Can ADHD Medication Stop Working? - CHADD's ADHD Pare...

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Can ADHD Medication Stop Working?

JJMom16 profile image
13 Replies

My son is 6, and was diagnosed at 5 with ADHD and Anxiety via a neuropsych evaluation. We did multiple iterations of medication trial and error, and landed with Concerta (first 18mg, then 27mg, now 36mg), Celexa (20mg), and Hydroxyzine (2mg) for daytime, and Clonidine (.1mg) for sleep. We had good success with this combination for over a year. There were noticeable changes while on medication, and any trouble in school with impulsivity or hyperactivity had improved.

Starting in July, following a year of success on meds, we started to notice an increase in aggressiveness, impulsivity, mood swings, and hyperactivity. Since Kindergarten started 3 weeks ago (same school), things have further spiraled out of control, both at home and at school. It's as if his medication is no longer effective. Today, he got temporarily suspended for throwing a rock.

Can medication stop working? Has anyone experienced anything similar? I'm working to get an urgent appointment with our child psychiatrist, but he brushed us off during our last appointment, indicating that the meds "should work."

13 Replies
Pattimum profile image
Pattimum

I am always stunned how brave multi medication is going on in US. In the UK NICE guideline states ‘mono therapy’ for treatment of children with ADHD is preferred. For sleep in kids the most you will get is ‘melatonin’.

When a child is on so many meds at the same time it’s very difficult to detect which one causes which side effect. When you look at medication leaflets- most of them can have such side effects.

Adverse effects mostly happen at the beginning but this is a misconception if someone thinks that they can’t happen later in the treatment.

Saying that, my child’s paediatric psychiatrist was the same blaze when I was reporting severe side effects of the ‘first line treatment mono therapy with a stimulant’. Psychiatrist told me blunt that what my child was experiencing wasn’t the side effect of the medication. He then told me when I insisted, that the only way to check it is to stop medication for 6 weeks and me carrying a daily diary to see if the events that I described stopped. And then restart the medication and do 6 weeks diary and if my child after restarting would again have adverse events’ then it would mean that it’s indeed the side effect of meds. Which mother would willingly put a child through such an ordeal as if in some cruel ‘clinical trial’?

I discussed with my hubby at home and he said ‘Well, he also suffers from more obvious side effects such as rebound so let’s stop bringing the ‘rare’ one that the psychiatrist is dismissing and start listing all the other side effects.’ So during our next consultation my husband was stalking (he’s a lawyer 😄). Consultant just coldly said ‘Yes that is ‘rebound effect’ of stimulants. So what shall we swap to? Do you want to try him on Atomoxetine or straight to Guanfacine?’

And I agreed to swap my son to Atomoxetine. Atomoxetine works round the clock- there is no daily ‘come down’ and a child also wakes in the morning ‘already on medication’. It also improves mood and helps with anxiety.

We are lucky- on non stimulant medication my son is doing well. He’s very happy that we swapped. The ‘rare’ side effect that the psychiatrist was insisting that it ‘wasn’t side effect’ never returned.

I am glad that my son is just on 1 medication as it’s very easy to monitor for side effects and adverse effects. I weigh him from time to time to make sure that he’s on a right dose for his weight. I will only make another appointment with the doc when I need dose increase.

I hope that you find the consensus with the psychiatrist. I feel they are often quite overconfident- just dishing out all these meds… Or maybe seek a consultation with a different doctor?

Onthemove1971 profile image
Onthemove1971 in reply to Pattimum

I am unclear on your message. Each medication help resolve certain symptoms of ADHD. So I am not sure if you think it is wrong to use 2 medications at the same time?

Stimulants only resolve impulsive control and deceasing excessive talking. For focus a non-stimulant helps resolve that issue.

I person take 2-3 different and there is no issue.

Pattimum profile image
Pattimum in reply to Onthemove1971

As other people pointed out- your child could just be having this behavioural change as a reaction to a new situation- starting kindergarten. However all the medications that your child is taking has possibility of side effects that behaviourally would present similarly. So let’s say they can cause irritability, aggression, instead of calming they can cause hyperactivity, emotional instability etc as a side effect. You are right- adding another medication can counteract side effect of the main one that treats ADHD symptoms. So for example your child is on Concerta (Methylphenidate) which is a stimulant ADHD medication that as side effect causes suppressed appetite but because he’s also on antihistamine (Hydroxizine) and antihistamines increase appetite - this means this side effect is ‘sorted’. Hydroxyzine also like most antihistamines has a side effect of ‘sedation’ so it can relieve anxiety and tension. However as pointed out above- Hydroxizine can also have a side effect of ‘irritability’. Methylphenidate can cause sleep problems- hence it looks like Clonidine is given in the evening to help the child with sleep. But Clonidine can cause a side effect of ‘anxiety’. Celexa (Citalopram) is an antidepressant and I imagine it can help with ‘anxiety’ but as a side effect it can actually cause feeling nervous, restless, insomnia and many more. So what I mean is that when a child is on so many medications and the list of side effects for these meds are overlapping, it is very difficult to immediately find out which one started causing ‘side effects’. Situation which I described to you about my child happened when he was on Methylphenidate - he was experiencing a rare side effect of ‘urinary frequency’ so basically even though his bladder wasn’t full, he’s constantly felt like he needed to pee and was not able to hold urine in, would frequently wet himself - a couple of times a week. He was also experiencing other side effects on Methylphenidate (Concerta)- he had severe ‘rebound’, he was irritable, aggressive, had pressure of speech, insomnia, appetite suppression and ‘over focus’ where he would just be preoccupied with football and footballers and football scores. It was easy to see that it was Methylpenidate (Concerta) causing all these debilitating side effects because he was just on this 1 medication and when we stopped Methylphenidate all the side effects stopped. The day we stopped giving him Methylphenidate and swapped to a non stimulant ADHD medication (Atomoxetine) all his side effects including ‘pressure on bladder and frequent needing to go for pee’ and ‘wetting himself during the daytime’ disappeared and never came back (it’s been now over half a year since he stopped Methylphenidate). However as I mentioned- psychiatrist initially was dismissing possibility that Methylphenidate can cause ‘urinary frequency/urgency’ and ‘day wetting’. Psychiatrist was telling me to check for physical health reasons (so I had his urine checked for bacteria- no infection detected), then he said that probably it’s psychological reaction to ‘stress’ and that maybe something changed in his life, at school etc and that I should seek help from psychologist, eventually he told me that I just need to refer my child to ‘incontinence clinic’. Luckily I stood my grounds. I insisted to stop Methylphenidate and as I said- the day we stopped giving him Methylphenidate, all his side effects, including ‘urinary frequency/urgency’ stopped. Atomoxetine also has a list of possible side effects and my son still suffers with decreased appetite whilst on this (but much milder than on stimulants) so I give him daily antihistamine (Zyrtec which is a hayfever tablet ) which has a side effect of increasing appetite. So to reply to your question- is it wrong to give 2 medications? It is not wrong to give 2 medications but it’s necessary to know exactly why you are giving those 2 medications and what side effects each of them can carry. I think it makes sense to try to give fewer different meds (to treat 1 condition) to a young child. So let’s say if the child initially was diagnosed with ADHD and anxiety disorder then instead of giving him Methylphenidate that can increase anxiety (and then give him on top of that lots of other meds to stop anxiety), maybe the way to do it would be to try to switch to a non stimulants like Atomoxetine, Guanfacine or Qelbree. Maybe one of these would work and wouldn’t cause side effects? These 3 non stimulants treat symptoms of ADHD and anxiety. In the UK Qelbree is not licenced yet but US is always ahead of us.

JJMom16 profile image
JJMom16 in reply to Pattimum

Our Psychiatrist told me flat out "non-stimulants will not work." I was flabbergasted, as everything I've read here says that isn't true. We added all of these meds one at a time, over time, to try and pinpoint side effects. You are absolutely correct that they often do overlap. We did try Guanfacine, but it caused insomnia/mania, unfortunately.

Pattimum profile image
Pattimum in reply to JJMom16

I am sorry that Guanfacine caused mania. It looks like all 3 non stimulants (Atomoxetine and Qelbree too) can cause mania as a side effect in individuals with the family history of bi polar disorder or predisposed etc. Also some meds combinations can make meds ‘stronger’ and cause mania. However you could try a different psychiatrist who would be willing to wean your child safely off the meds he’s now on (it looks like some of them can’t just be stopped in a day, also psychiatrist would know which ones to take off first etc- kind of going back to basics and starting all over fresh) and then try the remaining 2 non stimulants. It doesn’t say anywhere that once someone had adverse reaction of mania with Guanfacine, then they will have the same effect with Atomoxetine and Qelbree. And of course as we know from stories here- there are children who will have adverse reactions to all meds… Have you considered trying just Clonidine and nothing else? Your child is very young. How ‘focused’ do you want him to be? He doesn’t t need to be passing exams…All he needs to do is to be able to follow basic instructions and enjoy playing on his own or with the kids in his kindergarten. It’s almost like you could have him slightly ‘sedated’ with Clonidine during the day too- once you find psychiatrist who is willing to have a dialogue with you, you can ask all this, you can be slowly discovering solution that works for your child long term (because ADHD doesn’t go away, it’s a life long condition). It’s more tricky for older kids who actually have to be writing essays, doing maths and science, doing homework projects…and having ‘high pressure lives’ full of after school clubs etc. Form my son that’s why we settled on Atomoxetine- he’s happy, sleeps well, eats well, he can cope at school and then every day have after school sports club etc (before meds he was a mess after school, couldn’t do any sports or anything, it was like walking on egg shells even to get him to his swimming lesson …). Is he super ‘focused’- no, but he can read a book for 30 minutes or even more if he wants to, sit and watch a film (still somethings will walk off half way through to run about an kick a ball in the garden). He’s still quite oppositional and he will shout often at home ‘No I am not doing it.’ I realise that he learnt shouting because from young when we didn’t have any help or diagnosis for his ADHD we shouted at him a lot. It will take time to heal it. At school he’s doing as he’s told. Anyway, sorry for this ramble but all I want to say is you need to know what level of ‘functionality’ is good enough. Last but not least I just want to share what after suggestions from other parents I started doing to calm my son down after a full on busy day- people here said that occupational therapy works really work for their kids. Most kids with ADHD have some sort of ‘sensory integration’ issues. If you have space then get a hammock or a rocking chair. Some kids like trampolines (mine don’t). I noticed that my son calms down with a weighted lap blanket (he can sit and do his homework). I also bought him a body sock(supposedly it calms kids when they are inside something tight- like back in mother’s womb). I told him to try it on and pretend to be a ‘flying squirrel’ shape (when he stretches his arms and legs inside this ‘sock’). He’s older and he knows this stuff is ‘weird’ and different to other kids, and I wish I tried all this when he was 5…to show him natural ways to self sooth and relax… The lap blanket- even my non ADHD child loves it, I told him he can imagine that he has a cat sitting on his lap (my kids want a cat but I don’t want any animals). He says it relaxes him and after school and ‘clubs’ he sits and reads his book with this blanket on. He also tried it to fall asleep with it and he said it helped when his finger hurt and he couldn’t sleep but this blanket helped. Because why let’s say a cold compress helps. Or a hot water bottle? I think it’s like one sensory feeling counteracts the other and kids can then cope better and self sooth (well I don’t know exactly why ‘sensory’ stuff works but it seems it works for many kids). You don’t have anything to lose- trying these things and then sending them in to kindergarten. My son also has a wobbly wedge cushion to sit on at school - it helps him to manage to sit for longer periods in his desk (as required in the class from older children). Hope you find the way that works for your child.

Trying1978 profile image
Trying1978

Wow, that sounds like a lot of meds for 6 but, if it was working, great! My approach is, if it ain't broke...

Our 6 yo is on Methylphenidate. My 2 cents are that yes, stress & environment can really affect/reduce effectiveness of meds, especially if there isn't enough time to pursue the more psych type work with behavior.

That's been our experience as we've moved from half day kindergarten to full day 1st grade anyway. All that time to work on talking about feelings & practicing self control & social skills is just gone. Sounds like things are rough right now; they are over here too with our 6 yo, so hang in there! I know it's really overwhelming...

Momtrying profile image
Momtrying

starting kindergarten is so hard. My 5 year old is having breakdowns every day after school. I fully expected it as going from summer to 6 hours a day is soooo hard for little ones. So some of the behavior will probably calm down as he gets used to it. But, my older son has had to up his medication dose every year. We started meds right before 5th grade and we’ve noticed after about a year it’s like he’s not taking them anymore. His teachers will ask, are you SURE you took your medicine this morning? So we adjust the dose when that happens. Sounds like you may be in that situation, but also may be a little hard to tell because the beginning of the school year is always hard on their bodies and brains. But it’s also hard to wait things out, I know!

i’d also say if you get brushed off again by your doctor again, maybe look for someone else who will listen to you 😊 good luck!

Elijah1 profile image
Elijah1

It appears that he has anxiety in addition to ADHD, based on use of hydroxyzine and Celexa. Things to check

1. Do the Concerta tablets or Celexa tablets look the same? Sometimes changing to a different generic affects the blood level of the medication.

2. Are his behaviors features of anxiety with more easy upset and emotional reactions? This can happen from a dose increase in the Concerta (or a different generic)? Another reason is looking more wired from Celexa.

Don't ask the psychiatrist if the medication effect can stop happening. Ask if the behaviors can be a medication side effect (we had this happen with our son).

JJMom16 profile image
JJMom16 in reply to Elijah1

This is a great thought. Thank you for taking the time to reply. We have two diagnoses: 1. ADHD and 2. Anxiety.

I believe that the root cause of the behaviors we're seeing is anxiety. He's struggling in school and feeling anxious about his performance. When he gets in trouble, it amplifies his anxiety. ADHD is secondary.

We have a strong family history of anxiety, but no history of ADHD. Myself and 4 additional family members all take Effexor (Venlafaxine.) I talked to our psychiatrist briefly and he agreed that he would be willing to switch us from Celexa/ Hydroxyzine to Effexor.

I'm hoping to keep him home from school long enough to land the Anxiety piece before introducing stimulants back into the picture. Psychiatrist wanted to increase him to Concerta 54mg, and that seems like a lot for a 43lb 6 year old.

Elijah1 profile image
Elijah1

What happens if you stop the Concerta for a few days? Will the unwanted behaviors decrease?

JJMom16 profile image
JJMom16 in reply to Elijah1

We are finding out. :-) We started the process of discontinuing Celexa/Hydroxyzine today, to switch to Effexor. We're tapering off. We're also taking a "holiday" from Concerta for a long weekend. So far, my son is bouncing off the walls and is very irritable and impulsive. It could be from cutting the Celexa in half. We'll see how the next week goes.

julieboolie profile image
julieboolie

You've already gotten good counsel. I just wanted to share that years ago my daughter was on Concerta. We had been buying the generic and it worked well. All of a sudden her symptoms returned and the meds were no longer helping. After some research it turns out the generic for Concerta changed and others had the same issue. We couldn't afford the name brand and had to switch meds. They didn't work as well. Just something to check.

Hope you can figure it out. We've had a very rough start to Kindergarten. My son is on Clonidine and it's helping some (the stimulants were making him too aggressive alone). Im hoping to add stimulants soon as his schoolwork is suffering.

Aloysia profile image
Aloysia

There are lots of good replies here. I'm going to address one of your original questions "Can medication stop working"?

Yes and no. With my kids what I've noticed is that as they grow, we sometimes need to up the dosage. My guess is that as they go through growth spurts, their body now needs a higher dosage to achieve the same effects. So while it may seem like the medication has stopped working, it's really that their body mass has increased to the point that they need a higher dosage. This has occurred many times with my kids. I make sure to check in with them about the dosage when school starts in the Fall and again in Jan.

Of course, there are other possibilities as mentioned in other replies. And it will be difficult to figure out since there are 3 medications involved.

Wishing you the best...

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