alt Hacker News> The treatment for ADD is one of two medications, methylphenidate or dexamphetamine. You can try other things in addition to these, but not instead of these, and you should try both - there really is just no substitute.
No, not quite - there's a variety of different ADHD medications and I'd argue there's more popular ones like Vyvanse (lisdexamfetamine). Non-stimulants like Strattera or Intuniv absolutely can and are prescribed on their own, which are really useful for people that respond poorly to stimulants.
Perhaps you meant to say there's two main classes of stimulants (amphetamines, methylphenidates) that are worth investigating and shouldn't be skipped over?
Replies
Vyvanse is dexamphetamine. I suppose you can say “amphetamines” instead, I imagine the subtleties of the terminology differ quite a bit in different places.
Strattera can help (I mentioned bupropion, another SDNRI). Of course if you try stimulants and don’t respond well, it’s totally fine to just use e.g. Strattera. What I’m advocating against is e.g. “try Strattera first, if it seems to help, don’t bother with stimulants”. (Some places, cultures, or medical systems do have surprisingly strong biases against stimulants!)
Intuniv gets a bad reputation because the patient has to be titrated up to the final dose and it takes a long time to see the full effects. It's the opposite pattern of stimulants where the patient feels great (unnaturally so, due to stimulant euphoria at the start) and the effects wane over time.
The internet is really, really bad at pushing everyone toward ADHD diagnoses and then pushing them further toward stimulants. There's a darker part of some of the communities then pushes people to keep pressuring their doctors for higher and higher doses and also discourages people from trying therapy.
Outside of the internet I know several people who did the rounds with medications and ended up on the non-stimulant options and preferred them. This is an unthinkable conclusion if your primary source of information is Reddit, X, or TikTok ADHD influencers, but it's pretty common in the real world.
Stimulants have a habit of being enjoyable at first (meaning people like taking them, beyond their attention effects) and then the effects wane over the years, to the point that there are studies showing that the effects of stimulants taken long term in children are minimal to unmeasurable after several years. This is confusing to anyone who has been taking them for years and notices a difference on days when they don't take them, but that's explainable by the fact that it takes months (or longer) for the brain to adapt to not having them in the body. For some reason this same effect is not debated as much when you talk about people who drink 5 cups of coffee per day but then crash hard when they miss their coffee, but it gets protested and argued a lot when we talk about literal amphetamines.
Anyway, please don't listen too much to internet ADHD forums. They're just so, so bad these days with bad advice and poor psychology/therapy takes. You really need to engage with professionals with an open mind and not be single minded about acquiring and taking stimulants if you want to address this problem as a whole. The way the internet treats ADHD as a simple "low dopamine" state (which is wrong on many levels) and then points to stimulants as a "raise your dopamine" drug to neatly cancel it out sounds nice, but it's wrong on so many levels.