ADHD Medication Vacations. When Do You Take One?

The question of whether to take a medication vacation for ADHD comes up a lot. Yesterday I was seeing a man with ADHD who was on 10mg of Adderall in the Emergency Department. He had been involved in an auto accident and had a pretty good whiplash injury. I was going to have to prescribe muscle relaxants and narcotic pain medicine for his neck pain. He asked me if the neck medication would interact with his Adderall and if, given that I was putting him off work, he should take his Adderall. I told him that the muscle relaxant and narcotic would be OK to take with the Adderall but the question of whether to take the medication depended on the answer to several questions.

The symptoms of ADHD are helpful in a few situations and problematic in most situations. An example of when the symptoms of ADHD may be helpful is when the ADHD individual is involved in a sporting event. I have a friend who is a tennis pro. She does not take her medication before a big tennis match as she is more aggressive and quicker off her Adderall. My youngest son does Judo. He is much more aggressive un-medicated and does not take his medication before a tournament. I suspect that in prehistoric times, individuals with the ADHD impulsivity and hyperactivity gene were much more effective and efficient.
The inattentiveness of ADHD can often yield amazing intuition and inspiration.  I can see how individuals with Inattentive ADHD could be much more creative off of medication. 

As we all know, ADHD symptoms can be problematic in situations when you have to control your impulses and hyperactivity, and when you have to be attentive enough to avoid falling behind in work, school, or family responsibilities.

With the gentleman in the ER I first asked him, jokingly, if his wife (who would be home with him all day) could stand to live with him off his medication. He told me that she had met him off of medicine and had a high tolerance for his symptoms. I next asked him about his work and home responsibilities and if he would still be required to be productive given that he was injured. He assured me that his boss would pick up the work responsibilities and his wife would do what he normally helped with at home. I asked him if there was any chance that he would be communicating with any authority figures such as bosses or law enforcement people. Un-medicated individuals with ADHD run the risk of becoming Oppositionally defiant with authority figures which can be very problematic if you intend on keeping your job and staying out of jail. He told me that this was a huge problem for him.  He told me that he tended to get argumentative when he was off his medicine and since it was likely that his boss would be calling him with work questions, that he better take his Adderall.

I believe that it is probably helpful, for most individuals with ADHD, to take a medication vacation every once in a while. This may be especially important for the 5%-10% of ADHD patients who will require medication into adulthood. Medication vacations, however, should be taken only when it is unlikely that the repercussions from being un-medicated will result in harm to the ADHD individual's family life, social life, or work life.