Adderall, Stimulants & Modafinil for ADHD: Short- & Long-Term Effects | Huberman Lab Podcast

In this episode, I explain how medications such as Adderall, Ritalin, Vyvanse and other stimulants work to increase focus and treat attention-deficit/hyperactivity disorder (ADHD). I explain the brain circuits involved in focus and the key roles dopamine and norepinephrine play in their regulation. Then I explain how stimulants such as Adderall and Vyvanse can increase focus and reduce hyperactivity in kids or adults with ADHD, and how and why Ritalin and other medications (e.g., Modafinil, Guanfacine) may work better for some. I explain the long-term effects of ADHD medications on height, cardiovascular health, hormones, predisposition to addiction and psychosis, and whether these treatments can be used and then stopped. I also discuss the immense individual variation in dosage sensitivity for these medications and the negative side-effects that occur from recreational use. This episode ought to benefit anyone with ADHD, their parents, those on ADHD medications or anyone curious about how these medications work.

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Timestamps
00:00:00 Stimulants & Attention-Deficient/Hyperactivity Disorder (ADHD)
00:03:21 Sponsors: Maui Nui, ROKA, HVMN
00:06:35 The Brain-Body Contract
00:07:22 Attention, Prefrontal Cortex & ADHD
00:16:27 Stimulants “Sympathomimetics”
00:21:29 Adderall, Dopamine & Norepinephrine
00:25:58 Sympathomimetics, Dopamine & Norepinephrine
00:31:05 Sponsor: AG1
00:32:20 Vyvanse is Timed-Release D-Amp
00:36:36 Ritalin, Concerta
00:40:10 Dopamine & “Noise Reduction”; Norepinephrine & “Signal Amplification”
00:45:28 ADHD: Focus, Hyperactivity & Impulsivity; Drug Selection & Dose
00:50:57 How do Stimulants ‘Calm’ ADHD?
00:54:48 Neuroplasticity & Neuromodulators
00:58:06 Kids, ADHD Diagnosis & Treatment; Predispose Addiction?
01:04:02 Sponsor: InsideTracker
01:05:12 ADHD Medications: Individuality, Doses, Tapering & Long-Term Use
01:13:28 Medication & Long-Term Effects: Height, Cardiovascular Risk, Alcohol
01:19:32 Cortisol & Hormones
01:27:45 Psychosis & Addiction; Methamphetamine
01:38:20 Recreational Use, Addiction & Psychosis; Habituation
01:42:30 Drug Holidays; Ritalin & Long-Term Effects
01:45:35 Modafinil, Armodafinil; Side-Effects
01:53:03 Guanfacine, Alcohol
01:58:03 ADHD Medications
02:00:26 Zero-Cost Support, YouTube Feedback, Spotify & Apple Reviews, Sponsors, Momentous, Social Media, Neural Network Newsletter

[benjaminbrown]

Shoutout to those of us who had to rewind the video because we lost focus and zoned out!

[FlippinFruitFly]

Felt the need to add this as well: No doctor (at least in my country) is going to take their time and explain all of this to their patient. Thank you for putting out this for the public.

[jonnyjonny]

The irony of a two hour podcast discussing adhd stimulants .

[marianokirco]

I just discovered this man, i live is Spain, im just a regular guy, electrician, and waiter before, but i can notice this man is great, full of knowledge, and he speaks so clearly and straight, i start to follow him, and at the same time practice my poor english language, congratulations to you Doctor, youre amazing 👍👍👍

[DonnDenisse]

I was actually diagnosed with ADHD few years ago. Also suffered severe depression and mental disorder. Not until my wife recommended me to psilocybin mushrooms treatment. Psilocybin treatment saved my life honestly. 6 years totally clean. Never thought I would be saying this about mushrooms.

[metta]

Sometimes the timing Huberman has to upload things I suddenly want to know is pretty scary.

[Yuzushuu]

Great episode!! My partner has ADHD and wasn't diagnosed properly until he was 28-29 years old because his parents had a stigma against the medication when he was a child. He managed to get through and excel in his masters, but only through self-medicating with caffeine, smoking and alcohol which was detrimental to his physical health. Now he's doing his PhD with medication, he's off the drinking and smoking, exercising more, eating better, and it is a complete world of difference for him.

[labsanta]

Here are the key highlights from the discussion:

• Stimulants like Adderall, Ritalin, and Vyvanse are commonly prescribed to treat ADHD. They work by increasing neurotransmitters like dopamine and norepinephrine.
Adderall, Ritalin, and Vyvanse are stimulant medications commonly prescribed to treat attention deficit hyperactivity disorder (ADHD). They work by increasing the neurotransmitters dopamine and norepinephrine in the brain.

Dopamine helps treat the core symptoms of ADHD in a few ways:
Noise reduction:
By boosting dopamine levels, stimulants can help suppress distracting thoughts, stimuli, and urges. This helps "reduce noise" in the brain and improve focus.
Signal amplification:
Norepinephrine helps amplify relevant signals that the individual needs to pay attention to. This improves the brain's ability to detect important stimuli and direct attention appropriately.
Neuroplasticity:
Increased dopamine and norepinephrine levels promote neuroplasticity, which helps strengthen and "train" the brain circuits involved in attention, focus and impulse control. This can provide lasting benefits even after medication use ends.

So in essence, stimulants work by optimizing the balance of neurotransmitters in the brain to alleviate the core symptoms of ADHD: inattention, hyperactivity and impulsivity. The "calming" effects come from the brain's increased ability to filter out irrelevant stimuli and focus attention where needed.
This is a simplified overview of the basic mechanisms of how stimulants work to treat ADHD. Let me know if you have any other questions!


• Increased dopamine helps reduce "noise" in the brain by suppressing distracting thoughts and stimuli. Increased norepinephrine helps amplify relevant signals to improve focus.
Here are some additional details on how dopamine and norepinephrine contribute to improved focus in ADHD:
Dopamine:
• Dopamine increases the signal-to-noise ratio in the brain. It helps tune out irrelevant background thoughts, stimuli, and internal sensations. This "reduces noise" to improve focus.
• The prefrontal cortex uses dopamine to inhibit distracting activity in other parts of the brain, like the default mode network. This allows for more targeted attention.
• Higher dopamine levels allow the brain to shift attention among relevant stimuli or tasks more easily. This supports aspects of executive function like task switching.
So in general, dopamine helps suppress distractors to boost the "signal" the individual needs to focus on.
Norepinephrine:
• Norepinephrine activates the salience network in the brain, which detects important stimuli that demand attention.
• It amplifies relevant signals at synapses to strengthen communication between neural circuits involved in focus and attention.
• Norepinephrine is thought to help sustain attention on important tasks over time by optimizing cognitive performance.
Together, dopamine and norepinephrine work in complementary ways:
• Dopamine helps reduce noise and distractors, while norepinephrine boosts the salience of relevant signals to improve focus.
• The right balance of these neurotransmitters, as achieved with stimulant medications, helps individuals with ADHD better direct and maintain their attention on important tasks and information.


• The dosage needs to be individualized and closely monitored. Too high of a dose can cause side effects like anxiety, psychosis, and cardiac issues.
Dosage:
• There is tremendous individual variation in the optimal dosage of ADHD stimulants for different people.
• Some people require very low doses (e.g. 2.5 - 5 mg of Adderall), while others need much higher doses (up to 100+ mg for Vyvanse).
• The general approach is to start with the lowest effective dose and increase gradually as needed based on response and side effects.
• Weight-based dosing is used as a rough guideline, but actual dosage requirements vary widely and are determined by testing different doses.
Side effects of high doses:
• Too high of a stimulant dose can cause side effects like:
- Anxiety
- Insomnia
- Irritability
- Increased blood pressure and heart rate
- Psychotic symptoms (in susceptible individuals)
• High doses can also lead to addiction,  abuse potential and drug seeking behaviors.
• Peripheral effects like suppressed appetite,  weight loss, headaches and tics may also occur at excessive doses.
• Some individuals become tolerant to higher doses over time, requiring even higher amounts to achieve the same benefits. This increases risk of side effects.
Key takeaways:
• The optimal stimulant dose for ADHD treatment is the lowest effective amount that:
1. Significantly improves symptoms
2. Is well tolerated
3. Does not cause unwanted side effects
• Close monitoring of dose, response and side effects by a psychiatrist is critical, especially as doses change over time.
• Individualizing dosage based on a patient's needs, biology and characteristics can maximize benefits while minimizing risks.
Hope this expanded explanation of dosage and side effects provides useful additional context! Let me know if you have any other questions.


• Taking stimulants during development can help "train" the brain circuits involved in focus and attention. But they must be used judiciously to avoid long-term issues.
Benefits of early treatment:
• Taking stimulant medications during childhood and adolescence can promote neuroplasticity in the brain circuits involved in focus and attention.
• This "training" effect can help strengthen these circuits and establish better functioning even after medication use ends.
• Early treatment of ADHD with stimulants has been linked to:
- Improved executive function and cognitive performance
- Better school outcomes
- Higher rates of high school and college graduation
- Less severe ADHD symptoms over the long term
Potential risks of early use:
• Excessively high or prolonged doses of stimulants during development could potentially:
- Impact growth and development
- Disrupt the endocrine system
- Increase risk of substance abuse or addiction
- Lead to behavioral or sleep problems
• However, properly monitored and appropriately dosed stimulant treatment during childhood does not appear to significantly increase these risks.
Key considerations for early treatment:
• Monitoring growth, sleep, hormones, mood and behavior is important when using stimulants during development.
• Starting at the lowest effective dose and gradually titrating upward based on response and side effects can help maximize benefits while minimizing risks.
• Periodic "drug holidays" were originally recommended to allow the brain to normalize, though this practice has fallen out of favor recently.
• Combining medication with behavioral therapies and lifestyle modifications may produce the best long-term outcomes.
• Stimulant treatment during development should generally continue as long as it significantly improves symptoms and functioning without major side effects.
In summary, while stimulants carry some risks during development, properly monitored and appropriately dosed treatment appears to provide neuroplasticity benefits that can last well beyond medication use - especially when combined with behavioral interventions. However, judicious and individualized use is essential to minimize potential harms.
• There are risks of abuse and addiction with stimulants, but properly prescribed and monitored treatment for ADHD may actually reduce those risks compared to untreated ADHD.
• Other options like Modafinil, Armodafinil, and Guanfacine are also used off-label to treat ADHD. They work through different mechanisms.
• Combining drug treatments with behavioral interventions tends to be the most effective approach for managing ADHD.
• Regular check-ins with a qualified psychiatrist are important to determine the right medications, dosages, and monitoring of side effects over time.
In summary, stimulants and other drugs do have a role to play in treating ADHD when used properly. But careful consideration,  dosage adjustment, and combination with non-drug treatments are critical to minimize risks and maximize benefits.

[Jennifer-bwku]

Psychedelics are just an exceptional mental health breakthrough. It's quite fascinating how effective they are against depression and anxiety. Saved my life.

[berkowitzgil]

Huge service to the ADHD community. You summarise so much neurobiology into precise illuminated explanations. Your advocacy for ADHD in the popular podcast sphere is essential! 🙏

[bunnerkins]

I was an adult in my 30s when I was diagnosed. I was referred to a psychiatrist for depression. I waited 6 months for my appointment and when I went I thought I knew exactly what was going to happen. They were going to say I'm depressed and prescribe anti-depressants and recommend therapy. At the end of that first appointment, when my psychiatrist said "I think you have ADHD", I laughed out loud in his face. It was the LAST thing I was expecting to hear. I could not believe it. Being medically treated for ADHD changed my life. It was like I was experiencing the world for the first time. A fog I had never seen before was lifted off of me. I have been very lucky in my ADHD journey in that I have not experienced the many hurdles and horror stories I've heard from other people with ADHD, but I have certainly had difficulties. Getting the diagnosis was the easiest part.

For a time my prescription was 80mg Vyvanse daily. One time I couldn't get into my regular physicians office for a refill, because I left it to the last minute, so I went to a drop in clinic. And despite living in a country with socialized healthcare where health records have standardized access to all providers (the physician could verify my prescription history and diagnosis), this physician would not prescribe me the 80mg dose that I was currently on. To justify this decision, he brought out this little promotional card made by Vyvanse, and showed me where it said 70mg was the highest recommended daily dose. So he prescribed my 70mg. He didn't need to show me the promotional card because I knew the real reason. He risked being audited by his college if he refilled my prescription at the dose I was on.

For the first three years I had to physically go into my physicians office every single month for my prescription. I was a clinical researcher in my 30s, multiple university degrees, no legal or substance abuse history, and for 3 years they treated me like the primary risk of my condition was drug accountability. Now I am nearly 40 and I have been granted the comfort of a physician refill for 3 months at a time. I confronted my physician about this on my last visit. I said that I am going to have ADHD for the rest of my life. Are you really going to have me come into this office every 3 months when I'm 80? Yes. The answer was yes.

I have an American friend with ADHD, and he recently told me that he is required to submit a urine test, every month, before his provider will issue a prescription. He was told this was to make sure he was taking the full dose. But we all know the real reasons. It's unconscionable.

Being diagnosed with ADHD has improved my life, but being treated like a drug dealer for no other reason than complying with treatment for my condition has challenged me.

[TBotkinPMHNP]

I'm a psychiatric nurse practitioner specializing in the treatment of children and adolescents. This podcast episode was far more informative and immediately applicable than any lecture series or graduate-level course I have thus far attended. I am not surprised, as Dr. Huberman is a phenomenal teacher, but I am exceptionally grateful for all the easy-to-understand examples he puts forth in this episode that I can utilize starting today to help patients and their families better understand this disorder and available treatment options. Thank you, Dr. H!

[michelleking]

Thank you so much for this in depth review. I was diagnosed with ADD(ADHD) in second grade. I tried different medications over the years. Ritalin made me want to hurt my parents and Adderall gave me short term psychosis, even on a low dose. I have found other tools over the years to help me cope with my ADHD instead and personally respond really well to just a little caffeine, diet, exercise and sleep. My thoughts are with anyone who deals with this. You are not stupid your brain just works differently than others. 💙

[marissacarlson]

I have been extensively researching ADHD for 4 years after (finally) being diagnosed at 38 yr old. Inattentive ADHD in the female population is just now getting the attention it deserves. To hear the latest and greatest research is so helpful as it helps me understand the why behind the what and helps me be my own advocate with my doctors. Thank you for this amazing and valuable content!!

[jdk]

Im on Vyvance 70mg, prescribed in my 30's after a lifelong time of untreated ADHD. Its been a life saver and changed my life incredibly.

[robbiedread]

Thank you, Andrew. I am 57 and was diagnosed in June this year. I'm a retired teacher and always suspected I hd add due to my experience with students with add as well as all the PD I've received on the topic. The diagnosis and resulting treatment has absolutely changed my life. Beyond quieting the chatter in my head and improving my executive function, it has completely eliminated my sugar cravings. It'd truly been incredible. Thank you for this lecture.

[lilytea]

0:23: 🧠 Stimulants for ADHD treatment target specific brain networks involved in attention and focus.
10:06: ✨ Stimulant drugs used to treat ADHD improve symptoms by enhancing the prefrontal cortex's ability to suppress and enhance the activity of different brain networks.
20:17: ⚡ Adderall is a potent sympathomimetic drug that increases the activity of dopamine and norepinephrine in the brain, resulting in increased motivation, focus, and alertness.
31:16: 💊 Different drugs like Adderall, Vyvanse, and Ritalin increase dopamine and norepinephrine levels in the brain to improve focus and attention.
49:04: ✅ ADHD is a complex condition that involves challenges in focusing on various tasks, and the use of stimulant medications like Adderall and Ritalin can help increase dopamine and norepinephrine levels to reduce distractions and improve focus.
52:08: 🧠 The use of stimulant drugs like Adderall and Ritalin in the treatment of ADHD is not just about increasing neural activity, but about tuning the amount of dopamine and norepinephrine in specific brain networks to achieve the right balance of activation and synchronization.
1:03:08: 💊 Treatment of ADHD involves a careful diagnostic evaluation, consideration of both pharmacological and behavioral treatments, and monitoring of nutritional and supplementation aspects.
1:13:39: 🧪 The use of drugs like Adderall, Ritalin, and Vyvanse for ADHD treatment does not appear to negatively impact height or growth, but long-term elevation of sympathetic nervous system activity may carry some cardiovascular risk.
1:23:24: ⚠ The timing of cortisol release is key, as late day elevations in cortisol are a strong correlate of depressive symptoms.
1:33:53: ⚠ ADHD drugs, such as Adderall and Vyvanse, have a higher likelihood of inducing psychosis in individuals with a predisposition, but the overall incidence of psychosis is still fairly low.
1:44:06: 💊 Different drugs are used to treat ADHD, with methylphenidate being the most studied, followed by modafinil and guanfacine.
1:54:23: 🧠 Guanfacine is a medication used to treat ADHD by stimulating the alpha 2A system and activating pathways that dampen down the sympathetic nervous system.
Recap by Tammy AI

[emilyceloa]

I finally found a provider who actually listened to me and what I’d been struggling with my whole life, I had all the “potential” but never met up to it… I was called lazy among many other things. I couldn’t complete tasks and attempting college was an impossible task for me. My doctor encouraged me to get testing done and sure enough… adhd… it was hard at first grieving all the perceived wasted time I didn’t know or beat myself up over and over feeling like a constant failure. My doctor and I have worked to find a great combination of prescriptions that have completely turned my life around. I’m way more productive, I don’t miss things at work, I have a greater desire to exceed at my career. I have completely reframed my internal negative beliefs about myself and I’m able to feel accomplished when I complete things that used to be the biggest mountain to climb. I really enjoy digging into the science and understanding of my diagnosis and I really enjoyed this video. Thank you so much for providing this content.


Side note, where are my fellow adhd folks that listened to this on 2x speed and multitasked so we wouldn’t lose interest 😂😂

[nikita]

Would be cool to also touch on or hear about the dangers of undiagnosed or untreated ADHD. How those stack up against the negatives of these medications.

Great video!

[mmasimi]

As a provider who diagnoses and prescribes these medications, thank you, I’ll be sharing this video with my patients. This is such a wealth of knowledge.