when people say that (prescription) amphetamines “borrow from the future”, is there strong evidence on this? with Ozempic we’ve observed that people are heavily biased against things that feel like a free win, so the tradeoff narrative is memetically fit. distribution shift from ancestral environment means algernon need not apply
(I’m a psychiatry resident. I also have ADHD and take prescription stimulants infrequently)
The answer is: not really, or at least not in a meaningful sense. You aren’t permanently losing anything, your brain or your wellbeing isn’t being burnt out like a GPU running on an unstable OC:
Prescription stimulants often have unpleasant comedowns once they wear off. You might feel tired and burned out. They often come with increased anxiety and jitteriness.
Sleep is negatively affected, you get less REM sleep, and you might experience rebound hypersomnia on days you’re not on the drug.
There are minor and usually unimportant elevations in blood pressure.
While focus and stamina are improved, creativity and cognitive flexibility suffer. I’ve read claims that it also makes people overconfident, which strikes me as prima facie plausible. Ever seen how people behave after using coke?
Animal studies show oxidative damage to the brain, but this has not been demonstrated in humans on therapeutic doses, even if used for performance enhancement in those who don’t meet the normal criteria for ADHD.
If started at a young age, growth velocity could be slightly hampered, mostly because of appetite suppression.
Dependence or addiction liability, while is low but not nil at therapeutic doses.
In my opinion, all of these are inconsequential, and the side effects vanish quickly on cessation. I certainly need the meds more than the average Joe, but I don’t think even neurotypical people using it as a PED are at much risk, as long as they keep the doses within reason. I’m of the opinion that current medical guidelines are far too conservative about stimulants, but in practice, they’re easily circumvented.
On a more speculative note:
I’m of the opinion that the ancestral environment didn’t demand that our ancestors be always switched on. Attention and focus were useful during activities like hunting and foraging, but there was immense amounts of forced downtime and slack. Even if you have less than ideal levels of conscientiousness or executive function, gnawing hunger or a desire for shelter probably kept you doing the right thing.
With agriculture, this began to change dramatically. A lot of the previous highly tight reward and feedback loop ends up deferred. A farmer can do a lot more to prepare for the future and hedge his bets than a hunter gatherer can. And modernity rewards such an approach even more.
i haven’t looked into this deeply but how strong is the evidence for (lack of) oxidative damage? the SSC post is somewhat unsatisfying in that it doesn’t really consider outcomes other than literal Parkinson’s, and just kind of says the animal model results are confusion.
Dependence or addiction liability, while is low but not nil at therapeutic doses.
This statement really surprises me?
On average you get around 500-1000% more dopamine in the system as a consequence of using amphetamines and from a standard neuroscience perspective this is around 3x as much as caffiene for example.
Yes it is not heroin levels but dependency has to be a real concern here from a neuroscience perspective?
Long-term potentiation and return to baseline for the brain should mean that the learned patterns would be relatively hard to unlearn after 6 months of frequent usage?
How good is the studies on longer term behaviour change due to this stuff? I looked into the studies and it seemed like from a shorter term perspective the addiction effects of it were lower than I thought which I found quite interesting.
I think an important caveat here is that the addiction and dependence liability is quite dependent on how you administer it to yourself, the dosage, the specific routes that you’re ingesting it from etc. (which you mention but I think you’re understating some of the dangers of it)
I don’t think even neurotypical people using it as a PED are at much risk, as long as they keep the doses within reason. I’m of the opinion that current medical guidelines are far too conservative about stimulants, but in practice, they’re easily circumvented.
CNS drugs are powerful so yes I think we should still have some limits on this? I think one of the main things that are a bit difficult with them is that it can be hard to perceive the difference that they induce in yourself? Like if you’re on them, you don’t necessarily notice that you have less creativity and awareness, that is not how it feels and so if you’re overusing them or similar you just don’t get that feedback? (based on some modafinil experience & observations from friends)
I did try and make it clear that I’m only talking about therapeutic usage here, and even when off-label or for PED purposes, at therapeutic doses. I apologize for not stressing that even further, since it’s an important distinction to make.
I agree that it’s rather important to use it as prescribed, or if you’re sourcing it outside the medical system, making a strong effort to ensure you take it as would be prescribed (there’s nothing particularly complicated about the dosage, psychiatrists usually start you at the lowest dose, then titrate upwards depending on effect).
The Claude Research report seems fine to me, and I would think it aligns with my claims. The main issue with recreational usage is that a lot of people aren’t trying to be responsible users, or are taking intentionally talking large doses for recreational purposes. That’s more on them than it is on the drug! If you take it within the standard dosage range, the drug itself will not produce much in the way of craving for more.
>CNS drugs are powerful so yes I think we should still have some limits on this?
I am, if not outright libertarian, certainly leaning in that direction. So it depends on what the “limits” actually are. I think that doctors are currently overly risk-averse and conservative about prescribing them, but I don’t think they should be handed out like candy over the counter. I think there’s plenty of room in between that avoids the pitfalls of a maximalist position.
>I think one of the main things that are a bit difficult with them is that it can be hard to perceive the difference that they induce in yourself? Like if you’re on them, you don’t necessarily notice that you have less creativity and awareness, that is not how it feels and so if you’re overusing them or similar you just don’t get that feedback? (based on some modafinil experience & observations from friends)
The effects on creativity are rather minor. I can’t really tell a difference when I’m on them, but I do have ADHD so that might confound things. Some of the best and most creative things I’ve written were while I was on methylphenidate or dextroamphetamine! If you’re using it to make an often monotonous task like programming more palatable, or to improve your ability to study, then I wager the benefits massively outweigh the slight cognitive inflexibility. I don’t think you want stimulants if you’re trying to paint or write poetry, even if they won’t massively handicap you. The effects are subtle, you’re not becoming an automaton.
when people say that (prescription) amphetamines “borrow from the future”, is there strong evidence on this? with Ozempic we’ve observed that people are heavily biased against things that feel like a free win, so the tradeoff narrative is memetically fit. distribution shift from ancestral environment means algernon need not apply
(I’m a psychiatry resident. I also have ADHD and take prescription stimulants infrequently)
The answer is: not really, or at least not in a meaningful sense. You aren’t permanently losing anything, your brain or your wellbeing isn’t being burnt out like a GPU running on an unstable OC:
Prescription stimulants often have unpleasant comedowns once they wear off. You might feel tired and burned out. They often come with increased anxiety and jitteriness.
Sleep is negatively affected, you get less REM sleep, and you might experience rebound hypersomnia on days you’re not on the drug.
There are minor and usually unimportant elevations in blood pressure.
While focus and stamina are improved, creativity and cognitive flexibility suffer. I’ve read claims that it also makes people overconfident, which strikes me as prima facie plausible. Ever seen how people behave after using coke?
Animal studies show oxidative damage to the brain, but this has not been demonstrated in humans on therapeutic doses, even if used for performance enhancement in those who don’t meet the normal criteria for ADHD.
If started at a young age, growth velocity could be slightly hampered, mostly because of appetite suppression.
Dependence or addiction liability, while is low but not nil at therapeutic doses.
In my opinion, all of these are inconsequential, and the side effects vanish quickly on cessation. I certainly need the meds more than the average Joe, but I don’t think even neurotypical people using it as a PED are at much risk, as long as they keep the doses within reason. I’m of the opinion that current medical guidelines are far too conservative about stimulants, but in practice, they’re easily circumvented.
On a more speculative note:
I’m of the opinion that the ancestral environment didn’t demand that our ancestors be always switched on. Attention and focus were useful during activities like hunting and foraging, but there was immense amounts of forced downtime and slack. Even if you have less than ideal levels of conscientiousness or executive function, gnawing hunger or a desire for shelter probably kept you doing the right thing.
With agriculture, this began to change dramatically. A lot of the previous highly tight reward and feedback loop ends up deferred. A farmer can do a lot more to prepare for the future and hedge his bets than a hunter gatherer can. And modernity rewards such an approach even more.
i haven’t looked into this deeply but how strong is the evidence for (lack of) oxidative damage? the SSC post is somewhat unsatisfying in that it doesn’t really consider outcomes other than literal Parkinson’s, and just kind of says the animal model results are confusion.
This statement really surprises me?
On average you get around 500-1000% more dopamine in the system as a consequence of using amphetamines and from a standard neuroscience perspective this is around 3x as much as caffiene for example.
Yes it is not heroin levels but dependency has to be a real concern here from a neuroscience perspective?
Long-term potentiation and return to baseline for the brain should mean that the learned patterns would be relatively hard to unlearn after 6 months of frequent usage?
How good is the studies on longer term behaviour change due to this stuff? I looked into the studies and it seemed like from a shorter term perspective the addiction effects of it were lower than I thought which I found quite interesting.
(dropping a claude research report link here: https://claude.ai/public/artifacts/b10e54df-6616-477f-ac19-fe52b4c9d926)
I think an important caveat here is that the addiction and dependence liability is quite dependent on how you administer it to yourself, the dosage, the specific routes that you’re ingesting it from etc. (which you mention but I think you’re understating some of the dangers of it)
CNS drugs are powerful so yes I think we should still have some limits on this? I think one of the main things that are a bit difficult with them is that it can be hard to perceive the difference that they induce in yourself? Like if you’re on them, you don’t necessarily notice that you have less creativity and awareness, that is not how it feels and so if you’re overusing them or similar you just don’t get that feedback? (based on some modafinil experience & observations from friends)
I did try and make it clear that I’m only talking about therapeutic usage here, and even when off-label or for PED purposes, at therapeutic doses. I apologize for not stressing that even further, since it’s an important distinction to make.
I agree that it’s rather important to use it as prescribed, or if you’re sourcing it outside the medical system, making a strong effort to ensure you take it as would be prescribed (there’s nothing particularly complicated about the dosage, psychiatrists usually start you at the lowest dose, then titrate upwards depending on effect).
The Claude Research report seems fine to me, and I would think it aligns with my claims. The main issue with recreational usage is that a lot of people aren’t trying to be responsible users, or are taking intentionally talking large doses for recreational purposes. That’s more on them than it is on the drug! If you take it within the standard dosage range, the drug itself will not produce much in the way of craving for more.
>CNS drugs are powerful so yes I think we should still have some limits on this?
I am, if not outright libertarian, certainly leaning in that direction. So it depends on what the “limits” actually are. I think that doctors are currently overly risk-averse and conservative about prescribing them, but I don’t think they should be handed out like candy over the counter. I think there’s plenty of room in between that avoids the pitfalls of a maximalist position.
>I think one of the main things that are a bit difficult with them is that it can be hard to perceive the difference that they induce in yourself? Like if you’re on them, you don’t necessarily notice that you have less creativity and awareness, that is not how it feels and so if you’re overusing them or similar you just don’t get that feedback? (based on some modafinil experience & observations from friends)
The effects on creativity are rather minor. I can’t really tell a difference when I’m on them, but I do have ADHD so that might confound things. Some of the best and most creative things I’ve written were while I was on methylphenidate or dextroamphetamine! If you’re using it to make an often monotonous task like programming more palatable, or to improve your ability to study, then I wager the benefits massively outweigh the slight cognitive inflexibility. I don’t think you want stimulants if you’re trying to paint or write poetry, even if they won’t massively handicap you. The effects are subtle, you’re not becoming an automaton.
They definitely do for me- I sleep worse that night, and if I use too frequently I get exhaustion that takes weeks to recover from.