Are stimulants suppose to be temporary or lifelong?

[Pianoplayer28]

When I was on Concerta XR I ended up at the highest dosage and it did nothing for me every step of the way. I then got on Adderall 10mg IR and it was amazing for me! I ended up building a tolerance I guess because it went from lasting 6 hours to lasting 3 hours. My psychiatrist changed my medication to Adderall XR 15mg and I’m very hopeful it will be better since that is suppose to last me 8-12 hours! But I’m worried because if I built a tolerance that quickly to the instant release Adderall, does that mean I’m always going to need to bump it up? And does that mean that I’ll eventually need to get off of it if the highest dose ends up doing nothing over time?

[STEM_Dad]

A doctor, nurse, psychiatrist or pharmacist can probably answer your question with some authority.

What I understand is that after going off a medication for a while, you shouldn't have the tolerance anymore.

The only stimulant that I've developed a tolerance for is caffeine. I drink coffee daily, and sometimes other caffeinated beverages like cola or tea. Every once in a while (about once or twice a year), I'll develop a tolerance to caffeine (or even develop a reverse effect, where caffeine makes me sleepy instead of help me be alert).

When I know I've developed a tolerance, I will do a "caffeine fast", not consuming any caffeine for about 5-7 days. After that time, caffeine will work like normal for me again.

I hope that the same works for ADHD medicine, that going off the med for a while will make the person able to use the medicine again.

[Hanwan07 in reply to STEM_Dad]

That’s really interesting to hear. Recently I’ve been literally falling asleep after my morning coffee. I wonder if this is why.

[somiya_2003 in reply to STEM_Dad]

oh, that's what I was implying as well and definitely, it works for everyone.

[STEM_Dad in reply to STEM_Dad]

I do know that some people prescribed stimulant meds for ADHD will go on medication "holidays", which are spans of time that they will go completely without the meds.

One reason that people do this is because the meds make them feel different in ways that they don't like. Some have a holiday every weekend. Others, during academic breaks (Thanksgiving, Christmas, Spring Break... maybe even all summer).

I think I've read (though I can't be sure if I remember right) that one reason for these medication holidays is to keep from building up a tolerance to quickly.

As always, consult your prescribing doctor or psychiatrist before opting to go days off your meds.

---------------------------------------------------

I cannot take medication holidays, because I'm on a non-stimulant which takes time to build up in the body (atomoxetine, aka Strattera; it is a selective serotonin and norepinephrine reuptake inhibitor, SSNRI). Nor would I want to. It's effective for me (twice as effective as Adderall XR was), has no side effects for me (as far as I'm aware), but would have letdown side effects if I simply stopped taking it daily (I can miss a day or two with no ill effects, but I don't dare miss too many... because I like having a more functional brain).

[BreeMary]

I’m not a doctor but I’ve read you can build a tolerance quickly with stimulants yes. However, it’s important to note too that the medication is probably still working in your system it’s just not as powerful as it first was when you started it. Try to think of the smaller things it’s helping with. For me, as I go up doseages I get that initial burst or calming effect. But as I get used to them it plateaus and the effects are more subtle. For me my emotional regulation is FAR better on meds, and even tho the effectiveness overall in time frame is diminished I still see those changes. There was a good post about it on Reddit and I’ve attached it here! Something to think about. I’ve also read if you go TOO high with meds it can also make your adhd symptoms worse too. Again not a doctor but just some things to think about.

Black and white

[BreeMary in reply to BreeMary]

Part 2

Black and white

[BreeMary in reply to BreeMary]

Part 3

Black and white

[Hidden in reply to BreeMary]

Thanks for posting this. I experienced this with Adderall very recently. My doc started me at 20 mg, then 20 twice per day, then 30 mg twice per day. I got that kick, but if I’m being totally honest, my ADHD symptoms sometimes got worse because my brain was over stimulated. I started to notice symptoms that the meds should have helped. So I stopped taking them for a week, started seeing a psychiatrist vs my regular doc. She started me back on 20 mg twice per day. It’s exactly what I needed. My psychiatrist recommended Vyvance, but wants to formally have me tested before we really begin to work on the right combination for me. To mix things up even more, my husband and I started seeing the psychiatrist together and my husband has ADHD probably as bad or worse than me and he’s not medicated yet. That makes for interesting conversation sometimes. It will be nice after we’re tested to be able to help each other and have someone to go through this with. People don’t understand ADHD in adults and don’t have any idea how debilitating it can truly be in medicated.

[BreeMary in reply to Hidden]

Yeah exactly! And everyone is different in terms of med and doseage too. It’s a balance with these types of meds I find .

[Gettingittogether]

I've thought a lot about the matter of tolerance and I have read conflicting information ... from some people saying yes it happens ... and others saying ... well ... it's not clear that that happens ...

Here's what I ultimately concluded. And it builds on BreeMary's posts above. I have to make sure I'm am living in a way that allows the medication to function. I cannot "outsource" all concentration and ADHD issues to the medication. So:

I have to be sure to get enough sleep ... lack of sleep undermines any medication over time ...

I have to control my stress ... constant stress will overload the medication ...

I have to try to eat in a way that is healthy ... swings in blood sugar can cancel out the medication effect ...

Exercise works amazing wonders for my concentration ... am I getting some exercise?

I have to control my depression and anxiety ... I was shocked in my recent round of therapy to discover that I had a serious anxiety problem ... I didn't know I had anxiety until I began to lower it ... once I lowered it ... I was like, "OMG, this background noise has been here all along?!"

This isn't directly tied to stimulants, but I had a close friend who had his depression lifted--I mean in a huge way--by an antidepressant. He didn't believe in antidepressants, but a doctor convinced him to just try it. He was blown away ... But ... he never got therapy ... and he was a perpetual, chronic negative thinker. He could observe some situation that had lots of good and some bad and he would immediately obsess about and focus on the bad ... I mean he was allergic to good news ... or even a positive focus on anything ... I'm not taking about a fake positivity ... I mean even when some great news was right in front of him, he just dismissed it. This might have been anxiety that wasn't adequately treated.

Well eventually his depression returned ... my conclusion: we have to do our part to help a medication work ... his negative thinking and lack of work on it (I think he needed CBT big time) undermined the medication over time ... now this was just my pop conclusion. Not scientific ...

One more point: are you increasing your demands as you increase your medication?

The effect of medication is based on the difference between our responsibilities and goals ... and our level of capability to fulfill those responsibilities. The stimulant works to close the gap between what we want to accomplish and what we can accomplish.

Looking back, there were times when I would say to myself that my medication wasn't working like it used to ... But looking back now I think ... oh ... but because the med was working, I actually took on more responsibility ... you with me?

At one point, I took up a big hobby ... and I added additional responsibilities at work, I began to regularly keep a planner. I started scheduling all kinds of appointments I had previously avoided ... So when I began to feel like I was struggling (and that the med wasn't working like before), I'm not sure I had the right framework. My medication did work to help me with my previous level of demands ... but when I increased my ambition and responsibilities, so to speak, I felt overwhelmed again ... I don't think that means I was running into tolerance ...

[Pianoplayer28 in reply to Gettingittogether]

Thank you for your insight, that makes perfect sense to me. My friend kept telling me the same thing, “get enough sleep, excercise, drink more water” but I didn’t think it was the reason for why my medication wasn’t at its best

[Hidden in reply to Gettingittogether]

Thanks for posting this. Your experience is spot on with mine and makes 100% total sense. I was diagnosed 2 years ago at 52 and the main reason I went to the doctor was because I was failing at work and couldn’t keep up. I started a new job about 4 years ago, I was recruited to this company and have 30 years experience. The learning curve was intense and I couldn’t remember conversations I had with my boss 2 minutes before. Executive thinking and taking on large projects were impossible. I have 2 degrees and have had a successful career and then I hit the wall. I thought I was getting early onset Alzheimer’s, that’s how bad my memory was. It scared the crap out of me. I also stopped drinking alcohol over 2 years ago because I thought that might be contributing, other than feeling better it changed nothing. ADHD is real, but there is help. As you’ve said, less is more with stimulants and once you got that magic dose, your life will change for the better.

[Gettingittogether in reply to Hidden]

Sounds like anxiety as well.

[BreeMary in reply to Gettingittogether]

Yes! Thank you for adding onto my statement! That is so true. Medication helps us kind of get going but we have to do the work to make the medication work better if that makes sense? Once I realized that too I had a better relationship with them (funny to say lol) and was able to really put myself into gear re - therapy etc

[somiya_2003]

I just take Concerta 54mg so I can only recommend some things that have worked for me, I have noticed that some weeks I have the tolerance to my dosage so I give my self stimulant break for 2 to 3 days and after that start from 18mg in the morning and 36mg afternoon splitting my time so it stays in my system longer, I limit caffeine, processed carbs, fat and Vitamin C as they increase the stimulant being released in my system but after my stimulant wears off I consume these without a problem and I also noticed that I am tolerant to my medication when I have lack of sleep, when you have lack of sleep there is no way you can optimize ur brain function and if I don't eat well then my brain stops working and after food, I wonder this was the thing I needed.

I thought to myself, the higher the dose the more painful it is for your liver and some days it needs rest so that it can function better and that I have to stress less because that takes energy as well as getting mad at ppl. Just try to break a task down (ex: study a paragraph and if you think u can do more then continue till you get tired)

[Viper42]

Good morning. Good post and question. So ill preface this 1st by saying I too have ADHD and am a practicing pharmacist. You have had some great responses here. Well informed responses at that which is great to see. They have each hit on the critical points. With Adderall being immediate release, the rapid spikes and drops of the neurotransmitters is different than the extended release forms. That in mind, since the intent of the medication is to maintain attention, like any other interruption in life, the rapid drops in chemical levels affect your performance and abilities. Usually doctors will go from IR forms to XR forms not the other way. The reason is simple..you need to gauge the effectiveness of the drug dose and frequency. With ADHD this is behavioral condition. So dosage adjustment is only possible by viewing the results. Since you went from XR to IR you may see issues crop back up. But as one individual posted, the medication is only a tool to assist. Meditation, behavioral training, therapy etc must coincide. Therefore if staying on the IR is what is needed right now you will need to have frequent check in with your doctor to inform them of what you observe. Its also important to get outside observations as with ADHD perceptual issues of ourselves etc tend to cloud judgment. As for tolerance...thats a tricky term. Remember ADHD is a deficit in the transmitters that are at higher but normal levels in "Neurotypicals" Getting the right dose achieves normal steady state. This is why those without ADHD on amphetamines get hyperstimulated but we do not. Therefore tolerance really physically develops when you have exceeded your optimal dose and would be using the drug in an abusive way.

The best advice I can give is to make sure you keep close tabs on your physical and emotional responses at particular doses and frequency. With Adderall typical side effects are neurological as you might guess. While rare the time at which you need to consider a switch quickly is if you experience symptoms of Serotonin Syndrome. Fast heart rates confusion to name a few. You can check that online

Im hoping I have helped here. I hope you get the right dosing and treatment and that you get back to where you want to be. Best of luck to you

[BreeMary in reply to Viper42]

Thanks for that response!

[BreeMary in reply to Viper42]

I also like that you mentioned having others see if we’ve changed. My husband noticed a huge difference while I’m in meds vs not and in a good way but I don’t see it as strongly. I also forgot to take my meds yesterday and work was a struggle - I was much more annoyed by the sounds around me and generally an emotional regulation mess and couldn’t hold my focus for more than 5 minutes. So yeah once that happened I realized oh shit the meds are doing something lol

[Viper42 in reply to BreeMary]

Awesome....you were aware enough to see the difference and take an action. Typically, thats out biggest issue. Good for you

[BreeMary in reply to Viper42]

Well update from this week - I haven’t been doing good at ALL this week. Like the med is just not working and I can’t tell the difference between being off and being in so I just feel I’m popping pills with no effect now. Super frustrated but I have a doctors appointment follow up Feb 7th. I don’t know if I want to go up a dose, try a new med or just scrap this damn plan all together. Feeling super defeated today.

[Hidden]

Hi pianoplayer28. I happen to play the piano too. Lol. I don’t have any experience with Concerta, but I’ve been taking Adderall for around one year. I started on 20 mg and tolerance does build, but that’s normal. My PC diagnosed and was my prescribed until last week. I tried Adderall XR and took it right when I get up at 6 am. It worked well, but I could never get to sleep before 1-2 am. I’m now on 20 mg Adderall IR twice per day and that seems to be about right. 60 mg was too much. Something you may consider to help with tolerance is not taking it on weekends or days off if you don’t need it. I sometimes take a week off if work is a little slower. That helps a lot. Be honest with your doc. Mine told me this week there are several different types of stimulant medication and it may take a couple before you find the best one. I will say though, from the first hour after taking my first Adderall my life changed. My memory improved, I could actually think and execute things and focus for more than 30 seconds. It saved my career. All the best.

[Adultadhd]

Looks like you are getting lots of great replies, I will add my experience to the mix.

Finding my right dose took about a year.

30 mg at 5:30am

30 mg at 11:30am

15 mg at 3:30pm

I recently thought it is not as effective after 3 years of not missing meds so I went on a "drug holiday" and stopped for a week and a half. It was not enjoyable but what I learned is Adderall was working more than I gave it credit for. Also it did reset me to Adderall working more for me again.

It doesnt feel as punchy as it did when I first took Adderall though, it used to be 45 min after I took Adderall everything in the world just made sense. I think this is because I went 35 years before I was diagnosed and it was just new to me to actually have executive functions.

I have never tried extended release because instant worked so well for me and I sleep so well on this dosing I didnt want to chance losing my sleep.

Hope you find what is right for you!

[Neurolancer]

Hi! I haven't taken the time to read all replies so I apologize if I'm duplicating other responses.

My psychiatrist has told me that the way to reset the body's tolerance to the stimulant category of medications is to stop the medication for a short period of time, e.g. 2 to 7 days, depending on how sensitive your body is. Alternatively you can cut back on the quantity for a period of time. When you start taking the medication again, you no longer have the tolerance built up and you can increase the amount that you're taking as you need to.

-- I just tried the method of cutting back rather than going off entirely and this worked.

-- My son when in high school would take his Vyvanse and Adderall during the school week but not on weekends. Just that two day break every week resulted in his medication always feeling effective.

-- My daughter went the path of backing down her medication until she was off it rather than going "cold turkey" as she has a very sensitive system. When she started again she had the same experience of a complete reset.

The trouble for me is that I NEVER have a period of time when I'm doing nothing or have no responsibilities, so I have a hard time choosing a time not taking ANY medication. I FREAK OUT about being a blob on the couch. That's why I tried the approach of backing off the amount that I'm taking for a week or so then increasing it again as needed.

I hope this is helpful!

[75ADHDgal]

I am a Nurse Practitioner and I have ADHD primarily inattentive type . You can choose how to use the stimulat meds- some folks take daily no matter what - others do not take on their days off from work or school -Discuss with your Psychiatrist and get an ADHD coach!