How stimulants work in Adult ADHD: Most people know that the stimulant medications can be of great help in Adult ADHD, but most people think it just boosts concentration. They can be wonderfully helpful and I’ve witnessed many people who have found them to be transformative. But there’s no free lunch and it can be helpful to understand what some of the downsides are and how you can mitigate them.
If you’ve been prescribed stimulant medications and you want to understand the secret of what they do and what else they do listen on why is it when we’ve already got a system that’s kind of hyperactive and inattentive why don’t we give him stimulants okay lovely that’s kind of the fundamental question i don’t it does not compute so please explain okay give someone
Some stimulant right it improves their frontal lobe function and they get better at inhibiting all those impulses right okay so they can attend so you’re right it’s kind of paradoxical there’s something all over the place okay why are you giving this this juice that should just turn everything up it actually turns up the thing that helps you inhibit yourself the
The effect that we’re going for is this sort of improved frontal lobe function okay so what that will do right is it will create as we said it will decrease your distractibility yes and that’s what gives you improved attention okay okay that’s actually the sort of the whole point of taking yeah okay from a medical point of view yeah right now there’s a downside
To that as well potentially it decreases your spontaneity okay all right that’s why uh it decreases hyperactivity yeah okay so hyperactivity is basically manifested spontaneity yeah all right so decreases your spontaneity so you might think okay well that’s not too bad the downside of that as well though is you can reduce your creativity yeah like if you’ve got
People who are kind of artistic musical and used they’re kind of yeah it can really stifle their creativity yeah okay and also just just things like playfulness you’re less playful yeah because that’s a sort of there’s a lot of spontaneity yeah yeah yeah that’s that’s kind of you know that’s some of the downsides there of um of increasing your frontal lobe function
To dampen down your kind of impulsivity if you like all right but it comes yes you get more attention but it can have a cost now if you but if you overdo it okay people end up just feeling quite zombified okay they’re so kind of stifled all right that they’re just not having any fun at all yeah okay so so so this is where getting the dose right i’m getting more a
Bit more into that well if that’s the main function okay it’s all about that but i’ve got these other boxes here so what’s that about all right so the other things to me that we’ll do obviously is increase your arousal so people can feel quite wired yeah okay so they’re like physical agitations potentially if that’s that’s sort of one of the downsides people give
A lot of restlessness yeah right okay not always but they can okay okay so increased energy that sounds good unless it’s restlessness yeah okay increase alertness that sounds good all right if you take it too late in the day it’s going to keep you awake for sure right okay so if you’re kind of um under the effective stimulant still good luck trying to get to sleep
All right now if you overdo the arousal okay you end up with a lot of anxiety okay and potentially panic and potentially anger as well right yeah okay is it a fight flight it’s the fight yeah so you’re turning up your juice on your arousal traffic anxiety and anger and interestingly improving your frontal lobe function can actually decrease your anxiety and your
Anger you’re more able to think through things okay so it’s kind of got you coming and going a bit here all right so some people just find i can’t take it it makes me too angry all right yeah okay fair enough yeah yeah and some people like hey my name’s better all right so you can go either way all right so we’ve done the frontal lobe we’ve done the arousal okay
Now this is sort of what potentially can get us into trouble okay these medications are directly act activate your um reward pathways yeah all right so you might think oh that’s okay what’s wrong with that okay so you can increase in positive emotion you feel pretty good when you’re taking these things okay you feel good about what you’re doing hey my thinking’s
Really good i’m feeling really pretty they are yeah you may not actually be all that much more productive you feel pretty productive okay so it increases your positive emotion and as a result of that by the way tends to kill your appetite all right because you’re sort of satiated yeah well yeah yeah all right yeah okay so we’ve got more positive emotion wow what’s
Wrong with that it’s fantastic all right well you know okay so this is where if this gets off the kind of rails all right this is where addiction can become yeah all right because let’s say you don’t have any positive emotion in your life let’s your life’s a train wreck okay yeah there’s there’s every reason to numb the pain okay and every reason to seek things
To make you feel better this will do it okay so this is that’s where people can sometimes get to trouble with addictions yeah right addiction to the stimulant then to keep yeah getting that yeah yeah it’s like i i have no other source of positive emotion i feel dreadful when i’m off it better have some more yeah okay this is why people abuse and nicest okay body
Effects now it activates your sympathetic nervous system yeah it decreases your parasympathetic nervous system increase blood pressure increase heart rate if you’ve already got blood pressure problems yeah not good so risks increase of things like stroke yeah oh right yeah memory yeah not right not great yeah so you kind of want to be um you want to have you want
To make sure you’re in sort of condition that you can handle it because you get significant some people only get a small bump like 10 yeah 10 points so out of the systolic blood pressure but some get more obviously performance enhancement yeah okay so that’s why he’s paying sports right okay yeah of course okay because it definitely improves your performance so
That that all sounds like good news so you think of well problem solved no worries okay we just take a stimulants and away we go all right but there’s a problem there’s a problem yeah please okay so let’s say we start off i’ve done these question marks here as like you know i’m i’m inattentive like what’s going on all right so have yourself um my stimulant okay and
Up goes my attention wow i’m really attentive now yeah okay so hopefully i’m taking this during the day all right and i’m nice and nice and activated all right i’m not going to get into the slow release stuff just now i’m just going to keep it simple all right okay now when that wears off though all right connor you came back to where you were before plus maybe
Plus you know maybe fractionally fractionally lower than where you’re at this looks familiar yeah yeah from a denzel talk right yeah so but anyway it’s only a fraction so who cares okay um this is sort of like a tiny withdrawal effect yeah okay so why don’t we why don’t we just segue over to what happens with withdrawal effects of this medication then we’ll
Come back to here okay okay so so when you’re withdrawing of stimulant you get basically so it decreases your attention yeah it increases your tiredness yeah it reduces any feelings of positive emotion and reduces your performance does it feel good no okay so let’s come back to you so we’ve had our dose our performance and attention and so forth has improved now
It’s night time yeah no problem it doesn’t matter if our performance and arousal look down some people feel like they have a crash yeah okay no problem helps you sleep yeah okay now some people don’t get a crush and it you know it sort of persists a bit longer and it’ll keep them awake yeah so there’s a lot of variability in how long it lasts indifferently all
Right but just in general terms okay that’s fine no worries okay and we take it again the next day all right it works almost as well as it did the first day all right so we’re happy you know at daytime we’re all functional and great wears off okay and again yeah so this was our starting point a little bit lower still it doesn’t matter it’s night time getting good
Sleep new beauty okay next day okay oh it’s not quite as good now i’m exaggerating yeah you are yeah i mean it’s illustrated this isn’t going to happen over three days okay but but this is the sort of thing that happens but no worries okay it’s during the day fantastic okay um there’s like there’s no come down but it’s night time who cares all right okay it’s
Not working for me as well yeah here we go it’s not working no worries we know what to do okay w w does okay so we double dice and it’s working back up until surely at some point we kind of tap out the maximum dose and then go oh well yeah look yeah just to sort of fast forward to the conclusion you’re exactly right okay so what happens is you see your doc a
Couple of months later oh i reckon i need a bit more all right oh oh i started taking an extra one is that okay yeah right yeah yeah no worries yeah the dose creeps up okay this is kind of dose creep it’s because we become more tolerant to the medication yeah all right yeah so get the same effect you need more okay now why why does that matter okay why does
It matter because you end up having a bigger dose means yeah okay so you come off it you get big withdrawal effects yeah okay so low like i’m not getting much positive emotion i feel miserable until i get my dice yeah because your crashes are going to be pressure’s the worst wake up in the morning can’t function until i’ve had my tablet my and i had time for the
Tablet to be yeah now this is once the dose has crept up yeah so this doesn’t usually happen off the bat okay this is sort of six months in 12 months yeah something like that okay all right so so not not fantastic okay we stuck with these withdrawal effects and we’re not and the other thing is it’s not working as well it’s not can we add something else to it can
We add something else to it so how do we avoid this because it’s it’s look not everyone doesn’t seem to happen to everyone but it certainly seems to happen to us it’s the same thing with benzos it’s kind of the benzo it doesn’t happen to everyone but some people are fine on stable doses and other people get exactly this effect so what i would say the way i get
Around this issue okay now i’m not saying you should rush out and talk to your doctor and say oh i want to do what dr allen said no no talk to your doctor about you know what you think is best for you and get his advice but when i’m initiating her or her thank you okay but when i’m initiating someone on this medication what i do is i give them the following advice
I say take it no more than five days in a week okay no more because that gives you two days to sort of start to reset your kind of brain okay all right so five days in a row like two breaks yeah i i don’t know actually what the optimal is i generally tell people i want two consecutive days off oh okay all right so five on so kind of monday to friday weekend i would
Really like three consecutive days off but you know people will have a five day working week or students or whatever right so so i generally say look you’re gonna you’re gonna cop a bit of withdrawal effect on the days that you’re not taking it right that’s the way the cookie crumbles there’s no free lunches here yeah okay so what this curve ends up looking like
All right if you don’t do this if you don’t just keep on taking it every day so you get to so one two three okay so here’s day four he’s day five this is greatly exaggerated okay now yeah you have you come back up to your set of baseline stuff right and then you started the day where you’re sleeping yeah then you start your week again all right so it seems and the
Other thing i sometimes do with people is i might creep the dose up so some people say oh the first day it feels really strong but by the last day it’s not strong enough okay well why don’t we take a little bit less on the first day a little bit more on the last day have yourself a couple of days off okay so you reset your 12 months okay okay now again it’s got to be
Individually tailored yeah you guys need to be talking to your health professionals around this like we’re not giving individualized advice or dosing kind of ideas around well we’re talking about kind of ideas yeah yeah but we’re not giving you individualization so you need to be talking to your primary health care provider and whoever’s prescribing this talk to them
Yeah so to avoid dose fruit what i suggest to my patients right two consecutive days off a week you know i like you’re loving my handwriting yeah i’m glad he was narrating it okay two consecutive days off a week and the other thing i like them to do is i can have one full week off right every two to three months okay okay so people would have to really kind of
Plan for this like they were dependent on it to be able to function at work that may mean that they’re going to take a week off work or kind of that’s their holiday break or whatever where they can just kind of chill for it yeah now when people on holiday say kind of it’s like oh well i really want to get this done and get that done so it’s not no it’s not really
It’s not welcome news right okay soon as the weekend i want to do this on the weekend and i do it so much better when i’m taking my stuff okay so look i mean you know if you’ve got some awesome thing on the weekend and you really need to get it done okay okay take you know yeah skip your skip doses okay you know it’s like you’re potentially asking for tolerance
To creep in and thereby dose creep to go up yeah all right yeah like i said not everyone yeah okay 20 people want to stable those for you know years okay but plenty of people don’t they’re not on these you know stompingly high doses so there you have it folks the uh the secret to stimulants is uh it doesn’t just boost uh attention it has all kinds of effects on
Spontaneity on the reward system on body systems on appetite you name it so you’ve got to factor all this into account and most importantly the concept of tolerance and dose creep is real you don’t want your dose creeping up otherwise problems are really going to start creeping up on you so talk to your prescriber about what might be the optimal dosing pattern for you good luck
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ADHD Stimulant Medication Secrets: The 10 secrets to how Dexamphetamine, Ritalin and Adderall work By the PSYCH collective
