Why ADHD medication stops working as well as it did at first

Why ADHD medication stops working as well as it did at first

It’s a common experience that when people with ADHD start medication, they can’t believe how much their medication helps. Most of us find we can tackle tasks we’ve been meaning to do forever, complete jobs that have seemed impossible to finish and our racing minds often quieten right down among other benefits. 

But all too often, this is short-lived and they’re left wondering what happened. 

There are a few reasons why medications may stop working or work a lot less effectively than ideal either temporarily or permanently. And it’s complex because humans are complex!

So for the purpose of this post, I’m simplifying this topic. Here are three main reasons this happens:

1. There is an increase of stress on your ‘system’ including, for example, psychological distress, sleep problems, illness etc.

2. You hadn’t yet found your optimal dose/medication and stopped the titration process too soon when trying to find your medication ‘sweet spot’.

3. You’re one of a small group of people for whom the medication does in fact just stop working at usual doses. This can be due to genetic factors and even food allergies and sensitivities (which are more common in people with ADHD), and which can affect the metabolism of the medication.

Let’s dive into this a little deeper.  

Stress on your ‘system’

It’s not just psychological stress that affects our mind and body, it can be physical ‘stress’ too such as illness, eating poorly or drinking too much grog. Addressing the cause of the stress on your system is an important step to ensuring your medications work well at the lowest dose possible. 

A life event, such as the death of a loved one, moving house or starting a new job could also be elevating your stress levels.

Some doctors provide their patients with a prescription for short-acting medication to “top up” in times when their base dose isn’t sufficient. The importance of allowing us flexibility in managing our own symptoms is clearly explained in this webinar: Best Practice in ADHDMedication Management, by the Australian ADHD Professionals Association that you can share with your doctor if they’re unsure about doing this. 

In another example, some doctors recommend that women take more medication in the lead-up to their period if they find their dose isn’t adequate at this time.

Sleep is also a key factor,  if you are not getting enough quality sleep then this can impact how well your meds work. If this is the case, I would suggest ramping up basic ‘sleep hygiene’ practices, and if that’s not enough, discussing options for improving sleep with your doctor.


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Finding your optimal dose/medication

It’s also very common that you still haven’t found the correct dose or even medication. 

There are two main ‘types’ of stimulant medication. The active ingredient is either dexamphetamine or methylphenidate and it may be that you will have better symptom management by taking a medication that has the other active ingredient.  

If you’re at the more severe end of symptoms (as I was especially in relation to working memory before taking medication) it’s also possible that you will get the best symptom management by combining a simulant medication with a non-stimulant medication for ADHD (such as an alpha-agonist like clonidine or guanfacine). 

Medication doesn’t work at one of the ‘usual’ doses

And lastly, a small but significant number of people may not have adequate symptom management from either of the two main types of stimulants prescribed for ADHD at the usual doses prescribed. 

If someone has a very high rate of metabolism (some people are classified as ultra-rapid metabolisers) they may need higher doses of medication. Avoiding foods that cause allergic or other reactions can also aid in the metabolism of ADHD medications.

So if you are sure your medication isn’t working as well as it did when you first started taking it, you should now be a lot better equipped to find the right treatment for you. 

All the best!  

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