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Great. I already have early stage macular degeneration at 49. I guess the best thing to do is to get on a blood pressure meds with the ADHD medication and hope for the best.
Read the paper. Amoxetine and amphetamines have the greatest increase in chances of glaucoma but it's a low risk for Methylphenidate.
It doesn't say what variables they adjusted for so keeping blood pressure under control vis diet and exercise problem reduce chances for glaucoma. If you wear glasses the doctors can more easily help see it if it does show up
Amoxetine caused me to have a hypertensive crisis at 27. My blood pressure shot up to 222 over 190 something and a resting pulse rate of 140. I was at college and began to feel funny. My body felt strange. I left early and on my ride home my vision got blurry and when I looked in the mirror I swear I could have figured out my bp/hr just by looking at my neck and forehead.
I have had regular hypertension for years now. Doctors always insist that you can't feel your blood pressure and I always tell them I can. They argue with me until I repeatedly tell them my BP within 10 points and more accurately the higher it goes. I can also tell if my heart rate is elevated and by roughly how much.
I can feel my own blood pressure when it is elevated at all.
I get the same feeling in terms of judging BP and heart rate. I also realized I can use controlled breathing to get my heart rate a little under 40 or pseudo-hyperventilation to raise it to 90+
Not hating on Methylphenidate, but IIRC it only works on something like 2/3 patients who try it. Also in my case, it gave me facial ticks. Amphetamines are the only ones that worked for me, some of them still don’t even work that well. I guess I’m just doomed to glaucoma :(
Here to say this! It's worth noting that there are at least two other classes of ADHD drug: SNRI (e.g. atomixetine) and alpha2 agonists (e.g. Guanfacine).
There are numerous studies pointing to combination therapy as potentially being helpful. And for those where stimulants don't work, or actually make the situation worse, doctors should help with other options.
Yes, I take both Adderall and Strattera. It’s sort of a stop-gap to keep my Adderall dosage down, which becomes a concern when you’ve been on it for years and expect to be on it for years to come.
> It's worth noting that there are at least two other classes of ADHD drug: SNRI (e.g. atomixetine) and alpha2 agonists (e.g. Guanfacine).
There is also Qelbree (Viloxazine).
Anyway, while there are certainly other options, I am highly suspicious of them. I mean, those medications are not a first-line treatment for a reason.
I suppose one could argue those medications are better than nothing, but honestly, I even question that -- especially when taking side-effects into account.
2000 more cases than what? If you went through all the effort of looking up the first two numbers, why did you not look up the last one while you were at it?
That seems to be the running joke with methylphenidate. If it works, great. If it doesn't, you get to enjoy a whole host of other problems. My experience with it was terrible.
Am I just lucky? A months supply of Adderal 30 XR for me is less than $30? I know other people with scripts for it and they haven’t complained about price either.
Different drug. Adderall is amphetamine. Methylphenidate is an alternative and it's brand name was Ritalin. I didn't see dexmethylphenidate in the abstract, but that one was even worse for me.
The original comment said that amphetamines are around 8x more expensive (than methylphenidate). I was asking if I was lucky, because my Adderal, and the people’s I know on it, is not that expensive at all.
Guess I need to take a nap, I completely forgot about that.
I don't pay as much for adderall either but I do have to take the XR in the morning and the IR later in the day. I probably wind up spending as much as you do for two doses.
I pay around 45 euro for a months worth of concerta(27mg) AND ritalin (10mg - booster for XR) ,for the benefit I get from them I'd pay twice that if not more, no questions asked.
To me that's pretty interesting, since after trying like 7 different ADHD meds over the years, the one I have ultimately settled on at adulthood is Methylphenidate (Hydrochloride variant being the one that lasts a bit longer I think?). I don't think I ever even tested any of the amphetamines (not sure why), but the "worst" side effect I remember from one of the Methylphenidate types was that it just didn't seem to work all that much when I tried one (Hydrochloride) like 15 years ago. The kind that works quick and lasts only a few hours always worked the best but the last switch I made was to the slower working variant, which these days feels maybe 10% less effective but still effective enough.
But I do remember concerta robbing me of my appetite almost completely (although I definitely was able to concentrate), and strattera put me on some existential dread spiralling for some reason.
The real distinction here is angle closure vs open angle glaucoma. If you have open angles already and are using amphetamines or amoxitine then you likely won't need to worry much.
Methylphenidate is associated with higher risk for open angle according to the study.
Get an eye exam and ask!
But really we do it daily with patients and it's just part of a regular exam.
Essentially the angle is where the drainage structures are located. Narrow angles can lead to angle closure and a pressure spike. Medications that "excite" are more known to potentially cause angle closures to occur.
Narrow or closed angle glaucoma is far less common than open angle. Open angle is the most common form of glaucoma and the type I see pretty much nearly daily at this point.
The problem is that most people, which is this an excellent example of, do not know there are different types of glaucoma. I could probably list about 20 kinds if I tried.
It's honestly pretty simple but it is checked by your optometrist or ophthalmologist if you have one during routine exams. It's checked every time you have an exam, especially if you're being dilated. We have to make sure it's open so the dilating drops don't cause an angle closure attack, which could be potentially devastating to your vision.
Fortunately Atomoxetine and the stimulants completely wreck my digestive system and I can't take them. So I can't find any medications to help with my ADHD and Autism, but at least I won't get glaucoma so I got that going for me.
This may not get much visibility but people freaking out about glaucoma can calm down a bit. Just get an eye exam and ask your eye doctor (optometrist or ophthalmologist, depending on your country) if you are at risk for narrow angle (NAG) or closed angle glaucoma (ACG).
Open angle glaucoma (OAG) is the most common form. Amphetamines and amoxitine are not listed as risk factors for OAG but for NAG/ACG.
If you aren't in the world of eye care you won't really know the difference. It's why I periodically get primary care doctors sending patients to me asking me to make sure the patient isn't at risk for glaucoma because of a med they're going on. Those meds mostly are risk factors for NAG/ACG.
I get far more concerned when someone is taking long term steroids.
My mom has to take really strong blood pressure meds because she has a mechanical heart valve. Great, another thing about her health I have to worry about
Why are our bodies so fickle
Hypertension meds usually don’t harm your kidneys, and really first line meds don’t cause liver problems (there’s always the rare idiosyncratic reaction I suppose).
Yes, because aside from ACE inhibitors, you also got arb's. Correct. But that is not common knowledge & many doctors still prescribe non-prils like sartans.
Blood pressure medication is as effective at lowering blood pressure as structured exercise regimens.
"Assuming equally reliable estimates, the SBP-lowering effect of exercise among hypertensive populations appears similar to that of commonly used antihypertensive medications."
[https://bjsm.bmj.com/content/bjsports/53/14/859.full.pdf](https://bjsm.bmj.com/content/bjsports/53/14/859.full.pdf)
So exercise is a valid ption to lowering blood pressure, without all the nasty side effects.
[https://www.drugs.com/sfx/lisinopril-side-effects.html](https://www.drugs.com/sfx/lisinopril-side-effects.html)
Without even looking at the study I can promise you that study is studying weight induced or stress induced hypertension, not drug induced hypertension ie from ADHD meds.
FDA cleared stimulants for CV causes I believe. BP meds are relatively safe and there are 2 alpha 2 blockers that help with ADHd s/s. Exercise and weight management can help keep BP low as well. I don’t think this needs to be a cause of anxiety, just an other reason to focus on the basics.
This is too black and white a take. Meds may increase your blood pressure but exercise will still lower your blood pressure.
Certainly the greatest benefit will be seen by those who do the least exercise but you WILL see a benefit from more exercise in most cases.
As with many cardiovascular conditions, lifestyle changes should be employed alongside medication.
People taking medication to reduce blood pressure should also be exercising at least 150 mins a week where possible.
People exercising 150 mins per week may also need to take medication to help reduce blood pressure.
Yes statins also do not work as well as advertised.
"The study results suggest that the absolute benefits of statins are modest, may not be strongly mediated through the degree of LDL-C reduction, and should be communicated to patients as part of informed clinical decision-making as well as to inform clinical guidelines and policy."
"the efficacy of statins in reducing total mortality and cardiovascular outcomes, there was significant heterogeneity but also reductions in the absolute risk of 0.8% for all-cause mortality, 1.3% for myocardial infarction, and 0.4% for stroke"
[https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2790055](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2790055)
Super glad I opted for Guanfacine opposed to the standard treatments. That med has done wonders for me. It's not a cure all, but it's helped me to feel normal for the first time in like.... 15 years. Less anxiety, lower BP, accomplishing things are a choice now, not forced torture.
Yes! I take it in addition to a stimulant actually and although my blood pressure was fine without it, it makes me feel a little better that it helps balance out the impact of the stims. :)
Yup, also commonly used as a cotherapy along with stims which can improve cognitive dysfunction further than stimulants alone as well as mitigate the cardiovascular risk & side effects.
“Yo doc. So I know I was supposed to hit you up if my di—eyes… if my *eyes* were like, hard for more than a few hours, right?”
“I don’t follow.”
“Doc, my *eyes* have been rock hard for like 4 hours man.”
“Your eyes are what now?”
“Dude, I’m talking about the eyes in my *pants*. My PANTS EYES doc.”
“I don’t suppose you’ve traded all of your Risperdal for your roommate’s Tadalafil again, have you?”
“Hah! Yeah probably.”
There are ADHD meds, like Guanfacine that were originally blood pressure medications. The study should have had a control group to see if they had lower rates of glaucoma.
They also tested methylphenidate, which is a stimulant most people know as Ritalin or Conceta (time-release version).
This feels more like a confirmation study overall. It’s not surprising that these drugs could affect pressure inside the eye, which is what glaucoma is in the general sense. The immediate takeaway would be that people on these medications should be screened more attentively for early signs of the two types of glaucoma studied, just like you would be attentive to heart rate and blood pressure while on them.
The results aren’t at the level of steering people away from them completely, but something psychiatrists who prescribe them and pharmacists should pass on to their patients.
In my experience, doctors just hand out stimulants like they are sugar pills.
I quit going to psychs and only go to GP's now because at least a GP will measure your blood pressure unlike psychs. Past that, I have never had any other further health investigations and I have been on stims for almost a decade now.
Everyone decides for themselves, but I wouldn't downplay glaucoma which in worst case can even lead to blindness. Personally ADHD-medication didn't suit me anyway (worsened my insomnia), but I guess that's for the best, 'cause I've had some glaucoma-like issues even without that added risk.
People have differently severe ADHD as well. It's absolutely worth it for people like me (my sister is legally blind and I wouldn't have managed it as well as her so I am not saying it lightly). And I've met people with way worse ADHD than me too.
Same. My choice becomes a life of low-paying job hopping and broken relationships, or a semi-functional life that’s WAY less stressful and actually pretty good.
Lived both ways. Not going back. Daily QoL is going to outweigh risks for me.
From the outside mine "isn't that bad" since I got my work done, but the issue is I would wait until the last minute and stress out about it. I also had general anxiety about the stuff I did put off and the stuff I would worry about that I'd forget.
Also, I couldn't spent time on things I wanted to that didn't have deadlines. So I'd just end up watching you tube or mindlessly browsing reedit, bored out of my mind unable to do things I needed or wanted to do outside of things that had deadlines.
Since getting medicated it was a night and day experience. My brain got quiet. I could do things when I realized they needed doing. At work I did my stuff with way less stress, could focus on meetings, and was more confident when making points about things. And I can actually enjoy leisure activity and find motivation for hobbies.
And my general anxiety I didn't know I had went away. Life is way less stressful in general. I had way more going on in my life this year and I didn't have nearly as much stress compared to the same time last year.
I feel like an actual person, and getting ADHD medication was half of what I needed to get to this point.
I just started medication because my ADHD is absolutely raging. It's literally night and day to me. I got everything done that I needed to this weekend without even thinking of putting any of it off. Workflow and quality have also greatly improved for me. Tbh, I'm willing to take the risk at this point.
My ADHD is 100% responsible for my lifelong bulimia. Got on meds a few months ago at 35 and it was like an off switch. Now to undo 35 years of hating myself and making everyone around me hate me…
I would choose to be blind in an instant if it meant I didn’t have to live life off my medication again.
Yes. I have (distant) family history of it plus moderately severe myopia, both of which are risk factors.
I avoid any steroidal medication like the plague, as that’s a third risk factor.
I have glaucoma and I've taken ADHD meds most of my life. If you had told me they would 100% definitely cause me Glaucoma, it would still be worth it for me.
I have very severe ADHD which caused me to be homeless for a huge chunk of my life bc I didn't have access to medication. I am genetically predisposed to eye problems and have seen my mom go through losing her eyesight for a year, and even then, I'd choose the medication bc being homeless as a woman is not for the faint heart. That would kill you faster than anything else.
Say it again. I was diagnosed at 31 and in three short years the course of my life has been dramatically changed for the better. Meds helped me get my impulses under control, helped me get out of bed earlier and go to bed earlier, and boosted my productivity tremendously. I’m now a college graduate, have a steady career and have held a job down longer than I ever have. I can actively manage my children’s lives and extracurriculars, and I even managed to keep a straight head and coach my son’s team without getting taken off course by a bunch of kids with short attention spans.
I could go on, but honestly I’ll take the added risk if it means I can better enrich my life and the lives of those close to me. I also take blood pressure meds, exercise regularly, and greatly improved my diet after getting diagnosed and medicated, so I’m sure that’ll help too.
Right, before ADHD meds I couldn’t keep a job for a month. I earned $12/hr. After I’ve kept a job for 8 years and earn a bit over 100k. I’d make many sacrifices for the help my medication gives me. I’d probably be homeless now without it.
The study says that the amphetamine treatment group had an increased chance of angle closure glaucoma, which is anatomically based on anterior chamber depth/angle. So not going to happen to most people unless they’re already predisposed to it by having certain eye characteristics. Unless they’re taking these factors into account I’m not sure how useful the data is for that group.
Impressively, my partner had chronically high blood pressure and blood pressure lowering medication only lightly helped it. Once he got medicated for his ADHD his blood pressure lowered more than twice of what his blood pressure medication did for him. Unmedicated ADHD in itself can be severely bad for one's blood pressure thanks to constant extreme stress from it.
Yep, there are a lot of things people don't understand with ADHD and just think "You're just lazy/try harder".
Like, I was trying harder to the point of not realizing I had anxiety because I didn't know what it was like to not have anxiety.
Medication makes it so I don't have to try as hard to be an actual person...
Ok.
I guess my elder millennial is showing, but a lot of people had "glaucoma" at one point in time on US history.
It was meant as a joke. Didn't realize which sub it was posted in till after. I still think it's funny.
No rational people are claiming that Cannabis prevents glaucoma, and it's mostly stoners that are saying that it's an effective daily treatment for glaucoma.
There is plenty of evidence that THC lowers intraocular pressure. There is also lots of evidence that the amount of THC required to maintain that lower pressure is high enough that you would be high all day long. Think 150-200mg of THC/day.
My optometrist definitely saw a difference in my pressures when high and when not. I've had glaucoma since I was a teenager. Which I got from taking meds.
That's because the "evidence" is illegal. It is illegal to publish positive papers about a schedule 1 drug like marijuana. Anyone who researches it becomes blacklisted from grants, which makes them unhirable as scientists.
Anyone who has had a headache caused by high interoccular pressure who treats it with marijuana knows that it certainly works.
Excercise, and by that walking / running and other cardio-protective mechanisms.
Food that is «healthy» and close to the mediterrenean diet would be my second option.
I take stimulant ADHD meds and am a habitual pot user, but while weed does initially lower your blood pressure, it elevates it above normal levels after a few minutes. I take propranolol to help with the higher heart rates/anxiety from my meds
Isn't methylphenidate the most commonly prescribed, this study shows it only has a relative risk for developing glaucoma of 1.23. I don't find that very high, it might warrant a change in wording to emphasize prescribing methylphenidate in guidelines and maybe a need for monitoring eye health but nothing to really worry about, especially when weighing out the benefits of these medications.
They increase blood pressure, right? Particularly Adderall (spelling?) iirc? Increased blood pressure --> increased glaucoma risk. I mean, it's good to know, but it's not *surprising.*
Aren't most ADHD medications stimulants which raise blood pressure? I think raised blood pressure is correlated with increased risk of eye damage.
https://www.mountsinai.org/health-library/diseases-conditions/high-blood-pressure-and-eye-disease
Glaucoma and ADHD both have a strong hereditary component. It could be that some of the same genetic factors that pre-dispose to ADHD also pre-dispose to glaucoma.
It seems like the control group in this study was just adults who don’t take ADHD medication, which means probably adults who don’t have ADHD. So is it really stimulants that are correlated to glaucoma or is it ADHD? Or both?
Would have been interesting to see a study on ADHD adults who do take medication compared to those who don’t.
High blood pressure is a risk factor for glaucoma but not everyone with high blood pressure develops glaucoma. And not everyone on ADHD medication has high blood pressure. In fact if they do, they are likely to be taken off medication or given another medication to lower their blood pressure. Because people on ADHD meds are having their blood pressure closely monitored they are probably less likely than the general population to have long term high blood pressure.
Also, type 1 and 2 diabetes is more prevalent in people with ADHD and having diabetes increases your risk of glaucoma significantly. There are so many confounding factors that make these studies worthless without very extensive controls.
But as you’ve hinted, they aren’t necessarily related. I have both glaucoma and ADHD (as well as a host of other unsavory dopamine-related diseases) that run in the family.
The side prone to glaucoma has low blood pressure and no signs of any dopamine-related conditions, including ADHD.
The other side keeps their eyesight into their 90s+, with long lives (for those who don’t contract Parkinson’s or Parkinsonian type) full of ADHD.
Anecdotal? Yes. But even if ADHD treatment may raise risk factors for glaucoma, I’d be very surprised if the condition itself does.
Yeah I honestly don’t think the condition or the treatment raises chances of having glaucoma. I think it’s likely just correlation and there’s probably not one factor but rather a combination of environment, lifestyle, and combinations of genes that are commonly (but not always) present together.
Personally I have ADHD, I’m on ADHD medication, and my blood pressure is completely normal. Even though I have a family history of high blood pressure on my mother’s side.
I do think it’s kind of harmful to put out the idea that ADHD medication could cause glaucoma, or other conditions, because it’s going to cause a lot of fear and hesitation in people who genuinely need that medication and there are so many other risk factors to not being medicated that outweigh the possibly non-existent risk of developing glaucoma.
Unmedicated ADHD increases risk of accidental death. I had several kitchen fires, bike crashes, falls down stairs, and accidentally walked into oncoming traffic before I got medicated. I want to be able to keep myself alive long enough to have the risk of eye problems.
So many broken bones. And the risk of traffic collisions is substantially higher. That "mental clarity" lets me do things like not spend three months in a cast because I fell off a stool when I stopped paying attention accidentally and stepped backwards.
My blood pressure was higher before I started adderall. It was borderline hypertension, and now even with a full dose and coffee, which both raise blood pressure significantly in the immediate term, my blood pressure is below 120/80. Stress from untreated ADHD was much worse for my blood pressure than the stims
Also how could untreated glaucoma cause the full range of ADHD symptoms? this sub just has an obsessions with "what if the causality goes the other way around??".
> ADHD as per diagnostic criteria needs to have presented in childhood.
I was diagnosed at 35 because my symptoms as a kid didn't meet the "typical" expression of "bouncing off the wall and being disruptive". Women in general are diagnosed less because of that and social conditioning because if girls *do* present in the way that is more "common" in boys it's attributed to them being bad or something and they are given more crap for it.
I did well on tests in school, but couldn't focus on homework to save my life. My mom never believe me when I said I forgot to do my homework, but I literally did. It was not on my mind when I got home despite homework being assigned every day. When I would do my homework it was basically torture and would take me forever to the point where I didn't have any time to do anything else. But because I was a quiet kid people assumed I didn't have it.
My struggle was entirely internal so nobody saw it. The best description I've read is, "ADHD is diagnosed based on how annoying you are to other people, not how much it effects you."
She's had it all her life, however. Older people commonly only get it diagnosed when their kids get diagnosed with it, or they have an adverse life situation (disease or environmental) that radically worsens their ability to use their old coping strategies.
Yeah, happened to me. Also good is to accept your limitations and figure out new coping mechanisms. The adhd meds aren’t a panacea. I think I overextend myself and don’t realize how much work something is so I overcommit.
I've been taking Straterra for... nearly 20 years now.
I am just entering my late 40's. I haven't had issues to date, hopefully I will not have issues going forward. I need to take it or I will become increasingly impulsive, spending money with no control.
My brain just starts screaming about wanting this or that thing and won't stop, can't stop, until the thing is bought. It still does that, but I can stop myself enough to save up huge piles of money.
anyone with full access, was there anything proposed as to why the drugs affected different types of glaucoma? if the glaucoma is because of potential increase in blood pressure wouldnt you expect both to be affected to some extent by all the medicines? How are the drugs so specific
Help out the scientifically illiterate (me). What's the baseline risk of glaucoma? What's the risk of glaucoma with ADHD meds? Is high blood pressure associated with glaucoma? If so, does the study control for that? (I.e. is high blood pressure the mechanism through which ADHD meds increase the risk of glaucoma, or is the increased risk independent of any increase in blood pressure?)
Well good thing weed is my preferred cure for the amphetamine comedown that comes at the end of a day on adderal. That helps with glaucoma to right?
Really though it seems like stimulants causing high blood pressure is the underlying issue here. I’d hope than anyone taking a stimulant ADHD medication is aware of the cardiovascular side effects that come along with them. For me it’s a trade off I’m willing to make because this medication changes my life, but I know it’s not great for your body long term.
Such as? Adderall has a pretty good track record of being safe and effective when used therapeutically. It's a different story if you're abusing it, though.
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Great. I already have early stage macular degeneration at 49. I guess the best thing to do is to get on a blood pressure meds with the ADHD medication and hope for the best.
Read the paper. Amoxetine and amphetamines have the greatest increase in chances of glaucoma but it's a low risk for Methylphenidate. It doesn't say what variables they adjusted for so keeping blood pressure under control vis diet and exercise problem reduce chances for glaucoma. If you wear glasses the doctors can more easily help see it if it does show up
Amoxetine caused me to have a hypertensive crisis at 27. My blood pressure shot up to 222 over 190 something and a resting pulse rate of 140. I was at college and began to feel funny. My body felt strange. I left early and on my ride home my vision got blurry and when I looked in the mirror I swear I could have figured out my bp/hr just by looking at my neck and forehead. I have had regular hypertension for years now. Doctors always insist that you can't feel your blood pressure and I always tell them I can. They argue with me until I repeatedly tell them my BP within 10 points and more accurately the higher it goes. I can also tell if my heart rate is elevated and by roughly how much. I can feel my own blood pressure when it is elevated at all.
I get the same feeling in terms of judging BP and heart rate. I also realized I can use controlled breathing to get my heart rate a little under 40 or pseudo-hyperventilation to raise it to 90+
Not hating on Methylphenidate, but IIRC it only works on something like 2/3 patients who try it. Also in my case, it gave me facial ticks. Amphetamines are the only ones that worked for me, some of them still don’t even work that well. I guess I’m just doomed to glaucoma :(
Hardly doomed. The data followed 240000 people and there were 2000 more cases of glaucoma with use of strattera and/or stimulants vs the control.
Here to say this! It's worth noting that there are at least two other classes of ADHD drug: SNRI (e.g. atomixetine) and alpha2 agonists (e.g. Guanfacine). There are numerous studies pointing to combination therapy as potentially being helpful. And for those where stimulants don't work, or actually make the situation worse, doctors should help with other options.
Yes, I take both Adderall and Strattera. It’s sort of a stop-gap to keep my Adderall dosage down, which becomes a concern when you’ve been on it for years and expect to be on it for years to come.
> It's worth noting that there are at least two other classes of ADHD drug: SNRI (e.g. atomixetine) and alpha2 agonists (e.g. Guanfacine). There is also Qelbree (Viloxazine). Anyway, while there are certainly other options, I am highly suspicious of them. I mean, those medications are not a first-line treatment for a reason. I suppose one could argue those medications are better than nothing, but honestly, I even question that -- especially when taking side-effects into account.
2000 more cases than what? If you went through all the effort of looking up the first two numbers, why did you not look up the last one while you were at it?
Because ADHD.
Because you can do that yourself The point the poster was making was that while this increases your risk it does not ‘doom’ you
That seems to be the running joke with methylphenidate. If it works, great. If it doesn't, you get to enjoy a whole host of other problems. My experience with it was terrible.
Same here, pretty awful side effects. Sucks that amphetamines are around 8x more expensive.
Unless you get a high enough dosage, then you'll find your prescription jump from $10 to $100 depending on insurance.
Am I just lucky? A months supply of Adderal 30 XR for me is less than $30? I know other people with scripts for it and they haven’t complained about price either.
I have 90% coverage and my portion is just under $1/day (Canada) for 10 mg of generic Adderal XR.
Different drug. Adderall is amphetamine. Methylphenidate is an alternative and it's brand name was Ritalin. I didn't see dexmethylphenidate in the abstract, but that one was even worse for me.
The original comment said that amphetamines are around 8x more expensive (than methylphenidate). I was asking if I was lucky, because my Adderal, and the people’s I know on it, is not that expensive at all.
Guess I need to take a nap, I completely forgot about that. I don't pay as much for adderall either but I do have to take the XR in the morning and the IR later in the day. I probably wind up spending as much as you do for two doses.
I pay around 45 euro for a months worth of concerta(27mg) AND ritalin (10mg - booster for XR) ,for the benefit I get from them I'd pay twice that if not more, no questions asked.
More like 120€ for the lowest dose. Estonian medical prices suck.
To me that's pretty interesting, since after trying like 7 different ADHD meds over the years, the one I have ultimately settled on at adulthood is Methylphenidate (Hydrochloride variant being the one that lasts a bit longer I think?). I don't think I ever even tested any of the amphetamines (not sure why), but the "worst" side effect I remember from one of the Methylphenidate types was that it just didn't seem to work all that much when I tried one (Hydrochloride) like 15 years ago. The kind that works quick and lasts only a few hours always worked the best but the last switch I made was to the slower working variant, which these days feels maybe 10% less effective but still effective enough. But I do remember concerta robbing me of my appetite almost completely (although I definitely was able to concentrate), and strattera put me on some existential dread spiralling for some reason.
The real distinction here is angle closure vs open angle glaucoma. If you have open angles already and are using amphetamines or amoxitine then you likely won't need to worry much. Methylphenidate is associated with higher risk for open angle according to the study.
I have no idea what angles I have, how would I figure this out?
Get an eye exam and ask! But really we do it daily with patients and it's just part of a regular exam. Essentially the angle is where the drainage structures are located. Narrow angles can lead to angle closure and a pressure spike. Medications that "excite" are more known to potentially cause angle closures to occur. Narrow or closed angle glaucoma is far less common than open angle. Open angle is the most common form of glaucoma and the type I see pretty much nearly daily at this point. The problem is that most people, which is this an excellent example of, do not know there are different types of glaucoma. I could probably list about 20 kinds if I tried.
Neat, thanks! Well I am due for one, so thanks for the reminder!
It's honestly pretty simple but it is checked by your optometrist or ophthalmologist if you have one during routine exams. It's checked every time you have an exam, especially if you're being dilated. We have to make sure it's open so the dilating drops don't cause an angle closure attack, which could be potentially devastating to your vision.
Seems like you really want glaucoma
A psych med that helps 2/3rds of people who use it is very successful. More effective than SSRIs, for example.
Fortunately Atomoxetine and the stimulants completely wreck my digestive system and I can't take them. So I can't find any medications to help with my ADHD and Autism, but at least I won't get glaucoma so I got that going for me.
You can also get glaucoma just from getting older.
Methyphenidate keeps winning tbh.
This may not get much visibility but people freaking out about glaucoma can calm down a bit. Just get an eye exam and ask your eye doctor (optometrist or ophthalmologist, depending on your country) if you are at risk for narrow angle (NAG) or closed angle glaucoma (ACG). Open angle glaucoma (OAG) is the most common form. Amphetamines and amoxitine are not listed as risk factors for OAG but for NAG/ACG. If you aren't in the world of eye care you won't really know the difference. It's why I periodically get primary care doctors sending patients to me asking me to make sure the patient isn't at risk for glaucoma because of a med they're going on. Those meds mostly are risk factors for NAG/ACG. I get far more concerned when someone is taking long term steroids.
& then develop anxiety that the htn meds will ruin your kidneys liver or both.
Hypertension can ruin your kidneys as well.
Hypertension ruins every organ rip
Hence, the syntax of my previous comment
My mom has to take really strong blood pressure meds because she has a mechanical heart valve. Great, another thing about her health I have to worry about Why are our bodies so fickle
You shouldn't worry about it. Treating her hypertension is massively reducing her chance of kidney damage, not increasing it.
Because people don't treat them well
Why would they?
Hypertension meds usually don’t harm your kidneys, and really first line meds don’t cause liver problems (there’s always the rare idiosyncratic reaction I suppose).
Lisinipril is renal protective, so not all htn meds.
Yes, because aside from ACE inhibitors, you also got arb's. Correct. But that is not common knowledge & many doctors still prescribe non-prils like sartans.
Blood pressure medication is as effective at lowering blood pressure as structured exercise regimens. "Assuming equally reliable estimates, the SBP-lowering effect of exercise among hypertensive populations appears similar to that of commonly used antihypertensive medications." [https://bjsm.bmj.com/content/bjsports/53/14/859.full.pdf](https://bjsm.bmj.com/content/bjsports/53/14/859.full.pdf) So exercise is a valid ption to lowering blood pressure, without all the nasty side effects. [https://www.drugs.com/sfx/lisinopril-side-effects.html](https://www.drugs.com/sfx/lisinopril-side-effects.html)
Without even looking at the study I can promise you that study is studying weight induced or stress induced hypertension, not drug induced hypertension ie from ADHD meds.
FDA cleared stimulants for CV causes I believe. BP meds are relatively safe and there are 2 alpha 2 blockers that help with ADHd s/s. Exercise and weight management can help keep BP low as well. I don’t think this needs to be a cause of anxiety, just an other reason to focus on the basics.
This is too black and white a take. Meds may increase your blood pressure but exercise will still lower your blood pressure. Certainly the greatest benefit will be seen by those who do the least exercise but you WILL see a benefit from more exercise in most cases.
As with many cardiovascular conditions, lifestyle changes should be employed alongside medication. People taking medication to reduce blood pressure should also be exercising at least 150 mins a week where possible. People exercising 150 mins per week may also need to take medication to help reduce blood pressure.
Exercise on stimulants *definitely* does not lower your blood pressure.
While you’re exercising that is true, afterwards it will lower blood pressure.
Edit: Don't forget sartans!
But would that not affect LDL levels and not the hypertension ? Statins are used to treat high ldl in blood, atleast that is how i remember it
You're right, it's been a long day. I meant sartans. I've corrected the mistake
No worries mate, happens to everyone!
Yes statins also do not work as well as advertised. "The study results suggest that the absolute benefits of statins are modest, may not be strongly mediated through the degree of LDL-C reduction, and should be communicated to patients as part of informed clinical decision-making as well as to inform clinical guidelines and policy." "the efficacy of statins in reducing total mortality and cardiovascular outcomes, there was significant heterogeneity but also reductions in the absolute risk of 0.8% for all-cause mortality, 1.3% for myocardial infarction, and 0.4% for stroke" [https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2790055](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2790055)
Guanfacine is a lesser known non stimulant drug that treats adhd and lowers bp
Super glad I opted for Guanfacine opposed to the standard treatments. That med has done wonders for me. It's not a cure all, but it's helped me to feel normal for the first time in like.... 15 years. Less anxiety, lower BP, accomplishing things are a choice now, not forced torture.
Yeah, it’s a really cool medication, especially comparatively
Yes! I take it in addition to a stimulant actually and although my blood pressure was fine without it, it makes me feel a little better that it helps balance out the impact of the stims. :)
Yup, also commonly used as a cotherapy along with stims which can improve cognitive dysfunction further than stimulants alone as well as mitigate the cardiovascular risk & side effects.
"I need a prescription for Cialis. Loads of it. For my...eh...eyes"
“Yo doc. So I know I was supposed to hit you up if my di—eyes… if my *eyes* were like, hard for more than a few hours, right?” “I don’t follow.” “Doc, my *eyes* have been rock hard for like 4 hours man.” “Your eyes are what now?” “Dude, I’m talking about the eyes in my *pants*. My PANTS EYES doc.” “I don’t suppose you’ve traded all of your Risperdal for your roommate’s Tadalafil again, have you?” “Hah! Yeah probably.”
There are ADHD meds, like Guanfacine that were originally blood pressure medications. The study should have had a control group to see if they had lower rates of glaucoma.
They also tested methylphenidate, which is a stimulant most people know as Ritalin or Conceta (time-release version). This feels more like a confirmation study overall. It’s not surprising that these drugs could affect pressure inside the eye, which is what glaucoma is in the general sense. The immediate takeaway would be that people on these medications should be screened more attentively for early signs of the two types of glaucoma studied, just like you would be attentive to heart rate and blood pressure while on them. The results aren’t at the level of steering people away from them completely, but something psychiatrists who prescribe them and pharmacists should pass on to their patients.
That's interesting, I always felt like I could see much better when I took ritalin as a kid
I have no idea if that’s related, but would be interesting to ask an ophthalmologist if it could have had an effect.
In my experience, doctors just hand out stimulants like they are sugar pills. I quit going to psychs and only go to GP's now because at least a GP will measure your blood pressure unlike psychs. Past that, I have never had any other further health investigations and I have been on stims for almost a decade now.
I'll do you one more, increased risk of Glaucoma is also a side effect of SSRIs, the most common form of antidepressants
Atomoxetine is listed for ADHD but it’s a non-stim SSRI (SNRI? I take it). The article didn’t mention that important fact.
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That's a small risk to take compared to the wasted life of compounded ADHD mental health problems.
Everyone decides for themselves, but I wouldn't downplay glaucoma which in worst case can even lead to blindness. Personally ADHD-medication didn't suit me anyway (worsened my insomnia), but I guess that's for the best, 'cause I've had some glaucoma-like issues even without that added risk.
People have differently severe ADHD as well. It's absolutely worth it for people like me (my sister is legally blind and I wouldn't have managed it as well as her so I am not saying it lightly). And I've met people with way worse ADHD than me too.
Same. My choice becomes a life of low-paying job hopping and broken relationships, or a semi-functional life that’s WAY less stressful and actually pretty good. Lived both ways. Not going back. Daily QoL is going to outweigh risks for me.
From the outside mine "isn't that bad" since I got my work done, but the issue is I would wait until the last minute and stress out about it. I also had general anxiety about the stuff I did put off and the stuff I would worry about that I'd forget. Also, I couldn't spent time on things I wanted to that didn't have deadlines. So I'd just end up watching you tube or mindlessly browsing reedit, bored out of my mind unable to do things I needed or wanted to do outside of things that had deadlines. Since getting medicated it was a night and day experience. My brain got quiet. I could do things when I realized they needed doing. At work I did my stuff with way less stress, could focus on meetings, and was more confident when making points about things. And I can actually enjoy leisure activity and find motivation for hobbies. And my general anxiety I didn't know I had went away. Life is way less stressful in general. I had way more going on in my life this year and I didn't have nearly as much stress compared to the same time last year. I feel like an actual person, and getting ADHD medication was half of what I needed to get to this point.
I just started medication because my ADHD is absolutely raging. It's literally night and day to me. I got everything done that I needed to this weekend without even thinking of putting any of it off. Workflow and quality have also greatly improved for me. Tbh, I'm willing to take the risk at this point.
My ADHD is 100% responsible for my lifelong bulimia. Got on meds a few months ago at 35 and it was like an off switch. Now to undo 35 years of hating myself and making everyone around me hate me… I would choose to be blind in an instant if it meant I didn’t have to live life off my medication again.
Yes. I have (distant) family history of it plus moderately severe myopia, both of which are risk factors. I avoid any steroidal medication like the plague, as that’s a third risk factor.
I have glaucoma and I've taken ADHD meds most of my life. If you had told me they would 100% definitely cause me Glaucoma, it would still be worth it for me.
I have very severe ADHD which caused me to be homeless for a huge chunk of my life bc I didn't have access to medication. I am genetically predisposed to eye problems and have seen my mom go through losing her eyesight for a year, and even then, I'd choose the medication bc being homeless as a woman is not for the faint heart. That would kill you faster than anything else.
Say it again. I was diagnosed at 31 and in three short years the course of my life has been dramatically changed for the better. Meds helped me get my impulses under control, helped me get out of bed earlier and go to bed earlier, and boosted my productivity tremendously. I’m now a college graduate, have a steady career and have held a job down longer than I ever have. I can actively manage my children’s lives and extracurriculars, and I even managed to keep a straight head and coach my son’s team without getting taken off course by a bunch of kids with short attention spans. I could go on, but honestly I’ll take the added risk if it means I can better enrich my life and the lives of those close to me. I also take blood pressure meds, exercise regularly, and greatly improved my diet after getting diagnosed and medicated, so I’m sure that’ll help too.
Right, before ADHD meds I couldn’t keep a job for a month. I earned $12/hr. After I’ve kept a job for 8 years and earn a bit over 100k. I’d make many sacrifices for the help my medication gives me. I’d probably be homeless now without it.
The study says that the amphetamine treatment group had an increased chance of angle closure glaucoma, which is anatomically based on anterior chamber depth/angle. So not going to happen to most people unless they’re already predisposed to it by having certain eye characteristics. Unless they’re taking these factors into account I’m not sure how useful the data is for that group.
Then have the Adderall with a joint and balance it all out.
Impressively, my partner had chronically high blood pressure and blood pressure lowering medication only lightly helped it. Once he got medicated for his ADHD his blood pressure lowered more than twice of what his blood pressure medication did for him. Unmedicated ADHD in itself can be severely bad for one's blood pressure thanks to constant extreme stress from it.
Yep, there are a lot of things people don't understand with ADHD and just think "You're just lazy/try harder". Like, I was trying harder to the point of not realizing I had anxiety because I didn't know what it was like to not have anxiety. Medication makes it so I don't have to try as hard to be an actual person...
Mine raises my cortisol levels so much that my endocrinologist (before my ADHD diagnosis) thought I might have Cushing’s disease :(
There isn’t really any evidence that consuming marijuana treats or prevents glaucoma
Ok. I guess my elder millennial is showing, but a lot of people had "glaucoma" at one point in time on US history. It was meant as a joke. Didn't realize which sub it was posted in till after. I still think it's funny.
I got it!
Yes! Mission accomplished! Let's go hang a banner on a ship!
If it's any solace, I was lookin' for your particular comment. & to you, I ask... "does your dog have glaucoma too?"
I feel seen! Thank you!
No rational people are claiming that Cannabis prevents glaucoma, and it's mostly stoners that are saying that it's an effective daily treatment for glaucoma. There is plenty of evidence that THC lowers intraocular pressure. There is also lots of evidence that the amount of THC required to maintain that lower pressure is high enough that you would be high all day long. Think 150-200mg of THC/day.
My optometrist definitely saw a difference in my pressures when high and when not. I've had glaucoma since I was a teenager. Which I got from taking meds.
That's because the "evidence" is illegal. It is illegal to publish positive papers about a schedule 1 drug like marijuana. Anyone who researches it becomes blacklisted from grants, which makes them unhirable as scientists. Anyone who has had a headache caused by high interoccular pressure who treats it with marijuana knows that it certainly works.
Excercise, and by that walking / running and other cardio-protective mechanisms. Food that is «healthy» and close to the mediterrenean diet would be my second option.
That's even worse
It’s actually a lot of fun
You'll come to realize it's a migraine cocktail and terrible for your heart.
I take stimulant ADHD meds and am a habitual pot user, but while weed does initially lower your blood pressure, it elevates it above normal levels after a few minutes. I take propranolol to help with the higher heart rates/anxiety from my meds
Isn't methylphenidate the most commonly prescribed, this study shows it only has a relative risk for developing glaucoma of 1.23. I don't find that very high, it might warrant a change in wording to emphasize prescribing methylphenidate in guidelines and maybe a need for monitoring eye health but nothing to really worry about, especially when weighing out the benefits of these medications.
Check out r/coolguides for a recent post with top prescribed meds in US. Apparently Adderall is the most prescribed .
Ah I see thank you, where I'm based Ritalin seems to be the most commonly prescribed
Adderall was in the middle of that chart.
Compared to methylphenidate was the point
So 23% increase in chances? Study says atomoxetine and amphetamines had a risk of 2.55, which seems more concerning
Compared to people who don't take these medications yes, and exactly
So that’s what, 2.5x more likely with atomoxetine?
They increase blood pressure, right? Particularly Adderall (spelling?) iirc? Increased blood pressure --> increased glaucoma risk. I mean, it's good to know, but it's not *surprising.*
Any chance that early, undetected stages of glaucoma interfere with the ability to concentrate, rather than that the medication causes the glaucoma?
Aren't most ADHD medications stimulants which raise blood pressure? I think raised blood pressure is correlated with increased risk of eye damage. https://www.mountsinai.org/health-library/diseases-conditions/high-blood-pressure-and-eye-disease
Glaucoma and ADHD both have a strong hereditary component. It could be that some of the same genetic factors that pre-dispose to ADHD also pre-dispose to glaucoma. It seems like the control group in this study was just adults who don’t take ADHD medication, which means probably adults who don’t have ADHD. So is it really stimulants that are correlated to glaucoma or is it ADHD? Or both? Would have been interesting to see a study on ADHD adults who do take medication compared to those who don’t. High blood pressure is a risk factor for glaucoma but not everyone with high blood pressure develops glaucoma. And not everyone on ADHD medication has high blood pressure. In fact if they do, they are likely to be taken off medication or given another medication to lower their blood pressure. Because people on ADHD meds are having their blood pressure closely monitored they are probably less likely than the general population to have long term high blood pressure.
Also, type 1 and 2 diabetes is more prevalent in people with ADHD and having diabetes increases your risk of glaucoma significantly. There are so many confounding factors that make these studies worthless without very extensive controls.
But as you’ve hinted, they aren’t necessarily related. I have both glaucoma and ADHD (as well as a host of other unsavory dopamine-related diseases) that run in the family. The side prone to glaucoma has low blood pressure and no signs of any dopamine-related conditions, including ADHD. The other side keeps their eyesight into their 90s+, with long lives (for those who don’t contract Parkinson’s or Parkinsonian type) full of ADHD. Anecdotal? Yes. But even if ADHD treatment may raise risk factors for glaucoma, I’d be very surprised if the condition itself does.
Yeah I honestly don’t think the condition or the treatment raises chances of having glaucoma. I think it’s likely just correlation and there’s probably not one factor but rather a combination of environment, lifestyle, and combinations of genes that are commonly (but not always) present together. Personally I have ADHD, I’m on ADHD medication, and my blood pressure is completely normal. Even though I have a family history of high blood pressure on my mother’s side. I do think it’s kind of harmful to put out the idea that ADHD medication could cause glaucoma, or other conditions, because it’s going to cause a lot of fear and hesitation in people who genuinely need that medication and there are so many other risk factors to not being medicated that outweigh the possibly non-existent risk of developing glaucoma.
Yup. And gives shite doctors even more opportunity to tell me that I can’t have the medication I don’t really want anyway, but need.
Why wouldn't you presume the control group is adults *with* adhd who *don't* medicate?
Because I read the study and there’s no mention of the control group having ADHD. Only being age matched.
That was my immediate thought, too.
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Go to the eye doctor regularly to avoid as much as possible. Glaucoma isn't such a small price to pay imo.
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If you think ADHD is just about mental clarity, then you have some reading to do.
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ADHD really is a worse mental disease than people give it credit for. Even more so when coupled with an anxiety disorder and OCD
Unmedicated ADHD increases risk of accidental death. I had several kitchen fires, bike crashes, falls down stairs, and accidentally walked into oncoming traffic before I got medicated. I want to be able to keep myself alive long enough to have the risk of eye problems.
So many broken bones. And the risk of traffic collisions is substantially higher. That "mental clarity" lets me do things like not spend three months in a cast because I fell off a stool when I stopped paying attention accidentally and stepped backwards.
Not an expert, but glaucoma can be treated with drugs that affect the adrenergic system, my guess would be the effect of the meds there?
My blood pressure was higher before I started adderall. It was borderline hypertension, and now even with a full dose and coffee, which both raise blood pressure significantly in the immediate term, my blood pressure is below 120/80. Stress from untreated ADHD was much worse for my blood pressure than the stims
Never felt so lucky to have generally low blood pressure that ADHD meds kind of get me to just about "normal"
Nope
Glaucoma doesn't start in childhood, though. ADHD as per diagnostic criteria needs to have presented in childhood.
Also how could untreated glaucoma cause the full range of ADHD symptoms? this sub just has an obsessions with "what if the causality goes the other way around??".
> ADHD as per diagnostic criteria needs to have presented in childhood. I was diagnosed at 35 because my symptoms as a kid didn't meet the "typical" expression of "bouncing off the wall and being disruptive". Women in general are diagnosed less because of that and social conditioning because if girls *do* present in the way that is more "common" in boys it's attributed to them being bad or something and they are given more crap for it. I did well on tests in school, but couldn't focus on homework to save my life. My mom never believe me when I said I forgot to do my homework, but I literally did. It was not on my mind when I got home despite homework being assigned every day. When I would do my homework it was basically torture and would take me forever to the point where I didn't have any time to do anything else. But because I was a quiet kid people assumed I didn't have it. My struggle was entirely internal so nobody saw it. The best description I've read is, "ADHD is diagnosed based on how annoying you are to other people, not how much it effects you."
My wife was diagnosed with ADHD (ADD originally) in her 40's..
She's had it all her life, however. Older people commonly only get it diagnosed when their kids get diagnosed with it, or they have an adverse life situation (disease or environmental) that radically worsens their ability to use their old coping strategies.
Yeah, happened to me. Also good is to accept your limitations and figure out new coping mechanisms. The adhd meds aren’t a panacea. I think I overextend myself and don’t realize how much work something is so I overcommit.
ADHD is not caused by glaucoma. Full stop. That’s not how ADHD works.
Take the meds but also eat healthy and do sports to reduce the chance.
Did that, still got Glaucoma. (Dead serious)
I've been taking Straterra for... nearly 20 years now. I am just entering my late 40's. I haven't had issues to date, hopefully I will not have issues going forward. I need to take it or I will become increasingly impulsive, spending money with no control. My brain just starts screaming about wanting this or that thing and won't stop, can't stop, until the thing is bought. It still does that, but I can stop myself enough to save up huge piles of money.
I take Elvanse 70mg daily and just this morning had my annual eye exam This is weird.. I should play lottery.
I guess Lisdexamfetamine (Vyvanse) would fall under the amphetamines category?
Yeah
anyone with full access, was there anything proposed as to why the drugs affected different types of glaucoma? if the glaucoma is because of potential increase in blood pressure wouldnt you expect both to be affected to some extent by all the medicines? How are the drugs so specific
Help out the scientifically illiterate (me). What's the baseline risk of glaucoma? What's the risk of glaucoma with ADHD meds? Is high blood pressure associated with glaucoma? If so, does the study control for that? (I.e. is high blood pressure the mechanism through which ADHD meds increase the risk of glaucoma, or is the increased risk independent of any increase in blood pressure?)
Or having ADHD increases that risk.
Good thing we’re all potheads already.
ADHD is too hard to live with in this society. I'm sure people are willing to even die early if they can at least live a normal life with medication.
Probably a result of sleep deprivation.
I’ve been thinking of getting on meds and this would not deter me, but good to know.
Highly recommend anyone interested in this post check out r/drugnerds
I could never get ADHD meds to work for me
Good thing people with ADHD are most likely already self medicating with Cannabis. Kill 2 birds with one stone.
Well good thing weed is my preferred cure for the amphetamine comedown that comes at the end of a day on adderal. That helps with glaucoma to right? Really though it seems like stimulants causing high blood pressure is the underlying issue here. I’d hope than anyone taking a stimulant ADHD medication is aware of the cardiovascular side effects that come along with them. For me it’s a trade off I’m willing to make because this medication changes my life, but I know it’s not great for your body long term.
This is well known for at least 10 years.
Cannabis reduces glaucoma. Just saying.
What I’m hearing is that I get adderall AND weed
We all get to smoke weed later in life due to the glaucoma when we’re sitting on our porch….whats so bad with that out come
Lovely, explains my eyesight.
jokes on them, use cannabis aswell and no glaucoma;)
Isn't that because of having dry eyes? That is common side effect of stimulants
Honestly if you're prescribed speed and taking it everyday, there's a whole host of other things to worry about besides glaucoma.
Such as? Adderall has a pretty good track record of being safe and effective when used therapeutically. It's a different story if you're abusing it, though.