Monthly
NewsNotes
Monthly NewsNote
March 2007
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Fatigue When You Stop a Stimulant: Adults Beware
The stimulant medications are our primary treatment for Attention Deficit Disorder. While they are excellent, fatigue can be a problem of if they are abruptly discontinued. This NewsNote will focus on this problem and possible solutions.
Let me use some clinical material and let's see if you recognize yourself, a patient, or a family member.
Art is a 40-year-old male with ADD of the Inattentive Type. He was being successfully treated with Adderall XR 30 mg in the morning and regular Adderall 20 mg in the late afternoon. He went on vacation and stopped his medication because he felt he had no need to focus as he sat on a beach. When we talked he told me how tired he had been and though puzzled, thought it was due to his hard work before the vacation. By the end of the week his energy was back. In his mind there was no relationship between stopping the medication and his fatigue.
Art's situation happened about a year ago. Now I include a warming about possible fatigue when starting an adult on stimulants.
Here is another type of fatigue that is very common. I call it weekend fatigue and it's very frequent when medication is discontinued on the weekend. Ron, who should use medication on the weekend, doesn't do so. He did admit to getting tired and told me he drank three big coffees each weekend day. During the week he doesn't drink coffee.
What is clear is that the body can develop a need for the stimulant to generate energy, and its withdrawal can lead to a serious sense of tiredness.
Here's an example that has nothing to do with ADD. Ed was a heavy coffee drinker, having many cups daily. He became ill with a fairly routine intestinal virus and recovered in a few days. But he complained of fatigue for several more days, attributing it to the virus. When he went back to his coffee the fatigue was gone. Although he didn't realize it, caffeine withdrawal was key to the fatigue.
I have collected many examples of fatigue in my adult patients who stopped their medication abruptly. Obviously this can be a problem. But it is made more significant because the patient does not associate the fatigue with the stopping of the medication.
For the therapist, I think that it is very important to talk about potential fatigue when discussing side effects of the drug being prescribed. If someone who has been on a stimulant for a while decides to discontinue its use, a gradual reduction over about a week will prevent the problem.
With awareness and a bit of knowledge the ADD adult can prevent a potentially problematic side effect.
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