Tolerance to Stimulants?

Main Chapters:
00:00 Intro - Tolerance to Stimulants?
00:19 Take home message
02:26 Effects of Substance Usage Over Time
05:17 Dopamine Systems
06:50 ADHD and Dopamine
08:30 2013 Study on ADHD and Dopamine
18:32 Clinical Experience
21:59 Conclusion
22:37 Outro

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Free link to my Medium Article on Tolerance to Stimulants:

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Stimulant medications consistently outperform other treatments of reducing ADHD symptoms. Many individuals take stimulants for years. ADHD experts consistently say that, after some initial titration, most individuals find a dose that works for them, and that dose will continue to work well for years or decades.

In contrast, addiction experts claim the opposite. They say that almost everyone quickly develops tolerance to stimulants, and that dosage escalation is the standard, not the exception.

A 2013 study by NIDA chief Nora Volkow and colleagues is often cited as evidence for tolerance. A group of 18 individuals with ADHD showed a 24% upregulation in dopamine transporters after a year of treatment with methylphenidate. But not all research is consistent with this study, which has some methodological weaknesses.

In my own practice, the majority (80% or more) of patients continue to do well on the same dose of stimulant medication for years at a time. Simultaneously, however, I do frequently hear people report that their AHD symptoms are "much worse than before" if they skip their medication for a day or two, which could well reflect upregulation of dopamine transporters, or other systems in the brain.

References:
Long-Term Stimulant Treatment Affects Brain Dopamine Transporter Level in Patients with Attention Deficit Hyperactive Disorder (2013)

Consequences of Acute or Chronic Methylphenidate Exposure Using Ex Vivo Neurochemistry and In Vivo Electrophysiology in the Prefrontal Cortex and Striatum of Rats

Genetic imaging study with [Tc-99m] TRODAT-1 SPECT in adolescents with ADHD using OROS-methylphenidate

Responsivity of the Striatal Dopamine System to Methylphenidate—A Within-Subject I-123-β-CIT-SPECT Study in Male Children and Adolescents With Attention-Deficit/Hyperactivity Disorder (2022)

Full Chapter List:
00:00 Intro - Tolerance to Stimulants?
00:19 Take home message
02:26 Effects of Substance Usage Over Time
02:49 Sensitization and Tolerance
04:05 Tachyphylaxis
05:17 Dopamine Systems
05:27 Dopamine Transporter (DAT)
06:50 ADHD and Dopamine
08:30 2013 Study on ADHD and Dopamine
10:34 Study Results
12:20 Study Analysis
15:56 Comparison with Other Studies
18:32 Clinical Experience
21:59 Conclusion
22:37 Outro

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Psychiatrist, neuroscientist, and author John Kruse, MD, PhD presents practical, actionable, well-researched information about treatment options that scientists and clinicians recommend for adult ADHD and other mental health conditions. Subscribe if you're curious about how neuro-atypical brains can optimize their functioning in our shared, and somewhat strange, world.

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[maggiekelley]

I've been on stimulants for 27 years.

I've only raised my dose in the past 15 years by 5mg after a brain injury that effected my dopamine receptors.

[Kuchen]

I don't understand why Non Stimulant + Stimulant combos aren't more commonly prescribed. For me it was Guanfacine that helped.
That solved my 'tolerance' issues, which were actually a handicap / lack of emotional regulation, and ptsd.

[hiker-uybi]

Started with a prescribed low dose (10mg) of Adderall XR a couple of days ago for probable ADHD. I also have binge eating tendencies.

Could be placebo, but I seem to have gained a newfound executive control over my eating choices. I don’t have the same ridiculously strong urge to gorge on junk food. I eat a breakfast, take the pill, then am basically uninterested in food until dinner. And then I can just decide what to eat in a rational manner. Kind of amazing. Hope it lasts.

[zezezep]

Is it ok to have some days using my Vyvanse, other days on my Ritalin

[peterwaugh]

I stopped drinking caffeine for a month, three days, ten days on a few occasions. I like the result. I get off the bed if I feel like it. Time for work, then I'll be there.

[TheCuratorIsHere]

I take vyvanse, it helps, no addiction 🤷‍♂️ sometimes I spend 3 days without taking it. Coffee and sugar, now that’s a hell of an addictive drug.

[markmuller]

I've noticed that by taking care of my belly (intestine) temperature (as high as possible, especiallyafter meals) the effectiveness of stimulants increases dramatically but also the resistance to side effects like insomnia.

Also going on the treadmill after lunch

[zezezep]

Every morning I struggle deciding if I can put off making my coffee because I ought to take my adhd med immediately then WAIT an hour to have coffee

[mrmissionctrl]

I take Vyvanse. But prior to 2020 I was taking envaga shots paliperidone for 7 years, before that, lamictal. I just told my shrink I was assuming my old diagnosis from age 14. Being an multiple diagnosis patient I aren't gunna take nothing that doesn't get me out of bed.

[bobmathews]

"Keep taking your vitamins" - why did I hear that in Hulk Hogans voice 😂 (only 80's kids will get that)

[IamReloadHD]

Im selfmedicated. Can’t find any professional until now but i continue looking for.

The Euphorie faded away but I can focus better and I’m less hyperactive, at this Point there isn’t tolerance build up for me.

[soicybunny]

prozac and adderall, great combo and no hyperfocusing or obsessive actions... no pacing or anxiety. i still have all my emotions, m very regularly on a cycle with my hormones. i eat a mainly fiber and lots of oats, and plant protein based diet... what throws me off is crowds, over stimulation, too much caffiene (but i like Celsius drinks), stepping outside of my routine.

[TheDoats]

Adderall is the only one that remotely works for me. Vyvanse knocks me out at first and when it starts wearing off I realize how tight my muscles have gotten while on it. I have spinal injuries from the military and Vyvanse makes the pain much worse. Adderall only does that if i have been hyperfocused too long and have been on my feet or in a bad posture position for too long.

[brothernorb]

A fun word to say and spell" is not somethng I ever thought I would hear yoy say😅

[nvna]

It feels counter intuitive but i get more anxious on a lower dose but then i get scared that im taking too much idk. Because the anxiety is really intense + really bad during the crash too. When I take another dose I feel fine, but I guess I'm paranoid that the anxiety is caused by the drug & taking more calms me just because I'm not used to the dose & I'm damaging my body

[PatCrawford-jmrm]

These drugs brought me to my knees. I've spent over a quarter of the past 2 years institutionalized in rehabilitation facilities and detoxes because of stimulant and other drug addiction. They also were a gateway to methamphetamine (a crazy story I won't go into right now).

I cannot believe this stuff is prescribed to children! But I'm an addict and an alcoholic so if it works for others then to each his own I guess. At one point I needed 350mg of Adderall just to get out of bed! Tolerance, yep!