When it comes to ADHD medication, let’s just say, it’s complicated. And maybe not for the reason you think.
Simulants are a first-line treatment for ADHD—but they’re in short supply.
The Food and Drug Administration announced a nationwide shortage of Adderall in October 2022, and there’s been a shortfall of other ADHD medications since then.
Like any health condition, if someone has a proper ADHD diagnosis and would benefit from medicine, they should be able to get it.
But now tons of people with ADHD are burdened by the twisted reality of feeling like a drug-seeking criminal as they forage and ration their prescriptions each month.
And that’s only one part of the love-hate relationship ADHDers tend to have with ADHD medications. With side effects and stigma and thrice daily doses, it’s easy to understand why most people who take them don’t stick with them.
In one recent study from nine countries, more than half of teens and adults stopped taking their ADHD medication within the first year of starting.
While there’s no shortage of reasons to quit ADHD meds, I commonly hear vague comments, like “I don’t like them” or “They don’t work.”
Let’s dig into that.
Sometimes, a certain medicine is just not the right fit for a person—even if it’s great for someone else. It’s also possible to “grow out” of the need for medication, especially in milder cases.
That said, ADHD medications can be finicky. They’re not exactly easy to please, and getting them to work well usually takes some finesse. And time.
Finding harmony between optimal medicine type and dose can take months, or longer. That’s some serious patience.
But there’s more to it than that. Other significant—and perhaps surprising—things can make ADHD medications work better, or worse.
So, before you break up with ADHD meds—or to make the most out of your limited supply—consider the following tips. Of course, always talk with your doctor before making any changes to your medications. This is not medical advice.
ADHD medications may or may not be as effective when taken with a meal.
For example, it’s not uncommon to get better results taking instant-release medicines on more of an empty stomach—about an hour before, or two hours after, eating. Likewise, some find it best to eat a couple of hours before taking extended-release ones. It’s different for everyone.
Tune in to what works best for you, and experiment with the timing.
Don’t let yourself get too hungry, though. Going a long time without food can lead to feeling physically and emotionally unwell—and worse ADHD symptoms.
Eating is important, but when you eat relative to your meds matters, too.
On a similar note, ADHD medications don’t always play nice with other stuff we put in our body.
For example, caffeine adds extra stimulant to the situation. So enjoying that coffee or soda can give you an anxious, jittery, or all-around unpleasant feeling.
And if you like to take your medicine with a glass of OJ, think again.
Believe it or not, citric and ascorbic acid can affect how your body absorbs and gets rid of ADHD medication. That doesn’t mean fruit juice is off the table for good. You just might want to avoid citrus, carbonated drinks, and high Vitamin C items for an hour before and after taking your ADHD medicine.
And not to be a buzz-kill, but alcohol can make it seem like stimulants aren’t working, and vice versa—raising the chances of having too much of either. At best, you can end up feeling intensely amped—like a nightclub is thumping inside of you—or have trouble sleeping. At worst, the combo of ADHD meds and alcohol can be dangerous.
Easier said than done, especially with ADHD. But doing your best to sleep well is essential for a good ADHD life.
Being sleep-deprived can exacerbate ADHD symptoms and make it that much harder to get the most from your medication—or to accurately assess if it’s helping.
Do what you can to get a sufficient amount of sleep. That’s also different for everyone, but most adults need 7 to 9 hours per night.
Focus on your quality of sleep, too. There are loads of sleep hygiene strategies and healthy habits are personal, but aim to go to bed and wake up around the same time every day, keep a consistent wind-down routine, and try to make a comfy and non-distracting sleep space.
ADHD meds can get in the way of good sleep, so consider cutting your evening dose. That won’t always be realistic, especially if you work or study at night, but take your last dose as early as possible before bed.
ADHD medications vary in terms of how fast they kick in, and how long they last. Pay attention to how your mind and body feel in the hours after you take it.
If you notice peak effects after one hour, and you need to be at optimum functioning at 9 am, be sure to take your medicine around 8 am. Track the number of hours it takes to wear off, and talk with your doctor about when to take additional doses.
The ideal timing might be inconvenient, so a little planning can help.
Pro tips: Set daily alarms for each dose, schedule meals, and have your medication on you when you need it.
If you’re sluggish in the morning, keep the medicine next to your bed, so you can roll over and take it right when you wake up.
Play around with the timing until you find your groove.
Remember, more milligrams don’t necessarily mean more benefits. Taking more medication than your brain needs can even make ADHD symptoms worse.
So, as you work with your doctor to find the right dose, test different options—go up as needed, but also back down.
You might be surprised that a lower dose feels good and works, too.
Be curious and pay close attention as you make these delicate maneuvers. With each adjustment, take notes about how you feel and function. You’ll thank yourself later.
ADHD medications can be very helpful, and the right one could still be out there for you.
At the same time, medication isn’t right for everyone. Be honest with yourself about what you want. If you prefer a non-medicated approach, that’s OK too!
The key is that you hope and believe in your treatment plan—whether you stick with ADHD meds or not.
References
Brikell, I., Yao, H., Li, L., Astrup, A., Gao, L., Gillies, M. B., Xie, T., Zhang-James, Y., Dalsgaard, S., Engeland, A., Faraone, S. V., Haavik, J., Hartman, C., Ip, P., Jakobsdóttir Smári, U., Larsson, H., Man, K. K., de Oliveira Costa, J., Pearson, S. A., Hostrup Nielsen, N. P., … Chang, Z. (2024). ADHD medication discontinuation and persistence across the lifespan: A retrospective observational study using population-based databases. The Lancet Psychiatry, 11(1), 16–26. https://doi.org/10.1016/S2215-0366(23)00332-2
Caye, A., Swanson, J. M., Coghill, D., & Rohde, L. A. (2019). Treatment strategies for ADHD: An evidence-based guide to select optimal treatment. Molecular Psychiatry, 24(3), 390–408. https://doi.org/10.1038/s41380-018-0116-3
Dan, O., Cohen, A., Asraf, K., Saveliev, I., & Haimov, I. (2021). The impact of sleep deprivation on continuous performance task among young men with ADHD. Journal of Attention Disorders, 25(9), 1284–1294. https://doi.org/10.1177/1087054719897811
Helfer, B., Cooper, R. E., Bozhilova, N., Maltezos, S., Kuntsi, J., & Asherson, P. (2019). The effects of emotional lability, mind wandering and sleep quality on ADHD symptom severity in adults with ADHD. European Psychiatry, 55, 45–51. https://doi.org/10.1016/j.eurpsy.2018.09.006
Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O'Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., Ware, J. C., & Adams Hillard, P. J. (2015). National sleep foundation's sleep time duration recommendations: Methodology and results summary. Sleep Health, 1(1), 40–43. https://doi.org/10.1016/j.sleh.2014.12.010
Peterson, B. S., Trampush, J., Maglione, M., Bolshakova, M., Rozelle, M., Miles, J., Pakdaman, S., Brown, M., Yagyu, S., Motala, A., & Hempel, S. (2024). Treatments for ADHD in children and adolescents: A systematic review. Pediatrics, 153(4), 1-11. https://doi.org/10.1542/peds.2024-065787
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