ADHD stimulant medications such as Adderall, Vyvanse, Ritalin, etc. keep you awake, alert, and attentive throughout the day. While they are often taken in the morning, by the evening, you may notice your medication effectiveness wearing off, feeling less focused, and anxious thoughts taking their place. These medications, while effective in helping stay focused, attentive, and motivated throughout the day, come with some side effects such as increased heart rate, decreased appetite, insomnia, and anxiety or irritability.
What is ADHD, and what do ADHD medications do?
ADHD or attention deficit hyperactivity disorder can be inattentive, hyperactive, or a combined presentation. People with ADHD have differences in how they process information, maintain focus, and stay organized. Inattentive types often have difficulty maintaining focus, forgetting or losing items, completing tasks, and meeting deadlines. Hyperactive types often have difficulty waiting in line, sitting still, and interrupting others, and feel a constant need to be on the go.
ADHD can look different for different people and at various stages of life. ADHD in adulthood can cause disruptions in focus and motivation, among many other things. ADHD in adolescents often looks like feeling overwhelmed and difficulty balancing school, personal life, and deadlines. ADHD can even look different for females than for males, causing underdiagnosis. For females, ADHD can be more predominantly inattentive instead of hyperactive, with symptoms more turned inward and less outward expression.
ADHD stimulant medications are categorized into these groups: amphetamine and dextroamphetamine. Common examples include Adderall, Dexedrine, Procentra, Vyvanse, and methylphenidate. Common examples include Ritalin, Concerta, and Metadate. Each of these stimulant medications increases the levels of norepinephrine and dopamine in the brain. Norepinephrine and dopamine are neurotransmitters, which are chemical messengers in the brain. Norepinephrine is a neurotransmitter that plays a key role in the fight-or-flight response to stress, helps with attention and focus, mood regulation, sleep-wake cycles, blood sugar regulation, growth and development, and gastrointestinal function. Dopamine is another neurotransmitter that plays a role in reward and pleasure, motivation and movement, helping us plan, organize, and execute tasks, as well as in attention and focus, and learning and memory. ADHD stimulants have many benefits, including reducing distractions, improving attentiveness, enhancing memory, and managing hyperactivity. There are also adverse side effects with both short- and long-term implications, which are worth understanding. The short-term side effects specifically contributing to mood, irritability, and anxiety are worth paying attention to.
There are nonstimulant medications approved for ADHD use as well, Atomoxetine or Strattera, which help increase levels of the neurotransmitter norepinephrine. Guanfacine (Intuniv), approved for children, helps with impulse control and hyperactivity. Clonidine (Catapres or Kapvay), similar to the above, helps with sleep and hyperactivity. These medications have side effects, including drowsiness, dry mouth, nausea, fatigue, and changes in blood pressure.
Why does the crash happen with ADHD stimulant medication?
While stimulants help keep that focus and help with a lot of inattentive and hyperactive symptoms, even making it more manageable to get through the day, these stimulants also can wear off at the end of the day and take that focus away with it. These medications wear off because the time it takes for them to be absorbed varies. Some medicines are extended-release; they have an effect for a longer time on the body, while instant-release medications are in the body for less time. Once the medication wears off, it is no longer active. If the medication comes out of the body too quickly, it can lead to a crash. This crash is a result of the abruptness of ADHD symptoms of inattention, loss of focus, and hyperactivity, restlessness resurfacing after being controlled for most of the day. Sometimes, if the crash is too abrupt and uncontrollable, it may be worth speaking to your provider about a medication change.
5 Go to Moves to Help with this Crash:
Maintaining basic self-care
Make sure you are eating balanced meals, moving your body regularly, avoiding mood-altering substances, taking medication as prescribed, sleeping 7-8 hours daily, and reporting these symptoms to your prescribing doctor. Mood swings, irritability, and anxiety can all make basic self-care seem overwhelming, but maintaining this will help manage all of these things. Start minimally, track each of these, and give yourself grace if you falter.
Mindfulness and reflection
Anxiety often leads us to overthink the past or future, not feeling fully attuned to what we are handling currently. Increasing your mindfulness even before the crash happens through deep breathing, recognizing each of your senses, doing a body scan, appreciating one thing at a time, and not multitasking. Each of these can be done by redirecting your anxious thoughts and shifting your mind to what you are being mindful of, whether it is what you are cooking, not listening to music simultaneously, letting your mind wander from the chopping, or listening to music, intentionally singing along, and being immersed in one thing at a time, finding your present moment. It could also be reflection, reflecting through journaling or emotional processing, allowing yourself to feel what you are feeling, rather than avoiding it, gives you more control of these emotions and experiences.
Predictable and accessible routine building
Finding a way, you would like to wind down each day without too much thought or decision, even if it is one thing, such as eating at the same time each evening, a regular sleep schedule, ending each workday with a quick dance party, calling a friend or family member, or going for a walk. Routine and ADHD don’t always see eye to eye; the resistance to consistency is natural. Allowing creativity in your evening routine based on how you are feeling can be instrumental in managing your anxiety, but also having at least one thing that feels safe, that you do not have to decide, can allow your thoughts to ease as that anxiety comes in, knowing what it is that will follow. Adding reminders to build a routine can be helpful as well.
Accessing creativity and building mastery
Find something you would like to work on or towards that brings enjoyment. Is it adult coloring books, knitting, learning a new language, yoga, learning an instrument, baking, photography, etc.? The world is your oyster. What is something that you’ve been curious about exploring? What is something that you could work towards? Accessing our creativity and building mastery puts our energy in a directed outlet that can help us feel excited and productive outside of our 9-5.
Self-compassion
You can do this, this will pass, you are more than these emotions and thoughts! Self-compassion allows us to feel what we are feeling without turning this pain into suffering. It can be frustrating to feel this way; it is okay to acknowledge that. Speak to yourself the same way you may speak to a friend, notice if you are harsher towards yourself than you are to others. Increasing self-compassion and seeing things you do like about yourself by giving yourself positive affirmations can help reduce anxiety and manage unrealistic expectations that may be coming in.
After all of this?
Seek additional support! ADHD is not only best managed through psychiatric medications but also through talk therapy. A mental health clinician can help keep you on track toward your goals and support you through this process.
