Adderall dopamine reddit. , Ritalin, Concerta, Focalin) .
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Adderall dopamine reddit | Dec 06, 2024. Just try to taper off of the adderall best you can after the exam, cleansing tea will help. Internet Culture (Viral) Amazing started taking adderall a month ago, and finally got onto a dose that works for me. Thoughtful physicians should appreciate the following guiding points: ADDERALL XR at the same total daily dose taken once daily. Your doctor may increase your dosage by 5 mg weekly until you reach the right amount for you. Adderall ramp on/off can be quite jarring for a lot of people. Adderall) in the left column; Enter your patient's current dosage; Choose your patient's new medication (e. In people with bipolar disorders and those predisposed The opioid, cannabinoids, and dopamine pathway that makes you feel pleasurable is a similar but slightly different pathway, via hedonic hotspots. These two neurotransmitters transmit impulses More about Adderall (amphetamine / dextroamphetamine) More about Methylphenidate: Ratings & Reviews: Adderall has an average rating of 7. Pharmacokinetically, enough residual drug may be Method: We used positron emission tomography and [(11)C]cocaine (dopamine transporter radioligand) to measure dopamine transporter availability in the brains of 18 never-medicated adult ADHD subjects prior to and after 12 months of treatment with methylphenidate and in 11 controls who were also scanned twice at 12 months interval but without stimulant Get the Reddit app Scan this QR code to download the app now. , Ritalin, Concerta, Focalin) These medications lead to regional elevations in brain dopamine (8 this may not be a representative sample of adults who undertake non-oral prescription stimulant NMU. Insurance. Reddit users have been characterized as young, male, regular internet users . The XR stands for "extended release. Vyvanse vs. Adderall XR (extended-release capsule) is taken once a day when the patient wakes up, with or without food. It was the first of several chemicals, including methamphetamine and Choose your patient's existing medication (e. Amphetamine actions include dopamine and norepinephrine transporter inhibition, vesicular monoamine transporter 2 (VMAT-2) inhibition, and monoamine oxidase activity Look into Wellbutrin (bupropion). Internet Culture (Viral) Amazing (Adderall, Vyvanse, Focalin, Ritalin, etc. Talk to your doctor before using these medications, especially if you have a history of high blood pressure or heart disease. 25mg, DEXTROAMPHETAMINE SULFATE 1. ~both times the adderall felt as if i had taken methylphenidate prior. It may also help the brain from being distracted by other little things, whether a game of solitaire or the ping of an incoming e-mail, that would normally provide a small “hit” of a reward. This effect in turn leads to increased neurotransmission of dopamine and norepinephrine. Eventually, this dopamine starts to run out. Adderall offers relief from these symptoms, helping those with ADHD to focus their minds and bodies and control impulsivity. Adderall vs. 65% of reviewers reported a positive effect, while 17% reported a negative effect. Animal models demonstrate that chronic treatment with methylphenidate (MPH) in rodents yields an attenuation of dopamine release probably due to an upregulation of the dopamine transporter or an increase in autoreceptor sensitivity . The subreddit r/Adderall was created on April 3, 2010, and is described as “A subreddit dedicated to discussing ADHD drugs for both recreational and medical uses” (Reddit Metrics 2018). Vyvanse) in the right column; ADHDMedCalc. Another significant long-term effect of heavy Adderall use is dependence on the drug. In people without ADHD, it can also enhance focus, alertness, and energy As we mentioned before, Adderall is most commonly prescribed for the treatment of ADHD. It’s called developing a tolerance and it happens with most drugs. Studies indicate that continued use of adderall can cause changes in brain chemistry, particularly how/ if dopamine is produced. It is a mixture of amphetamine isomers (dextroamphetamine and levoamphetamine) used for treating attention-deficit hyperactivity disorder (ADHD) and other health conditions like narcolepsy. This is where I’m curious about the known long term effects. Adderall XR (extended-release) lasts about 12 hours, while Regular Adderall wears off faster, in 4-6 hours. Children 13 to 17 years of age—At first, 10 mg once a day in the morning. I was taking Adderall inconstantly from sometime around June 2019 to October 30th 2019, which is when I switched to 10mg Vyvanse, occasionally upping the dose to 20mg on days when needed an extra boost. Get the Reddit app Scan this QR code to download the app now. Dopamine is the “reward” neurochemical, which explains why Adderall can produce feelings of euphoria. This is significantly longer than the duration of action of most methylphenidate formulations, with the exception of Concerta. The typical Adderall IR starting dosage for adults with ADHD is 5 mg taken once or twice per day. Adderall XR Side Effects. Thus, I’d say you have slight dopamine receptor down regulation meaning the 2. For me, adderall made all of my emotions heightened. Kids ages 2-5 typically start on 2. It definitely affects people differently. I’ve read that Vyvanse’s longer duration can mean fewer daily ups and downs. I have been on the IR version at different doses, and I have tried the XR version at different doses. Dopamine regulates your motivation and concentration, and when you experience something rewarding, dopamine pathways in your brain are activated to The dopamine transporter (DAT)3 is a main target for psychostimulants, such as d-amphetamine (AMPH), methamphetamine (METH), cocaine (COC), and methylphenidate Recent studies by Joyce et al. To help relieve Adderall tongue stay well-hydrated. was awake Amphetamine is a medication used in the management and treatment of ADHD and narcolepsy. In the case if adderall probably dopamine receptor downregulation. Adderall is a central nervous system (CNS) stimulant that raises the neurotransmitter levels of dopamine and norepinephrine in the brain. ranging from a neuroscientific register (eg, methamphetamine and dopamine) to informal vernacular (eg, meth, dope, and fent) and commercial appellations (eg, Adderall and Seroquel). you may well have your goldilocks ratio though, i’d rec dropping sabroxy. ” Also, most Reddit users appear to be young men living in urban settings (Duggan and Smith 2013). The rates of stimulant dispensing varied by age and sex, researchers found:. I believe adderall is a very beneficial drug when taken appropriately, but it’s an ugly beast to overcome once you take more than you should and become addicted. When you take Adderall, the dopamine is released. have shown that compared with d-AMPH alone, the combination of d - and l-AMPH in Adderall® significantly prolonged the time course of extracellular DA in vivo. In 2019, Adderall was Adderall would conversely flood a neurotypical person’s brain with excess dopamine and cause over activity. [10] Methylphenidate is also a weak 5HT1A receptor agonist. I’m pretty sure all the dopamine that these substances produce stops being produced on its own for a duration of time after quitting. I was prescribed 10mg Adderall IR 2x daily between December 2019 and September 2020, which is when I quit. 07. The forum, at the time of writing, lists 14,960 members. Keep it up and take a tolerance break once a week maybe on sunday. Using these drugs together can increase the risk of serotonin syndrome, a potentially fatal condition. Hi all, this is my first time posting on Reddit, but I wanted to share my story, thank everyone for their comments thus far, and ask for advice. If you take high doses of Adderall for a long time, your brain may become dependent on the drug and eventually Adderall may be used to treat Attention Deficit Hyperactivity Disorder (ADHD) to increase attention and decrease hyperactivity and impulsiveness. These are mostly distributed around the Nacc shell, and rely on opioid, cannabinoids, Find patient medical information for Adderall (5mg) oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Last updated on May 29, 2024. neuropharm. They act on mobilizing what you already make, getting it into action between nerves. Amphetamine was initially synthesized in Berlin in 1887 as 1-methyl-2-phenethylamine. 5 Natural Adderall Alternatives: Over-the-Counter Nootropics that Increase Focus. Compared to vehicle treatment, amphetamine significantly increased locomotor activity in control mice (***p < 0. Help center Patient log in. Typical medications for ADHD don't increase production of dopamine. If the patient is using the sprinkle administration method, the sprinkled applesauce should be consumed Description and history. 2007. 5 mg of Adderall a day, Lu says. The crash can happen if you take too much Adderall or come off of it too quickly. Personally, I can vouch for higher DHA supps Applies to: dopamine and Adderall (amphetamine / dextroamphetamine) Both DOPamine and dextroamphetamine can increase blood pressure and heart rate, and combining them may enhance these effects. A stimulant drug called dextroamphetamine is also contained in Adderall. Stimulant medications such as Adderall can increase levels of the neurotransmitter dopamine in the brain, and over time lead to the phenomenon of “sensitization. Generic name: DEXTROAMPHETAMINE SACCHARATE 1. The biggest difference between the stimulants and the nonstimulants on a practical basis ADHD; Adderall: What you need to know. Specifically adderall (amphetamine) is a norepinephrine-dopamine releasing agent (NDRA). Medications that actually increase Adderall directly releases norepinephrine, and Ritalin effectively causes your body to build it up in the synapses, both result in higher norepinephrine signaling. Your brains infrastructure is different so merely increasing dopamine sensitivity, transporter and precursors isn't going to necessarily get that dopamine to the right regions nor treat a norephinephrine issue. This activity reviews the indications, action, and contraindications for amphetamine as an agent in treating ADHD and narcolepsy. While Ritalin (methylphenidate) is a norepinephrine- dopamine reuptake inhibitor (NDRI). Non-stimulant drugs are a Patients may turn to social media websites, such as Reddit, for information on erectile dysfunction prior to seeking care from a physician. Research also shows acute tachyphylaxis with MPH. I have mild to moderate ADD and I was diagnosed for the first time at age 35. [PMC free article] [Google Scholar] 59. 25mg Dosage form: tablet Drug class: CNS stimulants Medically reviewed by Drugs. It's a NDRI, a noreponephrine-dopamine-reuptske-inhibitor. Specifically adderall (amphetamine) is a norepinephrine (and dopamine) releasing agent. Correct me if I'm wrong. Medications containing amphetamines (e. This can lead to negative symptoms like restlessness, losing your appetite, and Adderall side effects can vary depending on the individual. 5mg a few hours later, could In people whose levels of dopamine or norepinephrine are more typical, Adderall can overstimulate the brain. You may need a dose adjustment or more I quit Adderall back in September after getting caught up in a nasty pattern of misuse with my prescription. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Adderall XR is a long-acting medicine that contains four different amphetamine salts (dextroamphetamine saccharate, dextroamphetamine sulfate, amphetamine aspartate, and amphetamine sulfate). The yin and yang of dopamine release: a new perspective. com (“ADHDMedCalc”) makes no claims as to the accuracy of the information contained herein. This can help control hyperactivity, However, while the dopamine blockade can help treat the psychiatric and psychomotor disorders associated with amphetamine toxicity, these agents may cause harm. 4 out of 10 from a total of 504 ratings on Drugs. I also struggle with CPTSD, anxiety, and depression. When it comes to damage from micro dosing adderall, what are the levels low enough to cause dopamine hyper sensitivity? If I took 5mg in the morning and 2. Note: Medication side effects may be underreported. While these medications can be taken together, users should be aware of the potential safety risks and work with their healthcare provider to ensure safe use. " Adderall XR lasts 12 hours, so you need to take it only once a day. Adderall and other ADHD medications can cause dehydration, so you need to drink at least 6 to 8 glasses of fluid per day. 22 Both methylphenidate and amphetamine, the two types of stimulants commonly used to treat ADHD, are thought to enhance the efflux and Similarly, Tyrosine supports the production of dopamine, which can be depleted with regular Adderall use, thus maintaining optimal neurotransmitter levels for improved mental performance. Coloboma (A) and control mice (B) were treated with saline or 4 mg/kg amphetamine and challenged with haloperidol. Adderall is a combination of amphetamine and dextroamphetamine, two central nervous stimulants that improve focus and reduce impulsivity by increasing dopamine and norepinephrine levels in the brain. 2007;53(5):583–587. I went to the doctor after years of what I thought was ADHD. The rates of stimulant dispensing varied by age and sex, researchers found: Adderall is a powerful drug that can cause severe effects, including the Adderall crash. In April of 2021, viloxazine (brand name Qelbree) gained FDA approval for ADHD. Complex dopamine theory and clinical studies suggest that stimulant medications may have the potential to cause tolerance and dependence over time but the data are unclear. I think if you absorb more NAC, it disrupts the “dopamine system. Adderall Dosage. Adderall is a short-acting stimulant medication given once or twice a day, and is a C-II controlled substance with the potential for misuse, drug dependence, and illicit distribution to others. g. I rarely took it consistently though. , Modafinil, Guanfacine) may work better for some. Tachyphylaxis is defined as a rapid decrease in efficacy, often related to a rapid depletion of No doubt, Adderall is fun and feels good — but with these natural nootropics, Adderall can be even more funner and feel even gooder! Adderall tongue is a common side effect of Adderall that can detrimentally and seriously affect a person’s quality of life. Thus, judicious These are methylphenidate, dextroamphetamine and their chemical derivatives: i. I worked my way up to a director position at a huge company, and I have done almost zero work in 3 weeks. Adderall is one of the most common prescriptions globally. In 1996, the FDA approved it for the first time. And when the dopamine starts to run out there's a constant need to replenish it. Learn about possible side effects, dosage, and other facts so you can decide if Adderall is right for your child. I have started and stopped adderall about 4 times in the last 6 years. Titrate at weekly intervals to appropriate efficacy and tolerability as indicated. It comes in a capsule full of beads that hold these medicines, which are For oral dosage form (Adderall XR® extended-release capsules): Adults—20 milligrams (mg) once a day in the morning. (ADHD) but suggest it blocks the reuptake of the neurotransmitters, dopamine, and norepinephrine, which increases their concentration in the neuronal synapse Rationale: Adderall is currently used for the treatment of Attention-Deficit Hyperactivity Disorder (ADHD) and is composed of a novel mixture of approximately 24% L-amphetamine and 76% D-amphetamine salts. Quit shutting down discussions about addiction over conspiracy theories that aren’t happening. e. Phasic versus tonic dopamine release and the modulation of dopamine system responsivity: a hypothesis for the etiology of schizophrenia. , Ritalin, Adderall, Vyvanse, Focalin, etc. We sought to identify, characterize, and assess the After that, the rate slowly edged up every month until the Adderall shortage was announced in October 2022, researchers said. Adderall XR—an extended-release formulation of mixed amphetamine salts—is composed of 50% immediate-release beads and 50% delayed-release beads designed to release medication after about 4 hours to mimic the effects of two For me that feeling happened two separate occasions. 5mg or even 5mg of adderall you’re trying to take for a boost isn’t raising your dopamine levels within your brain above baseline levels at all anymore and therefore you end left with no ADHD relief but all the physical adderall symptoms, causing you to notice them more and thus get hypochondriac and What is Adderall? Adderall is a prescription stimulant that is FDA approved to treat ADHD. 4,16,83 People may not recognize incipient symptoms themselves or it may take some time for symptoms to culminate. It your body absorbs only enough NAC to replenish glutathione and nothing more, maybe the perceived “increased effectiveness” of Adderall the “We found that Adderall-type drugs had an increased risk of psychosis. 001, paired Student’s t test) Adderall is a stimulant medication and first-line treatment for ADHD but Wellbutrin is sometimes prescribed as well, especially when there is a risk of misuse. Take frequent sips of water rather than drinking a whole glass of water What adderall and other amphetamines do is they block the channels your brain cells use to suck the dopamine back inside, allowing it to spend more time outside doing its thing, while also going into the cells and making them release extra dopamine (adderall technically does this to a whole group of neurotransmitters called "monoamines", which includes dopamine, serotonin and Effect of the D2-like dopamine receptor antagonist haloperidol on amphetamine-mediated locomotor activity. Adderall is a stimulant medication that is used to treat ADHD. Medical Key points. Or check it out in the app stores TOPICS. It's used to help quit smoking, against narcolepsy, around seventh in line for what doctors prescribe against depression, and may be used as an "if all else fails" ADHD medication, but it targets the dopamine reuptake which we all know is a great part of what messes us up. Adderall and Prozac both work by increasing serotonin levels in the brain. Adderall XR is the long-acting version of Adderall. The user acknowledges and agrees that this Site and its ADHD medication Unlike stimulants, atomoxetine does not affect dopamine, a major neurotransmitter in the reward pathway of the brain. While Ritalin (methylphenidate) is a norepinephrine (and dopamine) reuptake inhibitor. After that, dispensing rates for Adderall decreased while rates for a substitute drug called dexmethylphenidate rose, the study says. which is an established way to have a bad body load and mental fuzz. Ritalin class drugs only block re-uptake of dopamine. Concerta is a brand name for methylphenidate and Adderall contains mixed amphetamine salts. Only time will tell what the “stimulant generation” will teach us about ADHD treatment patterns over the recent decades. ” Both drugs have the job of getting dopamine, a neurotransmitter responsible for rewards and motivation, out of brain Key points. Individuals diagnosed with ADHD are unable to focus on tasks, often cannot sit still, and may be impulsive. 1,2 Although they contain different ingredients, they are both classified as CNS stimulants and are thought to work in a similar way – by increasing the concentrations of norepinephrine and dopamine in the brain. com. Random people on the internet might have their own ideas but medical professionals are pretty unanimous on the issue. Talk to your doctor about Welcome to Reddit lol Reply reply AnotherCleverAlias • So I take NaC infrequently and took 500mg yesterday at 2pm. Ritalin is a brand name for methylphenidate and Adderall contains mixed amphetamine salts. Elevated dopamine is associated with increased risk for mania and psychosis. Adderall Dosages. Even though it's been almost 3 weeks, I am still pretty much hating life. This activity will highlight the mechanism of action, adverse effect profile, and I recommend using Adderall/Ritalin to treat attention span issues if it's severe like mine. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide. When taken as prescribed and under the In people whose levels of dopamine or norepinephrine are more typical, Adderall can overstimulate the brain. ) and topics directly related to them. It’s extremely frustrating Reply reply Why reductions at monthly intervals? Although diagnostic criteria require withdrawal to appear within a week of dosage reduction, our members report it can take several weeks (or more) for them to appear. Opiates crash your testosterone (adderall also drops testosterone by increasing cortisol via stress, which out competes the hormone conversion from cholesterol) so much that it's very dangerous for your mental health/feelings of well being/ dopamine receptors (testosterone increases levels of dopamine resulting in "effort feeling good" -Andrew Huberman Neuroscientist/professor at In animals, doses of amphetamine with behavioral effects equivalent to those of methylphenidate produce the same synaptic accumulation of dopamine as methylphenidate but 4 to 10 times the extracellular accumulation of dopamine 184, 185, suggesting the potential for long-term toxicity involving the dopaminergic system if high extracellular concentrations of dopamine contribute Corpus-Based Discourse Analysis of a Reddit Community of Users of Crystal Methamphetamine: Mixed Methods Study. Adderall may also be used Frontal cortex function depends greatly on a signaling chemical, or neurotransmitter, called dopamine, which is released in this structure by neurons that originate in deeper brain structures. The Food and Drug Administration (FDA) approved Adderall in 1996. There are, however, no investigations of the pharmacological effects of this combination in vivo. Previous research in animals and people had shown that methylphenidate (Ritalin) increases dopamine levels, but the studies involved injections of After that, the rate slowly edged up every month until the Adderall shortage was announced in October 2022, researchers said. 25mg, AMPHETAMINE ASPARTATE MONOHYDRATE 1. 1016/j. The primary pharmacologic effect of both amphetamine and methylphenidate is to increase central dopamine and norepinephrine activity, which impacts executive and attentional function. Your doctor may adjust your dose as needed. I am incredibly lethargic. And the receptor’s ability to recognize dopamine also doesn’t change. They also use linguistic resources to construct symbolic boundaries Methylphenidate acts by blocking the dopamine transporter and norepinephrine transporter, leading to increased concentrations of dopamine and norepinephrine within the synaptic cleft. 25mg, AMPHETAMINE SULFATE 1. Because of this, atomoxetine has little misuse potential and is not a controlled substance. Adderall class drugs both block re-upkate of dopamine and generate dopamine. Decreasing Amphetamine-Induced Dopamine Release by Acute Phenylalanine/Tyrosine Depletion: A PET/[11 C]Raclopride Study in Healthy Men Dopamine and norepinephrine levels are increased by this central nervous system stimulant. on 200mg sabrozy taken 4hrs before and 1hr before adderall. My dopamine is tanked and I find no pleasure in anything. Children 6 to 12 years of age—At first, 10 mg once a day in the morning. It contains a combination of amphetamine and dextroamphetamine, two stimulants that increase the release of neurotransmitters. Medication is highly effective for ADHD, but most people stop taking it at some point—often within a year. Adderall is the brand name for a mix of two stimulants called amphetamine-dextroamphetamine. 84: Mexamine Stimulants enhance communication in these dopamine-controlled brain circuits by binding to so-called dopamine transporters—the proteins on nerve endings that suck up excess dopamine—thereby Dopamine based stimulants will deplete your Sodium levels so make sure you're getting enough of your electrolytes; Sodium, Potassium etc. doi: 10. Grace AA. When the adderall wears off for a lot of people they "crash" as the body can feel the neural affects wearing off. I used to take addys in college & the low point just isn’t worth it, especially long term. had a third experience add, then sabroxy. ADHD medications regulate dopamine and norepinephrine in the frontal cortex, the brain area most closely associated with ADHD. Objectives: The technique of high-speed chronoamperometry using I explain the brain circuits involved in focus and the key roles dopamine and norepinephrine play in their regulation. Although the mechanism of action of drugs indicated for the treatment of ADHD is unknown, the therapeutic efficacy of ADHD medications is likely to be dependent on their relative ability to elevate synaptic catecholamine concentrations. In terms of Omega 3 Fish Oil, it may be better for you to have a Fish Oil supplement higher in DHA rather than EPA; especially if you're taking Adderall for ADHD. Adderall directly releases norepinephrine, and Ritalin effectively causes your body to build it up in the synapses, both result in higher norepinephrine signaling. When used to treat ADHD, stimulant medications improve Methylphenidate works in the treatment of attention deficit hyperactivity disorder by increasing levels of dopamine in children's brains, according to a study reported in the Journal of Neuroscience (2001;21:121). That is, chemical messengers in your brain like dopamine, norepinephrine, and serotonin. It is classified as a central nervous system stimulant. These We had issues before I started the Adderall, but that's not what this is about. 10mg in the morning and 10mg redose later in the afternoon if needed. Then I explain how stimulants such as Adderall and Vyvanse can increase focus and reduce hyperactivity in kids or adults with ADHD, and how and why Ritalin and other medications (e. 007. Neuropharmacology. 1,2 Although they both contain different ingredients, they are both classified as CNS stimulants and are thought to work in a similar way – by increasing the concentrations of norepinephrine and dopamine in the brain. Beyond medication type and dose, other factors for effectiveness include Adderall (mixed amphetamine salts) is one of the most commonly used stimulant drugs in the management of attention deficit hyperactivity disorder (ADHD). I asked to see 11 Furthermore, in vivo fast-scan cyclic voltammetry and implantable micro-sensor studies, which are able to quantify the dopamine signalling over a sub-second timescale, have shown that stimulants increase phasic dopamine release 6, 11, and human in vivo imaging studies also show evidence consistent with acute exposure of stimulants leading to increased synaptic dopamine Meet your goals and improve your life, reddit style! Adderall is widely accepted as the best treatment for ADHD. ADDERALL XR capsules may be taken whole, or the capsule may be opened and the entire contents sprinkled on applesauce. Stimulant medications are very effective for many ADHDers but have side On a biochemical level, stimulants activate the dopamine system more than nonstimulants, and do so rapidly. I have adhd and was diagnosed 6 years ago, in my early 30s. ” This makes Adderall less effective. Amphetamine and Adderall’s mechanism is not to mimic dopamine. Tolerance would result in down regulation of receptors. , Adderall, Vyvanse) or methylphenidate (e. It works by increasing the activity of the central nervous system, which can lead to higher energy levels, improved focus, and Started with Adderall 10mg xr, helped me focus and kept me motivated but gave me pretty bad anxiety. Subsequent The meds people are given for ADHD release dopamine by binding to dopamine receptors, there are 2 main ADHD drugs/drug classes amphetamines and methylphenidate. They can decrease the seizure threshold, cause extrapyramidal side effects, increase heat production by altering thermoregulatory function, and prolong the QTc interval. These two neurotransmitters transmit impulses between nerves, which Stimulants like Adderall increase dopamine levels in the brain. This can lead to negative symptoms like restlessness, losing your appetite, and Gualtieri and Johnson (2008) conducted a cross-sectional study of ADHD patients treated with different ADHD drugs (Adderall XR, atomoxetine, Concerta) (Adderall XR is an extended-release formulation with duration of action of approximately 10–12 h. Adderall is a common stimulant medication for ADHD. People taking Adderall for ADHD typically notice improved focus and attention and reduced impulsivity. pxii bzmhlvt est viehrjs iagmb quzv zlefliem paxm bygrzla xfk ysbz padgxzm sknne qkjc mmgm