Does Tolerance Develop to Stimulant Medications for ADHD

Does Tolerance Develop to Stimulant Medications for ADHD?

The study discussed in the video is:

K. Handelman & F. Samiya (2022). Tolerance to Stimulant Medication for Attention Deficit Hyperactivity Disorder: Literature Review and Case Report

And can be found here:

[carloscontreras]

People on ADHD meds feel that the the initial rush of a dopaminergic medication means that it is working. That initial rush will fade over weeks, causing people to feel that the medication is “not working.”

[tankgirl]

Hi Doc, I wondered if my meds (Methylphenidate) were not as effective, and my conclusion, after just a couple of days off them, was that we forget how difficult things were pre-medication. I think it's human nature to push ourselves, so if meds help us achieve some things, we aim for more, then when we struggle we think the meds aren't working, not realising how high above our original base line we are - we're just raising our own expectations as our baseline ability increases... I'll stick with my meds thanks! Does that makes sense?!

[Alex-jslg]

It's important to remember that medication doesn't automatically provide life skills. If you've never managed a schedule or established a daily routine, medication won't always teach you how to do that.

[sarahciliavincenti]

I think what happens is when you start stimulant medication, low dopamine was your normal and increased dopamine becomes a special good state. Over time, increased dopamine becomes your new normal, and functioning with out it becomes harder. People think they are getting tolerant to it. But one is just getting accustomed to a new normal. Its a bit like spectacles. The first time you put them on, you're impressed with how more beautiful the world looks. Over time, it becomes your new normal and it doesn't keep surprising you. You get surprised when you don't put them on and struggle to see properly. That's why one must not rely on how one's feeling to monitor benefit of medication. You need clear targets to be set at the outset. For instance, relying on less external sources to regulate emotions, such as food or cigarettes etc, or the ability to quickly reframe negative thoughts and get on with what you're doing. Thanks. Great video as ususl.

[Chris-b-]

My psychiatrist had told me when I started that the effect we want from Vyvanse is subtle, and the initial euphoria is not the treatment we are looking for. He had said that I would notice this euphoria any time I am off the meds for a bit and start back up or go up in dose. I’m glad he did, because I didn’t associate the ‘energizing stage’ of the medication as anything more than a side effect.

[weaviejeebies]

I've experienced social tolerance. It wasn't that I felt personally that it wasn't doing all the things, I love the medication. It's that the improvement altered everyone's expectations of me, including myself, so the dramatic effect of the meds lost a bit of its obvious shine. I have to stop and remember I'm doing probably 10x more in a given day and am probably 100x more successful in completing objectives. It happens with such regularity that I don't even notice all the things I've grown accustomed to doing well. I have to remind myself that of course life's going to always feel hard and challenge my EF, because I still have ADHD, and the baseline expectations have shot up to somewhere just south of neurotypical.

[bluejules]

I think a short drug holiday is an educational opportunity to see the benefits; during a few days of withdrawal, I suffered a prolonged version of the worst aspect of my pre-treated ADHD. It was a reminder of symptoms I no longer get since being on the ADHD medication, mental exhaustion like sluggish cognitive tempo (SCT), now called cognitive disengagement syndrome (CDS). It helped me to see the benefits of the medication.

[topiuusi-seppa]

From my personal experience I definitely agree with the conclusions. As for the tolerances developed within days of starting the meds, I've had that with some meds and I feel like the problem could've been that it didn't work to begin with. It's just the novelty of just any kind of change and excitement of wanting to see how easy previously hard tasks have become. Running out of meds when needing them the most while thinking the meds didn't even work has been a very sobering experience on just how much the meds really do even if I had started to believe they don't do anything 😅 Getting diagnosed and medicated as an adult is a weird experience, because the meds are both an unbelievable magical miracle cure for almost everything and a huge dissapointment at the same time. I don't know how to explain it any better or if it can be even truly understood without having personally experienced it 😅

[recynd]

I’ve been on stimulant meds for going on 20 years (I’m 55); the effectiveness has been linked more closely with my hormones and not time. It still works well for me. 👍🏼

[ThatADHDKid]

I've been on stimulants for almost 3 years now and I still get the same benefit I did when I began taking them. I did notice that I'm often able to take my medication in the morning as it's an XR and can you usually go back to sleep for an hour or so until it fully kicks in before I get up. And I'm finding myself getting a little more tired throughout the day even though I'm taking the same amount of medication I always have.

So I definitely think you're on to something with it being mainly energetic feeling, I still have great success controlling my symptoms with medication and I was recently prescribed clonidine to help with sleep and with ADHD symptoms and I feel 10 times better than I did taking stimulant medication alone.

It the first two weeks I've felt really really good I'm not as anxious and I am not as quick to get upset or let my emotions take the best of me

[laurasteben]

Thank you, thank you, thank you for this channel!! You are giving researched backed (as opposed to opinions) knowledge to us ADHD folks in a way we can understand and use. I was diagnosed with ADHD in 1982 and have struggled with it my entire life. Now, as an adult, I am watching my children (who are now teenagers) struggle with it.

[Mightydoggo]

Thank you, I wondered about this as well. For me, the effects seem to be pretty inconsistent. Sometimes the medication massively boosts my mood, sometimes I can focus like never before, sometimes it doesn´t seem to do anything at all... It´s really weird. I´m still not sure if its actually like that or if my brain is playing games on me, you know like having the feeling it works on good days and it doesn´t on bad days, something like that.

It´s not like I have an easy objective way to assess how good it´s working and in what context. However I do keep taking them cause the one thing they do for me is fixing my memory issues. I turned from barely being able to remember what I ate yesterday to actually remembering entire phone calls and names! Yeah, I can finally remember people´s names. Big W.

[lagomorphia]

Thank you for this information! Initially I loved the meds because, if I set an alarm and took them early, it could cut through the hours of morning grogginess that I always experience. I felt I had discovered the secret to what normal functioning would be like, but it wore off. I did as you said, tried a few days off and boy was I hit upside the head with the demon ADHD, so concluded that the meds are working just fine and the morning benefit was simply my body not being used to it. I now sleep through the meds so my lifelong dream of being an early riser is not to be but I still am a thousand times more competent with the meds in the long term. Glad to know this is just social tolerance, I think you called it. Happy New Year to you and all.

[normietwiceremoved]

I find that even the 'focus' benefits go away too. Sure, the motivation effects going is a bummer, but I find that feeling of focus gets lost too, and I end up with just having a 'meh', feeling. Like I've reached baseline, almost like I had a good nights sleep and I'm just, fine. Which in itself, isn't.

[barhamitzvah]

I was JUST searching your channel for this exact question last week! Thank you for sharing!

[N-R.D]

Dear Dr. Russell Barkley,
my name is Jeroen, I am a Dutch actor and have ADHD. I am very happy that I came across your channel. I've been pushing myself to watch all your videos. And I do that with great pleasure. I now understand myself much better and have also started using medication, with success.
Now there is actually one more question and concern in my mind that I would like to share with you.
In addition to all the benefits I experience from medication, I also notice that my identity sometimes becomes cloudy. The question "who am I really?" haunts my thoughts regularly.
Are the challenges I experience perhaps partly shaped by the demands of our modern, stimulus-rich society? And if so, what lessons can we learn from lifestyles that are closer to nature? Someone recently shared with me the idea that ADHD is only considered a condition if you experience it as a problem yourself.
This got me thinking, and I started to wonder: would farmers who live in the middle of nature, surrounded by few stimuli, actually suffer from their ADHD complaints?
I'm very curious about your view on this.

Regards,
Jeroen

[kukoistava.]

When I was first diagnosed and started psychiatric medication, the professionals I saw suggested breaks from stimulant medication to avoid "developing a tolerance". On the weekends, during holidays, breaks as long as a week. 

I tried - and perhaps it was helpful in understanding the medication and my symptoms more. But these breaks were doing more harm than good: My body needs the medication to regulate itself - not just emotionally, or cognitively, but physically, too (i.e., motor control - digestion, sleep regulation, and so forth). 

I feared if I wouldn't take these breaks that I would lose the effectiveness of the medication. Years later, I'm working with an actual psychiatrist who supports my decision to not take frequent breaks from the medication. Looking back at the prior advice, I can't help but wonder - if it were any other condition, and any other treatment, would they have wanted me to take "breaks"?

There's a persistent stigma and fear regarding stimulant prescriptions amongst healthcare professionals that decreases the quality of care for those with ADHD. It's clearly born out of ignorance. That's why I can't thank you enough for the work you do, and continuing to publish discussions on these topics well into your retirement!

[obi]

i got diagnosed 3 days ago and this is my 3rd day on concerta(18mg), on first day, i felt the calmness and silentness in my head and i was actually feeling the control and direct my focus for whatever i needed or wanted to focus, also the hyperactivity impulses were reduced, almost gone i can say. That day, realizing all that was what people were experincing and what it was supposed to feel like made me cry for hours. I felt more mature and stabil. For the first time, i believed im loveable and i have a great potential.

Later at night about after 10 hours i took my medication, the very first thing i could feel was the hyperactivity coming back very fast and i was feeling it even more, or so i thought.

Yesterday, after taking the medicine, i was also feeling the calming and focusing effects in a good level, although it did not feel like how it was yesterday but later that day, when the med starting to wear off, the adhd effects came back much softer.

And today, i took my meds in the morning and for some time, it gave me the effects but after 5 hours or so, i felt the hyperactivity and impulsivity coming back again and the blurriness and being unable to focus were also there, but it was supposed to last minimum 8 hours, so im confused if it is working or if im taking the wrong dose guys. If anyone experienced what i experience, help me on comments pwease

[Songbird]

I have never felt a ‘rush’ when I take my stimulant medications. I just feel more capably present and calm. The only rush I get is when I play music dance or jog or make lit art.

[carloscontreras]

Thank you for this great lecture. You made some really amazing points going over this article.