ADHD Drug Holiday — Or Horror?

ADHD drug holiday

An ADHD Drug holiday, they call it. As if stopping to take ADHD medications guarantees a fun, freedom-filled break from tedious routine.

On a recent trip to Hawaii, my friend John decided to not take his stimulant medication. After all, he was on vacation!  Only after he arrived home did he realize: “I way overdid it in the souvenir stores.”   Now, to outside observers, this might seem “obsessive” shopping. But to the ADHD-savvy among us, we recognize it as “no brakes.”

“No brakes” can manifest in myriad ways.

For example, we might assume that “neat freaks” or “obsessional housecleaners” have Obsessive-Compulsive Disorder (OCD).  When it comes to diagnoses, though,  be on alert for look-alikes. You might be surprised at the many ways in which ADHD can camouflage itself as something else—depression, anxiety, OCD, and much more.

Which brings us to a remarkable story. My friend Katy was late in getting her monthly stimulant prescription filled. So she’d have to spend a few days without—what’s the big deal, she thought. Lo and behold. That’s when she found herself launched into a roaring display of OCD behavior.  Or so the uninitiated might assume.

Now I’ll let Katy tell you the story. At the end, you’ll find another post on this theme:  Our Lost Weekend Without ADHD Meds

obsessive cleaning

It Was a Lousy “ADHD Drug Holiday”

By Katy Rollins

I was out of Concerta for a couple of days. In the interim, it was funny watching the ways that I unravel, when I don’t take my medication. Of course, the unraveling isn’t always what people might expect if they didn’t know much about ADHD. One thing’s for sure: It’s no holiday.

For example…

1. I was up until 2:30 am because I got obsessed …

…with a shopping dilemma online and just…didn’t go to sleep.

Didn’t even want to go to sleep at 2:30. But I realized I had to get up in 4 hours. So I laid there for a while. Pretty typical ADHD scenario, but then…

2. Sunday night, my husband fell ill with the flu….

… No prob.

So I needed to clean and do laundry solo. But thanks to “no meds”, I was really crabby about doing it and put it off for two days. But once I started, I couldn’t stop.

I fell into my “pre-meds life” mode of working working working working working until I was so tired that I was completely nauseated. And easily enraged. Haha.

My husband came downstairs, at one point, to see how I was doing. He said, “WOW, I can’t believe everything you got done!” All I could think was, “If he doesn’t get the **** back in bed and leave me alone, I am going to punch the **** out of him”.

(It’s basically a miracle that this didn’t come out of my mouth).

Meanwhile, I was feeling like I’m about to vomit and refusing to stop. Some ADHD Drug Holiday.

ADHD Drug Holiday

3. Even when I finally made myself stop…after hours of binge cleaning…

…I went in the bathroom to pee and then said, “I can’t stop”

I don’t know how to stop. I can’t stop. I can’t stop cleaning. I can’t even stop to pee. Because all I see is stuff that needs to be cleaned. I can’t stop seeing it and I just want it done RIGHT NOW.

I’m just staring at the bathroom sink. And I can’t stop. I was getting upset.

It wasn’t about germs or order or any of that OCD stuff. It was about the fact that I hadn’t taken meds. That means  I couldn’t shut out my environment and all the “stuff” in it.

There were so many things to do. So I was going to do them.

I was completely possessed and it was all I could think about.

ADHD Drug Holiday

4. I finally made myself pee and go to go to bed. But then…

… I had to clean the bedroom room. It had gotten messy over the weekend and I couldn’t take it.

The room was “screaming” at me. So I cleaned it.

While I was cleaning, I set my prescription out. That way I could remember to fill it in the morning. So I could stop feeling crazy.

5. This morning…I now have an exhaustion hangover …

…from all the cleaning. I feel turrrrrible.

I almost couldn’t come to work this morning.

I felt shaky. (I hadn’t eaten dinner last night because ADHD and don’t like stopping what I’m doing to eat or pee or anything while I’m hyperfocused like that). And dizzy.

ADHD Drug Holiday

I Used To Do This ALL THE TIME!

I was up all night getting things done—then unable to function in the morning. My struggles with sleep time are nothing now, compared to what used to happen to me before I took stimulant meds. Nothing.

This is why, in some ways, I was more “productive” when I didn’t take meds. Yet, as for my consistency, endurance, and emotional stability? So much better with stimulant meds. My stress level is lower, too.

An important caveat: I can’t always make myself “productive”  when I don’t take meds. I can only do it if it happens to be the thing I care about right that minute.

So, on one day I might have obsessed over answering my entire email box. Another day: obsessed with a particular art project.

With meds, it’s easier to choose to do the various things I need to do, with more consistency. That way, when I have more time and energy I can do some of the things I want to do, not just the things I need to do.

ADHD Drug Holiday

People Say, “You Have ADHD, Yet You’re So Organized?”

Duh.

  • Organized in spurts
  • Organized at the last minute
  • Organized when my job was on the line
  • Organized when the idea is new

Now I have reminders in notebooks—and many fewer clutter piles. I don’t panic about laundry on Sunday nights anymore.

As great as my house looks today, I don’t miss feeling that way all the time! It was terrible. I remember how I used to do this when I was a kid! I binged on “productivity.” Until I had to lie down in the middle of my project. Sometimes on top of it—such as when I was cleaning my room and stuff was all over the bed. I had to just go to sleep before I threw up.

All the time. For decades.

I can’t believe I lived like that for so long!

___________

How about you?  Can you relate to Katy’s “ADHD Drug Holiday” experience?

Please share in a comment.

In general, “drug holidays” are not a good idea when it comes to ADHD treatment.

—Read about another couple’s experience: Our Lost  Weekend Without ADHD Meds

—This Harvard Health Newsletter addresses some of the general-health issues around “drug holidays” (Should You Take a Drug Holiday)

—Gina Pera

47 thoughts on “ADHD Drug Holiday — Or Horror?”

  1. Maria Pugliese MD

    I never let my patients or my kids take a drug holliday/horrorday. The no brakes and a computer makes them shopaholics. I get the organization part. My daughter has an extensive wish list with internet addresses and prices up to two pages for her birthday and Christmas. My son cannot deviate from going to Wawa three times per day for his coffee. It is really amazing to watch.

    1. Hi Maria,

      Amazing indeed!

      I hear so many stories about online-shopping “addictions”. One woman — highly trained computer scientist — tells me she shops online every night but only at stores where she can return. And she returns everything before evening opening! 🙂

      g

  2. I was finally diagnosed with ADHD about five months ago at the age of 55, after a lifetime of wondering what the heck was wrong with me. Everything in Katy’s article resonates with me.

    Like one of the commenters, Chris, I was instructed by my doctor (in my case my PCP, not a psychiatrist), to take my Concerta weekday mornings, but to skip it on weekends to avoid building up a tolerance, as well as to give my heart a bit of a rest. The Concerta definitely raises my resting heart rate by a bit, according to my Apple Watch. Not high enough to make my doctor overly concerned, but I have to admit that I do feel a bit of relief when it goes back to normal on the weekends.

    All that said, I would love to be able to take the Concerta on the weekends as well. As it is, weekends feel like ‘lost’ days to me. They’re also the days I’m far more likely to get into the familiar ADHD spouse vs non-ADHD spouse arguments with my wife.

    I’ve read with great interest your comments on medication holidays being unnecessary, Gina. I would love to believe that to be the case. Are you able to point to any studies that specifically address the issue of seven day a week Concerta use with regard to effect on heart rate/heart attack risk and tolerance build up? And also whether seven day a week use increases severity of a Concerta crash?

    1. Hi David,

      I cannot medically advise you about any heart conditions you might have. But I can convey best practices to you.

      It is difficult to find a published study on a topic that is difficult to study due to so many variables. That is, how will a group of people on Concerta with unknown pre-existing heart rate respond to Concerta in terms of heart-rate and heart attacks. For one thing, genetic variations mean some people respond better to MPH than AMP — and vice-versa. For another, what about their diet and stress level and sleep?

      To answer these question, we have to extrapolate from other research.

      First, it makes ABSOLUTELY NO SENSE that you’ll have any less of a cardiovascular risk from Concerta if you don’t take it on the weekends. Ask your MD for a paper on that!. 🙂

      Second, people don’t habituate to Concerta. Ditto.

      Back to the “resting heart rate,” what exactly is your resting heart rate, without Concerta? Is it abnormally high? Do you have diagnosable hypertension?

      If you have diagnosable hypertension, what are you doing diet/lifestyle-wise to lower it?

      If you have diagnosable hypertension and ADHD, the rule of thumb is to stabilize blood pressure first, and then add a stimulant….if the stimulant seems to be interfering with your heart rate.

      Beyond that…are you consuming caffeine or nicotine? That will exacerbate a stimulant’s effect.

      Are you sleep-deprived? You might be on too-high a dosage of Concerta, in an effort to compensate for sleep deprivation. But the stimulants don’t treat sleep deprivation, they treat ADHD.

      Are you taking a Concerta generic or brand (or the authorized generic, which is same as brand)? That will affect the rate at which the MPH is released into the system, thus potentially affecting heart rate.

      So many questions! But, I’m afraid, your MD doesn’t seem qualified to give you reliable answers.

      Best,
      Gina

    2. Hi David, I’m a 35 year old male who was first diagnosed with ADHD when I was 21 and have been on a stimulant at fairly high doses (80 mg/day d-amphetamine) for the entire time. Except for the past 7 months which I had to stop for other reasons. I can tell from my perspective that without having taken med holidays nothing has been worrisome cardiovascularly. When I did have breaks from the meds (a month or two here and there over the 14 years) I noticed all my symptoms came back and when I started the meds again I had to spend a few nights restless due to the high dose (I weighed 135 lbs) but overall I never built a tolerance I could discern. The last year I took them I couldn’t get the right dose so I had to skip weekends and every weekend indeed felt like a complete waste. Just my experience, but I never liked doing med holidays.

  3. Very interesting account . I am make and go through a similar combo of both hyperfocused behaviour as well as exhaustion and suffered serious burnout for 3 or 4 years.

    Only disgnosed at 49 (last year) – had all the signs, and this kind of strange behaviour runs in the family, so just thought it was type A personality. Seems so obvious now.

    Have tried short acting ritalin, but had a roller coaster ride on it. I became more agitated and uncharacteristically interested in social media, which I usually disdain (I got banned on Reddit and Twitter – read between the lines!). Also started scratching my head a lot which is wierd and never felt satisfied. I was also crashing when the final dose wore off at 5pm. Essentially, I became someone I didn’t recognise.

    Am now trying Vyvanse 20mg sustained release. A big positive difference so far! I feel much calmer thankfully and not noticing a crash in the same way. Lost interest in social media again and not feeling irritable or as impulsive.

    The biggest issue I face is my weekly days off the meds. It is horrible as I am lethargic and need to sleep, I crash around mid morning, and revert to my pre-med status. The psychiatrist says I should have 2 days off a week to avoid tolerance build up, but I can I only manage 1. I would prefer not to have any days off. I have noticed some people don’t seem to have days off their meds and some psychs don’t even suggest it according to comments I have read. Can anyone explain the disparity around this?

    1. Hi Chris,

      I love that you mention “problematic” social-media behavior as a side effect of your taking Ritalin. People have no idea.

      As for the head scratching…is it more picking? That can be a sort of anxiety. It’s a delicate balance…dopamine….serotonin…that Ritalin might have been either too high a dose or released too much/quickly for your system.

      That’s great that you kept trying — and that Vyvanse is working better.

      “Days off” stimulants? That’s a very antiquated notion. I know of no acknowledged ADHD medical expert who would ever suggest that. Instead, they recommend as close to 24-7 treatment as can be managed.

      It’s good you’re asking questions.

      good luck!
      Gina

    2. Thanks for replying Gina! I had no idea that other ADHD sufferers had issues with social media – it certainly took me by surprise. Yes, it was more like head picking than scratching – it was kind of uncontrollable. That’s interesting your comment about ‘days off’. The pscyh talks about it like it is a normal thing…
      I’d suggest he hasn’t had to endure what it is like not to have it. The reason he gave for the ‘days off’ is to avoid tolerance to the drug. Is that a thing?

    3. Hi Chris,

      Oh yes, I’d say “trolling” is almost diagnostic for oppositional defiance disorder. :-). But I’ve seen even older people with ADHD who have quit smoking (a stimulant) and suddenly turn up the volume on their car radio of the political “shock jocks.”

      Anger can be very “self-medicating”. Here’s my very popular post on that:

      https://adhdrollercoaster.org/adhd-and-relationships/adhd-relationship-arguments-conflict-self-medication/

      But your case, it doesn’t seem that your ADHD symptoms are the issue — your “treatment” is. In provoking anxiety.

      As for your MD’s reasoning, again, it’s an old myth.

      Actually, it’s more apt for people abusing stimulants. They have the most trouble with “habituation.”

      So if you visit some sites where people are talking about “hacking” Adderall and whatever….they’ll be talking about that there. But these are people abusing medication (they probably also have ADHD but that’s another story).

      What often happens is this:

      1. The person newly diagnosed with ADHD takes an amphetamine (e.g. Vyvanse, Adderall)…this doesn’t happen as often with the methylphenidate stimulants (e.g. Ritalin, etc.)

      2. EUREKA! The clouds have parted. The angels are singing. They can see what must be done and be motivated to do it. etc etc.

      3. This EUREKA! feeling wears off. The person thinks Rx has stopped working.

      Partly the body adjusting, partly forgetting what life was beforehand, partly not doing the other things to maintain cognitive functioning (e.g. sufficient sleep, good diet, exercise, external supports for organizing goals, etc.).

      Also: The “shiny” has worn off.

      4. In the case of Adderall, there can be more of a “it stopped working” effect. Because Adderall differs from the other amphetamines, in its mechanism of action. It can actually deplete cells of the require neurotransmitters.

      That’s it in a nutshell!

      Gina

    4. Ok – yes, I was ‘trolling’ – you caught me!! Amd yes, I have definitely been more tuned into the shock jocks! Unlike my normal personality, although as you explain in your article link, I do think I was using it as a form of self-medication. I definitely have anxiety as a comorbidity and this was what lead me down the path to the ADHD diagnosis. Started on Lexapro, which helped but didn’t completely solve my issues – if anything, the Lexapro helped partially take anxiety out of the equation, and I was able to clearly see how chaotic I was. On a side note, my psych wants me to slowly come off Lexapro to see of the Vyvanse is enough to control the anxiety as well. I am a bit nervous about this though although I would welcome the reversal of the impotence I am now suffering (have enhanced sex drive but no ability to really do anything about it. My wife and I have made adaptions, but it is pretty much just her having orgasms during sex now).

      The steps you have described, reflect my experience very well. I would like to read one of your books – which do you recommend starting with?

      Thanks for engaging in discussion with me. You really are helping to bring the level of detail and nuance to the world of ADHD, which all sufferers and their families know is a jungle. As you have said, self-education is mandatory. I only wish my Psychiatrist was more engaged around the nuances regarding the behavioural side of things. The drugs are only one part of the equation!

    5. Careful, Chris. I am an informant for the Facebook police. 😉

      Another friend posting about mental health just got sent to the pokey—again. Crazy.

      Thanks for noticing my work. It’s so “noisy” online these days in ADHD lane, and I’m not a shouter.

      re: anxiety. Here’s my observation, developed over years of hearing 1,000s of first-person stories. And also learning a bit about neurotransmitters — though no expert, for sure.

      Anxiety disorders are one thing. ADHD is another. But they are often confused for each other.

      ADHD symptoms can create “cognitive anxiety” — that is, disorganized thoughts, worry about when you’ll again step on that invisible banana peel, the old habit of using worry and fear to drum up stimulation so you can focus, etc. (My husband calls his version of this, developed while he was completing his PhD in molecular biology, “Fear-Based Management” — and I don’t recommend it.)

      So, you (meaning a person with ADHD who is dealing with above) are prescribed an SSRI or other anti-depression/anxiety medication. Voila! The anxiety is lessened.

      Some people feel this with Cannabis, too.

      In other case, the person thinks the medication is “working.”

      Maybe. But maybe the medication or cannabis is just beating back the anxiety with a cudgel……not helping the brain to be more organized and so to better manage cognitive anxiety. There can actually be LESS motivation, initiation, organization, no brakes on eating, etc. But NOW YOU DON’T CARE! 🙂

      re: psychiatrists. They are low on the totem poll of medical specialists, in terms of insurance payment. Most provide only medication management appointments, which last about 15 minutes. Some offer more, for private pay. It’s too bad. And it means that ADHD patients are left to cobble it all together. Irony of ironies.

      Yes, the drugs are only part of the equation. But done poorly, it might mean that other strategies might never “land.”

      Yes, SSRIS (like Lexapro and many others) can create impotence, especially in men with ADHD. For some men with ADHD who have early ejaculation, that helps. But for others…..zippo.

      Maybe you don’t have to eliminate Lexapro altogether. But maybe you can wean down bit by bit. That way, you’ll have a clearer idea about whether it was helping or hurting.

      re: reading. This is my first book and still highly relevant and comprehensive. You could jump to the last chapter (that one that most people miss!) to discuss with your wife some behavioral strategies to support Executive Functions.

      https://amzn.to/3uIudtf

      This presentation (my first, so be kind!) is based on these strategies.

      https://www.youtube.com/channel/UCOa5Pd5-yGirwdAvrZiiS3A

      good luck!
      g

    6. Cheers Gina!

      I’ll have to come up with a ‘code’ when discussing mental health.
      “..cobble it all together..” Love that description! They are the exact words I have used to describe my experience of life as someone with ADHD .

      Your husband and I sound similar. I too did a PhD and was an academic up until I resigned end of last year after 17 years. Never quite got the traction I needed. Anyway.

      Can totally relate to “…using worry and fear to drum up stimulation….”. Story of my life, but always super motivated person because of it. Of course downside is I ended up suffering 5+ years if burnout and PTSD from the stress of that. And as you say, once I went on the drugs I lost motivation – stopped exercising (used to do crazy amounts); difficulty finding motivation to study (I’m retraining); haven’t given up but at times the ‘contentment’ from positive feelings sure feels like it.

      I’m meeting with my Psych today, so I’m raising the Lexapro and see how it goes.

      Thanks for the links. Appreciating your apt descriptions explaining what is going on for people with ADHD. It certainly resonates.

    7. Thanks, Chris. I’m happy to be making sense for you. 🙂

      But I’m curious…..I wonder about the wisdom of raising Lexapro now instead of taking the Vyvanse daily, weekends included.

      Food for thought. No response needed!

      g

    8. Yes, meant ‘raising’ as in discussing not increasing. The aim is to get off the Lexapro!

  4. This article is fabulous in that it clearly depicts how different all of our symptoms are . I can 100% relate to the rage /wanting my husband to go away that happened to the author . My temper (which is already an issue) becomes extremely short when I take a med “holiday “ … and I get hyper focused with and without meds … so we are all different. I agree with Gina – our common issue is about not finding that proverbial middle ground. I’ve been looking for it my entire life , lol .

    1. Hi Veronica,

      I agree….fabulous essay from my talented friend.

      Middle ground….that’s what eludes most humans…just a matter of degree!

      Cheers, g

  5. The binge cleaning is totally me. Plus I have really bad back problems and need to lie down frequently. When I’m not on meds, I can’t stop, even when I’m in serious pain, hypoglycemic from not eating, etc. When I finally do stop, I can’t move for a week. The whole time I’ll be telling myself this is too much for my body, but the effect of the clutter is stronger. I can’t stand seeing everything I have to do. This is all made worse by my husband’s inability to even see clutter. Don’t get me wrong. He tries to keep the apartment clean for me. I appreciate it more when I’m on meds.

    I hate the rules for filling controlled substances, because it pretty much guarantees occasional days with no meds. One way I deal with it is saving the extra pills when my dose changes. My psychiatrist understands the anxiety caused by not having an emergency stash and is willing to work with me…

  6. gratefulcrazylady

    OMG…. This might be me. I was only recently at age 48 prescribed 20 mg Adderrall IR a day. Just started this week and had to take an extra 5 mg (10-10-5) two of the three workdays I was on it. Yesterday was the 4th day only two doses. My doc is on vacation and simply prescribed 20 mg every morning. The therapist is the one who told me to break the doses down. Anyhoo googling because I am debating taking it on weekends….but the bottle said every day. And I read this, your vacation sounds like my life. Either I go full steam or vegetate. Lots of success in life and prior diagnosis was always GAD, but even with the headaches and in between dose wear off, I was excited at what it did. It slowed me down. The chatter “so much to do” voice in my head was quieted and I did not feel compelled to get up to do other things while working. Think I will go take my medicine ( I was thinking because I took the extra 10, I might run out and need to skip weekends). But not going to now.

    1. Yay! Good for you!!

      I laugh every time I read this post, and it’s been years! 🙂

      And remember, there are many other choices besides Adderall. Your doc should give you a trial on some of the sustained-delivery stimulants so you don’t have to deal with the ups and downs all day.

      In the end, it might be that Adderall still works best for you. But good protocol requires trying at least one or two other types of stimulants.

      I wrote about it here:

      https://adhdrollercoaster.org/adhd-news-and-research/the-tragic-truth-of-adderal-or-madderall/

  7. Honestly? I can relate to this is, but mine happen in spurts..I’d suddenly get angry cause I see dirt and untidiness all around and start cleaning BUT, I try to take it all on and then feel wretched when I get tired or bored and can’t finish…I wish I had Kathy’s issue (I am down playing the effect it as on her) , But living a life where you think of yourself as lazy dirty and other help by telling you that just makes you wish you were the cleanest pond on the road…

    1. Thank you, Adina, for that very clear description. Just imagining how that would feel makes me very uneasy. I am sorry this happens to you.

      I encourage you to keep working on treatment and on implementing strategies that help you get a handle on your surroundings.

      best,
      g

  8. Having lived without a diagnosis for most of my life, and offered the wrong meds 20 years ago, I decided to try stimulate meds a few months ago.
    I have gone through my life “flying blind”, and have felt very alone, as I am not a 12 year old boy, but a 61 year old woman, who is a professional in the Mental Health field.
    There hasn’t been much out there, or safe people to talk with about what is happening to me, or how I am supposed to feel.
    Sadly, I can’t talk about this at work, as coworkers and managers are hugely judgmental, and have gossiped unmercifully about colleagues who have addictions, or mental health issues.
    I laughed about the desperate cleaning jag, as I had spells of that before when I was stressed at work. I was a midnight closet organizer, and tiny grooves in the gasket of the stove and fridge cleaner. My towels looked great, but my life was a mess.
    It’s getting better, and I’m hopeful that I have found a tool to manage life better. Thank you for your blog

    1. HI Linda,

      Thanks so much for taking the time to write.

      I’m thrilled that this wonderful post has spoken to your experience. Isolation, being misunderstood….these are almost as bad as the behavior that we’re struggling with.

      We’re all in this together.

      g

  9. Omg! This SPEAKS to me! I’ve been toying with the idea of trying medication but haven’t taken the plunge. I totally binge clean and become enraged when I get interrupted. I never stop to eat and totally almost pass out by time I actually do. I cannot go to bed before 1am. This is SO ME.

    1. I should note that I am not officially diagnosed, my house is NOT orderly as frequent binge-cleaning might imply, and I CANNOT stop once I start. two days after a binge-cleaning episode it all falls apart and becomes a bigger mess than ever.

    2. Hi Lindsay,

      That’s fairly emblematic of ADHD’s core challenge: self-regulation.

      Not over-doing. Not under-doing. But finding the middle ground. Consistently.

      Maybe it’s time for you to pursue an evaluation? If it turns out you do have ADHD, diagnosis and treatment might mean a huge positive change in your life.

      Good luck!
      g

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