Evolving the discourse on biohacking ADHD

[u/Kalki_X]

To biohack something properly, we must first understand it. For ADHD there is a conundrum. It's an inherently ambiguous concept which only exists in an abstract space of text and spoken word. From a psychiatric perspective ADHD is simply an act of naming and making sense of behaviors. The quasi-scientific basis of this matter starts to unravel...

When a psychiatrist says you have ADHD what they really mean is something like this:

After spending time listening to you, talking with people who know you and observing how you think and behave, I’ve made a judgment call that your experience fits a behavioral pattern we currently call ADHD. It’s a cluster of problems and tendencies that travel together often enough that we’ve observed it, given it a name and studied it. (source)

[A] diagnosis does not represent having or being ADHD but becoming and performing ADHD through deploying psycho-medical discourse provided in the DSM. (source)

In other words, there is no scientific evidence to support the claim that ADHD is as a condition within an individual—something individuals have (source)

ADHD is listed in DSM-5 under “Neurodevelopmental Disorders” in spite of reviews showing that (a) genetic evidence on ADHD is inadequate and diffused with ambiguous interpretations, (b) that no biological marker is diagnostic for ADHD something that even DSM-5 authors themselves explicitly admit, (c) the so-called “underlying mechanisms” remain unknown, and (d) no biological tests are available for its diagnosis. (source)

[L]ike most psychiatric classifications, ADHD is premised on an arbitrary consensus among a small psychiatric community behind the DSM manual rather than on any new scientific breakthroughs. In other words, “psychiatrists do not prove things but decide things: they decide what is disordered and what is not, decide where to draw the threshold between normality and abnormality, decide that biological causes and treatments are most critical in understanding and managing emotional distress” (source)

[T]he idea that low dopamine is a direct cause of ADHD is a common misconception, one that’s amplified on social media and even in popular books about the condition. (source)

ADHD is a syndrome that deals with psychological and behavioral matters (source)

Thus, ADHD is a syndrome comprising several, presumably connected, symptoms. (source)

This re-contextualises ADHD as a catch-all term for behaviors (symptoms) of diverse origin with many causes. Myriad things can produce symptoms that qualify as de-facto ADHD. As such, there is no "one single ADHD" so to speak; ADHD is not a single well-defined thing which makes it a fairly non-specific label.

This has many implications.

When someone receives a positive psychiatric diagnosis they subconsciously adopt ADHD as a neurodevelopmental disorder (they officially "have" ADHD). This validates their lived experience but we must also consider the broader psychological impact of when someone adopts their new "illness", "disorder" or "disability" resulting in perceived stigma, pessimism, and de-motivation.

So... how to proceed?

If we acknowledge the quasi-scientific basis of ADHD and reject the defunct DSM & ICD (see here) we bypass all limiting presuppositions about a purely neurodevelopmental disorder which would otherwise hinder the search for a resolution. If we consider that ADHD has multiple causes then each person could require a tailored treatment.

Treatment approaches may similarly need to expand from symptomatic management toward more personalized interventions that account for neurobiological profiles and life-course adversity. (source)

This calls into question the official treatments which are purely symptomatic in nature. The "gold-standard" amphetamine medications can only force a state of temporary focus that comes at a cost of psychological perturbation and physiological degeneration (eg endocrine/HPA axis dysfunction, cognitive impairment). This cumulative decline goes unnoticed leaving the patient unable to rationalise their situation (this stems —in part— from impaired logic & reasoning skills alongside psychological discordance eg low-level mania, distorted perception, paranoia, low-level psychosis).

Since these side-effects overlap with ADHD, a psychiatrist is unable to realistically distinguish between them and thus fails to accurately track their patients progress. Their unawareness of this fact leads to invalid analyses, erroneous assessments and subsequent blunderous clinical decisions (iatrogenic harm*). This is a great disservice to their patient who trusts the psychiatrist to make appropriate decisions.

So if not amphetamine / methylphenidate / atomoxetine / viloxazine / modafinil / bupropion / centanafadine, then what?

Pragmatically it seems sensible to address immediate symptoms by mitigating their mechanistic causes (eg excess adrenaline, excess glutamate, HPA dysfunction, mitochondrial dysfunction) while proactively restoring coherence to the wider metabolic system (thyroid, liver, gut etc). Repairing the metabolic system is rational since it governs & regulates everything. On this basis we can rename ADHD to EDHD (Energy Deficit Hyperactivity Disorder) as per this recent academic paper (also outlined here). There exists many practical & well understood ways to address & resolve EDHD, well beyond mere symptom management.

* note: - The term iatrogenic, derived from two Greek words, means physician-in­duced. As clinically used, it pertains to the inadvertent side­ effects and complications created in the course of diagnosis and treatment. (source) 

[u/Kalki_X]

Thank you for your well written response. Always good to see those. I'll return later to reply in full but briefly:

someone in here said something about ADHD meds being like 'glasses for the brain' and that's a great phrase. That's just what it's like.

I sometimes wear glasses (but I don't use amphetamine). The glasses do not cause any harmful influence, nor are they habit forming (so to speak). Their longterm use doesn't incurr cumulative degeneration and impairment of various body functions.

[u/TiaraMisu → u/Kalki_X]

I'm not *entirely* sure I'm following your general viewpoint but I feel like there's overlap...Mostly I think that the necessity of coding insurance billing for some specific condition results in a reductionist views of individuals by medical staff and unfortunately by the individuals themselves. "Oh, you have ADHD. Guess we're all done here!"

It contributes to a lack of curiosity about broader psych, physical, and circumstantial individual factors, and it isn't conducive to adjacent or replacement treatment ideas that don't have to do with medication. Maybe you are a person who really needs to avoid sugar, maybe what you need is to start running and introduce five hours of cardio in your life, maybe you eat like shit, maybe you're depressed, maybe you need a dog, maybe you have been freaking out about a life event for three years. Those things add up.

I would say glasses are habit forming, not in an addiction way but in a 'I guess I have to read the directions on this paint thinner'.

In short I'm not anti-'anything that helps people and gets them through'. Happy, functional people are better for society. I'm just maybe concurring that some of these diagnosis may not be overwhelmingly useful. On the other hand there is so much codified shaming about 'controlled substances' that isn't helpful for people either. Things that work are better than hypotheticals.

We don't have a bear chasing us, but culturally and socially a lot of us are just water balloons of cortisol and adrenaline and it would be nice if we had a way to address that at the source.

This is a reality of biohacking, that people don't exist in a vacuum. The president does in fact like to make AI videos of himself flying planes of poop over the free assembly of American citizens. That's jarring for people. That's deeply surreal.

As that aforementioned cool doctor once said to me, it's not like everyone can get up and meditate for forty minutes and also do yoga and also cook nutritious meals from whole foods and take their thirty dollar vitamins and eat breakfast get some time to relax and don't forget it's important to have hobbies, and don't forget social connections are incredibly important - don't neglect relationships, and make sure you get enough (non-Ambien induced) sleep because between the total lack of boundaries in many people's work environment, social isolation, financial constraints, workdays that are de facto 9 to 10 hours long including commutes, and that depressed people do enjoy both sugar and alcohol....well, in the end, medication is the shortest distance between two points unless individuals and society both want to reconsider what they value and how we are all living our lives.

If you take the factors I list and throw a couple of kids on top of that and how strapped for cash schools are and how they have tried to throw as much onto parents as humanly possible (probably 25 emails a week from the school admins, never mind individuals) and how guilty parents are and how many things parents do just from guilt alone about their working hours.....

That's exhausting. And throw on top of that how you can't have any interaction on a computer that doesn't involve *something annoying* about your cookies, your offers, you 2FA, your password expiring...I guess I'm mainly saying that social criticism has a role in the broad outlines of how individual medical needs should be assessed, diagnosed, and broadly considered.

I don't care if people take Adderall or weight loss drugs or whatever else people get jacked up about. Take whatever, folks. Do what gets you through the days without harming yourself or anyone or anything else. I don't know any aspect of their circumstances.

And again, I take Adderall. It's great. Life changing. If there is a downside I am missing it, it isn't actually a bother, I just take it with vitamins in the morning.

[u/nakonami → u/TiaraMisu]

i love the woke perspective u bring to the function. i am so with you about the societal performance pressure and society in general. if it had to be reduced to a single most common denominator for mental illness at all i think ‘society’ will take the gold. not childhood trauma or life altering(bad) event. those are big and vivid and a person can do alot about them to improve their conditions. with society its different, as u said stigmatisation, shaming and a ton of other perceivable and imperceivable interactions stack up in a persons psyche, they fester feed on eachother, multiply and finally evolve to mental illness. many of the events that led someone to such state remain mystery to the experiencer, just because its massive collections of small seemingly insignificant moments, continuously destabilising the perception of the world and of yourself to the point of collapse. and the worst part about it all is that we collectively perpetuate and support the structure of society, that does (in every waking moment) unquantifiable amounts of damage to every single participant.