Factors favoring medication breaks
Patient wants to know if medication is still necessary. Bodies change with growth, puberty, childbirth, lactation, and menopause. Life's demands also change. Teens, in particular, often need a break to demonstrate whether they need to take medicine for ADHD or not.
Person only needs meds to focus on work, school, or a particular project. Some patients with milder ADHD may only need medication for high focus tasks like college examinations or major work deadlines. Stimulants may be prescribed for some patients like this on an as needed basis. However, there is no research to prove that this approach is safer or better than daily administration. For example, we don't know if taking medication one day a week might be a higher risk for addiction or cardiac rhythm disturbances than taking it daily.
Patient has problems with appetite and uses med breaks to catch up on eating/growing. Sometimes medication breaks are recommended when a patient has problems with appetite and those problems are causing weight loss in a child or pregnant woman. However, most children who take stimulants do initially seem to grow less when a stimulant is started, only to catch up or even become obese later, so the benefit of a medication break only comes in to play if there is sustained weight loss and the medication is good enough to warrant staying on it despite the weight loss.
Medication affects social functioning during the proposed break period. Medication does change how you function socially. For most people, it is for the better. You can pay attention to conversations better, avoid making impulsive remarks, and carry through on what you say you are going to do. For some people, though, medication can make them less witty and overly focused enough to not be able to enjoy having fun with friends on weekends. This can be a particular issue for young adults.
Patient is pregnant or breastfeeding. In general, having a baby on board does change the balance of risks and benefits of medicating ADHD. We do not fully understand how medication for ADHD affects the developing human in utero or through breast milk. You will want to consider the risks and benefits carefully with their obstetrical provider. The following article can help: ADHD and Pregnancy: Should I Stop My Medication?
Medication affects social functioning during the proposed break period. Medication does change how you function socially. For most people, it is for the better. You can pay attention to conversations better, avoid making impulsive remarks, and carry through on what you say you are going to do. For some people, though, medication can make them less witty and overly focused enough to not be able to enjoy having fun with friends on weekends. This can be a particular issue for young adults.
Patient is pregnant or breastfeeding. In general, having a baby on board does change the balance of risks and benefits of medicating ADHD. We do not fully understand how medication for ADHD affects the developing human in utero or through breast milk. You will want to consider the risks and benefits carefully with their obstetrical provider. The following article can help: ADHD and Pregnancy: Should I Stop My Medication?
Patient is developing tolerance. There are very few clinical studies on tolerance and ADHD medication. No one knows for sure how often patients who take low doses of stimulants require higher and higher doses to produce the same effect due to tolerance versus other issues such as increasing body mass or increased cognitive demands (for example, harder school work). In the same vein, no study has examined the effectiveness of any duration or schedule of drug holidays on preventing tolerance. With this in mind, if a person is not showing signs of tolerance, it is not a good idea to impose drug holidays with the hope of preventing tolerance, especially if the holiday causes other major problems.
When medication breaks may not be appropriate
Symptoms affect social functioning during the break period. If a person is sufficiently impulsive or hyperactive to engage in dangerous behaviors off medication, then they probably need to be on medication every day. For example, if a child darts into traffic or starts physical fights off medication, then breaks probably are not in their best interest. A person with comorbid ODD also may need to stay on medication continuously until the ODD symptoms are well controlled for long enough that a break won't cause them to relapse.
The patient takes a long time readjusting to medication after it is restarted. This can be related to the medication or the patient. Some medications cannot be started and stopped immediately. They need to be tapered on and off to ensure that dangerous side effects do not occur, or they just take a while to kick in. Many nonstimulants fall into this category and cannot be given "as needed".
Some patients take a day or more to readjust after restarting a medication. They may be sleepy or seem more wired than usual for a day or two after missing even one or two doses. This can pose big problem for short, frequent breaks.
The patient is taking breaks to "learn to cope with ADHD symptoms on their own". Being unmedicated makes it harder, not easier, to learn coping skills. Medication is also not perfect. Most of the stimulants do not give all day coverage and do not treat all symptoms, so there is some time built in to learn coping skills off medication. The bottom line here is, treatment does not have to be only behavioral or medical. A combination of both is usually needed to address different challenges faced by the person with ADHD.
References:
Ibrahim, K., and P. Donyai. "Drug Holidays From ADHD Medication: International Experience Over the Past Four Decades." Journal of Attention Disorders 19.7 (2015): 551-68. Ibrahim, K., and P. Donyai. "Drug Holidays From ADHD Medication: International Experience Over the Past Four Decades." Journal of Attention Disorders 19.7 (2015): 551-68.
Swartz, B. S., L. Bailey-Davis, K. Bandeen-Roche, J. Pollak, A. G. Hirsch, C. Nau, A. Y. Liu, and T. A. Glass. "Attention Deficit Disorder, Stimulant Use, and Childhood Body Mass Index Trajectory." Pediatrics 133.4 (2014): 668-76.
Yanofsky, Jason. "The Dopamine Dilemma--Part II." Innovations in Clinical Neuroscience 8.1 (2011): 47-53.
Everything ADHD Medical Disclaimer
When medication breaks may not be appropriate
Symptoms affect social functioning during the break period. If a person is sufficiently impulsive or hyperactive to engage in dangerous behaviors off medication, then they probably need to be on medication every day. For example, if a child darts into traffic or starts physical fights off medication, then breaks probably are not in their best interest. A person with comorbid ODD also may need to stay on medication continuously until the ODD symptoms are well controlled for long enough that a break won't cause them to relapse.
The patient takes a long time readjusting to medication after it is restarted. This can be related to the medication or the patient. Some medications cannot be started and stopped immediately. They need to be tapered on and off to ensure that dangerous side effects do not occur, or they just take a while to kick in. Many nonstimulants fall into this category and cannot be given "as needed".
Some patients take a day or more to readjust after restarting a medication. They may be sleepy or seem more wired than usual for a day or two after missing even one or two doses. This can pose big problem for short, frequent breaks.
The patient is taking breaks to "learn to cope with ADHD symptoms on their own". Being unmedicated makes it harder, not easier, to learn coping skills. Medication is also not perfect. Most of the stimulants do not give all day coverage and do not treat all symptoms, so there is some time built in to learn coping skills off medication. The bottom line here is, treatment does not have to be only behavioral or medical. A combination of both is usually needed to address different challenges faced by the person with ADHD.
References:
Ibrahim, K., and P. Donyai. "Drug Holidays From ADHD Medication: International Experience Over the Past Four Decades." Journal of Attention Disorders 19.7 (2015): 551-68. Ibrahim, K., and P. Donyai. "Drug Holidays From ADHD Medication: International Experience Over the Past Four Decades." Journal of Attention Disorders 19.7 (2015): 551-68.
Swartz, B. S., L. Bailey-Davis, K. Bandeen-Roche, J. Pollak, A. G. Hirsch, C. Nau, A. Y. Liu, and T. A. Glass. "Attention Deficit Disorder, Stimulant Use, and Childhood Body Mass Index Trajectory." Pediatrics 133.4 (2014): 668-76.
Yanofsky, Jason. "The Dopamine Dilemma--Part II." Innovations in Clinical Neuroscience 8.1 (2011): 47-53.
Everything ADHD Medical Disclaimer
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