Buckle up, this post is on the long side.
Medical and psychiatric professionals who prescribe stimulant medications to people with ADHD tell you that it’s absolutely safe (and often advisable) to take it every single day. Yet if you look online, you’ll find people with ADHD who say you should take days off and then rattle off what is often misinformation about why.
It had taken me time to come around to the idea of trying medication. I’d had pretty bad experiences with other psychiatric drugs (back when I was repeatedly misdiagnosed), and the internet is full of misinformation and negative press about stimulant medications for ADHD. Data and information on people who do not have ADHD and who abuse stimulant meds is incorrectly taken as relevant for people who do have ADHD and take their therapeutic doses (low doses) as prescribed. The two are not the same. This post is specifically about stimulant medication (Adderall XR for me) for ADHD, taken exactly as prescribed.
I got very lucky that the first medication I tried, Adderall XR, worked. Side effects are minimal, and the nurse practitioner slowly upped my dosage over several weeks. Unlike SSRIs and other psych meds, stimulant medication doesn’t need to build up in your system to see results. They work immediately— within a half an hour or so of taking them, depending on your metabolism. Also unlike SSRIs, etc, they’re out of your system within hours. As an example, regular Adderall lasts for around four hours, the XR version around eight hours, and Vyvanse around twelve hours. The effects were immediate, and I was stunned to discover several unexpected, positive, cascading effects. (I’ll talk more about those later.) Though I recently increased the dose by another 5 mg, my dose (20 mg) is still very low, and I’m happy to keep it that way. Every time I told my psychiatric nurse practitioner that I was “only” taking it x number of days per week, she shrugged and said, “Whatever you want to do. Take it every day or some days, it’s fine!” I was hell-bent on taking it during the week and taking weekends off, but then I realized there were immense benefits to taking it over the weekend. So, I announced to the nurse that I was going to take it over the weekend and take Mondays and Tuesdays off.
“Whatever you want to do. Take it every day or some days, it’s fine!”
Online, many people post about taking a couple of days off a week or taking it “only” when they need it for work or school. Most people said they did this for reasons that sounded based on the negative press about stimulant medication abuse. Being new to all of this, being anxious about being “dependent” on a medication to function (i.e. wanting to feel a sense of control), and the ever-present fear of taking OMG stimulants had me following along with the “days off” crowd. When a situation came up where it felt beneficial to take them every day for a couple of weeks, I told the nurse again, and she said, “Sounds good!”
I took the meds every day for two weeks, and on the fifteenth day, I realized that the benefits and my sense of well-being were far greater when I took them consistently than when I took random days off. I made the decision to take them every single day, just like many other psychiatric medications. When I went looking online to find others’ experiences taking them daily, I was really disheartened to find yet more negative press and more misinformation. There’s a lot out there to discourage people with legitimate prescriptions who take their meds as directed. I’m writing this to tell you that if you have ADHD and a prescription for stimulating medication and you take it responsibly, as directed, it is absolutely ok to take it every single day (barring any instructions from your doctor that tell you otherwise).
Let’s clear up a few things.
Adderall XR Is a Stimulant Medication
Yes. Adderall is a stimulant. This scares the bejeezus out of people. But people with ADHD take therapeutic doses, not street doses, and we take them to fill a deficit so that we can function more like “normal” people. These low, prescription doses do not cause euphoria or “super productivity.” I mean, I was “euphoric” when I first realized that I finally had a correct diagnosis, that Adderall works for me, and I could actually sit down and not only start a task without anxiety and procrastination, but I could stick with that task to completion. The fact is any and all medications can be dangerous if taken improperly. Did you know there are dangers associated with regular use of acetaminophen (Tylenol)? And ibuprofen? (Just Google it. There’s plenty of information out there about this.) If you take any medication for a condition that you don’t have, it can have severe, negative health consequences. If you take any medication improperly, it can have severe, negative health consequences.
As to side effects, you should be started on low doses and slowly work your way up in the process of “tritation.” When the negatives (side effects) outweigh the benefits, you either return to the lower dosage or try a new medication. I had very slight side effects (dry mouth, slight increase in heart rate the first hour my meds kick in) that disappeared as I began taking the Adderall daily. In my case, the potential side effects of increased heart rate and blood pressure were a good thing because I’ve always had very low blood pressure and dizziness. If the side effects are intolerable for you, you experiment with dosage or different meds.
The Dangers of Long-Term Adderall/Stimulant Medication Use
I’ve seen several mentions of the “dangers” of taking your meds every day, but they’re all pretty vague. Yes, you can find tons of information online about health risks and dangers… but all of it is in regard to people who abuse Adderall—people who fake ADHD to get a prescription, people who take it without a prescription, and people who don’t take it correctly/as prescribed. For people who actually have ADHD, who have a legitimate prescription for stimulation medication from a knowledgeable doctor, and who take it exactly as prescribed, stimulant medications are safe. Research has continually proven this.
Dr. Rachel Klein, PhD, professor of psychiatry at the New York University School of Medicine, and a group of colleagues did a 2-year controlled study of more than 100 school-aged kids back in the late 1970s, and then followed up with them repeatedly over 33 years. Most are now 41 years old, and those who took ADHD medication showed no negative effects, in terms of medical health or other functioning, compared to those who didn’t.
Dr. Klein notes that we don’t know for sure what the long term effects of this medication on the brain might be, because of the great difficulty of treating patients a scientifically systematic way for a long time, and of measuring the results. But she adds that parents have to weigh the unknowns of long-term use against the known risks of not treating ADHD in children: a higher rate of school failure, conflict with parents and authorities, and dangerous behaviors.
It’s also the case, adds Ron Steingard, MD, a child and adolescent psychiatrist at the Child Mind Institute, that doctors report unusual side-effects or problems their patients encounter to drug companies in what are called “post-marketing surveys.” Over four decades, he notes, nothing significant in terms of long-term effects has surfaced.
Note: If you have a heart condition, you probably won’t be prescribed stimulants, or you’d be closely monitored. Stimulants may exacerbate things if other factors (lifestyle, diet, overall health, etc) are at play, but stimulant medication taken as prescribed is highly unlikely to *cause* a heart condition.
Here’s something else that I think is critical to point out: I am taking much, much better care of myself since starting Adderall. I never ate that much to begin with because I was always too distracted or didn’t feel like putting in the effort. Because Adderall kills the appetite I barely had to begin with and revs up my metabolism, I feel pretty crappy when the Adderall wears off if I haven’t eaten much throughout the day. So, I now prioritize eating, whether I feel like it or not. I used to hate eating breakfast. I skipped lunch. All I would eat is a small dinner. I started forcing myself to eat breakfast… and now it’s a habit. I’ve gotten my taste for food back, and I’m eating far more regularly and healthfully than I used to. I exercise more consistently. My ADHD-induced stress and anxiety are way, way down. (Constant stress is dangerous. Cortisol is toxic.) When people say they take days off to “give their body a break,” I think… as far as I’m concerned, the Adderall has been giving my body a break from a lifetime of neglect.
What About Addiction?
Here’s a funny thing. The very nature of ADHD already puts people with ADHD at a higher risk for drug addiction and alcohol abuse. People with ADHD often self-medicate, are prone to impulsive and risky behavior, and have “conduct” issues (lying, skipping school, sneaking around, etc.). There’s a great deal of research on this topic. Here’s some information from CHADD, here’s a study from UCLA, yet more info from the Child Mind Institute, Attitude.org, another research study on NCBI, and one from Healthline titled: Exploring the Powerful Link Between ADHD and Addiction. I can attest to a lot of this. I did lots of drugs in my twenties, and I started drinking at the age of sixteen. How I escaped without a debilitating addiction, I don’t know. An ex-boyfriend and I used MDMA heavily for a couple of years, and when there wasn’t any available, I would take whatever people handed me, without question.
There were several studies that showed stimulant medication for ADHD reduced the risk of addiction in adolescents and young adults. A more recent UCLA study showed that it neither increased nor decreased. Whether it does decrease the risk or not is up in the air, but studies have proven time and time again that stimulant medication for ADHD (taken as prescribed) absolutely does not put them at higher risk of addiction or act as a “gateway drug.” Stimulant medication does reduce “risky behaviors.” People with ADHD are risk-takers and thrill-seekers, always in search of that elusive dopamine hit. I can attest to this, too. Sure, teenagers do stupid stuff, but a “normal” teenager’s version of “stupid stuff” is a far cry from my ADHD version of “stupid stuff.” I’m not exaggerating when I say that I’m lucky to still be here. Knowing about my ADHD and taking medication for it in my teen years or early twenties could have prevented me from repeatedly throwing myself into dangerous situations. Granted, there was more to my behavior than *just* ADHD, but the ADHD amplified it by a few hundred.
People (with ADHD) worry about addiction to the stimulant medication itself and being able to stop taking it. Well. When I was first misdiagnosed and put on Prozac in 1992, I was repeatedly warned to take it every day and never quit cold turkey. I hated Prozac and decided to stop taking it after a short while. I quit cold turkey. It was a bad idea that put me in a tailspin for a couple of weeks. MANY medications should not be quit cold turkey. I’ve been told just stopping the Adderall would be fine. I imagine that if I take it every day for years, it may not be that simple. At worst, you would have to taper off it. This is true of many medications, and I simply don’t find it to be that big of a deal. As to Adderall addiction… I mean, I’m pretty excited about feeling like I can make plans and follow through for the first time in my life. I’m working hard, with Adderall, to create structure and new habits that I can follow even without the Adderall. (It’s all about those neural pathways!) But the therapeutic doses that are prescribed are not, in and of themselves, enough to be addictive.
Tolerance could be an issue over time, sure. Tolerance is an issue with most medications. I’ve spoken to people who’ve been taking it for years and to my therapist. They’ve all said that tolerance doesn’t generally go up *that quickly*. I’ve started late in life, so I don’t see it being as big a concern for myself, but it’s certainly something to think about. Honestly, I don’t think that taking a couple of days a week “off” from taking Adderall is going to have that much of an impact on keeping tolerance down. You do not have to do anything every day for your tolerance to go up. If you drink alcohol three or four days each week, every week, you will still build tolerance; those couple days off will not prevent it.
Stimulant medication, as I’ve said, is “immediate.” It works the day you take it. It will help you that day, however, the biggest benefits are cumulative—they occur over time. To reap those benefits, you should take it consistently.
New habits and patterns need to be developed consistently over time. You create new neural pathways each time you do something new. “Neurons that fire together, wire together.” In order to cement those new pathways (create new habits), you need to use them consistently. Let’s take my getting dressed as soon as I wake up as an example. (I work from home and often sat around in my pajamas well into late morning or early afternoon. This is one of those little things that mentally drags me down.) I started out by taking the Adderall 3-4 days per week. I had put a sticky note on my bathroom mirror that said, “Get dressed!”—on the days I took Adderall, I remembered and was able to do it. On the “days off,” I lapsed into old habits and found myself still in my PJs at 11:30. Even though the note reminded me, I’d either forget about it as soon as I walked out of the bathroom or just couldn’t motivate myself to follow through. Since taking the Adderall every single day for the past… oh, three weeks or so, I’ve not only gotten dressed immediately, but I’ve started wearing “all” my clothes again, not just my “fancy” sweatpants. (Yes, I have fancy sweatpants—I believe they’re called “joggers?”) Sitting here writing while now wearing my favorite pants from Sézane and a nice sweater creates an immeasurable mental “lift.” It’s highly likely that, while on the Adderall, getting dressed first thing will become so ingrained that I’d continue to do it if I were to take a day off at some point… or if I decide to quit Adderall altogether after a year or so of habit-building.
What I’ve found is that taking Adderall “some days,” allows me to do things differently on those days and those days only. In just the few weeks I’ve been taking it every single day, I’ve seen more of a “butterfly effect”—slight, continuous changes in my day-to-day that are resulting in some pretty big things happening over time.
Dependence and Control
My very first few days with Adderall, I felt mild panic about being “dependent” on a medication and going down this road again (as when I’d been misdiagnosed decades ago and given other meds). Part of me liked the idea of the “days off” with Adderall because it gave me a sense of control. But I’ve come to realize a couple things.
I was very much a “slave” to my emotions once I was “activated.” My “lizard brain” (the primitive, “bottom-up” part of your brain that reacts first and thinks later) was often in charge. I was also at the mercy of my whims; ADHD makes it really hard to “just do” the simplest things, no matter how badly you want to. Some people are successful at managing their ADHD without medication… I have, after all, survived all these years without it. My personal life was a disaster, and I failed miserably at every creative, personal endeavor I pursued, but in terms of work, I was fine. This is because I used to work traditional 9-5 jobs that gave me the structure and routine I very much need; I’m great with deadlines and high pressure work. Now I freelance and work from home, which is wildly inconsistent. Without structure and routine… I’m struggling. I’ve always relied on external influence (traditional jobs, deadlines, due dates, bosses, coworkers, etc) to give me that structure. But even in those 9-5 jobs, work was the only area I was “succeeding” in. I couldn’t follow through on college classes, writing, personal projects, language learning, weekend plans, etc.
Because I don’t want to go back to the 9-5 grind, and because I’m finally pursuing the things I’ve always really wanted to do, I have NOT been successful at managing my ADHD without medication. (I’ve been trying for a long, long time.)
In these past couple of months using Adderall XR, I haven’t felt dependent… what I have felt is that for the first time in my life, I have control. I can finally corral my creativity and all my thoughts. I can decide what I want to do and do it. I can follow through on my writing projects. I have control over my time and attention. I have control to stop and think about how I’m feeling and to respond, rather than plunging head first into my emotions and reacting. Even my therapist, who’s worked with me off and on for ten years, is noticing a major shift. She’s noticing that after years and years of spinning my wheels, I’m finally moving forward.
So like I said—I probably won’t take Adderall forever. I may take it for a year, take time off, and go back, who knows? I’m taking it as it comes… and that’s also a big deal. I’ve spent so much of my life exhausting myself and wasting time thinking about every possible outcome of every single scenario. I seriously never realized how anxious I was until I just wasn’t anymore. I’ve always thought about five hundred steps ahead of everyone… which is great for innovation? But not so great for relationships and daily life.
Taking medication to manage ADHD is a personal decision. But my point of writing this is to tell people who choose to do so that it’s ok to take it every day, just like the person who prescribed told you. It pains me to see how much misinformation is out there, even coming from people who have ADHD. It pains me to see people who are newly diagnosed get smacked down in online forums when they express amazement about how well the meds work, and then fearfully ask how often it’s safe to take them. (Hint: Your doctor/psychiatrist/nurse practitioner already told you. Don’t ask strangers online.) I’ve seen people say things like, “I can see how this would be bad for addictive personalities.” (ADHD is an addictive personality.) We are all scared of the “dangers” of stimulant medication even though the rules are different for those of us for whom it was created, who have legitimate prescriptions, and who take it as prescribed.
Honestly, I think we need more education for people who have ADHD and get diagnosed. I’ve studied psychology and neurobiology for years. Well, decades, really, but formally (college) for a few years. I’ve got a lot of experience with mental health issues (thanks to my own history and my family’s), psych medications, and psychiatry. (There’s so much I haven’t talked about and probably never will, publicly.) My experiences with other meds made me afraid of Adderall at first, but it also helped me to come around and think critically about the information that’s out there. Having studied brains for so long was very, very useful in understanding the “risk analysis” of taking this medication.
While some of what I talk about here is anecdotal and personal experience, my reasoning is based on research, decades of data, and sound medical knowledge from professionals who specialize in psychiatric conditions and who’ve worked with people taking prescribed stimulant medications for decades. I trust these people more than the ones on Reddit. You should, too. And I realize the irony of me saying, “don’t ask strangers online” because here I am, a stranger online telling you it’s ok to take your meds as directed. But no one asked me any questions. I’m just trying to break up the sea of discouragement for people who really don’t need any more of that and who want some reassurance about their desire to take their medication every single day.