I think this is a really interesting, nuanced point. It's one I talked to my doctor about because it was a concern I felt (and feel). Thanks for sharing it here! HN is usually a good space for contrarian opinions, but even so this sort of thing might get shot down a good percentage of the time.

The way I would express it is: ADHD medication curbs the downside of ADHD, but many people report and experience significant upsides to their condition too. The traditional view of ADHD medication is also that it turns children into "zombies". Do I run the risk of losing my 'edge' as a person?

I'm not a scientist, and I'm not a doctor. With that said, here are my notes from my doctor when we discussed this:

1. I feel that oftentimes negative and positive personality traits in people go hand in hand, outside of ADHD. For example, the calm, methodical, detail-oriented people who make excellent assimilators and "deliverers" in startups are often a necessity to building something incredible, but can also be the very *worst* people to have around you when you're trying to "yes and" about fragile ideas, because they live relentlessly in the real world. Do the traits I exhibit in my ADHD also make me a more effective leader? Do I simply not understand the upsides because they exhibit as personality traits?

2. Dr. X: There is little in the way of conclusive evidence, but he believes that it's possible that ADHD medication can curb traits that are either perceived as positive or genuinely positive in ADHD patients. This is why a key assessment is the extent to which negative traits manifest themselves. If you have ADHD but do not suffer from life-deranging consequences in some material sense (executive function impaired to the point where your career, relationships, or emotional wellbeing are suffering), then it's often not necessary to take medication at all.

3. Dr. X: the common impression of ADHD medication -- and in particular Ritalin -- seems to be magnified by the fact that parents are in general deeply worried about their children and the sense that their personalities are altered in some way. In adults, the available treatments do not appear to have serious long term consequences for personality and cognitive function. So it's completely permissible to take XR/IR medication for ADHD on days when you especially need to focus, for example, and not worry about "missing" a day. Equally, if -- in consultation with your doctor during titration and your family and friends -- you feel that there is an untenable negative consequence of medicating, then you can of course stop.

4. Dr. X: Anecdotally, ADHD sufferers frequently both underestimate and ignore the consequences of the disorder in their lives. Sometimes it's necessary to have them tell stories about areas of their relationships and personal lives which they find are surprising or hard which are unrelated to their ADHD, and very often doing so reveals that their ADHD manifests itself in ways which are wholly unsurprising but not visible to the patient.

5. Taking the time to find the right medication and dosage is vital. Diagnosis is step one, and after that it is very often months of tweaking, talking, and collaboration with the doctor to establish the right dosage level (strength), formulation (XR/IR, and within that e.g. prodrug is an XR which is a sort of "prequel" to the chemicals you need -- so it stimulates the body creating them rather than dumping the chemicals themselves into your system), and brand (e.g. Ritalin, Concerta, and Medikinet are all methylphenidate, but Concerta is commonly a 25/75 release, Ritalin is available in IR or XR although XR is less popular than Concerta XR, and Medikinet is a 50/50 timed release). Finding something which works for you takes time, and is not an easy feat.

It's fantastic that you're not experiencing significant downsides to ADHD! I'm glad you were as clear as you were in your articulation of your concern, I worry that when some people express things like this they cause unnecessary worry in those who are experiencing meaningful downsides which put them off seeking medication. The tradeoffs are different for everyone.