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Comment by isolli | Hacker News Reader

I know exactly how you feel, but I there is a bigger question: how well do these medications do in the medium term (counted in months)? I have read people testify how the initial boost evaporates, and when things come back to normal, they have to either continue the drug for not much benefit or face withdrawal.

Edit: to clarify, I'm not telling anyone not to try medication. Everyone's response will be different. Just beware of the initial euphoria.

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No idea, but habituation is a much bigger deal than people give it credit for.

I did the titration regimen after my diagnosis with a licensed psychiatrist and ADHD specialist, so you start very low and test a dosage for a month at a time. You increase it slightly until side effects are noticeable, then you scale back. This was my timeline:

Euphoria lasts perhaps two days, and you're on the lowest dose so it's pretty mild. You're just doing something and feeling happy about yourself. Good, it's a side-effect, and needs to go ASAP. Many people start on too high a dosage, so euphoria lasts maybe weeks, and when it stops they think it stopped working. This opens the doors to abuse, especially in teenagers.

Adaptation, during which other negative side effects start to lessen, lasts about 10 days.

Then there's peak productivity with little side effects for 6 months or so.

Then you start to question if it is still doing anything. There are days that you just don't feel like doing much. Take a couple days off, and it's obvious it was working all along. Without it you're still unproductive and scatter-brained as you've always been without. Also, you've started getting good at using this new powerful tool, but still don't know what to do with it. This is where I'm at at the moment.

When you're used to having good days, good days become normal days and it is very hard to remain objective in your assessment.

Thanks, this was very useful information.

> Take a couple days off, and it's obvious it was working all along.

This is key to appreciating the value of the medication and also benefits as a way to fight tolerance. "Medicine holidays" it's often called. Every month take a weekend off, and every 6 months take a week off. Those off days will leave you terribly lethargic. But going back on will make you really appreciate it. Or not in which case take a longer break and maybe lower your dose.

AFAIK there is no real proof these holidays work, and many therapists do not even prescribe them to their patients.

I wonder if the dopamine system might need more than a few days to reset. In my experience with addiction, it takes months.

You don't need to get tolerance to zero as you might with addiction-level situations, just back to levels where it's no longer completely adapted.

I've been on adderall for 20 years and haven't ever had to increase my prescribed dose. I even usually reduce my dose in the summer after my week-long break. I bring it back up after subsequent holidays in the autumn.

The only times when I've thought it wasn't working, the med holidays brought it right back on track.

Could be placebo. Also n=1. There's very little lost in attempting (it assuming your dr is kosher with it).

Well, if it's worked for you I might as well give it a shot. Reaching now the 6 months mark, already took a a few days off here and there, I'll try a whole week off around Christmas.

What was good to know was that there doesn't seem to be any addiction potential for me at all. I hate being lazy and unmotivated without the meds, but there is no urge nor withdrawal whatsoever, which is fantastic, as someone that got addicted to half a dozen things in their life.

I was afraid I would start to enjoy the meds too much, but I am much more dependent on the cup of coffee I drink once a week (and every day during work I start craving a Coke) than amphetamine.

I thought it took at least 3 days for the medication to clear your system.

The lessened effect is due to your body getting used to having increased levels of dopamine and norepinephrine, so stops producing as much.

The fact that the medication is out doesn't make your dopaminergic system more sensitive by itself. It might take a while.

I've been on the medications for almost a decade now, so when I take a weekend off, then I am basically useless by Monday when I start them again. I swear it takes days from them to start working again every time I take a break.

So, my dopaminergic system probably has holes burned through it.

Yes, I have certainly noticed it takes a few days for the full effect to ramp up as well. And there seems to be residual effect for about 12 hours after the last dose, though in general the peak effect lasts about 4 hours for me (on lisdexamphetamine)

I take methylphenidate slow release, and have for several years now. If I take an extended holiday, the first ~week back definitely feels like there is a stronger effect, but days when I take it vs don't are very noticeable in how difficult my day is. People in my personal life can call it out when I am unmedicated, my sleep is worse, chores don't get done, I waste more time at work, I go more crazy at social events and so on.

I really hope it keeps working in the longer term because it's been life changing so far.

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