When Dana Rayburn learned she had ADHD in her 40s, her doctor prescribed Adderall. She did well on the drug for a few years, but then her insurance stopped covering it. Rather than struggle to pay $200 a month for the medication, she decided to try going off it.
For other adults with ADHD, side effects like appetite suppression or sleeplessness are what prompt them to stop their medication. Some say the drugs make them less fun and spontaneous. Others dislike the stigma that often goes along with medication or simply relish the idea of handling their condition more naturally, without the help of pharmaceuticals.
Whatever your motivation, before you try going off your meds, it’s wise to talk to your doctor first and get a good idea of what to expect.
Talk to Your Doctor
Anytime you want to make a change to your medication regimen, it’s best to loop your doctor in. If your provider agrees that it’s OK to stop, you should discuss whether it’s safe to go cold turkey or if you need to taper off.
The answer depends on the medications you take, says L. Eugene Arnold, MD, resident expert for CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder). You don’t need to taper stimulant medications like Adderall and Ritalin, he explains, and you shouldn’t experience any withdrawal effects.
Nonstimulant medications, on the other hand, do usually require tapering. “Atomoxetine (Strattera) has a long half-life, so it kind of tapers itself,” Arnold says. But if you’ve been taking an alpha 2 antagonist such as clonidine or guanfacine -- many people with ADHD take a stimulant in the morning and one of these other drugs at night -- you need to go slow to avoid a potentially dangerous spike in your blood pressure, he warns.
Expect Temporary Physical Changes
Whether you’ll feel any different physically depends on your medication, the dose, and your body chemistry, Arnold says. He says that some patients who stop stimulant drugs report a little more fatigue during the daytime. That said, they might sleep more soundly at night. Some suddenly feel ravenously hungry.
Shifts in energy and focus tend to even out after a day or two. But, it might take a few weeks for your appetite to go back to normal. Of course, “If you had an excessive appetite before [starting ADHD drugs that were suppressing it], it’s going to be permanent,” Arnold says.
You May Not Function as Well
Unless your diagnosis was wrong, you got ADHD medication for a reason. Will you be able to stay on task and finish projects without the help of these drugs?
Luckily for Rayburn, nondrug approaches -- including organizational strategies, fish oil supplements (which some studies suggest may help with ADHD), and staying hydrated -- did the trick. She hasn’t needed ADHD drugs in 16 years. But Rayburn, who coaches other adults with ADHD, is hardly anti-medication. In fact, she says that most adults with ADHD do best with medication, at least during certain periods of their lives.
Rayburn advises anyone who is considering going off medication to first think about why they were on the drugs in the first place and what might have changed since then. Have you adopted specific organizational strategies, significantly overhauled your lifestyle habits (like exercise and diet), or made other changes that are likely to help keep you on task?
Monitor Yourself and Act Accordingly
“If you’re going off medication, you’ve got to be very self-aware and notice when your brain isn’t working and be able to adjust,” Rayburn says. She says that some people can catch themselves losing focus but do fine once they recommit to strategies that have helped keep them stay on task in the past. Others realize that they now need extra help from a coach or a therapist who specializes in cognitive behavioral therapy for ADHD, Arnold says. Some find that taking a fish oil supplement helps. “It’s a subtle effect, but it kind of takes the edge off,” he says.
Of course, some adults with ADHD who stop their medication realize that they need to go back on it to function well -- and that’s OK, too. “It’s a good idea to enlist another observer -- a spouse, roommate, or coach -- who can give you objective feedback about what’s happening,” Arnold says. And if you do go back on medication, don’t assume you can ditch the nondrug therapies you’ve been using.
“Medication for ADHD is not a cure; it’s a tool,” Arnold says. “It makes things possible but not necessarily easy. You still have to work at it.”