View Full Version : Christmas Medication Break - all or nothing, or can I cheat a little?


Swordson
12-31-15, 02:06 PM
Been visiting the forum now and then, but posting now for the first time (I had a user name earlier as well, but perhaps not surprisingly, I forgot it, and also what email I had used to register.)

I have been on ritalin (the only ADHD-drug offered where I am from) for a little under two years, and I am trying to get better at regular medication breaks. This is something that my doctor recommends as he believes it helps ensure that I don't build too much tolerance for the drug, and I help prevent the development of side effects.

This time I have taken a break over Christmas (I have a three week vacation with my SO's family). Usually I have been reluctant to take medication breaks over the Holidays, as the inactivity, the break from routines and the resulting frustration and confusion makes me feel like a caged animal within a few days. This time it has been relatively good, however, after I gradually reduced my daily dosage to nothing between the 20th and the 23rd of December, and then nothing since then. Instead of the powerful anxiety that usually comes with Holidays it seems like I have I have mostly been able to accept the fact that I will not get anything done while I am off the drug, and I will be distant and not as engaged with my SO and her family as I would like to be. I think this has made everything a lot easier.

Nonetheless, I feel the absence of my medication, and I cannot completely shake the frustration and annoyance over my behaviour, especially during family gatherings, dinners and short trips. I know I CAN be so much more present than I am, and be more pro-active, engaged and contribute so much more. So my question to you guys out there is - what do you usually do on these occasions? In your experience, do your medication breaks (if you have any at all) have to be absolute from beginning to end to have their intended effect, or can you still use the drug for special occasions and events during that time, and then stop again? And how long breaks do you usually take in the first place?

Little Missy
12-31-15, 04:45 PM
I have never taken a break. Unless I had the flu maybe or a really bad cold.

Swordson
01-01-16, 08:28 AM
Thank you, that is interesting. I never intended this to be a thread on for/against medication breaks (I am sure there are others in the forums) but I hope you will indulge the newbie. I don't have anyone around me with the diagnosis and that are on Ritalin so this is my only opportunity to discuss with someone that does.

My impression is that both the formal medical advice on medication breaks and the actual practice of such breaks within the ADHD community varies a lot. I see from various forums that I have googled that a lot of people never take breaks. On the other end of the scale I know of people that constantly vary, having a few weeks on, then a few weeks off, all depending on workload and what she is doing. My doctor does not specify how long or how often I should stop using Ritalin, only that it is important that I do now and then (he seems to favor more frequent, shorter breaks.) Then I see some books that say that to have any effect, you should have a break of at least two weeks. You can see why I might be a little confused.

My personal conclusion based on what works for me (which seems to be what most people base themselves on) is that I need breaks now and then, and once or twice a year, I should have a longer break of 7-10 days. My reasoning is that;

- It confirms that the drug still works. I was first diagnosed at age 31, and before that I had clawed myself through education and several years of professional life by constantly kicking myself, ramping up the stress levels, and trying one self-organizing system after another (which of course collapsed every time once the novelty wore off.) The enduring anxiety for the past two years has been that this too (the positive effect of medication) will wear off, and once again I am back at square one, looking for another solution. The experience of coming back on medication after being off for more than a few days helps reassure me that "no, it is still working." Even though I can never replicate the sense of relief I felt the first time I started (and I would never want to either, as that would mean that I have allowed myself to get completely worn down again) it still helps confirm that this is not something that I am just imagining - this is right for me.

- Taking breaks helps me slow down. I love to work. Having a passion for what I do has been among the few things that enabled me to keep steady employment once out of university (not to mention getting through university to begin with). The downside of that is that I don't know how to turn off, and after I started Ritalin, I have noticed that it is easier to work myself to exhaustion, and then the drug looses effect anyway (when I am exhausted/tired, I have far less effect - maybe others have noticed this as well). While I relax better on Ritalin, I also work better, and the temptation is to use the focus the drug gives me to keep on delivering great stuff to a job that I love. But even on Ritalin I need to take a break now and then, and turning off the tap on the drug helps me do that (but I have learned that I need to taper off gradually and come to a soft landing, or I will crash emotionally as well.)

As for the length of breaks, my conclusion for now is that I will feel when it is time to go back on. For me Ritalin has a powerful anti-anxiety effect as well as a focus-effect. 30+ years of untreated ADHD created a powerful co-morbid anxiety stemming from never feeling like I am in control, always fearing that I have forgotten something, always fearful that I am unwittingly insulting someone by not listening, that I missed the point in a conversation, that I am being left out. Once those feelings begin cropping up again it is time to come back on again. Though I can never medicate away my anxiety completely, there is no point in me torturing myself needlessly, and that point usually comes after 7-10 days.

sarahsweets
01-01-16, 08:32 AM
Why do you need to take a break?

Pilgrim
01-01-16, 02:31 PM
I would never take a break if I can avoid it. I have had to in the past due to basically giving my body a chance to catch up.

I have found that ,due to some ability to cope, I have been able to have breaks due to a lack of medication.

My pitfall in this situation is being unable to cope when without medication.

Little Missy
01-01-16, 04:05 PM
Hey, if it feels good, do it. It just seemed that you were uneasy "taking a break."

dvdnvwls
01-02-16, 02:32 AM
There isn't a scientifically solid reason to take a break. But don't forget that there's usually no solid reason not to take a break, either. IMO: be safe, be reasonable, and do what seems right to you.

Fuzzy12
01-02-16, 04:40 AM
My psychiatrist had recommended the same and in the beginning I took a break every weekend, ehich meant I got nothing done , was extremely irritable and kept arguing with my husband on weekends.

I then realised that I needed the meds on the weekends as well and my life improved. . ;)

I did take a few breaks, mainly when we went on very stimulating and invigorating holidays with no other people around (can't deal with people off meds) and lots of physical ecerise like hiking holidays. I ddint really need meds then. Taking little breaks did seem to make the meds work more effectively but keep in mind when you restart the side effects might be worse.

I'm glad you are doing as well as you are but personally for me, people bring out the worst in be and for me that would be the worst time to take a med break. I'd take breaks when you are doing something that is naturally stimulating. Maybe exercising might help too.

Regarding cheat days during your med break, I'm not sure. I mostly took a reduced dose on the weekends, mainly because I always forgot to take them regularly on weekends, but I'm not sure what difference that made.

Swordson
01-02-16, 07:44 AM
Thank you guys for all your feedback - love that the forum seems to be very active with lots of good quality posts - will make me come back for more!

I agree with a lot of what you all are saying, and to answer the question about feeling uneasy - it is not so much that I am uneasy, but rather unsure, as I don't know a whole lot about all of this, and there aren't that many others around for me to rely on. If I am uneasy it is mainly because I don't want to do something wrong that limits the effectiveness of my treatment (that old underlying fear of always doing something wrong, I guess) I think in the end, as dvdnvwls said, I need to be concious of what I am doing, be safe, reasonable, and do what works for me.

Fuzzy12
01-02-16, 09:23 AM
The nice thing about adhd treatment is that there really isn't that much you can do wrong. You've found a medication and a dose that works for you so now, to be honest I really don't think it makes such a big difference if you take medication breaks or not. The biggest drawback of breaks is that your symptoms aren't controlled in that time but if that's acceptable then it won't really interfere with your treatment once you start them again in any other way.

sarahsweets
01-02-16, 10:33 AM
My thoughts on medication breaks are that they are unnecessary. You have adhd 24/7 365 days. Your disorder doesnt take a break on weekends, so you dont need a med break either. JMO.

thelostone
01-28-16, 12:39 AM
You really should avoid 'stimulant holidays'. While it's true that there is the potential for stimulant tolerance, the verdict at this point is 'we just don't know'. The details are here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036556/

What they do know is that the majority of the tolerance will happen within a few hours to a few days and you'll stabilize at a baseline above your normal baseline. They also know that when you take 'holidays' your dopamine levels crash http://quittingadderall.com/wp-content/uploads/2009/11/dopamine-crash.gif This causes a worsening of symptoms, slower mental functioning, etc. and can cause sudden bouts of short-term "artificial" depression as your brain is "starved" for dopamine which, if severe enough & combined with other factors, has been known to lead to suicide. The ideal way to go off a stimulant is to slowly step down the dosage rather than go cold turkey.

Swordson
02-16-16, 01:53 AM
Thanks, thelostone - that makes a lot of sense to me. Like I said, the slow step down worked a lot better than my previous stimulant holidays. However, if the majority of tolerance has already occurred, then much of the point is gone anyway...