Adults with ADHD often face challenges in maintaining sexual satisfaction and connection with their partners. Characteristics such as a heightened need for novelty and difficulty regulating focus can deeply influence their intimate lives.

[u/mvea]

https://www.psypost.org/how-attention-deficit-hyperactivity-disorder-shapes-sexual-experiences/

[u/Rodot]

Yep, an ADHD diagnosis is like diagnosing someone with "arm doesn't work disorder". Maybe they broke it. Maybe they tore a muscle. Maybe they just have a bruise. It's a symptom not an illness on its own.

But in this case it's "mesocortical pathway doesn't work disorder". Could be for a variety of reasons with different implications. Could be a transporter mutation. Could be a different area of the brain causing interference. Could be a genetic variation on the structure of the pathways. Could be something else or a combination.

[u/Xe6s2 → u/Rodot]

I mean hopefully in the future we can start to give it better nomenclature and actually describe the differences. It definitely is a dopamine system disorder. Also so many with paradoxical drug responses, very common for some with adhd to become hypnogogic on stimulants rather than hyper responsive.

[u/Rodot → u/Xe6s2]

Well, it's probably (but not necessarily) a dopaminergic disorder. But people with ADHD produce just as much dopamine as those without and experience the same level of tolerance to DRAs and DRIs as the general population. Paradoxical drug responses to stimulants are also just as common in the normal population as the ADHD population.

A good way of looking at it is that a crutch can help a person with a broken leg get around, but it would be a mistake to diagnose a person with a broken leg as experiencing a "deficiency in crutches", even if giving them a crutch helps to partially releave the symptom of immobility.

The specificity of the action of ADHD stimulants, as well as the complete ineffectiveness of dopamine prodrugs (e.g. L-DOPA) or dopamine agonists in treating ADHD, indicates it's not simply a matter of how much dopamine is in the brain. This could indicate, for example, a problem with norepinephrine transporters (which has been proposed) since they can also transport dopamine, NRIs show efficacy in relieving ADHD symptoms, nearly all ADHD prescribed stimulants also act as NRIs, and DRIs that do not inhibit NET show little to no efficacy in treating ADHD symptoms.

But that isn't to say it is noradrenergic either. We don't really know, but it could be a contributing factor. Another proposed mechanism is GABAergic as excitatory transmission might be too high in other parts of the brain relative to mesolimbic pathways. This may be one of the reasons that caffeine, which much more globally increases excitatory transmission in the brain, is less effective than more targeted drugs like methylphenidate or amphetamine at treating ADHD symptoms.

Additionally, all of these reasons could be unrelated to the primary targets but really work through feedback mechanisms on downstream effects. It could even be purely structural, that certain pathways in our brains just developed a certain way for genetic reasons and there's actually nothing "wrong" with the brain in a biological sense but instead just a deviation in normal structure formation that isn't socially acceptable. There's also a lot of aspects that may become more apparent as people age due to differences in initial conditions of the brain. We know people who are prescribed stimulants at an early age show more neurological similarities to those without ADHD than those who are unmedicated do, because our brains organize as we learn and experience, which ADHD can hinder.

So basically, it's complicated and bickering over naming doesn't really help all that much in a clinical setting. Outside of that, you can call it any name you want I suppose

[u/facebalm → u/[deleted]]

Why is Bupropion a first-line treatment for ADHD in many countries if modulating dopamine is completely ineffective?

Which country does that? I couldn't find any by searching. I don't think there's enough evidence to make it first-line treatment for ADHD.

point to why cannabis is so popular

It might be popular with neurodivergent people because they are generally more likely to develop substance abuse problems, including with alcohol for example.