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The Good, the bad and the ugly- Effects, side effects and withdrawal effects (of stimulants)

When you go to the pharmacy and pick up any medication, you also will get an extensive handout of details about that pill you're about to expose yourself to. It is a scary and overwhelming moment. The concerns are endless and it may even make you wonder if it is worth it, or as the doctor would say, does the benefit outweigh the risks?

Umm... Maybe?? Hopefully??

Here is a cheat sheet of the benefits of stimulants, side effects (or unwanted or unnecessary effects) and withdrawal affects. The equation works like this: the benefits are most likely to occur. The side effects occur much less frequently (or if present are mild). The withdrawal effects are rare- that is, they generally do occur but are so mild as to not be noticeable in most cases. By the way, when the bad outweighs the good, i.e. when side effects or withdrawal effects are significant, then that is a good enough reason to stop the medication.

Here we go...

Beneficial Effects Possible Side Effects

Improved focus and attention Wakefulness

Improved concentration Anxiety and associated symptoms:

Improved organization elevated heart rate

Improved planning decreased appetite

More interest in things for a longer period of time tics (muscle movements)

Improved executive functioning dry mouth

Improved judgment headache

*Improved mood

Although mood isn't what we are trying to treat in ADHD, stimulant medications can be prescribed to treat depression for this effect of improved mood. It is a good thing, for sure. However, when the medicine wears off, if the improved mood effect was substantial, there may be an associated withdrawal effect where the pendulum swings in the other direction. This can last for an hour or so and include feelings of sadness but more often presents as irritability in children.

Withdrawal means the possible experience of the reversal of all of the effects (both positive and negative) of the medication for a limited period of time (about an hour or so) until the brain goes back to its baseline functioning.

Beneficial Effects Withdrawal Effects

Improved focus and attention worse focus and attention

Improved concentration worse concentration

Improved organization worse organization

More interest for longer time less interest

Improved executive functioning worse executive functioning

Improved judgment worse judgment

Improved mood worse mood

Possible Side Effects Withdrawal Effects

Decreased appetite Increased appetite

(i.e. eating little at lunch) (i.e. eating twice as much for dinner)

Short acting stimulants may act so fast (within a 3.5 to 4.5 hrs) that they need a 2nd administration during the day. Therefore, it may be hard to notice a withdrawal effect if there is one. However, when long acting medications (lasting for the bulk of the day, i.e. 10 to 12 hours) are used in the higher end of the dosing range, noticeable withdrawal effects are more likely. The silver lining is that the medicine's effects are temporary. Although the benefits are temporary, so are the side effects and withdrawal effects. Again, side effects and withdrawal effects, if present, typically do not outweigh the benefits. However, if and when they do, they can be quickly and effectively addressed.

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