I have attention deficit hyperactivity disorder and I also take Adderall, which has changed my life in myriad ways: It's made me focused, organized, timely and calm. It's also made me thin.
A decreased appetite is one of the many side effects my psychiatrist and drug labels warned me about and it's one that, frankly, I don't really mind. I'm not proud of this: For all the infinitely valid and valuable reasons there are to take ADHD medication, maintaining one's weight and food intake seems like it should be at the very bottom of the list, if on the list at all.
For some, though, using Adderall to control their weight matters, maybe even more than its intended purpose. There's a fine line between using Adderall to help improve your life and venturing into the territory of disordered eating — and about 4.8 million American young adults are straddling it.
It's well-documented that drugs like Adderall, Ritalin, Vyvanse or Concerta — all stimulant medications used to treat ADHD, which cut down hyperactivity and improve focus — can cause weight loss. According to Dr. Lenard Adler, a psychiatrist and ADHD specialist at New York University, both short- and long-acting ADHD stimulants can cause appetite suppression. That means people who take them might need to "set reminders to eat even if not hungry at lunch, eat a large breakfast, dinner and possibly a snack," Adler told Mic.
But that would defeat what's sometimes seen as the purpose of these drugs: that they are de facto weight loss supplements. Vyvanse, for instance, was recently marketed as a way to combat binge-eating disorder precisely because of its appetite-suppressing qualities. Such side effects tend to be seen as a welcome benefit among older adolescents and adults, particularly those who are anxious to meet society's beauty standards.
"We live in a diet-happy culture, and one that celebrates the thin ideal," Stacey Rosenfeld, a clinical psychologist who specializes in eating disorders, told Mic. "I think people are willing to sign on to anything that will help them get to a certain point, even if it feels like a doctor prescribed it for another purpose. It's what they do with [the drug] that determines if and when it becomes a problem."
"I think people are willing to sign on to anything that will help them get to a certain point, even if it feels like a doctor prescribed it for another purpose."
Whether or not an ADHD patient will rely on prescribed stimulants to lose weight — a condition sometimes referred to as "Adderexia" — often depends on their pre-existing relationship with food and body image, according to Rosenfeld. But it also has plenty to do with our cultural reverence for thinness.
"I think the danger is that if you don't have a disordered relationship with food to begin with, taking drugs and experiencing appetite suppression could lead to disordered eating," Rosenfeld said. "For people who are prone to eating disorders, when they start to experience reduced appetite and lose weight, there can be some momentum that gathers and cause someone to cross the line."
That's where things can get murky for people with ADHD who (mostly) take the drugs for its intended purpose. Even for people who don't have eating disorders, it can be difficult to escape feeling like not wanting to eat is a wonderful added benefit of the drug that helps you function.
"Once I got to college and my metabolism slowed, I started to appreciate the fact that if I didn't force myself to eat lunch, I would often completely forget about it," Eli*, 26, told Mic. "I wouldn't say it was about losing weight, but there were times when I was feeling like I was gaining weight and I would sort of regulate myself a little [more] at lunchtime."
One 24-year-old, Ash*, developed a full-blown eating disorder before he finally stopped taking his Adderall; after years of using the drug to restrict his food intake, he eventually developed a heart condition.
"I started abusing the meds to get the same Superman-like sense of control that they gave me when I was younger, which turned into a strange Adderall-centric eating disorder," he told Mic.
Ash said his Adderall always made him focus on whatever was "at the top of his brain," which for him meant focusing all of his attention and energy on his appearance. He started falling behind in his classes, but the medication was no longer helping him control anything but his weight.
"I'd had a strange relationship with food and my weight for years, but it wasn't until college that I made active, unnecessary efforts to lose weight with the help of Adderall, just because I could," Ash said. "In retrospect, I probably would have done much better in school had I just settled as a B student without the help of Adderall, instead of becoming a boom-and-bust student who would make one A each semester then fuck everything else up."
"I started abusing the meds to get the same superman-like sense of control that they gave me when I was younger."
Lara Milbauer, 23, told Mic the unhealthy relationship with food she developed while taking ADHD medication also stemmed from other body image issues she already had. Having a doctor-prescribed tool to restrict her eating pushed Milbauer over the edge, and eventually she viewed the medication that once helped her focus as "completely a weight-loss drug."
"I stopped [taking Adderall] because it was making me super depressed, [but] I was nervous I wouldn't be able to remain as thin as I was when I got off it," Milbauer said. "I definitely should have stopped taking it when I realized how bad it made me feel, but I continued taking it intermittently when I wanted to not eat a lot and work out. It took me a while to put my mental health above my appearance."
Relying on appetite-suppressing medication to function means living in a gray area when you also live in a society that validates people for having visible hipbones under their skin. It's fairly easy to hide behind all the more "legitimate" motivations for staying on medication, because those reasons often do carry as much weight as, well, concerns about weight. There's all the more reason to hide with a condition like ADHD, which is so often critiqued as being over-diagnosed and over-medicated. After all, who would want to admit to taking drugs for a vain, unintended purpose when taking them at all is already stigmatized?
A consequence of that stigma, however, is that it can be easy for people with ADHD to lie to themselves about their own motives for medicating, according to clinical social worker Michele Kabas, who specializes in treating eating disorders.
Kabas told Mic the true question of why someone with ADHD wants to take their medication might have a different answer each time they swallow their pills — and acknowledging the honest one isn't always easy.
"People experience a lot of denial about what they're really feeling," Kabas said. "There's pressure to look a certain way in our society. I don't know that it's always so clear if a person feels 'I'm definitely going to be on this [drug] because it's making me thin,' or, 'Oh, this [side effect] is pretty cool,' because of all that societal pressure."
When we capitulate to that pressure, we're not supposed to admit it. "So many times we feel we need to portray a certain image of ourselves as perfect, that we have it all together," Kabas said. "All of this is perfectionism. It's about controlling everything, but at what price?"
This is always the question with ADHD medication, whether we're talking about body image or not. Generally speaking, drugs are supposed to make us better, more functional versions of who we already are. We self-medicate to achieve perfection, which often entails skipped meals, frenetic workouts and cherishing a stomach that refuses to rumble. And in a culture that views professional achievement and being too "busy" to function as the ultimate accomplishment, it's easy to view the side effects of ADHD meds as positive, not negative.
Maybe the problem isn't with stimulants and their side effects, but with the way we characterize both. As a culture, we treat Adderall and its compatriots as wonder drugs, and appetite suppression as a hoped-for benefit, yet we view both eating disorders and attention deficit disorder as signs of personal shortcomings. Society says that what ADHD meds do for people is good, while simultaneously shaming the people who take them.
These contrasting messages make it difficult to answer a question Kabas said most people who take ADHD meds eventually have to answer:, "Is the medication interfering with your life, and with your quality of life? Is it something you need to function better, or something not to eat?"
"I was nervous I wouldn't be able to remain as thin as I was when I got off Adderall."
I was, admittedly, elated in the first few months I started taking ADHD medication, when I lost a significant amount of weight. But my joy also could have been attributed to the fact that I stopped forgetting to turn in assignments, trailing off in the middle of conversations or spilling food on my (new, smaller) clothes. Being on the medication truly did change my life for the better, to the point that I felt like it helped me become the person I was always meant to be.
ADHD meds help me work better, which in turn helps me feel better about my work. As awful as it sounds, in its own way, skipping meals and ignoring my rumbling stomach helps me work better too. But of course, when I'm on Adderall, I don't really feel like I have much time to dwell on how problematic that might be. I just wait for the drugs to wear off, until I'm ready for dinner.
*First names have been changed to allow subjects to speak freely about private matters.