The guest
Andrew Huberman: Professor of neurobiology and ophthalmology at Stanford School of Medicine and host of the Huberman Lab podcast. This is a solo episode with no guest.
What this episode covers
In this solo episode, Andrew Huberman breaks down the neuroscience of ADHD and the stimulant and non-stimulant drugs used to treat it. He explains how the prefrontal cortex acts as an 'orchestra conductor' that fails to properly coordinate brain networks in ADHD, and how Adderall, Vyvanse, Ritalin, dexedrine, modafinil and guanfacine work at the level of dopamine and norepinephrine. He addresses the central paradox of why giving stimulants calms hyperactive children, and reviews the literature on long-term effects including addiction, psychosis, height, cardiovascular and hormone health. Throughout he stresses correct diagnosis, minimal effective dosing under a board-certified psychiatrist, and the dangers of recreational or unprescribed use.
Also referenced (named, not recommended)
ProductReferenced
Adderall
Teva Pharmaceuticals
“Adderall is a combination of what are called amphetamine salts amphetamine salts refers to the fact that there are two major forms of amphetamine”— Andrew Huberman
ProductReferenced
Vyvanse
Takeda Pharmaceuticals
“Vyvanse is a drug in which the pharmaceutical industry has taken one component of Adderall just the D amphetamine component and attached to it an amino acid called lysine”— Andrew Huberman
ProductReferenced
Ritalin
Novartis
“ritalin or what sometimes also called Concerta depending on again the time release forms Etc Ritalin was very commonly prescribed for the treatment of ADHD”— Andrew Huberman
ProductReferenced
Dexedrine
GlaxoSmithKline
“dexedrine is pure D amphetamine so if we're going to be very direct vivance is time release dexedrine it's not time release Adderall”— Andrew Huberman
ProductReferenced
Modafinil (Provigil)
Cephalon
“the major drug in this category of non-amphetamine treatments for ADHD is modafinil which is also called by its commercial name Provigil”— Andrew Huberman
ProductReferenced
Armodafinil (Nuvigil)
Cephalon
“there's a variance on this which is our modafinil which goes by the brand name Nuvigil the major difference between modafinil and arm modafinil”— Andrew Huberman
ProductReferenced
Guanfacine
Shire
“the last in this category of atypical is guanfacine guanfacine is an interesting compound it's a compound that was developed to lower blood pressure”— Andrew Huberman
ProductReferenced
Wellbutrin (Bupropion)
GlaxoSmithKline
“the less typical would be modafinil armodafone proprion Wellbutrin and so forth the last in this category of atypical is guanfacine”— Andrew Huberman
Big reveals from this episode
- As high as 80% of college-age young adults have used prescription stimulants like Adderall or Ritalin at some point without a prescription.
- Up to 75% of black-market drugs are contaminated with fentanyl, making unprescribed stimulant use potentially deadly.
- Vyvanse is not extended-release Adderall but time-release dexedrine (pure D-amphetamine with a lysine attached as a prodrug).
- Children with ADHD treated appropriately are at LOWER risk of later illicit drug abuse, while untreated ADHD kids have higher addiction risk.
- One ~300-pound male patient gets relief from just 2.5mg Adderall, while two ~130-pound sisters needed 180mg and 240mg daily doses.
- Adderall-induced psychosis can be long-lasting even after stopping, whereas Ritalin-induced psychosis usually ceases when the drug is stopped.
- Huberman reveals he has personally taken only armodafinil (in 2017 for jet lag) and disliked the prolonged 'narrow tunnel' state so much he wouldn't repeat it.
- Guanfacine profoundly lowers alcohol tolerance, so even small amounts of alcohol can cause serious problems or potentially death.
Worth remembering
- At rest, thinking about essentially nothing, your brain consumes about 25% of your daily caloric needs.
- Adderall is a 3-to-1 ratio of D-amphetamine to L-amphetamine; L-amphetamine drives peripheral effects like heart rate and blood pressure.
- Stimulants work mainly by raising dopamine and norepinephrine, which are so similar it takes just one chemical conversion to turn one into the other.
- In the 70s and 80s there were movies and criminal trafficking around dexedrine, which is pure D-amphetamine.
- Roughly 100mg of Vyvanse translates to only about 9mg of Adderall because most of the molecule is the inert lysine.
- Children with ADHD treated with meds actually reach slightly higher BMIs than peers; the drugs do not appear to stunt height.
- Methamphetamine releases about five times more dopamine than the other ADHD drugs, with a very fast onset and crash driving its abuse potential.
- The original clinical guidance had children take stimulants only on school days with weekends and summers off (drug holidays), now rarely followed.
- Modafinil can cost $25 a pill or more than $1,000 a month, while armodafinil is far less expensive.
- Stevens-Johnson syndrome, a rare and sometimes fatal skin condition, was flagged in a modafinil ADHD trial and limits its approval.
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