With the increase in the number of stimulant prescriptions we are seeing, I sure hope that research is conducted on a lot of the points you've brought up. Great video
Thanks doctor for your knowledge sharing videos. I recently read your reply to my recent comment on one of your videos to me. You recommended this video to think about adding stimulants to my adhd med guanfacine. I’m seeing a nurse practitioner at Albany Medical Physicians in NY. I am on this journey to help my recent diagnosis of adhd. I’m assuming that she with her psychiatrist that she works under will try a stimulant to see if I can tolerate them. I have been watching numerous doctors videos since coming home 4 months ago from Albany Medical 2 week psychiatric stay due to my emotional over reaction to self stopping my duloxetine for depression. I’m now on Prozac generic and feel best I have felt in years. Just wanted to say for others to work with your doctor if you want to get off meds. I need to stay on them.
You would not want to take a 4 day or longer drug holiday, unless you are going on a really low risk low responsibility actual holiday. 60-day holidays might help kids learn to manage their ADHD without drug training wheels over a lower risk period such as summer vacation. I but then you are going to need to ramp up slowly over a few weeks or months afterward to make the best use of the medication during the period and in order to prevent tolerance happening faster. I think that the tolerance happens within a few weeks to months, and you can't just increase the dose to get to the same place, because the point of ADHD medication is not stimulation, its a sweet spot where you have the right level of stimulation and whatever other side effects (higher baseline stimulation/stimulant neurochemicals), but maintaining reactivity to fluctuations in these chemicals or their effects based on environmental factors, preventing complete burnout of the processes by which neurotransmitters are produced in the first place or even negative effects of constant over-stimulation (including mental exhaustion or fatigue'/burnout). So not taking it every day of the week (6, 5 , or even 4days instead of 7 for example) will allow the medication to work better at any dose, and allow patients to take a 10-20 mg lower dose, which can have lower side effects even compared to higher doses, even without tolerance being considered.
Thanks doc! What about cardiovascular complications like acute lowering of blood pressure? I’ve heard this happen given that the body had become habituated to the stimulant. Then, suddenly without it, it feels somewhat unable to compensate for the lack and restore normal cardiac function. This of course would only last a few days, but could be dangerous. I’ve been in the ER twice for severe withdrawal reactions from sudden SSRI cessation. I nearly had a seizure. I was having heart palpitations. It was the scariest moment of my life.
In my experience SSRI withdrawals are much much worse than stimulant withdrawals 😩 SSRI withdrawal feels like my body and brain are throwing a fit. Stimulant withdrawal is just lots of sleepiness.
@@stephen7715 I feel you Stephen. It sucks that Big Pharma has used our generation as the Guinea pigs for its latest lethal product designed to capitalize on American misery.
Annecdotal evidence but relavent to your point, I have POTS and I find for the first ~2 days off stimulant medication I will experience significantly worsened postral symptoms; becoming incredibly faint and/or fainting if I stand too quickly. This is manageable with moderation of activity, keeping snacks on hand to make sure its not worsened by lowering blood sugar, consuming electrolyte drinks and ensuring I consume a good (upper end of normal consumption) volume of water. I do not feel is a risk as long as you are prepared to make some adjustments and are mindful of daily fluctuations in any symptoms. The same goes in the opposite direction for the first day or two back on stimulant medication (only after an extended break or with a dosage increase) the tachycardia/"jump" in HR when standing is more noticeable, however, it is not also accompanied by the usual lighteaddedness/faintness/nausea that comes with it when not on stimulant medication. Naturallly I understand this is not by any stretch enough to inform you medically, but might provide some patient insight to coping with the associated blood pressure drop in a stimulant habituated body during pause of medication, particularly as a patient with pre-existing blood pressure concerns.
Last time I looked, the research was really sparse and meager. It's unlikely to cause harm, and some individuals certainly feel that it has helped their focus.
Thanks for sharing your thoughts here along with as muscular data as there *actually* is. Very grateful
With the increase in the number of stimulant prescriptions we are seeing, I sure hope that research is conducted on a lot of the points you've brought up. Great video
Thanks doctor for your knowledge sharing videos. I recently read your reply to my recent comment on one of your videos to me. You recommended this video to think about adding stimulants to my adhd med guanfacine. I’m seeing a nurse practitioner at Albany Medical Physicians in NY. I am on this journey to help my recent diagnosis of adhd. I’m assuming that she with her psychiatrist that she works under will try a stimulant to see if I can tolerate them. I have been watching numerous doctors videos since coming home 4 months ago from Albany Medical 2 week psychiatric stay due to my emotional over reaction to self stopping my duloxetine for depression. I’m now on Prozac generic and feel best I have felt in years. Just wanted to say for others to work with your doctor if you want to get off meds. I need to stay on them.
Thank you for sharing your experiences.
You would not want to take a 4 day or longer drug holiday, unless you are going on a really low risk low responsibility actual holiday. 60-day holidays might help kids learn to manage their ADHD without drug training wheels over a lower risk period such as summer vacation. I but then you are going to need to ramp up slowly over a few weeks or months afterward to make the best use of the medication during the period and in order to prevent tolerance happening faster. I think that the tolerance happens within a few weeks to months, and you can't just increase the dose to get to the same place, because the point of ADHD medication is not stimulation, its a sweet spot where you have the right level of stimulation and whatever other side effects (higher baseline stimulation/stimulant neurochemicals), but maintaining reactivity to fluctuations in these chemicals or their effects based on environmental factors, preventing complete burnout of the processes by which neurotransmitters are produced in the first place or even negative effects of constant over-stimulation (including mental exhaustion or fatigue'/burnout). So not taking it every day of the week (6, 5 , or even 4days instead of 7 for example) will allow the medication to work better at any dose, and allow patients to take a 10-20 mg lower dose, which can have lower side effects even compared to higher doses, even without tolerance being considered.
That certainly might be what happens for many people, but we have almost no hard data to back that up.
Thanks doc! What about cardiovascular complications like acute lowering of blood pressure?
I’ve heard this happen given that the body had become habituated to the stimulant. Then, suddenly without it, it feels somewhat unable to compensate for the lack and restore normal cardiac function. This of course would only last a few days, but could be dangerous.
I’ve been in the ER twice for severe withdrawal reactions from sudden SSRI cessation. I nearly had a seizure. I was having heart palpitations. It was the scariest moment of my life.
In my experience SSRI withdrawals are much much worse than stimulant withdrawals 😩
SSRI withdrawal feels like my body and brain are throwing a fit. Stimulant withdrawal is just lots of sleepiness.
@@stephen7715 I feel you Stephen. It sucks that Big Pharma has used our generation as the Guinea pigs for its latest lethal product designed to capitalize on American misery.
Annecdotal evidence but relavent to your point, I have POTS and I find for the first ~2 days off stimulant medication I will experience significantly worsened postral symptoms; becoming incredibly faint and/or fainting if I stand too quickly. This is manageable with moderation of activity, keeping snacks on hand to make sure its not worsened by lowering blood sugar, consuming electrolyte drinks and ensuring I consume a good (upper end of normal consumption) volume of water. I do not feel is a risk as long as you are prepared to make some adjustments and are mindful of daily fluctuations in any symptoms.
The same goes in the opposite direction for the first day or two back on stimulant medication (only after an extended break or with a dosage increase) the tachycardia/"jump" in HR when standing is more noticeable, however, it is not also accompanied by the usual lighteaddedness/faintness/nausea that comes with it when not on stimulant medication.
Naturallly I understand this is not by any stretch enough to inform you medically, but might provide some patient insight to coping with the associated blood pressure drop in a stimulant habituated body during pause of medication, particularly as a patient with pre-existing blood pressure concerns.
Dr Kruse can I get your thoughts on l-theanine. Does this amino acid help with adhd and focus. Thank yoyu
Last time I looked, the research was really sparse and meager. It's unlikely to cause harm, and some individuals certainly feel that it has helped their focus.
Interesting 🤔 topic.
Doc is on a drug holiday himself .