Stimulants and building up a tolerance

October 13, 2012 1:51 PM

Why don't people with ADHD build up tolerance to their stimulant medications, unlike people without ADHD who take them?

I have a few friends who have struggled with ADHD since they were children, and take stimulants to manage their conditions. They've been taking the same dosages for years and allegedly haven't become desensitized to their effects. They don't get a "high" from the meds either, supposedly.

I've heard about people without ADHD who take Adderall and become addicted, feeling some sort of euphoric sensation. These people take more and more of the stimulant to get the same "high". Some end up abusing stimulants. What's different about how ADHD works in individuals with the disorders vs those without the disorders that affects tolerance and that "high" feeling? I can't get a straight answer about this with all the information to sift through on Google.

posted by sunnychef88 to health & fitness (16 answers total)

I have ADHD (tested and confirmed without question by neurologists on several occasions) and I definitely build up a tolerance to my medication, as do several other people I know with ADHD. Doctors often recommend taking a medication "holiday" and skipping the prescribed dose on days when the medication is not needed to reboot the effectiveness of the medication, which I try to do whenever I can, although it's tough to find time because I really shouldn't even drive when I'm not on my meds. I'll sometimes get to a point where my prescribed dose truly has no effect anymore, at which point I'll know that one of these holidays is in order ASAP. The euphoric "high" feeling you describe usually last only a few days after starting the medication again after a break, but the medication is (usually) still effective (albeit not as noticeable) even without this euphoria. Of course everyone reacts differently to different meds, so other people's experiences my vary.
posted by slightlyamused at 2:17 PM on October 13, 2012 [4 favorites]

They do.
posted by lalala1234 at 2:25 PM on October 13, 2012 [2 favorites]

A huge part of this equation is quantity and deliver method.

Taking two 5mg halves of a 10mg tablet (with food and water) a day; is a lot different than snorting the crushed remains of four 10mg tablets before you hit the club. I don't know how much ADD plays into that.

One method is going to build a tolerance and dependance a hell of a lot faster.
posted by French Fry at 2:48 PM on October 13, 2012 [1 favorite]

I don't know about Adderall as it's not available in the UK. It's not very common to develop a tolerance from taking ADHD drugs as directed, I know I haven't.

When people take these drugs not as directed, by definition they are doing things that might have unexpected results. ADHD drugs are controlled *because* they can be addictive if they're misused. If you take a drug to get "high" you clearly aren't even expecting to have the same experience as someone who is not taking that drug to get high but to function "normally" as you do naturally without taking anything. Since you're starting from a different place, why would you expect to arrive at the same destination?
posted by tel3path at 2:57 PM on October 13, 2012

And yes, the form of preparation is essential to the effect as French Fry points out. If you shot up caffeine you'd also have a dramatically different experience than you would if you just drank it.
posted by tel3path at 2:58 PM on October 13, 2012

Just one more, I'm not sleepy.

To put it more simply, apart from any neurochemical explanations, it's like asking "my neighbour is legally blind, why can't I see better when I put on her glasses?"
posted by tel3path at 3:13 PM on October 13, 2012 [2 favorites]

Tolerance is not a single, uniform process. Drugs typically affect multiple systems in the body, and not all of these systems adapt at the same speed or to the same degree. Some systems don't develop significant tolerance to the medications that target them, some develop tolerance in hours or days, and some actually become more sensitive with increased exposure.

With opioids, for example, users become tolerant to the "high" fairly quickly, to the analgesic effects less quickly, and to the side effects not much at all. And though they become less pleasurable with each dose, parts of the reward pathway sensitize over time, eventually prompting cravings for continued use.

As others have mentioned, dose and route of administration matter too. Generally, the higher the dose and the more quickly it enters the body, the faster tolerance will develop. For a given dose of amphetamine, tolerance will develop fastest for IV administration, followed by inhalation (smoking), insufflation (snorting), and oral as a distant fourth. Same dose, different impacts on the body. Several ADHD meds are also offered in "extended-release" formulations that delay absorption even further.
posted by dephlogisticated at 3:34 PM on October 13, 2012 [2 favorites]

I am on 10mg of Adderall. If I took 50mg of Adderall I would get fucked up instead of feeling normal and coherent. Similarly, I've taken it for years in the past and had to stop and switch to something else because of side effects and lessening useful effects. It's a drug.
posted by elizardbits at 3:35 PM on October 13, 2012 [1 favorite]

I do develop a tolerance to my Adderal (40 mg am, 20 mg pm non xr) after several months of taking it 7 days a week, so I usually only take it weekdays. It takes about 9 months or so before I notice it losing effectiveness and then I take a whole month off.

The only euphoria I've ever felt is when my house is clean day after day and I carried a 4.0 GPA while on it.
posted by hollygoheavy at 8:14 PM on October 13, 2012

We develop tolerance to the speedy effects of the drugs like anyone else, but the stimulation in the places in the brain where ADHD occurs is still happening. It's a lot like how people with alcohol problems can't feel the effects of a normal amounts of alcohol, but their ability to operate heavy machinery is just as impaired. Or like how cocaine (an anesthetic) will still make a heavy user's gums numb even if they no longer feel the high.

I take adderall and can't "feel" the drug working. But if you put me through the neurological tests, they will show that my attention is improved when I am on the medication.

At therapeutic doses and delivery methods, stimulants don't "blow out" the receptors in the brain the way recreational doses do.
posted by gjc at 8:18 PM on October 13, 2012

Yeah, others have answered correctly. To reiterate and reinforce:

Why don't people with ADHD build up tolerance to their stimulant medications

Your premise is incorrect; they do build up tolerances.

They don't get a "high" from the meds either, supposedly.

Again, flawed premise. They don't get high because either their dosage is low enough to avoid that, or they're taking a high dose but have developed a tolerance (see above). Give them a high enough dose and they'll be higher than the goodyear blimp.
posted by Justinian at 10:09 PM on October 13, 2012

I have a few friends who have struggled with ADHD since they were children, and take stimulants to manage their conditions. They've been taking the same dosages for years and allegedly haven't become desensitized to their effects. They don't get a "high" from the meds either, supposedly.

Another reason it is a flawed premise is that "they were children" = what, 12? 13? 14? How old are they now, 21? 22? 23? Give it some more time.
posted by mlis at 12:33 AM on October 14, 2012

They do. Adderall is an amphetamine, and it effects people with ADHD the same way it effects everyone else.
posted by sophist at 12:47 AM on October 14, 2012

Well no, stimulants don't affect people with ADHD in the same way because our brain chemistry is different. I can take an Adderall and then go have a nap. I drink caffeine until bedtime and then fall asleep immediately. And actually, my sleep improved once I started taking Adderall.
posted by elsietheeel at 5:56 AM on October 14, 2012

> They've been taking the same dosages for years and allegedly haven't become desensitized to their effects.

They might not take them every day. Some people take their ADHD meds only on days when they need to concentrate; this would prevent, or at least delay, their getting a tolerance for them.
posted by The corpse in the library at 9:55 AM on October 14, 2012

They don't get a "high" from the meds either, supposedly.

High? No, I don't get a "high" from ADD medication and I've taken 72mg of Concerta every day (except for the weekends) for almost 10 years. Now, when I let my medication run out, and can't take it for two or three days, I do start having really, really bad withdrawal symptoms...
posted by playertobenamedlater at 1:53 PM on October 17, 2012