Risky Business: ADHD Isn’t 9 to 5. Why Are Your Meds?

By Dr. Jeffrey Rapp

Successfully managing ADHD depends on self-awareness and using your medication to your advantage. Not every person with ADHD needs or chooses medication, but if you are taking some, make sure you’re using them to your advantage.

Medication for ADHD is like a pair of glasses to help you see. Glasses bring things into focus – but they can’t teach you to read. Treating ADHD is more successful when you use cognitive therapy along with medication. Medication doesn’t improve every ADHD symptom, and is only one piece of the puzzle.

People with ADHD have two neurotransmitters in short supply: norepinephrine and dopamine. Medication can help maximize the use of these neurotransmitters to help keep you on track. While some medications kick-in within 15 to 30 minutes, others can take an hour to be effective. Some medications last three to four hours, while others might last up to 14 hours. These numbers can vary depending on your metabolism or on what you’ve eaten. You must understand how your medication affects you to be able to collaborate with your physician in designing a regimen that meets your needs.

Learn what your medication does.

How does your medication affect you and how long does it last? Is your medication helping you be your best? Are you using it optimally? Are you experiencing side effects or lacking therapeutic effects?

Consider your unique needs.

How does ADHD affect you and where do you need the most support? Do you have a work meeting at 9 PM? If you take your pills at 7 AM, you may not be at your best during that meeting.

ADHD affects every aspect of your life. It’s not just about test taking or focusing during work. It’s about your family, your friends, your checkbook and your health. What if, instead of a work meeting at 9 PM, you’re hoping to make a favorable impression on a first date? Or perhaps you’re meeting with your ex over dinner to try to understand where things went wrong. You’d better be able to focus!

Ask yourself if your medication is still around when you need it.

Perhaps you aren’t even aware of the consequences of being un-medicated in the evening. Pay more attention to this. Does your temper flare more than usual in the evening (and are you blaming it on being tired instead)? Are you forgetting medication for other medical issues because you’re unable to concentrate? Is impulsivity resulting in poor decision and risk-taking behavior more common at night?

Getting an A on a test is terrific and we all want to shine at our mid-day business meeting, but let’s get our priorities straight. Your significant other, your kids and your friends mean a great deal to you, and they deserve to be very high on your priority list. To live your best life, it’s not much help if your daytime colleagues think you’re great while your loved ones only see you during chaotic and problematic evenings and weekends. Many of my patients take medications to optimize their performance 9-5 Monday through Friday and some choose to take medication breaks on the weekend. They say, “I need these meds to be productive at school (or work) but not at home.” This may not be the best approach if you consider the breadth and depth of your ADHD symptoms and unique needs.

Not taking medication can be risky business.

I treat individuals with infectious diseases for a living. From my perspective when working with my patients, the argument that medication should only be taken 9-5 Monday through Friday doesn’t hold water and can be extremely damaging. This is especially true if your symptoms lead to, stem from, or are worsened by risky behavior. Looking at the big picture (your life) — and in my small part of the world (infectious diseases) — you could argue that you need your medication most of all at night and on weekends.

Work with your ADHD team to learn how to customize and optimize your medication. Be frank and keep an open mind, but don’t settle for a one-size-fits-all approach. Your ADHD is unique, and so is the way your meds work for you.

Jeffrey S. Rapp, M.D., is an infectious diseases specialist who practices at Cedars-Sinai Medical Center in Los Angeles, California.