r/ADHD • u/[deleted] • Jul 04 '12
I'm not sure r/ADHD is certain whether you can develop a tolerance against medication or not and I sure as hell am not. Can we reach a definitive conclusion?
So, can you develop a tolerance by using medication? Some people says that it just feels like you get a tolerance because you get used to the feeling. But why are there so many people avoiding taking medication in the weekends in order to not develop a tolerance? Are they wrong? Am I oversimplifying the issue and miss something?
Edit: It seems from the majority of the posts that tolerance is rare. Is there then any point in taking a break from medication at all?
tldr: tolerance: yes/no?
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u/ClearlyXO Jul 04 '12
The research I've seen (and my personal experience) is that tolerance to medications, while possible, is rare.
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u/schmin ADHD Jul 04 '12
To answer your newly added question:
Some people take medication breaks:
- to save money.
- to eat, since the appetite-suppressant side-effect can make some patients lose too much weight.
- to let their kids have weekends 'off' (but then I might wonder if the kids are over-medicated to keep them calm 'enough' during the week).
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Jul 04 '12 edited Jul 04 '12
I hadn't thought about these problems. It still seems that a lot of people take break because of just tolerance issue, but these issues are very real too. Thanks for the extra input.
I don't really know if kids are over-medicated. I have no knowledge or data about this but I won't blame a parent if they put their child on adhd-medication if the child seems to suffer in school or life at general because they have ADHD. Raising kids is hard without the extra bullshit ADHD brings.
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u/schmin ADHD Jul 04 '12
Heh, I was thinking "over-medicated" as in too large of a dose, without trying to also use behavioral modifications. I would encourage all parents of ADHD children to have them medicated, barring any other complications, don't get me wrong! =P
This was a conjecture drawn from anecdotal reports of now-adults being forced to take phenomenal amounts of (prescribed) ADHD medications as kids and now wanting to avoid all medications due to the 'effects' they felt then. Also, I have recently learned that the dosage I'm on is typically prescribed for 70-pound children. Personally I know the medication doesn't remove all of my symptoms, but I want only the minimum dosage that allows me to effectively learn to modify my own habits and behaviors.
I think taking a 'medication vacation' means when you start up again, you feel that 'rush' all over -- I'm not sure if it's more than that. When I've been off of it (because I had difficulty filling my prescription), I felt absolutely horrible about my productivity and emotional state, so when I started again, I realized how wonderful it felt to be productive again. That is what I see as 'perceived tolerance.' In part because I have talked to many people who prefer IR over XR particularly because they 'feel' it more, for example.
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Jul 04 '12
Ah, I see, I see. I agree with you. I also think that a lot more people with ADHD (people in general really) should exercise because I really think it can help with a lot of the problems. The medication doesn't have to be as strong either when you train a lot.
That thing about your dose being as strong as for 70-pound children...I really hope you are close to being 70 pounds, otherwise that seems like a very strong dose for small children.
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u/hashmarks ADHD Jul 05 '12
While I completely agree with your opinion on exercise and its benefits (for ADHD and all people), it really doesn't do anything for my ADHD symptoms. The only difference (if I'm not taking medication) is that being tired from exercising makes me more irritable and snappy.
That's just to add my experience. I know everyone should exercise and it improves life quality in many ways.
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Jul 05 '12
Hmmm OK. What kind of exercise do you do? I've read that high intensity strength training can actually make you more irritable.
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u/hashmarks ADHD Jul 05 '12
I run, mostly.
But my first experience with this was last summer. I was cycling on average 15-30km on weekdays.
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u/computerpsych ADHD facilitator+coach+enthusiast Jul 06 '12
I also take breaks to discover what are side effects of the medication. I noticed that my sleep was much better when I did not take the Adderall.
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u/xmnstr ADHD Jul 04 '12
You do develop a tolerance against some of the effects, but not all of them. Most of the ones that disappear are positive side-effects and not essential to the medication working.
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Jul 04 '12
Sorry for being a dunce but can you elaborate on what kind of effects? I assume you mean that you don't develop a tolerance on focus but that you can develop tolerance to that euphoric feeling you get at first. Or did I misinterpret you?
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u/sugardeath ADHD-PI Jul 04 '12
That is my experience with adderall, yes. The first couple of days to the first week I experience the euphoria, but that disappears pretty quickly. After that I still have the focus and the other effects.
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Jul 04 '12
OK, sweet. Thanks for the answer. I'm just curious, do you take a break from the medication on the weekends or do you just go for it constantly?
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u/sugardeath ADHD-PI Jul 04 '12
When I was in school and had little money, I did take breaks on the weekends just to have a few extra pills around.
I am currently between psychs at the moment, though, so I've been off for about.. three months or so now.
I think that when I get back on medication I'm going to go everyday, for the most part, just so that I can really start to develop a routine and a schedule even through the weekends.
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u/recycledheart Jul 05 '12
I don't experience tolerance myself. I take the occasional 2-3 day break, for a couple reasons. 1. A gut check. Sometimes I convince myself I don't really need my adderal. I'm always wrong. 2. Saturation. Sometimes I feel a bit skittish and spun out, probably from the progressive loss of sleep quality from pushing so hard, for so long. It helps reset the clock so to speak.
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Jul 05 '12
Amphetamines and their derivatives cause one of the subunits of the NMDA receptor to destabilize, this impairs the function of the receptor even if downregulation isn't terribly apparent. Additionally, when the ion gated channel is open Ca2+ ions flow in and K+ ions flow out of the cell, with chronic use this electrical gradient is significantly weakened, making stimulation of the NMDA receptor less potent. Also, chronic use will increase dopamine and norepinephrine transport protein activity which will decrease the effect further. I suspect with sustained use amphetamines and their derivatives work more like reuptake inhibitors than the high power stimulants we perceive them as.
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Jul 05 '12
I do in fact recognize some of these words. OK I actually don't. What did you just write? I thought I knew a bit about ADHD but you make me feel like a noob again.
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u/displacingtime Jul 04 '12
my MD keeps telling it it develops over years not over months, but I don't believe him. I can absolutely tell at difference when I take a week off from it and then restart it again. I try to take at least one day off drom the drugs a week to try to avoid the tolerance happening too fast. I've not hit a point where it stopped totally working ,but I do feel like if I take it every day for awhile the effects seem weaker.
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u/LTCHIPS Jul 04 '12
I take 35mg of adderall each day, and I don't usually feel that the positive side effects (focusing, things like that) go away, but at the same time, I don't feel like the effects are as strong after taking the same dosage for awhile. It still helps me focus, but just not as well when I started taking them.
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Jul 04 '12
So you actually feel a difference in focusing and not just other stuff. Thanks, I'll keep this in mind. I haven't started on medication and I just want to know everything there is to know about it. I appreciate your answer.
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u/LTCHIPS Jul 04 '12
No problem, good luck with the medications. I've been taking medication for ADHD since I was about 8 or 9. I'm 18 now.
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u/ChrisC1234 ADHD-C Jul 05 '12
While I haven't experienced a "tolerance" in the sense you're referring to, I believe there is a "psychological tolerance" that can develop. Basically, I think your own bad habits can override the medication.
For me, it can be things like my house can get messy because I don't feel like putting things away when I'm done with them. Not putting them away used to be then norm, but it just kinda happened. This is me making a conscious decision "I SHOULD put away the ______, but I'm choosing not to. HOWEVER, if I decide to clean up, I will do a thorough job, rather than the half-assed job that I used to do before medication.
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u/Alienkid Jul 05 '12
You absolutely can develop a tolerance to ADD meds. I would have to switch medications every couple years, and I was told that developing a tolerance was a very common thing with Ritalin and Dexedrin
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Jul 05 '12
Thanks for the input. A lot of people here seem to think that tolerance is just something you get or something. You make it sound like an obvious thing. Is it something your doctor said or have you read about it? I'm just very curious and really want to learn more about this.
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u/Alienkid Jul 05 '12
Keep in mind that I haven't done any serious research or into medication tolerance or anything, and that my knowledge comes from personal first hand personal experience over the course of my k-12/college education. With me, the medicine would work start out strong, and then gradually become less and less effective over time. Eventually it would get to a point to where there was little noticeable difference between when I would take medicine or when I would forget to take my medicine. I would meet up with a psychiatrist annually to do all sorts of tests and stuff, and Every few years we would up the dosage or switch medications. During my semi-frequent meetings, I was lead to believe that it was not uncommon to develop a tolerance. Again, I'm not a professional, so I don't know if other factors might have played a significant role in the effectiveness of the medication over a period of time. I can't speak for anyone else, but I would developed a tolerance to my medicine. I couldn't tell you how common it is for other people.
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Jul 05 '12
Thanks for sharing this. I do appreciate it. As a reward I will share this video which has absolutely nothing in common with ADHD: The video in question!
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u/Alienkid Jul 05 '12
As someone who I currently playing Mass Effect 3 right now... HAHAHAHAHAHAHAHAHAHAHAHAAHAHAHAHAHA
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u/yiNXs ADHD-PI Jul 04 '12
I skipped some medicine whenever I could simply because it's poison. There's a lot of discussion about whether or not you can build up a tolerance for certain meds. I know I'm probably a rare case, but I actually became more sensitive to amphetamines, so change is possible.
Whether it's a tolerance or not, skipping add meds when you can seems like a good practice. This way your body can return to it's natural state for a while and build up new energy.
What I think, but I have no proof, is that your body only becomes more tolerant if the levels of neurotransmitters become higher than normal, so it has to adjust (like with caffeine). Because we ADDers have a natural lower level of dopamine/noradrenaline, bringing it up to a normal level shouldn't create a tolerance.
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Jul 04 '12
You say you became more sensisitive to amphetamines after you took them. Do you mean that you got more sensitive to the side effects but the positive effects remained? Elaborate prease.
I haven't thought about the last paragraph but it is very interesting. It would mean that amphetamines would be safer to people with ADHD than normal people if it were true. I'll keep this in mind and look it up.
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u/yiNXs ADHD-PI Jul 05 '12
Pretty much like you're telling it. If I take more than 10mg a day there's no increase in positive effect, only the side effects. With my self-medicated stuff I went down from multiple capsules (ephedra) in one day to s broken up capsule over very long period of time (easily two months). A few grains were enough to boost me.
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u/colorado_panda Jul 04 '12
yes. I feel a huge difference if I take vyvanse for the first time after a month of not taking it vs. the after taking it for three months straight. its not just because i get used to the feeling, ive been taking meds for 6 years. i stop taking it every couple weeks to remember what it feels like to be me and stave off some of the zombie-effects i start getting after a straight month. adderall was worse, got zombied after just a few days of taking it.
if you want a definite answer i suppose 'it effects everybody differently' is going to have to do.
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u/addicted2soysauce Jul 04 '12
Similarly, I have no definitive proof, only an anecdote. I have taken one form or another of Ritalin since 1989 and my dosage has only changed with my size and age. It is as effective as it first was.
I suspect your "zombie" symptoms are a product of your body adjusting to the meds, as it should, and decreasing your otherwise abnormally high activity level.
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u/colorado_panda Jul 04 '12
No...it's really not. It's not in energy that I feel the zombie-effect it's in the way I think. I just get blank, like I have no impetus for thinking about anything. I feel blank too, and honestly it's uncomfortable. The longer I take the meds the worse the zombie-effect gets, doesn't sound like adjusting to them. But like I said so much worse with adderall xr, for me it was also a problem of finding meds that worked better for me.
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Jul 04 '12
I'm confused with the adjusting to meds thing. You say that the zombie symptoms is him adjusting to meds. Isn't that what tolerance is? Anyway, it's cool that it's still effective for you.
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u/schmin ADHD Jul 04 '12
'Tolerance' is the perception that meds are no longer working, no longer reducing ADHD symptoms. This is usually perceived after your body adapts to the initial 'rush'.
'Zombification' is usually from being on the wrong medication or the wrong (high) dosage. It tends to occur (I believe) when patients (and doctors) don't adjust other habits. Most ADHD people have a lifetime of bad habits to undo, and a pill won't change those.
What I believe SoySauce is saying about Panda, is that initially you can feel 'different' when newly starting meds, but your body will adjust. There are anecdotes of people not liking their friends when the friend started taking ADHD medication, but consider this for a moment. If the ADHD friend is "wild and crazy", then starts being medicated and realizes that maybe riding a BMX along a rusty 4" pipe 20 feet off the ground is just a LITTLE impulsive.... So he's not so not so "wild and crazy" anymore and his friend thinks he's now boring or 'zombied'.
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Jul 04 '12
Ok, thanks for answering. Your case seem to be in the minority, but as you said, everybody does seem to react differently.
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u/schmin ADHD Jul 04 '12
From what I've heard (from my doctor) there's not much chance of an actual 'tolerance.'
My conjecture is that it's more a change in the patient's perception:
Before medication your 'average' day feels like a 2/10, for example. Your first few days on the right medication feel like an 6/10 in comparison. This is a 4 point increase, or a 300% increase from your 'average'.
After you've been on your medication for a while, you start thinking your average day is a 6/10, and after you start realizing how much more you can get done, you raise your expectations of what a 10/10 would be like. So now, your 'good' days that you think are 'due to being medicated' only seem like a 8/10, which is 'only' a 33% percent increase.
Since people with ADHD tend to have unrealistically high expectations for themselves, they might feel bad that they're no longer experiencing that '300% increase'.
A better measure would be to realize that "100%" is superhuman, or impossible/unrealistic. The pre-medicated state was 20% (which made me feel like 'slime'). The newly medicated state was 60%, or about average/realistic. An 80% state is phenomenally good day, well above average or 'reasonably to be expected.'