What Happens If You Stop ADHD Medication?

In the voices of the people who ask me this question I usually hear two separate fears, and the two get mixed together.

The first: "will I become addicted, will I not be able to stop?" The second: "will I be on this for life?" These are completely different questions, and their answers are completely different. Because they get mixed up, people are afraid in the wrong place.

I am not writing anything about my own use. What I explain here is what I learned while trying to separate these two questions.

Is there withdrawal

ADHD medications used under a doctor's supervision do not produce the kind of withdrawal picture seen with addictive substances.

What usually appears when they are stopped is the return of the symptoms. This is not counted as a withdrawal picture; it means that the work the medication was doing has stopped.

The distinction is here:

• Withdrawal: A new picture, one that was not there before, appearing in the absence of the substance.
• The return of a symptom: Something that was already there before the medication becoming visible again.

What is observed with ADHD medications is the second.

The medication does not cure ADHD. It eases the symptoms for as long as it is used. Like glasses: when you take them off your sight does not get worse, the correction is simply gone.

I use this comparison a lot because it puts something in the right place. When you take your glasses off, nobody says to you, "so you've become dependent on glasses."

Not confusing rebound with stopping

There is one more short-lived picture: in stimulant medications, the symptoms becoming marked for a short time in the hours when the effect has ended. In the glossary it appears as rebound.

It is usually experienced as a restlessness or irritability that appears in the late afternoon, and it is often interpreted as "the medication was bad for me." Yet what is seen is not the badness of the medication, it is the hour when the effect has ended.

This observation should be told to the doctor. It can often be managed by reviewing the form of the medication, its release period or its timing. This is the first question to ask before deciding on your own to stop.

What a medication holiday is

A planned break from the medication. It usually comes onto the agenda on weekends or during school holidays.

Its aim can be several things: reducing the effect on appetite and growth, seeing whether the medication is still needed, giving a break from side effects. If there is a worry about growth in children, this becomes one of the options talked over with the doctor; I covered the details in the article on whether ADHD medications affect height in children.

It does not suit everyone. If the symptoms seriously affect social relationships and the running of the home, being without the medication during holidays can create new problems. If a child's holiday goes by in fights because "they will be spending it without medication," that holiday is not a rest.

This is a decision to be talked over entirely with the doctor.

Is it necessary to stop

The NICE guideline (NG87) recommends that treatment be reviewed at regular intervals and that it be assessed whether it is still needed. In other words, there is no rule that "if you started, it is for life"; on the contrary, reviewing is part of the process.

In some people the symptoms ease over time or the medication becomes unnecessary because life arrangements have changed. The European consensus statement also recommends that the need for treatment in adults be reassessed periodically (Kooij et al., 2019).

The only way to find out is a planned break. How it is done changes the result completely:

• Choose the timing. An exam period, a job change, a move or a busy deadline week is not suitable. Choose a calm period.
• Set the criteria beforehand. What will you look at? "How do I feel" is a vague measure. "How many deadlines did I miss, how many times was I late, how many times did an argument escalate" is measurable.
• Set a length. A few weeks. An open-ended trial is not a trial.
• Take someone else's observation. A relative's or colleague's observation can be more reliable than your own impression. I am the last person to notice my own bad week.
• Assess the result with the doctor.

Do not stop on your own. Stopping suddenly may not be suitable, especially with non-stimulant medications. Also, the sudden return of symptoms can produce concrete consequences in work and school life. Talk to your doctor about the decision to stop.

Why people stop

The reasons reported by people who stop using it are usually these:

• Side effects. Loss of appetite, sleep problems, emotional flatness. Most of these can be managed with a change of dose or medication. Flatness is an especially important sign; details in the article on whether ADHD medication changes your personality.
• Insufficient effect. The network meta-analysis by Cortese and colleagues (2018) shows the different profiles of different active ingredients; not getting a response from one medication is not the end of the road.
• Feeling well. This is the most common and the most misleading. A medication stopped because things are going well may be the reason things are going well.
• Access and cost. This is also a real reason and something you need to tell your doctor; there can be alternatives. Many people do not say this only because they are ashamed.
• Pressure from the environment. The sentence "you can do this without medication too" is said with good intentions and does a lot of harm. I covered this topic separately in the article on people who insist about ADHD medication.

The reason I wrote the last item separately is this: there is a big difference between the decision being made on medical grounds and its being made because of a sentence heard at a table. The second happens far more often.

What happens after stopping

The return of symptoms is not instant; depending on the type of medication it varies between a few hours and a few weeks. That is why the first two days usually go well and a person thinks, "see, I didn't need it."

The real information comes out in the third week. This is the reason for keeping records: your memory will remind you of the first two days.

There is also this: the returning symptoms can feel worse than before. Not because they have got worse, but because you now know the difference. This feeling is real but is not counted as evidence of getting worse.

When it is not suitable to take a break

This also needs to be written openly, because the advice "just try it" does not fit every situation:

• If you are in a loaded period such as an exam, a deadline, a job interview or a move.
• If you have started a new job or a new school; no measurement can be made while the environment is already changing.
• If you have a job that requires intensive driving. Attention and impulsivity are directly a safety matter in traffic.
• If an accompanying condition is active: marked low mood, intense anxiety, a collapsed sleep pattern.

In these situations, postponing the break is not an escape; it is moving the measurement to a time when it will be useful.

If the break happened not by your own decision but because the medication could not be found at the pharmacy, I laid out the order of steps in the article on when the medication cannot be found.

What there is on the medication-free path

If you choose to stop, or do not want to start at all, the other components of treatment stay in place: cognitive behavioral therapy, coaching, adjusting the environment, work on sleep and routine, reasonable accommodations at work.

I compared these in the article on medication or therapy in ADHD.

What I take from it

I know this from my own case too: I received the diagnosis at 23, met medication again at 28 and stopped again.

The most useful distinction I took from this article is the difference between "stopping" and "trying."

Stopping is a decision. Trying is a measurement: with a set length, with written criteria, one that is described to someone at the end. When you make the first on your own, all that is left in your hands is a feeling. When you do the second, what is left in your hands is information, and that information makes the next decision easier too.