生物与医学2025bmj.com
ADHD 药物治疗与负面事件及结局风险
ADHD drug treatment and risk of negative events and outcomes
进阶 · 约 40 分钟读完前置知识：流行病学与队列研究基础、基础统计推断（风险比、置信区间）、ADHD 临床诊疗常识
导读
这篇发表于 BMJ 的研究考察 ADHD 药物治疗与负面事件及结局风险之间的关系，基于大规模数据评估兴奋剂类药物的获益与风险。HN 讨论更多围绕实际就医体验：成人确诊难、医生倾向开效果不佳的安非他酮、以及长期用药后的倦怠等问题。
HN 关注点：HN 读者中大量 ADHD 患者和从业者，讨论焦点是药物获益与风险的权衡，以及获取处方为何如此困难。
HN 评论精选
这几条评论里：质疑 1 补充 1 亲历 2
补充医疗体系让 ADHD 患者陷入悖论：最需要治疗的人最难获得治疗
讽刺的是，ADHD 患者恰恰最不擅长坚持流程、也难以承受被拒绝，所以病情越重的人越难获得治疗。很多医生因为怕像阿片危机那样被吊销执照，宁可拒绝开兴奋剂——拒绝对他们零风险，开药却有风险。多数医生要么让你走开，要么开效果很差的安非他酮。
klipklop查看英文原文
The irony about getting treatment for ADHD is that medical providers make it very hard to get the proper medication and treatment. People with ADHD are horrible at following through and handle rejection poorly. So the worse the ADHD is, the less likely somebody will be able to actually get treatment for it. A lot of people suffer because doctors fear losing their license like so many did during the pain pill debacle. It's a risk for them to prescribe a stimulant, but zero risk to tell you to eff off. As many have said in this thread, most doctors will tell you to go away or give you Welbutrin (which works poorly, if at all). I feel for your struggle.
质疑质疑 ADHD 诊断的区分度，认为兴奋剂对所有人都有效
我的长期假设是：兴奋剂能让所有人都更高效（有代价），而 ADHD 是一个区分度很弱的诊断，几乎可以套在大多数人身上。人们戒烟后可能失去了类似的东西——虽然尼古丁有害健康，但此前大量公众通过吸烟规律摄入兴奋剂。
homefree查看英文原文
My hypothesis about this for a long time has been stimulants help everyone be more productive (with some tradeoffs) and ADHD is kind of a weakly differentiated diagnosis that could apply to most people. Probably something like this was lost when people stopped smoking, obviously beneficial for health - but a huge amount of the public was taking stimulants regularly via nicotine until relatively recently.
亲历亲历：药物带来巨大收益，但多年后出现严重倦怠和记忆问题
我 30 岁出头确诊 ADHD 并服用专注达。用药那几年简直是恩赐：工作效率大增、事业起飞，收入翻了三倍。但现在我严重倦怠、出现明显的记忆问题，正在休病假调整。我不认为全是药物的锅，压力也有关系，但医生目前只能减药再评估。一方面用药让我终于成为想成为的人；另一方面如果它导致了现在的状况，可能是最糟糕的选择。如果能比我平衡得更好，用药可能还是值得的——我不后悔，只是希望没被耗竭成这样。
bluefirebrand查看英文原文
I was diagnosed with ADHD in my early 30s and prescribed Concerta to help manage it For a few years being medicated for ADHD was a godsend. I was finally able to be more productive and focus on work, my career took off in a huge way, I've literally tripled my income since I started medication Now I'm incredibly burned out, I've been having pretty severe memory problems, I'm on medical leave from my job to try and course correct a bit here. I don't think this is purely caused by the medication, I think it is stress related as well, but my doctor's only course of action right now is to reduce and re-evaluate my meds On one hand, being medicated was incredible for me. It felt like it finally let me overcome my demons and be the person I wanted to be and always knew I was capable of being On the other hand, if it led to my current situation it's probably one of the worst choices I could have ever made. I hate having massive holes in my memory like this, and being burned out this way is extremely difficult to bear So... If you can balance things better than I could, it's still probably worth being medicated. I don't regret it I just wish it hadn't burned me out like this
亲历亲历：Kaiser 的成人 ADHD 诊疗流程僵化，医生凭个人信念而非证据拒绝开药
我在 Kaiser SF 尝试成人 ADHD 诊断，被告知没有童年时期的问题记录就不做成人诊断。2017 年被推荐安非他酮，2021 年换保险后用上了 Adderall，2024 年回到 Kaiser 又被同一个精神科医生拒绝，再次推荐安非他酮。我用在线诊所做的评估被她否定，理由竟是 2016 年吸过大麻。我指出自己是收入相当的职业成年人、亲身体验过两种药的效果差异、Adderall 的疗效证据远多于安非他酮，她只回答'我发自内心相信我做的是对的'。整个情况非常荒谬。
2c2c2c查看英文原文
Curious if anyone has gone through the process of an adult adhd diagnosis at Kaiser SF. Through my attempts, I've been told they don't really do adult adhd diagnoses without documentation of issues as a kid. I was recommended Wellbutrin to deal with symptoms in 2017. Got onto adderall when I moved health insurance in 2021. Back to Kaiser in 2024, I was routed to the same psychiatrist who once again wouldn't budge on adderall and once again recommended Welbutrin. I used an online clinic to get my assessment (which I understand isn't taken seriously) which is what she cited. I asked what aspect of the assessment documentation did she think left me unqualified and she cited marijuana use in 2016. I asked her how she squares the fact that I'm an adult professional that makes comparable money to her, I have experience using both wellbutrin and adderall and see the former doing nothing and the latter helping, there's hundreds of times more evidence for adderall efficacy vs the flakey data on wellbutrin... She responded with something like: "I believe in my heart of hearts that what I am doing is right". I thought the entire situation was kind of insane. Further research into the person makes me think they're a bit of a loon.
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