude and the frequency of tics.
412
00:33:45.741 --> 00:33:52.346
So if you have tics and you have attention deficit disorder, guanfacine is a very, very interesting drug to look at.
413
00:33:54.227 --> 00:33:56.349
Me personally, I love this drug.
414
00:33:57.821 --> 00:33:59.944
I can do deep work for hours on this shit.
415
00:34:00.145 --> 00:34:01.086
It's super low key.
416
00:34:01.567 --> 00:34:05.853
It's just basically letting me be calmer and less frustrated with work difficulties as they come up.
417
00:34:06.874 --> 00:34:08.116
Alt work just got more complex.
418
00:34:08.337 --> 00:34:08.817
No big deal.
419
00:34:08.937 --> 00:34:09.618
I'll just deal with it.
420
00:34:10.460 --> 00:34:11.000
That's huge.
421
00:34:11.882 --> 00:34:12.423
Side effects?
422
00:34:13.572 --> 00:34:15.453
I legit can't even tell you I feel any.
423
00:34:16.133 --> 00:34:19.114
I am on a bunch of blood pressure drugs, as they all make me have low blood pressure.
424
00:34:19.394 --> 00:34:21.335
I can't even tell you guanfacine makes me tired.
425
00:34:21.955 --> 00:34:24.496
This medication is a dream medication for me.
426
00:34:24.756 --> 00:34:26.537
I will be on it until one of two things happens.
427
00:34:26.597 --> 00:34:31.198
I die, they run out of it, three things, or they find something better.
428
00:34:32.179 --> 00:34:33.679
All right, next drug.
429
00:34:33.899 --> 00:34:35.080
We're almost through a whole list.
430
00:34:35.540 --> 00:34:37.881
It's out of left field for ADHD, but check this out.
431
00:34:38.081 --> 00:34:41.062
It is bupropion, all right?
432
00:34:43.250 --> 00:34:49.251
Bupropion is known better in its brand names as well, Buterin and Zyban.
433
00:34:50.932 --> 00:34:56.373
Bupropion is primarily an antidepressant and has been used as a smoking cessation medication.
434
00:34:57.073 --> 00:35:01.374
It modestly increases norepinephrine and dopamine signaling by inhibiting their reuptake.
435
00:35:01.414 --> 00:35:06.735
It is not FDA approved for ADHD, but is commonly used off-label like prescribed by doctors and all that stuff.
436
00:35:08.716 --> 00:35:18.824
Unlike most antidepressants, it is generally not serotonergic, is less associated with sexual side effects than many SSRIs, so it's probably not going to make Mr. Winky not want to be Mr. Winky anymore.
437
00:35:19.845 --> 00:35:23.587
It is not a controlled substance and does not usually produce an immediate stimulant-like effect.
438
00:35:23.888 --> 00:35:27.350
So it's a very, very low probability you get addicted to it or anything like that.
439
00:35:28.251 --> 00:35:29.912
But how does it improve attentional focus?
440
00:35:29.952 --> 00:35:34.436
The thing is, it can improve energy, initiation, and mental engagement all by itself.
441
00:35:34.456 --> 00:35:34.996
Okay.
442
00:35:35.288 --> 00:35:38.369
It can reduce distractibility and improve persistence modestly.
443
00:35:39.590 --> 00:35:46.313
It is especially useful when low mood and low drive are magnifying ADHD symptoms, the opposite side of guanfacine.
444
00:35:47.133 --> 00:35:50.535
Because guanfacine, you take that, you have low mood, low drive, it doesn't do shit for you.
445
00:35:51.195 --> 00:35:52.596
You're just going to be even lower, sort of.
446
00:35:53.622 --> 00:35:58.044
But with bupropion, you can increase mood and drive.
447
00:35:58.264 --> 00:36:05.827
And if you have potentially guanfacine in the mix as well, pending your psychiatrist allows this combination, it can work really, really well.
448
00:36:07.027 --> 00:36:11.589
Also, its effects were gradually appearing over days and weeks, then appearing within the hour.
449
00:36:12.009 --> 00:36:15.511
It is really, really, really, really awesome for that role.
450
00:36:16.302 --> 00:36:17.722
That does have its downsides.
451
00:36:17.863 --> 00:36:23.524
It can cause insomnia, dry mouth, nausea, tremors, sweating, anxiety, or agitation.
452
00:36:23.905 --> 00:36:26.465
A lot of these things have like very contradictory side effects.
453
00:36:26.485 --> 00:36:28.206
We're like, I'm taking it for the opposite of this.
454
00:36:29.086 --> 00:36:30.047
It's got some gnarly stuff.
455
00:36:30.067 --> 00:36:31.467
It is a very serious drug.
456
00:36:32.688 --> 00:36:37.189
People who already feel physically anxious may find that it's too activating because it kind of gets you going.
457
00:36:37.209 --> 00:36:38.650
Remember, it's an antidepressant.
458
00:36:38.930 --> 00:36:42.371
Antidepressant, people who are depressed feel the opposite of anxiety in most cases.
459
00:36:42.391 --> 00:36:45.812
They just feel like totally like beaten down, and so it gets you going.
460
00:36:47.772 --> 00:36:50.493
It lowers a seizure threshold in a dose-dependent manner.
461
00:36:50.553 --> 00:36:53.555
So if you're prone to seizures, it can make those happen for you.
462
00:36:54.375 --> 00:36:57.917
It's generally avoided in people with seizure disorders and a few other conditions.
463
00:36:58.157 --> 00:37:06.241
It can increase blood pressure and definitely is not good to take if you're withdrawing from alcohol or certain sensitive drugs.
464
00:37:07.562 --> 00:37:11.124
Relative focus improvement here is about four, five, or six out of ten.
465
00:37:12.178 --> 00:37:16.241
Controlled adult ADHD trials suggest real but modest average benefits.
466
00:37:16.681 --> 00:37:27.830
It's not going to do the amphetamine thing for attentional control, but if you have low drive, depression, or nicotine dependence, it can outperform itself as an ADHD drug.
467
00:37:28.851 --> 00:37:34.615
If you have bad anxiety, agitation, or insomnia, it can really be radically not the right choice for you.
468
00:37:35.817 --> 00:37:45.470
The headspace here is gonna feel probably more energetic and willing to engage, probably slightly brighter and less foggy, more motivated, though not always precisely focused.
469
00:37:45.910 --> 00:37:49.415
Sometimes people get buzzy, sometimes they get impatient, sometimes they get irritable.
470
00:37:52.118 --> 00:37:53.140
It's definitely in effect.
471
00:37:54.109 --> 00:38:08.962
Now, the people who respond best to it are folks who have inattentive type ADHD, which means you're not super up and around because if you're hyperactive, this is probably not the drug for you, plus folks that are dealing with depression at the same time.
472
00:38:09.893 --> 00:38:14.137
People with seasonal depression or chronic legal energy that because of the depression, they have trouble focusing.
473
00:38:14.157 --> 00:38:15.638
This is a drug that works really well.
474
00:38:16.559 --> 00:38:20.021
And in a few other situations, this drug can be really, really good.
475
00:38:20.662 --> 00:38:28.549
And so this is a drug that you can take sustainably and doesn't lose its activity for whatever months and years and as far as we've studied it.
476
00:38:29.229 --> 00:38:38.757
So it is definitely something serious to consider as a drug that may be pretty effective, a little bit from a side route and not a stimulant and doesn't have the downsides of a stimulant.
477
00:38:40.427 --> 00:38:49.233
Next, another class of drug, non-stimulant, called valoxazine, and the brand name here is Quelbre, spelled all wrong, of course, because that's how they do all the drugs.
478
00:38:50.114 --> 00:38:55.337
Valoxazine is a non-stimulant medication approved for ADHD in children and adults, which is really cool.
479
00:38:56.618 --> 00:39:02.462
It increases primarily norepinephrine signaling and also increases certain serotonin symptoms, which is a TRIP.
480
00:39:04.285 --> 00:39:15.176
It is taken regularly, as all of these drugs are, but it builds its therapeutic effect over weeks and months rather than producing an obvious same-day performance surge.
481
00:39:15.957 --> 00:39:21.883
It is newer in American ADHD practice than adamoxetine, which is a drug we'll talk about just after this.
482
00:39:22.523 --> 00:39:26.687
So its long-term and comparative evidence base is smaller, but it does some good stuff.
483
00:39:27.781 --> 00:39:32.144
It seems to reduce distractibility and improve sustained engagement.
484
00:39:33.165 --> 00:39:36.528
It may improve impulsivity and hyperactivity as well as inattention.
485
00:39:37.869 --> 00:39:43.693
And it has an all-day background action, so it's way smoother than a short-acting stimulant.
486
00:39:44.886 --> 00:39:50.632
It doesn't cause a sharp, the medication is switched on moment for you, but it's always in the background.
487
00:39:51.613 --> 00:39:57.819
Basically, the aim is a lower baseline level of ADHD interference rather than a kind of conspicuous burst of productivity.
488
00:39:58.460 --> 00:40:04.265
If you're already plenty motivated, but have trouble with attention, this is a serious drug that you need to consider.
489
00:40:05.346 --> 00:40:09.549
Does have some downsides, including insomnia, sleepiness.
490
00:40:09.769 --> 00:40:11.531
I know both depending on the individual.
491
00:40:11.631 --> 00:40:14.233
Nausea, dry mouth, headache, fatigue, lower appetite, and constipation.
492
00:40:14.633 --> 00:40:19.437
These kind of like all drugs, mostly like placebo symptoms that people report, but it does have some problems.
493
00:40:19.977 --> 00:40:23.720
Maybe for you, it'll be really inappropriate because one or two of those will be really high.
494
00:40:23.760 --> 00:40:26.162
For most people, it's tolerated super, super well.
495
00:40:28.140 --> 00:40:31.882
It can increase heart rate and blood pressure in some patients, usually not by a bunch.
496
00:40:32.543 --> 00:40:40.167
The label does include a warning about unaliving yourself thoughts and behaviors, especially requiring attention and treatment after dosing changes.
497
00:40:40.828 --> 00:40:50.573
It strongly affects the CYP1A2 enzyme and can thus interact importantly with several other medications like tizanidine, theophylline,
498
00:40:51.734 --> 00:40:54.636
clozapine, and even caffeine, actually.
499
00:40:55.097 --> 00:41:10.008
You've got to be really careful here because if you take those drugs in addition to this drug, you might multiply their effects by a ton, and they basically don't wash out of your system nearly as rapidly.
500
00:41:10.049 --> 00:41:11.109
So this is a big deal.
501
00:41:12.190 --> 00:41:16.614
It gets a 5 or a 6 or a 7 on relative focus improvement.
502
00:41:17.479 --> 00:41:19.722
It's a meaningful benefit over placebo.
503
00:41:20.403 --> 00:41:24.168
It is super legitimate ADHD treatment than merely like a wakefulness aid.
504
00:41:25.109 --> 00:41:30.056
It's not as powerful as Adderall, but it is pretty goddamn close.
505
00:41:30.937 --> 00:41:32.339
Really, really close.
506
00:41:34.418 --> 00:41:38.080
With this drug, your headspace is probably going to feel smoother and relatively unobtrusive.
507
00:41:38.800 --> 00:41:39.780
It's less scattered.
508
00:41:40.281 --> 00:41:41.341
There's no strong push.
509
00:41:41.381 --> 00:41:42.902
There's no euphoric reinforcement.
510
00:41:43.762 --> 00:41:45.023
Some people can feel sleepy.
511
00:41:45.063 --> 00:41:47.804
Other feels activated or have trouble sleeping.
512
00:41:49.945 --> 00:41:53.226
It's one of these things that people say the improvement is visible retrospectively.
513
00:41:53.426 --> 00:41:58.529
You're like, huh, like I finished a lot of stuff this week and didn't have problems paying attention.
514
00:41:58.569 --> 00:41:59.569
It's been week three of the meds.
515
00:41:59.949 --> 00:42:00.410
Oh, cool.
516
00:42:00.470 --> 00:42:01.310
I guess I am different.
517
00:42:02.390 --> 00:42:15.301
The people that respond the best here are adults with inattentive or combined ADHD who want to avoid controlled stimulants and have like a real bad time with them because this drug, remember, is going to keep working and working and working and working.
518
00:42:15.321 --> 00:42:19.525
And this is for people who need broad coverage without a conspicuous daily onset and offset.
519
00:42:19.885 --> 00:42:22.407
Some people work in jobs that need to be on all the time.
520
00:42:22.667 --> 00:42:25.209
This is the drug for you if you have that situation.
521
00:42:26.150 --> 00:42:26.470
All right.
522
00:42:27.812 --> 00:42:28.312
Lastly.
523
00:42:30.210 --> 00:42:32.971
is adamoxetine, and the brand name here is Stratera.
524
00:42:33.231 --> 00:42:35.031
You might have heard of it because it's very popular.
525
00:42:35.851 --> 00:42:40.972
Adamoxetine is a selective norepinephrine reuptake inhibitor developed specifically for ADHD.
526
00:42:42.072 --> 00:42:49.974
It increases norepinephrine signaling, particularly in the prefrontal brain circuits involved in executive control, which is bringing your attention to where you want it, which is huge.
527
00:42:51.074 --> 00:42:54.255
It is neither a stimulant nor a controlled substance, so that's really cool,
528
00:42:55.618 --> 00:43:03.861
has to be taken consistently, and its benefit, like guanfacine and valoxazine, typically develops over weeks rather than hours.
529
00:43:05.722 --> 00:43:09.363
It can even take longer than guanfacine to get developed on the order of months.
530
00:43:11.144 --> 00:43:17.387
Among these established non-stimulants, it has the deepest adult ADHD evidence base and probably effectiveness.
531
00:43:19.347 --> 00:43:23.109
It has been shown to reduce distractibility and improve sustained attention.
532
00:43:24.137 --> 00:43:28.179
It is likely to improve impulse control and allow you to complete tasks better.
533
00:43:29.500 --> 00:43:31.280
It's total continuous action.
534
00:43:31.320 --> 00:43:34.842
It can cover mornings, evenings, and transitions way better than stimulants can.
535
00:43:36.483 --> 00:43:40.365
It just reduces the overall background probability of being knocked off course.
536
00:43:40.465 --> 00:43:43.746
Once you're in vibing something, some kind of work, it's really pretty good.
537
00:43:44.727 --> 00:43:51.870
It doesn't supply the immediate drive, salience, or motivational force associated with amphetamine, but it seems to do a little bit more of that than guanfacine does.
538
00:43:52.892 --> 00:43:57.876
It's got some downsides, reduced appetite, insomnia, fatigue, dizziness, constipation, sleepiness, etc.
539
00:43:58.716 --> 00:44:05.481
In some rare cases, sexual and urinary side effects can occur, including erectile dysfunction and urinary hesitation in some men.
540
00:44:07.735 --> 00:44:08.375
That's not great.
541
00:44:08.475 --> 00:44:11.216
It can raise heart rate and blood pressure, usually only by a small amount.
542
00:44:11.456 --> 00:44:22.759
People who metabolize it slowly through the CYP2D6 enzyme pathway can experience higher exposure and more side effects, but then they just need way less of the drug and they save money on the dose, which is kind of cool.
543
00:44:22.879 --> 00:44:28.260
The relative focus improvement here is like a six or seven or eight compared to Adderall.
544
00:44:30.359 --> 00:44:33.640
In order to assess how good it is for you, you have to be on it for months.
545
00:44:34.140 --> 00:44:35.080
That's the only way you can tell.
546
00:44:35.120 --> 00:44:40.121
So if you just do two or three days of anamoxicine and I say I don't feel it, you're not supposed to feel it, right?
547
00:44:40.461 --> 00:44:43.682
It's like planting an oak tree and after 15 minutes being like the acorn doesn't work.
548
00:44:43.862 --> 00:44:45.303
That's not how it works, right?
549
00:44:46.123 --> 00:44:55.725
Now, the average effect is below that of the strongest stimulants, but it is very, very strong, consistently demonstrated, and it's better than most off-label alternatives.
550
00:44:59.178 --> 00:45:15.614
It upon review of the total literature for adults, Adamoxetine as a very effective medication that consistently works is right up there with stimulants as the first go to to like, I need this shit to end now and I need to have a normal attention span.
551
00:45:16.975 --> 00:45:31.063
So for strong responders who value continuous coverage and have low misuse potential, don't get a lot of side effects, it's a real world value, may exceed its raw symptom relief score because it is so effective and all the time.
552
00:45:31.384 --> 00:45:32.644
Anamoxetine is the real deal.
553
00:45:33.405 --> 00:45:39.488
And a lot of people, when they take it, they feel kind of like less dramatic.
554
00:45:40.849 --> 00:45:44.832
They can have internal attention
555
00:45:46.027 --> 00:45:51.271
that is less scattered, but without a feeling of acceleration that you would get from things like Adderall.
556
00:45:53.352 --> 00:46:04.500
It's good responses can basically be that thing where you don't feel much, but you look over after a whole week of having taken it for months.
557
00:46:04.721 --> 00:46:06.902
You look over the last week and you're like, holy crap, I got a bunch done.
558
00:46:07.323 --> 00:46:09.704
I could have never done this had I not been medicated.
559
00:46:10.125 --> 00:46:14.047
So it's less the thing you feel a ton in your head and more of just it works.
560
00:46:14.988 --> 00:46:26.051
So if you're an adult with inattentive or combined inattentive and hyperactive ADHD who needs continuous coverage, maybe you've tried some of the other stimulant drugs and they're way too much for you, have really bad downsides.
561
00:46:26.492 --> 00:46:28.732
Maybe you tried guanfacine, but it's just not enough.
562
00:46:29.293 --> 00:46:31.113
Amoxetine may be a good thing to try.
563
00:46:31.133 --> 00:46:43.117
And interestingly enough, in many cases, it can be combined with guanfacine to get you very, very close to the attention-enhancing effects of Adderall.
564
00:46:43.900 --> 00:46:45.921
but with very few downsides relative.
565
00:46:46.101 --> 00:46:47.822
So this is something to definitely look into.
566
00:46:48.183 --> 00:46:53.526
There's a new drug, super bonus round, just approved called centenafedine.
567
00:46:55.007 --> 00:46:59.650
It, for many people, increases intentional focus more than guanfacine does.
568
00:47:01.211 --> 00:47:04.373
It doesn't have as much force as moderate dose Adderall does.
569
00:47:06.006 --> 00:47:09.128
But it also sedates you less than guanfacine.
570
00:47:09.728 --> 00:47:16.131
It is similar to adamoxetine in its effects, but for many people, it is very, very effective.
571
00:47:16.171 --> 00:47:26.816
We don't have a ton of literature on it because it was just released, but if you've been through these other drugs and you haven't found your vibe, centenafidine can 100% be something that you look into.
572
00:47:27.377 --> 00:47:27.597
Now...
573
00:47:28.483 --> 00:47:30.345
We're basically done, but I just want to say this.
574
00:47:31.086 --> 00:47:35.910
People talk about modafinil as an incredible drug that helps you focus, and it is.
575
00:47:36.591 --> 00:47:42.456
The big problem with modafinil is that it's a half-life of 12 hours, and it's specifically designed to keep you awake.
576
00:47:43.237 --> 00:47:46.741
There's no way that I know of to take modafinil daily.
577
00:47:47.870 --> 00:47:50.732
So another thing, I've heard modafinil, you just don't get used to it.
578
00:47:50.893 --> 00:47:52.474
So that's amazing, if true.
579
00:47:53.335 --> 00:48:00.500
But you can't take modafinil daily because at the doses at which it's effective, it keeps you awake for 24 hours at a time.
580
00:48:01.341 --> 00:48:08.286
So if you need to be in a fighter bomber and have an air refueling mission that all in all takes 18 hours, modafinil is your shit.
581
00:48:08.927 --> 00:48:16.073
If you are a medical doctor and you're doing residency and you're being asked to stay awake for 36 hours and be sharp, modafinil, I know a shitload of doctors on modafinil.
582
00:48:16.746 --> 00:48:25.252
that is not a realistic ADHD drug because you can't get your sleep on it and sleep is going to absolutely be the critical factor for paying attention and the rest of your life.
583
00:48:27.334 --> 00:48:39.583
Another thing, you can combine multiple drugs here in this class with the direction of your doctor and psychiatrist because a stimulant plus guanfacine works really well for a lot of people.
584
00:48:40.744 --> 00:48:45.287
A long acting stimulant plus a short acting booster can be a good thing for some people.
585
00:48:46.337 --> 00:48:51.979
A stimulant plus adamoxetine can pair really well and adamoxetine and guanfacine can pair well.
586
00:48:52.959 --> 00:49:04.762
In addition to that, bupropion can sort into a few of those categories and then have this kind of additive and enhancing effect.
587
00:49:05.322 --> 00:49:07.423
So there's a lot to take here, right?
588
00:49:09.257 --> 00:49:15.241
Remember that if you're stacking these drugs, something that discussed with your psychiatrist, you don't want to do two drugs for the same job.
589
00:49:15.261 --> 00:49:17.643
You don't want like Ritalin plus Adderall.
590
00:49:18.304 --> 00:49:30.392
You want a drug that's maybe a bit good on the forceful side and then another drug that's low key, which means like guanfacine paired with a bunch of other drugs or bupropion paired with a bunch of other drugs.
591
00:49:31.333 --> 00:49:33.374
Here's my main takeaway from this, guys.
592
00:49:35.156 --> 00:49:36.677
With so many drug options,
593
00:49:37.378 --> 00:49:46.542
and even entire drug class options, the probability that you can benefit from drugs to notably help you focus is now higher than ever.
594
00:49:47.243 --> 00:49:49.944
When I was a kid, it was like Britalin or Adderall, that's it.
595
00:49:51.145 --> 00:50:02.010
And look, use microwaves, you drive your car, you turn on the AC in your car and in your home, you take antibiotics when you get a bacterial infection,
596
00:50:03.337 --> 00:50:19.568
If you have ADHD and you're not a fan of having it, talking to your doctor or getting a psychologist or psychiatrist referral might be a wise move because you already use artificial things to help you be better than you otherwise would, like air conditioning and antibiotics.
597
00:50:21.189 --> 00:50:28.113
What is exactly stopping you from taking medication if you need it?
598
00:50:28.134 --> 00:50:28.614
I myself
599
00:50:29.856 --> 00:50:40.903
took Adderall from age basically 15, just before I turned 15 to age 20, burned out on it, failed out of school, came back in, did it drug free.
600
00:50:42.144 --> 00:50:47.107
So from age 20 to age 41, I did not take any attention deficit disorder medications.
601
00:50:47.847 --> 00:50:48.748
I was super productive.
602
00:50:49.948 --> 00:50:56.993
But I recently got on guanfacine because being awake is the opposite of my problem and I wanted something subtle.
603
00:50:57.919 --> 00:51:00.000
My history with stimulants is not a fun one.
604
00:51:00.880 --> 00:51:05.802
Stimulants worked, but they eventually didn't work, and they caused a crap load of side effects.
605
00:51:07.243 --> 00:51:09.064
Being on guanfacine worked.
606
00:51:10.177 --> 00:51:16.725
Two milligrams where I started worked really well, and now I upped it to three milligrams a few months ago, and dude, you guys, it is great.
607
00:51:16.765 --> 00:51:24.515
It's subtle, it's effective, there's no notable signs, like no side effects, and it helps me lower my blood pressure and helps me sleep.
608
00:51:24.735 --> 00:51:25.256
That's crazy.
609
00:51:25.296 --> 00:51:26.718
That's like all the best things in the world.
610
00:51:26.738 --> 00:51:27.078
That's awesome.
611
00:51:28.160 --> 00:51:28.941
If you're struggling,
612
00:51:31.257 --> 00:51:37.160
Don't let I'm going to not take drugs and beat this myself pride talk nonsense to you.
613
00:51:37.660 --> 00:51:40.881
You don't need drugs, but you may benefit from them.
614
00:51:41.141 --> 00:51:45.003
Remember, if the store is an hour away, you can walk to the store.
615
00:51:45.223 --> 00:51:46.144
You can walk an hour.
616
00:51:46.404 --> 00:51:51.366
The real question is, do you drive and take five minutes to drive versus walk for an hour?
617
00:51:52.662 --> 00:51:58.966
Maybe in some cases, driving is a good idea because you drive to the store, you come back, you have oodles of time, you already did the thing.
618
00:51:59.787 --> 00:52:15.237
Just the same way, you could slog through life with no ADHD drugs, but if you really need them, once you take them, especially if they're the kind like guanfacine, amoxetine, veloxacine, that don't diminish in the returns over time, then like, you're just gonna be better on the drugs.
619
00:52:15.638 --> 00:52:19.220
Remember, you already eat food that's farmed in really artificial ways.
620
00:52:19.280 --> 00:52:21.362
The clothes on your body are made by machines.
621
00:52:22.460 --> 00:52:24.982
Taking drugs is not some kind of cop-out.
622
00:52:26.184 --> 00:52:32.169
You can take all the drugs in the world and be a total derelict piece of shit because you don't do anything in your life.
623
00:52:33.090 --> 00:52:38.456
And you can be drug-free and wish you were a person that accomplished things, but you can't because your brain needs the drugs.
624
00:52:39.557 --> 00:52:45.863
You can be a person that takes the drugs, already has the intent to be a fucking awesome person that does their work and accomplishes things,
625
00:52:46.620 --> 00:52:55.529
you and your intent, plus drugs and their action, can make it so that you are dependably able to focus better, this shit can change your life.
626
00:52:56.470 --> 00:52:59.293
Talk to your doctor, do some reading, talk to AI.
627
00:53:00.414 --> 00:53:01.435
I wish you my best.
628
00:53:02.376 --> 00:53:06.139
You don't need drugs, but if they're going to work for you, it could be a big deal.
629
00:53:07.861 --> 00:53:09.823
See you guys next time on drugs.