A new study offers good news about the cumulative benefits of ADHD medications taken over time:
Results showed that adult ADHD patients who received drug treatment for more than two years had fewer symptoms and less psychological distress compared to those treated for two years or less.
Just yesterday, a consulting client asked me, “How long will it take after starting medication for my ADHD to start seeing the benefit?” My answer was the same as given in my book:
- Symptoms tend to get better within weeks.
- Functioning gets better within months.
- Perhaps most important, careful observation may identify changes in development taking place over years. For example, the individual who never had a friend now makes and keeps them. Another who could not keep a job has now kept one for a year.
In other words, this study seems to confirm that the “higher-order” functioning does not happen immediately after starting medication. (Even if, by some miracle, you happen upon the best type of medication for you in the early days of treatment.)
Rather, it happens more gradually over time. Of course, some symptoms can be alleviated immediately — suddenly, you “see” that sock lying on the floor or how to clear that garage of longstanding clutter. But the more complex Executive Functions? Those connections might take longer to develop.
Implications for the Famous MTA Study
Another reason this study is important: Many people who should know better, including psychologist Alan Sroufe writing in a New York Times op-ed, have spread far and wide their gross misinterpretations of a well-known study called the MTA.
The MTA is a long-term, rigorous, multi-site study examining the effects of medication and other strategies on school-age children with ADHD. (Sorry but I’m not providing the link to the Times story; it only encourages them.)
These people claim the MTA offered proof that medications stop working after two years. (They don’t! the truth is more complicated!). They either are willfully misinterpreting the study or, honestly, they just aren’t smart enough to understand it. A source I respect, the Child Mind Institute, wrote a clear essay on this topic.
When it comes to misinterpreting the MTA findings, it’s not just the academics with an ax to grind (e.g. they’re miffed that medication works better than their specialized “therapies”). It’s also the anti-ADHD wingnuttery. Moreover, it is also certain people seeking to exploit the “ADHD Market” by offering their dubious services. Please consider your ADHD information sources carefully.
The study was led by Michael B. Lensing, MA, of Oslo University Hospital in Norway. You can read more about”Long-Term Treatment For Adult ADHD and here.
Hello,
I was diagnosed with ADD about 3 years ago as an adult, and have been on medication since. I actually found your site because I was searching for information on long-term effects (both effectiveness and onset of new side effects). Lately I just haven’t felt that the medication has been as effective, and I’ve seen some changes in my mood overall.
Your post makes the comment: “These people claim the MTA offered proof that medications stop working after two years. (They don’t! the truth is more complicated!).” Can you explain what this means a little more, or point me in the direction of another post that discusses it? Specifically, why do people believe the medications stop working after a couple years and what the “more complicated” answer is.
Thanks
Hi Kat,
There are so many misconceptions and even propaganda-tropes on the Internet. If I addressed all of them, it would be another unpaid full-time job! 🙂
Bottom line is: The MTA subjects’ medication “stopped working” because they stopped taking it—or they relied on “community care”. That is, prescribers in the community, not the more careful and attentive prescribers who worked with them for the study.
Other reasons the medications “stop working”:
1. Over-relying on the stimulant to propel one through the day instead of implementing supportive strategies.
2. Developing sleep deficits
3. Eating a poor diet, therefore depriving the brain and medication of the building blocks of neurotransmitters.
4. The prescriber failing to account for co-existing conditions (e.g. depression, anxiety, etc.) that could be exacerbated by a stimulant alone and therefore reduce effectiveness.
When it comes to Adderall, it has a different mechanism of action, compared to the other stimulants. And it can actually deplete cells of key neurotransmitters.
Just a few possibilities!
g
HECKFREAKINGYEAH!
I’m sorry, this study just makes me do a happy dance. It makes perfect sense to me as to why it takes two years: the medication brings clarity quickly, but you have to build habits over time.
I’m at two and a half years medicated, and I’m just now starting to see the overall balancing of life-issues (like keeping friends, maintaining momentum towards goals, long-term patience with my kids, etc.)
My husband, on the other hand, just got diagnosed last week. 🙂
Ms. Pera, I kid you not, we were in marriage counseling, and the counselor mentioned (for the 50th time) how some of his “quirks” were due to super-high intelligence. I raised my hand like a 3rd grader: “Um, how come if I lose things, miss bills, can’t find my glasses, can’t get the house clean, and get the kids to school late, that I have ADHD, and am desperately trying to manage it—but if he does the same thing, it’s because he’s a genius?” She smiled, nodded, and said, “No, you’re brilliant too. And he has ADHD.” It took him more than a year to follow-up on that statement, and I’m honestly fine with that. He had to come to his own conclusions, without me leading him by a hook in the nose. Now, he’s passionate about managing his ADHD well, and rejoiced with me at the thought of having a more even keel two years from now.
Thanks for all you do.
–djy
ACCCKKKKK!!!!
“Um, how come if I lose things, miss bills, can’t find my glasses, can’t get the house clean, and get the kids to school late, that I have ADHD, and am desperately trying to manage it—but if he does the same thing, it’s because he’s a genius?”
I love you, Dotty!! THIS is genius!!!!!
And I am just thrilled for both of you. Congratulations!!!
g
Hi Gina, thanks for sharing this wonderful information. Hehe people with ADD need to have patience regarding their medication.
Ha! And isn’t that a Catch-22-type joke, Dave! First, they have to be organized and persistent enough to slog through the maze we call our mental-health system. Then they have to be methodical and careful in noticing the progress (or side effects) with medication, even if their physicians don’t help them with this. Then they are expected to wait more than two years to see the full effect of medication. 🙂
It is a testament to the willpower and perseverance that many people with ADHD do, in fact, have that they stick it out. 🙂
And more re: the findings:
Our study has 4 main findings. First, among participants,
a majority reported ongoing treatment with ADHD medi-
cation after more than 4 years. Second, current treatment
was associated with fewer self-reported ADHD symptoms
and better mental health functioning. Third, pharmacologic
treatment for more than 2 years was associated with better
outcome. Fourth, psychiatric comorbidity at baseline pre
dicted poorer outcome.
One of the main challenges in treatment is that “drugs
don’t work in patients who don’t take them.”
In studies of ADHD samples, difficulties with compliance with drug
treatment over time have been reported frequently.
Although based on self-report, the high percentage of cur-
rent treatment among participants in our study is striking.
Possible explanations for our finding can be
found in the Nordic welfare system, which is based on equal
treatment conditions, eg, the availability of specialists for all
inhabitants, and expenses for necessary medical treatment
are mostly covered by the national welfare system…..
FYI — here is the abstract.
http://www.ncbi.nlm.nih.gov/pubmed/23419235
And here is a snippet from the study (which was based on self-reports, not any type of brain-imaging). Not that this supports what I wrote earlier; long-acting stimulants are a better choice than short-acting, if you tolerate them.
Current Use of ADHD Pharmacotherapy
At follow-up, 232 subjects (63.0%) reported current
psychopharmacologic treatment, and, of these, 116 sub
jects (50.0%) reported use of long-acting methylphenidate,
while 77 subjects (33.2%) were treated with short-acting
methylphenidate. Thirty-nine subjects used other ADHD
medications (mostly dextroamphetamine sulfate or
atomoxetine). Self-reported treatment adherence, defined
as not missing a single dose during the last week, was sig-
nificantly higher when patients were treated with long-acting
than short-acting stimulant medication (75.7% vs 42.9%;
75.7% vs 42.9%) Among patients taking atomoxetine
(n=13), 50.0% reported not having missed a single dose
during the last week.
At follow-up, 136 subjects (37.0%) had discontinued drug
treatment (off-medication group). Nearly half of this group
had used short-acting methylphenidate as the last medi
cation before discontinuation. Most frequent reasons for
discontinuation were adverse events (55.1%), lack of efficacy
(32.4%), and misuse of medication (16.9%, reported by men
only). Eleven subjects (8.1%) reported remission as reason
for stopping medication.
FYI — here is the abstract. I’ll try to hunt down the study….
http://www.ncbi.nlm.nih.gov/pubmed/23419235
What is unclear to me regarding the study is if the medicine is causing higher functioning over time. Seems to me that neurostimulants only have a medicinal effect during a certain short term duration. The medicine helps an ADHD person meet a deadline or remember to take out the trash and over time the short term alleviation of distraction, inattention and hyperactivity will yield long term success in these “higher functioning” areas. So, circling back to my original statement, is the medicine actually improving the connections from the PFC made throughout the brain or is short term success building on each other?
Good question, Andrew. I think the answer is: We don’t know for sure. 😉
That said, there is much to be said for 24-7 medication treatment — or as long as possible throughout the day. That allows one to consistently achieve a certain level of functioning and keep building upon success.
Perhaps some people can get by with a short-acting stimulant, but many people with ADHD do better when they help the brain achieve homeostatis — a predictable flow of neurochemicals. And that means 24-7 strategies. For many people, that’s a low dose of Strattera (24-7) combined with a long-acting stimulant (Concerta, Vyvanse, etc.) — sometimes even a booster dose of the long-acting stimulant in the afternoon.
Otherwise, it can be like that movie Ground Hog’s day, with the person unable to keep building on the connections made because they’re riding a jagged neurochemical roller coaster.
This is written quickly, when I’m hungry and tired. But I think you catch my drift!
When you refer to meds helping bridge the executive functioning gap over time, are there specific ADHD meds that do this more effectively than others?…and does it actually bridge the gap/malfunction in the pre-frontal cortex, or is there another mechanism at play?
Hi Joel,
The medications considered the first-line treatment for ADHD are the neurostimulants. Most of the research has taken place with that type of medication.
We talk about the prefrontal cortex as being the seat of so-called Exeuctive Functions. But in point of fact, the brain is much more complicated, with connections to/from the pfc made throughout the brain.
I write at length about this in my book: http://www.amazon.com/dp/0981548709/?tag=wwwginaperaco-20
best,
g
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Well done Gina, many thanks for this update. These note support what we’ve seen for years with responsible med management coupled with specific development of interpersonal skills previously left unattended.
Fabulous news..
Yes, it is fabulous news. And, I hope it is an encouragement to people just starting out, that it might take a while to achieve full benefits from medication. Patience is often not an ADHD strong suit (but Rx can usually help with that, too!). 😉