How to Manage ADHD Medication Rebound

Many people who take ADHD medication may find that they do well—until it starts to wear off. Then, they suddenly develop a range of severe mood and behavior symptoms. If this sounds familiar, you're not alone. You or your child is likely experiencing what is often referred to as medication rebound.

What Is ADHD Medication Rebound?

As an immediate-release or short-acting ADHD stimulant medication starts to wear off, people sometimes experience negative side effects. These effects are known as ADHD stimulant rebound, sometimes referred to as "the crash." Such symptoms can appear as excessive hunger, a severe decrease in energy, and an intense mood drop.

Other signs of medication rebound may include:

• A marked change in demeanor
• Excessive moodiness
• Irritability or anger
• Nervousness
• Sadness or crying
• Fatigue
• An increase in the severity of ADHD symptoms
  

What Causes ADHD Medication Rebound?

Types of stimulants that may be used to help people manage their ADHD characteristics include methylphenidate-based medications such as Concerta, Focalin, and Ritalin and amphetamine-based medications such as Adderall, Vyvanse, and Dyanavel XR.

ADHD medication rebound happens as a result of stimulant medication leaving the body. Medications sometimes wear off gradually and evenly, but each person metabolizes these medications differently.

People who metabolize medications more quickly may experience a sudden drop in medication levels in their bodies. As a result, they may experience rebound symptoms as their brain tries to adjust to the rapid change.

Medication Rebound vs. Side Effects

Medication rebound is not the same thing as a side effect.

Side effects are negative reactions to the medication itself. A headache, stomach ache, or loss of appetite can all be side effects of ADHD medications and, in most cases, become less of an issue as the body starts to get used to the medication.

Rebound, however, is a result of the speed at which the medication is metabolized. A "four-hour pill" refers to the average duration of its effectiveness. However, your particular child may metabolize the medication more rapidly or slowly. If your child has a fairly high metabolism, they may experience a quick drop-off in medication effectiveness before it's time for the next dose.

What Are the Effects of Medication Rebound?

Often, medication rebound occurs after school and before bedtime. It may result from the reality that there is no one available to remind your child that it's time for medication—in many cases, parents are still at work or distracted by the demands of dinner and other household chores.

This is the period of time during which children tend to socialize and take part in after-school activities. Friendships and team memberships depend upon your child's ability to respond to a coach's instructions, collaborate with friends, or simply hang out and chat without taking over or giving offense.

Treating Medication Rebound

If your child is experiencing any of these effects, talk to their healthcare provider about your concerns. Rebound tends to occur more frequently with the shorter-acting stimulants that can move out of your child's system quickly.

For some people, the rebound effect is reduced when taking longer-acting stimulants, which move out of one's system more gradually. Longer-acting stimulants have also been linked to better medication adherence.

Your treatment provider may also make other changes, such as:

• Modifying your medication dose
• Switching to a different type of stimulant
• Adding a short-acting medication to boost effects and minimize or avoid rebound
• Adding another medication, such as an antidepressant
  

Changes in ADHD medications or their doses can also help ease side effects. For example, if you're wondering how to avoid irritability while taking Adderall, research suggests that changing to a non-amphetamine medication may help reduce this side effect.

How to Manage Medication Rebound

There are also steps you can take to help cope with the effects of ADHD medication rebound. Strategies that can help include:

• Track your symptoms: Pay attention to how you feel throughout the day and keep a journal to notice any changes in how your ADHD traits are expressed. You may notice patterns, such as increased irritability or mood changes, that follow a predictable pattern each day.
• Watch your diet: What you eat can also affect how your medication works. Try to balance your intake of protein, carbohydrates, and fats to ensure that your medicine is metabolized well. Avoid eating foods or beverages that are high in vitamin C for an hour before and after taking your medication since it may impact how some stimulants are metabolized.
  
• Get enough sleep: Getting enough rest each night can also affect how you feel during the day. Be sure to go to bed and wake up at the same time each day.
  
• Get regular exercise: Physical activity can help manage ADHD characteristics. It may also boost mood and well-being, which may minimize the impact of some rebound symptoms.