How Does ADHD Medication Work? With Lots of Monitoring

We know from years of research that ADHD medications work — in fact, studies show they work up to 80 percent of the time. Unfortunately, many children and adults taking ADHD medications for the first time find their prescriptions don’t work the way they expected at first. Sometimes, the medication is the problem; other times, the expectations are the problem. Either way, it’s good to know the signs of success and the signs of a bad fit.

I’m always surprised how often my clients come in and say, “My doctor keeps asking me how the medications are working, but I’m not sure what to tell him!” We will discuss some common medication pitfalls later on; but first we need to explain how to know that your medication is working, plain and simple. What follows are a few positive signs that your medication is doing its job.

If your medication is starting to work, you’ll be able to focus for longer periods of time than you used to. This doesn’t mean hyperfocus or “zombie focus” — just a nice, sustained focus that you can direct where you want it to go. Maybe you can sit and finish paperwork that you couldn’t before. As a result of this sustained focus, you’ll be more productive.

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If your medication is working, you’ll notice less impulsivity — both physical and verbal. You will interrupt people or jump out of your seat less often. You’ll notice that your thoughts are less impulsive, too. Instead of jumping from one thought to the next, you’ll follow a train of thought more effectively — without getting distracted by “brain chatter.”

With optimized ADHD medication, people typically report an improved overall mood. They’re less stressed, with less anxiety — usually resulting from higher productivity and fewer social challenges. When you’re able to plan out your day, act on those plans, and better control your words and actions, you’re bound to feel better emotionally!

You’ll notice that details stick out more — instead of skipping a row in your spreadsheet or skipping a step in a math problem, you or your child will find that you catch small mistakes before they happen. Once your attention to detail is improved, however, you might not always like what you see: The mess in the garage or the piles of your desk may suddenly bother you much more.

Some people report improved memory once they start medication. I had a client who was writing a book. Before taking meds, she struggled to remember what she’d written from one day to the next, so before she could start writing, she’d have to reread what she had — which felt like wasted time. Once she started taking medication, she remembered what she’d written the previous day and could dive right in without reviewing. For her, this was a big improvement — and convinced her that medication was the right choice.

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Some people report sleeping better once their medication begins working. This may be surprising, since many of us know that sleep problems are a common side effect of ADHD meds. This is true — sleeplessness is a red flag to watch for — but, in some cases, medication actually helps those with ADHD fall asleep by quieting the racing thoughts that kept them up before. If you struggled to fall asleep in the past but now find that you drift off comfortably and quickly, it may be a sign that the medication is working.

Now, for the bad signs. The most obvious sign a medication isn’t working? You aren’t feeling any of the positive signs mentioned in the last few slides. But even if you’re feeling some or many of them, the medication might still not be perfect. You might not feel the benefits as consistently or as strongly as you would like, or you might now be dealing with uncomfortable side effects — like headaches, nausea, or appetite loss. If this is the case, ask yourself these five questions:

The first medication you try often isn’t right for you. If you’re taking the wrong medication, you may feel some of the benefits discussed earlier — but they’ll be faint, and any negative side effects will outweigh them by a considerable degree. To find out if you’re taking the wrong medication, ask yourself how you feel physically. Are you more irritable? Do you have a persistent headache? Are you sleeping worse than before? If you answer yes to any of these, you might be using the wrong medication.

If you think you’re taking the wrong medication, ask your doctor about switching. Make sure you try both types of stimulants (amphetamines and methylphenidates) — as well as a non-stimulant — before you give up on ADHD medication entirely. Remember: If you’ve only tried one ADHD medication, you haven’t really “tried ADHD medication” — you’ve just tried that one. If you don’t fully explore your options, you’re limiting your chances of finding the right treatment plan.

Some patients report that their medication feels good — productivity, focus, and mood are all improved with minimal side effects — but it doesn’t feel like enough. Maybe you can focus for 20 minutes now instead of 5, but you still can’t get your work completed. In these cases, you might be taking the wrong dose — either too much or too little. In most cases, it’s too little, since prescribers typically start at the lowest recommended dose. But everyone responds to medication differently, and even a “low dose” might be too much for you. If you feel like your medication is helping, but could be doing more, talk to your doctor about adjusting your dose.

Staying on the same dose for too long can also be a de facto “wrong dose” — our brains change throughout our lives, and what worked for us when we started ADHD medication won’t necessarily work forever. This is particularly true for women, who cycle through dramatic hormonal changes as they age, which can greatly affect the effectiveness of their ADHD medication. If you’ve been on the same dose for a long time, periodically check in with yourself to assess how well it’s working. If it feels like it used to work better, you may need to change your dose.

It's possible you're taking your medication at the wrong time — either too early, too late, or at an incorrect frequency. Taking it too early means it wears off before you want it to, while taking it too late means it doesn’t kick in by the time you need it. For example: if you take your medication right as you’re heading out the door, and then spend the first hour of your workday stressed and unproductive, you’re probably taking the medication too late. If this sounds like you, try taking your medication first thing every morning.

People with ADHD often struggle to remember to take their medication on time, or to refill their prescription at the end of the month. This can lead to gaps in coverage — gaps that can make your medication less effective. To avoid this, implement a medication reminder system. This might mean setting an alarm in your phone or on your computer, or setting up a visual reminder like a note taped to your front door reminding you to take the medication or refill it as needed.

People often ask about “drug holidays” — particularly for children on break from school. In most cases, this is a personal decision. Taking a medication holiday may help a child catch up on growth, or help an adult judge whether they can succeed without medication. However, be aware: most research shows that the best results are achieved when medication is taken consistently. If you’re considering a drug holiday, make sure you try it at an appropriate time (not when you have a big project coming up at work!)

Even if you’re doing everything “right” — right medication, right dose, and right timing — something might still feel off. In these cases, it’s important to look at additional factors that could alter a medication’s efficacy, like other prescriptions. While most medications interact well with those used to treat ADHD, there are a few exceptions — particularly SSRI medications. If you’re using an SSRI or other medication for mood disorders, make sure your doctor explains how it could affect your ADHD medication.

Caffeine is another common culprit. It’s also a stimulant, and many people with ADHD unknowingly “self-medicate” with caffeine everyday. Once you start taking an ADHD medication, you may find that the levels of caffeine you used to tolerate easily now make you jittery and anxious. This is most likely because they’re supplementing your dose of ADHD medication, causing you to be overstimulated. You may need to lower your caffeine intake — or perhaps cut it out entirely.

Generics can differ from brand name medications by about 25 percent — in fact, it’s perfectly legal for them to do so. But when you switch from a brand name to a generic medication, from generic to brand, or from generic to generic, you may find that the medication affects you in a vastly different way. If you switched due to insurance requirements but find that a previous medication was more effective, talk to your doctor. She may be able to work with your insurance company to get you back on your previously used medication.

[Free Slideshow: Considering a New ADHD Medication? Ask These 13 Questions First]