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.
The gist
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.
Big reveals
- 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.
Things 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.