ive never made a post before sorry ill try my best 
In outpatient practice I inherit or get a lot of new patients that were on stimulants for reported ADHD that are either retired or chronically unemployed their adult lives (many on disability for one reason or another, sometimes questionably). Obviously, many are resistant to coming off stimulants. In these scenarios I try my best to assess any ongoing necessity for this - for instance people getting in MVAs because their ADHD is do bad when unmedicated. The people I'm speaking up mostly sit at home watching TV and aren't doing anything cognitively demanding. They'll often complain of poor motivation even with stimulants. I also discuss diet, exercise, sleep schedule, and try to maximally treat psychiatric comorbidities. In my mind, potentially forgetting to finish the laundry or run an errands isn't worth the risks of taking a stimulant in perpetuity. How do you all handle this discussion? I try to give everybody a fair shake, but I'm sure my skepticism shows through in this paragraph.
I could get on my soap box about overdiagnisis and oversaturation of ADHD in the clinic setting, but I'll leave that for another time.
this was the original post, and a lot of "fellow psychiatrists" and patients chime in 
for those who admit they arent a professional, i will mark them in bold 
I just had 6months off work and I tried to not take my stimulants because of this type of thinking "why bother, you're not working" but turns out ADHD affects more than work !? I was frustrated and unproductive without it, unable to initiate tasks. I eat well, exercise, go to therapy blah blah blah. Your patients might need it to function at baseline.. even that boring life of watching tv, doing chores, not having anger outbursts or sensory meltdowns.
My advice would be ask for a trial of a lower dose but make them keep an activity / mood diary to track tangible difference. Or switch from long acting to short acting so they can use it for targeted activities. But also, just try ease up on the capitalist mindset that work is the only legit reason for meds.
the op replies, earning himself 9 downmarseys:
I understand where you're coming from. I've had patients and close friends that can't function daily without it. So I know it happens. Regarding jobs, I meant more from a highly cognitively demanding standpoint, not really a productivity thing. Thank you for your input!
another person replies, earning themselves 17 downmarseys 
"anger outbursts or sensory meltdowns."
Anger and sensory meltdowns are not ADHD symptoms and stimulants are not the solution
to interrupt, you might be wondering 
why its a problem to just give someone ritalin or something forever
to keep it simple, stimulants, which are usually a form of amphetamine, put a lot more strain on our bodies cardiovascular system 
long term use can eventually lead to issues with your heart
to be less medical, 
high doses, which are increasingly common with internet or phone doctors, can make you feel very irritated, on edge, and wired, possibly making things like anxiety much worse! it is an amphetamine after all 
so someone who doesnt do anything with their life that ADHD might interfere with (i.e, being unemployed), you are just damaging their heart and their wallet slowly overtime for something with little therapeutic benefit 
anyway 
Assuming they stay unemployed (stimulant or not) and the stimulant improves quality of life (employed or not), I don't see the point of making this distinction apart from a moral value judgement. If the stimulant isn't helping that should be addressed but that's a separate issue from whether they're employed or not. Surely the goal is to improve quality of life, with employment hopefully being a consequence of that? Not the other way around.
unsurprisingly, a patient thinks this is a moral judgement and totally unfair 
If i give a stimulant to 100 people, ADHD or not, I'd bet good money more than 90 of them would say they feel better and are more productive. It doesn't mean everyone should get adderall if they want it and feel better.
op got downmarseyd again for this
Of course, when I say improving quality of life I mean correcting the reduced quality of life caused by the disorder. Presumably the reason you prescribe stimulants to people with ADHD is because the benefits outweigh the risks for them and not the general population. Either way I don't see how your reply addresses why employment is a factor in this
a patient still doesnt understand why keeping someone on drugs forever might be a bad idea. then again, they are a 19 year old posting on drug subreddits and about adhd quite a bit so, im sure you know the kind of person they are
Your use of productivity in this way seems inconsistent with treatment standards. Is there a reason you're not examining the degree of improvement to life domains? Your proposed metric seems biased towards puritanical ideas.
When my patients talk about "not getting anything done", that counts as productivity (chores, errands). People are really trying to roast me on this $ and capitalism ideal I made no mention of. Part of my job is to minimize risk, I'm trying to do that job the best I can. That includes difficult discussions with people about controlled substances.
You didn't answer my question.
I stand by my position that you're using a puritanical lens here rather than the standard of treatment (to weigh the benefit to their life domain functioning versus the risks). Whether someone is working or not is irrelevant. Considering you based your question on something that you've failed to explain the relevance of is the basis of the judgment you're receiving, IMO.
I've explained time and time again in this thread that not all people need stimulants when they're not doing something that they need maintained attention and concentration. Examples being work and school. This has nothing to do with morals or whatever you're getting at. The standard of treatment is to balance risk/benefit. When you prescribe stimulants, how do you manage it?
"I've explained time and time again in this thread that not all people need stimulants when they're not doing something that they need maintained attention and concentration."
That is the problem. Life is dimensional, not categorical. Your thinking that someone needs stimulants (or doesn't) based on sufficiently intensive tasks completely ignores the benefits of stimulant treatment to their life domains outside of what you have judged as meeting your identified threshold.
"This has nothing to do with morals or whatever you're getting at."
I find it utterly chilling 
that you still have been unable to even begin to understand my point, especially considering the complete absence of attempts on your part to clarify your understanding. You don't get it and you've demonstrated no interest in changing that. You seem utterly emblematic of paternalistic medicine.
Learn more about the ADHD experience. You're overly invested in your own viewpoint. I'm signing off of this conversation. Good luck.
by the way this guy prescibes adderall to a guy who smokes weed daily so 
op tries one final riposte, but the downmarseys are too strong:
I'm talking about having a discussion with patients about why they may or may not still need their meds after a dramatic change in lifestyle. If you think that doesn't warrant a discussion about medications, you're mistaken. Yes, I use my judgment and my thresholds to prescribe. That's how my job works. If I left my prescribing entirely up to my patients, I'd be really bad at my job. Adderall and Xanax for everyone!
almost the entire thread is against OP here, and seem to think those with ADHD are some sacred cow you dare not deny their meth
You're fixing something that isn't broken.
I used to think when I was a younger psychiatrist that people who are unemployed or don't have a job should not be prescribed medication for ADHD. Don't they just sit around all day? But I started looking at each case with more nuance.
Sometimes, these people with ADHD, although unemployed or retired, have significant problems with irritability, insomnia, and are at higher risk of abuse of substances when they are not receiving treatment. Forgetting all their grandkids, kids, and spouses birthdays and anniversaries and forgetting important medical appointments also can cause them significant problems in their lives.
TLDR: If the patient's social or occupational functioning is impaired, I treat ADHD, whether they have a job or are in school or not.
when you cant eat or brush your teeth because you dont have your meth 
this reply annoys me a little specifically, its really common with ADHD discussion online to mention 'irritability' being common with ADHD sufferers (it sort of is), and that stimulants will somehow improve that situation
it can quite often do the opposite! adverse affects are so commonly ignored in discussions and even by those that prescribe it themselves
common sense would tell you this but its controversial at this point to believe it might not be some miracle drug for every problem in someones life when they have some level of executive dysfunction 
The idea that you need to be producing value for share-holders in order to earn treatment for your mental health problem is a very dystopian take, IMO.
What an unhinged comment. Productivity does mean making money. It can be chores and errands. Many people can manage fine without stimulants when not working or in school. I'm not talking about their contribution to society. I wanted to know how other mental health professionals approach this. I don't know what's with these capitalism witch hunt comments. We have a duty to assess risk/benefit. That's all
ADHD impacts many areas of life, even in patients who are not working. If you explain the risks and benefits, and they want to continue, why fight them? It seems like you're assuming that this particular patient population has the same values as you do, which is probably not the case. Your job is to treat illness and reduce suffering, not to be a stimulant cop.
stimulant cops 
there is a bit more in the thread, and more comments rolling in because its a fairly fresh thread, these discussions often go this way online about ADHD 
this is my first post i hope i did it right 
thanks for reading
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Taking stims without anything productive to do is a one way ticket to ruining your life. There was a foid on here (I forget their name, probably not worth remembering) that would take stims and spend hours writing tons of bullshit for no reason. It was incredibly obvious she was taking so much she went into some kind of hypomania. And she's probably still a loser, while also fricking up her dopamine system with nothing to show for it. Hopefully pizza learned from her.
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Darn I think this post is about you
@tempest !besties 
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!besties explain the @tempest-
@gaslighter beef to me
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And after that, someone (unironically) explain the
@August - 
@gaslighter beef to me !metashit
https://rdrama.net/search/posts?q=gaslighter+author%3Aaugust
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And
@gaslighter is a gross moid.
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My experience with prescription stimulants - as someone with a chronically bad attention span (more likely due to bad diet and lifestyle) - is that too high of a dose makes me focus, yes, but it also makes me sweaty, jittery, and too unhinged to be in a workplace (my job involves talking to ppl, I'm not an IT strag w/ permanent WFH). Too low a dose doesn't actually improve focus or motivation and instead just takes away my appetite which isn't a side effect I require (I'm not a whale).
I suspect that the people who say ADHD diagnosis and stimulant meds "changed their life" and now they "know how normal people feel" are actually just dosed way too high, are riding a meth-like wave, and instead are just terminally lazy at baseline
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In particular the widespread usage of stimulants for ADHD and benzodiazepines for anxiety are going to be looked upon as utterly insane in the future.
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Yep. Exactly how we mock the 50s for going crazy on Valium
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I think ADHD meds can help transforms half-r-slurs into hardworking half-r-slurs which has some value to them., and is rewarded in academic settings. In grad school no one manages your time /output so if you can achieve the same results with Adderall and 3x the time you can make it all the way to tenure.
Well, it's not the "same" results. Their stuff is still dumb and over refined but the half r-slurs that have already powered through primarily want to recognize / reward effort over all else.
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Yeah pretty much most people who "need" adhd meds are just clincal druggies. I'm of two minds on it 'cause hey you're getting shit done, i guess, but also, you've enslaved yourself to pharma companies.
I also don't trust there won't be long-term side effects.
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20+ marseys,
, a dozen links, dunks on amphetamine addicts (some may show up in the comments here 
)
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thank you for the support
as for the addicted, this will only increase as the years go on, with the general belief that ADHD is "under diagnosed"
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WHAT RISKS, b-word? METH IS fricking GOOD FOR YOU, motherlover!
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Fakecels hire a lawyer. True regards are too busy eating paint chips.
I saw a clip online of one of those court shows where a guy was on disability. A woman was sueing him, but had been letting him stay with her in exchange for housework (lol). The scrote argued his work meant he didn't owe her anything so he really wanted to emphasize how much he did. The judge baited him masterfully by having him list off all the chores he did. He didn't even see it coming. Then she's like "So you can do all that, but you're on disability?"
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Found it
I forgot some details. It's even more weird and pathetic than I remembered. She let this dusty fresh out of prison take care of her daughter
And he had 4-6 (he doesn't know) kids of his own he had to put up for adoption. It was dismissed though because the yt woman was also r-slurred.
!nonchuds this should be required viewing for our yt supremacist chuds. Disgusting crackas.
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I still love that blog post from a white supremacist who moved out of the city and into a rural area only to find out that he was surrounded by white trash and hated it:
https://newaltright.substack.com/p/why-im-no-longer-a-white-nationalist
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but what if they really are on the couch bc no one thought to give them diet meth
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they need to just legalize it already
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Make all drugs OTC and let God sort out the rest
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/r/psychiatrist
actual licensed psychiatrists
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All fats
should be prescribed stimmies 
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Snapshots:
https://old.reddit.com/r/Psychiatry/comments/1fln17n/stopping_stimulants_in_retiredchronic_unemployed/:
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In outpatient practice I inherit or get a lot of new patients that were on stimulants for reported ADHD that are either retired or chronically unemployed their adult lives (many on disability for one reason or another, sometimes questionably). Obviously, many are resistant to coming off stimulants. In these scenarios I try my best to assess any ongoing necessity for this - for instance people getting in MVAs because their ADHD is do bad when unmedicated. The people I'm speaking up mostly sit at home watching TV and aren't doing anything cognitively demanding. They'll often complain of poor motivation even with stimulants. I also discuss diet, exercise, sleep schedule, and try to maximally treat psychiatric comorbidities. In my mind, potentially forgetting to finish the laundry or run an errands isn't worth the risks of taking a stimulant in perpetuity. How do you all handle this discussion? I try to give everybody a fair shake, but I'm sure my skepticism shows through in this paragraph.:
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I just had 6months off work and I tried to not take my stimulants because of this type of thinking "why bother, you're not working" but turns out ADHD affects more than work !? I was frustrated and unproductive without it, unable to initiate tasks. I eat well, exercise, go to therapy blah blah blah. Your patients might need it to function at baseline.. even that boring life of watching tv, doing chores, not having anger outbursts or sensory meltdowns.:
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I understand where you're coming from. I've had patients and close friends that can't function daily without it. So I know it happens. Regarding jobs, I meant more from a highly cognitively demanding standpoint, not really a productivity thing. Thank you for your input!:
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"anger outbursts or sensory meltdowns.":
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Assuming they stay unemployed (stimulant or not) and the stimulant improves quality of life (employed or not), I don't see the point of making this distinction apart from a moral value judgement. If the stimulant isn't helping that should be addressed but that's a separate issue from whether they're employed or not. Surely the goal is to improve quality of life, with employment hopefully being a consequence of that? Not the other way around.:
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If i give a stimulant to 100 people, ADHD or not, I'd bet good money more than 90 of them would say they feel better and are more productive. It doesn't mean everyone should get adderall if they want it and feel better.:
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Of course, when I say improving quality of life I mean correcting the reduced quality of life caused by the disorder. Presumably the reason you prescribe stimulants to people with ADHD is because the benefits outweigh the risks for them and not the general population. Either way I don't see how your reply addresses why employment is a factor in this:
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In my job we had a rise in candidates claiming to be ADHD until they realised it wasn't helping their case. Now the numbers
have dropped 
significantly.
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Pretty sure legally the job is mostly being a stimulant cop.
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I take baby doses of Adderall (7.5mg) because I'm just trying to correct ADHD fatigue other treatment doesn't work for anymore because I'm old. People taking absurd amounts is bizarre to me, if I can't eat/nap on a dose I know it's too high and I need less.
I have no problem with the pharma slop, it helps lots of people, but the levels of pure entitled cope about ADHD is insanity. If ADHD is fricking with my life I'm going right to the doctor to fix it, I'm not whining on reddit about how hard it is or trying to make excuses about how hard life is. There are people who get fricking disability for ADHD, they need their parents to beat the shit out of them not meth and gibs.
I'm guessing that guy is frustrated at that but can't say that. Otherwise what he is saying looks like he shouldn't be practicing, I have a harder time with things that don't require cognitive load like Vidya and TV as my mind wonders so I have no idea what's going on.
Playing some goyslop EA and then your mind wonders to planning the perfect r*pe and how it would have been awesome to live 1200 years ago where you could be a traveling priest who r*pes and then has the foids put to death is pretty tiresome.
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Mommy is soooo proud of you, sweaty. Let's put this sperg out up on the fridge with all your other failures.
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is it scary to have these kind of thoughts or just mundane
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It sounds like a terminal gooner's version of wanting to murder a slow driver on the highway.
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You don't ever think about how you would commit perfect crimes (in Minecraft) and how different eras would have influenced your strategy?
It's like the thought version of the floor is lava but with an extra dimension.
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Uhhhh... this person thinks they have ADHD?
/u/Pickled_banana_90, you are an r-slur and a loser. Keep yourself safe now.
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I'm looking forward to these bros who think all social contribution is bad because capitalism discovering how sympathetic the apparatchik is when the tractor factory is running behind because of their 'executive disfunction.'
Be sure to pack sweaters for the gulag
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