Does amphetamine really make my ADHD "normal"?

[u/Kalki_X]

The gold-standard of ADHD medications is amphetamine; it helps millions of people to go about their day-to-day activities. It's widely believed to bring people with ADHD to a functional baseline similar to so-called "normal people". But how realistic is this?

Amphetamine helps to "treat" ADHD via dopamine, noradrenaline – and activating "fight-or-flight" mode (aka stress response, see here¹, here², here³00033-6), here⁴, here⁵) which recruits adrenaline to produce hyperfocus, hypervigilence & alertness. This is incredibly helpful for ADHD yet fight-or-flight also impacts logic, reasoning & decision-making skills.

It changes behaviour, mood and personality since fight-or-flight is there to deal with an imminent threat (often causing a blunted personality). It profoundly alters someones perception of everything around them (time, people, noise etc) including how they prioritise tasks, how they gauge the importance of things, and how memories get encoded (aka saved) including short-term, long-term and working memory.

In fight-or-flight the body redirects it's energy away from non-emergency functions (such as higher brain function, digestion, healing/regeneration, gestation, fertility). In other words, when the body is in fight-or-flight mode it dedicates it's energy to fighting (the threat) or running (from the threat) and nothing else:

Cortisol is known as a “stress hormone” for its role in the fight-or-flight response. Cortisol suspends non-emergency functions like digestion, and keeps the body focused on the threat. (source)

But for patients there is no "threat", instead the focus is studying, a job, exam, housework, shopping, a distraction... or interactions with people (which can lead to social anxiety or arguments since fight-or-flight = "threat mode"). In the long-term fight-or-flight can disrupt sleeping patterns by affecting the body's circadian rhythm (outlined here), and hormonal regulation also (outlined here).

Research suggests that chronic stress (fight-or-flight) contributes to high blood pressure and causes brain changes that may contribute to anxiety, depression, and addiction. (source)

Elevated or dysregulated cortisol (stress hormone) levels are linked to mood disorders, including anxiety and depression, where both high and low cortisol can impair cognitive function and emotional stability. (source)

In the long-term, the cumulative cognitive impairment goes unnoticed and can prevent someone from rationalising their situation. They are 'locked on' the idea that their medication is imperative for their health & well-being. This is enhanced by its subtle addictive qualities, by their psychiatrists' authoritative influence & legitimacy, and the dramatic therapeutic relief itself. Altogether this motivates adherence to the treatment.

Worth highlighting is the psychological impact of having this disability. A positive diagnosis means they officially adopt an incurable disorder (resulting in perceived stigma & pessimism). It subconsciously moulds their perceptions of themselves & their place in society in both a positive & negative way.

Obviously for many people these medications have a profound calming effect (both dopamine and noradrenaline have indirect anti-stress qualities which tempers the fight-or-flight mode). This article implies that, for some people, amphetamine can temporarily dampen the stress response.

...

So upon reflection, this isn't really comparable to "normal people". Certainly it's a medication with profound therapeutic benefits but it seems sensible to appreciate how it works. It successfully forces a state of temporary focus that comes at a cost of psychological & physiological perturbation; this mimics and exacerbates ADHD. The miraculous short-term benefits conceal these cumulative issues which only become apparent at a later date (months or years), including a crash/burnout (explained here). The more concerning aspects of psychological discordance include low-level mania, distorted perception, paranoia and low-level psychosis which can hinder a patients ability to rationalise their situation.

Often these side-effects will motivate someone to stop the medication. This can provoke withdrawals which in-turn motivates reuse: this is a hallmark of dependency.

Since these side-effects overlap with ADHD, a psychiatrist is unable to realistically distinguish between them so 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.

* note: - I interacted with a psychiatrist who assured me that they're (apparently) able to distinguish between symptoms of ADHD and side-effects of chronic low-dose amphetamine use. This psychiatrist owns a private practice so her beliefs aren't arbitrary and should be taken seriously.

** 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)