My medicine stops working too soon! What can I do?

Teens have long days. The most common medicines they use to manage ADHD symptoms last 8-12 hours. It isn’t surprising that stimulants don’t last long enough, but that doesn’t make it okay. What can you do to get everything done if you medicine doesn’t last long enough?

Sleep.

It goes without saying that we all need sleep to focus. People with ADHD often struggle with sleep, but they need sleep.

If you struggle to sleep, check out How can you get better sleep?

Don't underestimate the power of sleep
Don’t underestimate the power of sleep!

Organize it!

Organization helps us all. If you can stick to a schedule an prioritize things appropriately, you can get a lot more done than you realize.

Taking a little time to make a schedule can save you time in the end so you’re not lost trying to figure out what to do next, especially if you start and stop projects often.

For more on scheduling, see 10 Secrets of Productivity.

What can you do to be the most productive? Our top 10 secrets of productivity are found here! Start with a schedule!

Knock out the hard stuff.

Get the hardest task done first.

Try to get your hardest subject’s homework done in your spare time during school hours or right after school.

We often put off the hard stuff due to procrastination, but that comes back to haunt us later! Get it out of the way and check it off the list!

Reminders.

Set reminders to get back on track. If you get distracted easily, figure out what helps remind you to refocus.

Use post it notes where they will remind you when you need the reminder. 

For example, if you frequently stare out of a window, put a sign there to remind yourself to get back to work.

Turn off notifications.

No one needs an alert to know that they have a new social media message or email.

Yes, notifications and alerts can help you remember to do what you need to do, but only if timed properly. If you set an alert at the time you need to take medicine, that’s great! But random notifications that pop up when you’re in the zone doing something is distracting.

Schedule time to check  whatever will need to be checked, but don’t check them while doing other tasks.

Those notifications are simply too distracting. Turn them off!

Accountability partners.

Would you benefit from studying in a public place, where having people around will keep you from daydreaming?

No one wants to be seen drifting off… 

Or maybe you can simply invite an accountability partner to work with you. Ask a friend to study with you. Be each other’s accountability partner. Keep each other on track. Don’t talk and distract one another.

If your friend isn’t good at this, then have a heart to heart or find another study partner.

What can you do to be the most productive? Our top 10 secrets of productivity are found here! Make the most out of your time with these tips. Would a study buddy help?

Move!

Exercise has been proven time and again to help us focus. Plus it’s just good for our bodies.

If you need a brain break, even a few minutes of walking around can help reset your brain.

Food!

We all have a hard time focusing when our bodies are hungry.

Grab a healthy snack to get recharged.

Healthy is not a sugar snack. Sugar might pop us up temporarily, but then we’ll crash later.

Think of snacks as mini meals. Eat something with protein and either a fruit or vegetable.

Good snacks are apples with peanut butter, carrots or cucumber with hummus, grapes and cheese, strawberries and yogurt.

Change your medicine 

If your medicine doesn’t last long enough and all of the above still doesn’t help you focus for the duration of your day, talk to your doctor.

Sometimes increasing the dose of your long acting stimulant can increase the time that it remains above your treatment threshold. This may or may not be tolerated, since a higher dose may increase the side effects. 

Some people will add a short acting stimulant in the afternoon. For instance, if you take a long acting methylphenidate in the morning, you could add a short acting methylphenidate in the afternoon. If you take a long acting amphetamine in the morning, you could add a short acting amphetamine in the afternoon. 

Other people benefit from adding a different type of medication, such as guanfacine or clonidine to their daily routine. These medicines can last longer and have a different side effect profile from the stimulants, so if the addition of a short acting stimulant isn’t tolerated or desired, it can be another option. 

Another long acting medication is atomoxetine. It also works differently than the stimulants do, so is an option for some people.

For more on ADHD Medications, see ADHD Medications: Types and Side Effects. 

Stimulants decrease brain function? Say what?

If you heard the recent news that stimulants decrease brain function, don’t freak out and immediately think you need to stop a medicine that helps you. The study was done in neurotypical (“normal”) people. There’s a big difference in what these drugs do in a brain that has imbalances of neurotransmitters and in a brain that does not, so don’t freak out. Read on to learn more!

If this is all too much information, you can jump to the TL:DR section, but it’s always good to learn the details!

What are stimulants used for?

Prescription stimulants are approved to use in the treatment of ADHD, narcolepsy, and obesity. They increase alertness and attention and often decrease appetite. Stimulants such as Adderall and Ritalin are considered safe for long term use in appropriate circumstances.

Stimulant misuse.

Misuse can lead to psychosis, anger, paranoia, heart, nerve, and stomach problems. Stimulants can cause heart attacks or seizures when used inappropriately. Misuse also can lead to addiction and tolerance, requiring higher and higher doses to get the same effect, increasing the risk of overdose.

Studies have shown that 20-30% of college students have taken a stimulant medication inappropriately within the past year.

The 2017 Monitoring the Future Report shows that 5.5% of high school seniors reported non-medical use of Adderall during the past year.

Adderall is the most commonly abused stimulant, but ritalin is used inappropriately too.

Why was this study done?

Many students believe that if Adderall and other stimulants help people with ADHD stay focused and perform better academically, it will improve their focus and make them smarter. Juggling school with all the extracurriculars, work and social life is hard. Many teens are sleep deprived and hope the Adderall will help them stay alert and study more effectively.

Since the use of stimulants by students without ADHD is common, many wonder if it’s true that they actually work to help focus in people without ADHD.

The big question:

Is Adderall safe and effective for those without ADHD?

What could be wrong with using it?

You might wonder why researchers care. Since many kids, teens, and adults are prescribed this medicine to help manage their ADHD, it should be okay for others to take, right?

Wrong.

There are many reasons to question the safety and efficacy of any medicine or supplement.

Drugs of abuse include stimulants but this does not mean they are dangerous for those who need them to treat a condition.
Source: https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts#prescription-stimulants

Legality

First and foremost, it is illegal to use someone else’s prescription medicine.

All prescription medicines are to be used by the person who it’s prescribed for. Stimulants are controlled substances. This means they are monitored closely by regulating authorities.

Controlled substances fall into various categories, ranging from Schedule I through V. Schedule I medications are the most dangerous. They have no known medical use, are unsafe, and have a high potential for abuse. The least dangerous category, Schedule V, has a small amount of narcotic quantity. Schedule II-IV fall in between.

Stimulant medications are in the Schedule II class. This class is considered to have a high potential for abuse and can lead to dependence. Please note that studies show that when children with ADHD take stimulants properly, they have a lesser risk of developing drug and alcohol problems. Even though there is abuse potential, the risk of all medicines should be weighed with the benefits.

When used properly, stimulants have medical benefits. If the medicine is prescribed to you, it is perfectly legal to have them in your possession and use them according to your prescription. But if they are someone else’s prescription, they are illegal to have and use. It is also illegal for you to sell or give your medication to another person.

Because these medications have resale value, it is recommended to keep your stimulants in a lock box when you live with other teens and young adults in college and early adult life. You can take a few out at a time to use as needed.

Right medicine at the right dose.

Most students who take stimulant medications have titrated their dose with the help of their physician to find the right medicine at the right dose. This can be a time of trial and error and needs to be monitored by a professional.

When friends share medications or people buy or steal stimulants from someone, they get what they get. They may or may not get a dose that is safe for them.

There are also fake drugs that are sold as stimulants but can be much more dangerous. It can be hard to tell the difference, so getting your medicine only from a licensed pharmacy is important.

If someone else is taking it, the person with the need doesn’t get it.

Many people downgrade their problems associated with ADHD. They might think they can get by with skipped doses, but they often underestimate the many benefits of their medication. Stimulants are not just needed for school.

Dr. Russell Barkley has been researching ADHD for 40 years and has found that ADHD is the single condition most associated with early death.

People with untreated ADHD tend to live up to 25 years less time than people without ADHD or with treated ADHD.

That means ADHD leads to early death more than tobacco, obesity, heart problems, and other chronic diseases when it’s not treated appropriately.

It makes sense that the issues associated with ADHD can lead to early death.

  • People with ADHD tend to be less focused. They are involved in more accidents when not medicated.
  • Many with ADHD impulsively overeat, which leads to obesity and the associated problems. In fact, obesity is five times more common in adults with ADHD versus the general population.
  • Many will self medicate with drugs and alcohol due to the secondary low self esteem, anxiety, and depression that is associated with ADHD.
  • The suicide rate is much higher for people with ADHD. They tend to have more depression and impulsivity than people without ADHD.
  • Risk taking behaviors are much more common in people with ADHD due to their impulsivity. They have a higher risk of starting negative habits, such as smoking, which are associated with shortening lifespan.

In short: don’t give or sell your medicines to anyone else. You need them!

A new study

When headlines say something shocking, don't just believe them. Read critically. The study that shows adderall decreases brain function doesn't apply to those with ADHD.
Stimulants decrease brain function? Say what?

Lisa Weyandt, a professor of psychology at the University of Rhode Island, studied how students without ADHD responded to Adderall. She wanted to test if it was true that Adderall could make people smarter and study more effectively if they didn’t have ADHD.

Study set up

It was a relatively small study. This means it shouldn’t be generalized yet. Bigger studies should be done.

She recruited 13 students to participate. They took a 30 mg dose of Adderall before one lab session and a placebo pill before another lab session. They were blind as to which pill they took each session. During the lab sessions passages were read to them and they had to answer a series of questions about them.

Researchers looked at how well they performed, their alertness, and their ability to focus on the Adderall and the placebo.

Results

Students showed improvements in alertness and focus with Adderall. Unfortunately these improvements did not help them think, remember or problem solve. They did not improve their reading comprehension, fluency, or recall of facts when they took the Adderall versus when they took the placebo.

Even worse: The Adderall actually inhibited their working memory. This is the ability to remember and use information to solve problems. People with ADHD often have problems with working memory and Adderall and similar medicines help to improve it. It appears that if your brain has normal function in this area, the Adderall makes it worse.

This makes sense. If your neurotransmitters are off, giving a medicine to stabilize them helps. If your neurotransmitters are at normal levels, giving a medicine that changes the levels hinders.

They also had elevations in their heart rate and blood pressure. If a student has an underlying heart condition, it could cause serious heart problems. This is one reason doctors ask about family and personal history before starting a patient on stimulant medications. If there is an increased risk, an ECG is recommended.

Without a physician monitoring the medication use, the risk goes up!

TL:DR

Stimulants have been proven to improve focus, attention, and working memory in people with ADHD.

When a physician prescribes stimulants, doses should be carefully titrated and routine follow up is required.

It is illegal to take stimulant medicines without a prescription.

Giving or selling prescription medicines to others is illegal.

If people take stimulants that are not prescribed to them or get them from a non-licensed pharmacy, they are at risk of getting fake drugs. Counterfeit drugs can lead to serious consequences.

When people without ADHD take stimulants, they may feel more focused, but their working memory is worse. This hinders their ability to perform well. They also suffer from physical risks without medical supervision.

When people with ADHD go without their medicines, their risks go up. Untreated ADHD is associated with early death. The risks are real if ADHD isn’t managed well!

Today we have so much information available to us through the internet, but you have to be very careful when you read it. Always remember to think critically when you read. Look at the source as well as the content. Don’t jump to conclusions – especially after just reading titles! A great read on this is An invisible unicorn has been grazing in my office for a month… Prove me wrong, so if you have the time, check it out!