Mad in America

I am asking you to tell me how you came to your conclusions, specifically that:

1) there are "large structural brain differences" between those with and without ADHD, and

2) there is a 'tragically' high co-morbidity between bipolar disorder and ADHD

The literature, as best as I could determine, says that there are no large structural differences, and there isn't a tragically high co-morbidity. I pointed you to relevant research articles which say that. It seems that you are trying to change the topic. My tentative hypothesis is that your knowledge of ADHD helps you cope with the disease, and you don't want to evaluate the possibility that some of your knowledge may be incorrect.

Rather than point to research which confirms you point (2), you now say that there are "many subtypes, co-morbidity differs based on subtype." That's a perfectly reasonable argument, but it's a different argument than your previous one. You previously wrote "ADHD's co-morbidity with bi-polar disorder is tragically high" not "co-morbitity between some subtypes of ADHD and bi-polar disorder is tragically high."

That's okay - this is HN, not peer-reviewed literature and I don't expect you do put in all of the details when you first write something. My question is only, how do you know that what you wrote is true?

You pointed me to a video. I stopped after 23 minutes into it because it was low-information content and I didn't like the speaker's style. There are no links to the primary research, no…

It's great when someone replies as thoughtfully as this, and I love your phrase "gently disagree". Would that more disagreements were of this kind.

> Well, for something like bipolar disorder this feels like it's true.

I agree. The open question is on what level these things are best to be understood. In some sense everything about us is biology, just as in some sense everything is physics. But we don't think of, say, heart disease as best addressed by physics. Similarly, that there is a biological stratum to our actions and feelings does not automatically mean that chronic emotional suffering is best understood as biology. One might as well conclude from the tongue and larynx that language is biology too. And indeed it is, sort of—yet its meaning lies elsewhere. Or you might as well conclude from the importance of neurons to learning that education is brain biology. Why bother with teachers or schools? We should just 'learn' the neurons directly. Such examples are obviously silly, at least given our current knowledge.

To know that chronic emotional suffering is a biological disorder requires more than the involvement of biological phenomena in it; it requires an experimentally verified model. My understanding is that we don't have anything close to that. The one that entered the public imagination, the serotonin-deficiency theory, is widely dismissed by experts [1,2,3,4]. The only argument seems to be whether they knew it was false from the beginning or discovered that…

I wonder where you get the idea that psychiatric detention is adequate health care, or that it helps patients. Regularly studies pop up pointing out that involuntary treatment in general does not lower the odds of suicide.

https://www.madinamerica.com/2019/06/involuntary-hospitalization-increases-risk-suicide-study-finds/

And before you ask, doing nothing does work, or at least it beats this option. Yes there are yet better options, actual interested attention from an actual human being, but literally leaving the person on the street works better than any mandatory treatment, and is a lot better than involuntary detention.

https://pubmed.ncbi.nlm.nih.gov/1023455/

And frankly, find a local Psychiatrist and ask them this question "Who is best of: a person committing suicide, or a person in involuntary detention NOT committing suicide for 6 months". They will illuminate what causes this problem.

So why are we doing this? Well, this gets done to those people to give Police an option to deal with people who've done nothing wrong but are judged to be "at risk" and generally being a nuisance, slowly getting worse but not actually having done anything wrong.

Lastly, some people are doing this because they see it as a form of euthanasia. They are ill, or have destroyed their lives (for example with medical bills) beyond repair and they just want out. It takes a long time for them to actually do something about this. Needless to say, any form of "treatment" for this will only…

> Luckily, all my friends are fellow techies who are upper-middle class, and can afford medication and therapy (and in one case, out-of-state long-term hospitalization.) But even with insurance, they're looking at many thousands of dollars of treatment.

Please understand that I am not anti-psychiatry at all. Your kid and their friends are best doing intensive therapy, and if necessary, sessions twice per week, outpatient. That is their best bet, health-wise. Because of taking Pristiq (desvenlafaxine) [SNRI] and Rexulti (brexpiprazole) for severe depression, I literally have suffered the worst thing imaginable, a drug side effect known as *akathisia*. In no exaggeration, it is worse than death. You have to move constantly, but it does not relieve the terror that you go through. You cannot physically relax at all. Your mind can only think haunting and terrorizing thoughts. It feels like you have been doused in gasoline, lit on fire, and you have been locked in a coffin. You literally survive moment-by-moment not to kill yourself. By the way, it is gruesomely painful from a perceptual standpoint. One time, when I was extremely sick, I went to the hospital and I had no idea whatsoever when I went to the emergency room that I was in sepsis along with diabetic ketoacidosis, due to being in the throes of akathisia. If you have it severely, it can cause violence and suicide. I had it severely and it lasted for about a year. I have 2 rare immune-mediated neurological disease plus…

"Let me tell you from personal experience, these people are doing more harm to their children than good."

The problem is that the science clearly says the opposite:

"At the end of 14 months, core ADHD symptoms were reduced more in the children treated with stimulants than with behavioral therapy. However, at the end of three years, 'medication use was a significant marker not of beneficial outcome, but of deterioration. That is, participants using medication in the 24-to-36 month period actually showed increased symptomatology during that interval relative to those not taking medication.'"

http://www.madinamerica.com/madinamerica.com/Children_files/3-year%20followup%20of%20the%20NIMH%20MTA%20Study.PDF

"At the end of six years, medication use was 'associated with worse hyperactivity-impulsivity and oppositional defiant disorder symptoms,' and with greater 'overall functional impairment.'"

http://www.madinamerica.com/madinamerica.com/Children_files/Mta%20at%208%20years.PDF

"Within 21 months, 11 percent of children treated with a stimulant for ADHD developed 'psychotic symptoms.'"

http://www.madinamerica.com/madinamerica.com/Children_files/Psychotic%20side%20effects%20of%20stimulants.pdf

"Two-thirds of the adolescent patients hospitalized for mania at the University of Cincinnati Medical Center had been on stimulants 'prior to the onset of an affective episode.' Stimulants, the researchers concluded, may 'precipitate depression and/or mania in children who would not…

No problem, I like to spread awareness of this stuff! BTW here are a few more RCTs about the relationship https://www.madinamerica.com/2021/03/antidepressants-still-linked-increased-suicide-risk/

Honestly it's hard to say and I'm not even sure if you'd be able to study this empirically in this population. I do think that's why doctors fall prey to this bias, and especially so in a stigmatized population. "Ah, they were likely to have these symptoms anyway". It would be interesting to do a wider study, but there already was a history of these companies withholding damaging trials and results so I doubt it would be done, especially given that suicides have occurred in these trials.

I really do believe that these classes of medications are treated differently due to the great power the industry has on this issue. If you look up the background of NAMI it's quite suspect and reminds me about how doctors were getting textbooks that were written by the opioid prescribing company. NAMI goes on to inform public opinion and then this stuff becomes "fact". I'm glad the "too little serotonin" thing is being examined but it was crazy to see how many weirdly defensive memos and articles there were out when it first came out. I see I'm getting downvotes on my original comment but I do think it's extremely important to examine these intuitions and where they came from, because as we've seen some of this stuff has been based on profits/trial P-hacking/junk science.