Does medication always work.

August 14, 2019 adhd-drbarr
  • meds don’t always work, but that’s less than 3% of patients

Unfortunately not, though it’s pretty uncommon. In a few percent of patients they either don’t respond to medication or do so only very briefly.

Far more often patients complain medication is no longer working. While this may be tolerance developing it is often that the medication doesn’t last as long as expected, wearing off as early as 1 PM. It can be particularly frustrating for partners who only see the patient in the evenings and by then the patient is essentially not on treatment any more – the medication having long since worn off. This is an easier problem to fix.

Occasionally the problem is the delivery mechanism of the medication. It’s assumed that all patients metabolize the medications at the same rate and have the same sensitivity to medication but nothing could be further from the truth. Some patients need more than the maximum recommended daily dose of stimulant. Uusally those doses were determined in the original research that got the drug licensed, and more experience since then has shown that higher doses or more frequent doses are often needed.

It’s very common for those early studies to show that there is no advantage to higher doses, and yet within a few years, we have learned the value of much higher doses.

How high a doctor is willing to push medication is based on experience, subsequent teaching, nerve, and some might say recklessness.

I not only need to justify a certain dose to myself, I need to know that I have evidence to support such decisions or I put myself and my patient at considerable risk.

Sometimes ADHD medication fails because of underlying depression or severe anxiety, but if you hate your job, it’s doubtful there is any dose of stimulant that is going to make you focus. And if you hate your boss…

I have had patients be issued with a different and usually generic form of their medication and that explains why it’s no longer working.

If we missed borderline personality disorder or bipolar disorder, that might well explain why the ADHD medication isn’t working. Doesn’t necessesarily mean they aren’t ADHD, just that they have bipolar in addition.

Addictions can prevent ADHD medication from working. A very toxic relationship may trump medication effect but on the other hand, might have been caused by the ADHD in the first place.

Category: Medication