Stimulant Withdrawal - Is it a Problem?

Main Chapters:

As the opioid epidemic stabilizes and begins to recede, stimulant abuse has surged, keeping addiction treatment centers very busy. The psychological and physical misery of withdrawal plays a major role in continuing addiction to stimulants. While there has been considerable research into withdrawal from cocaine and methamphetamine, much less attention has been paid to withdrawal from prescription stimulants.

This lack of research is particularly troubling given the ongoing prescription stimulant shortages, which have forced many individuals to abruptly stop their medications. In general, prescription stimulant withdrawal tends to be less common and less severe than from abruptly stopping coke or meth. But when their medications wear off, many individuals with ADHD do experience crashes in mood, energy, focus, or all three.

Slow release formulations of stimulants tend to decrease the likelihood of daily withdrawal. Higher dosages tend to create bigger crashes. General health, and family history also appear to be factors in who will develop prescription stimulant withdrawal. For meth and cocaine withdrawal, limited evidence suggests that mirtazapine, modafinil, and transcranial stimulation can all lessen the severity.

Some of the studies on prescription stimulant “withdrawal” actually didn’t explore withdrawal. They looked at symptoms in individuals who stopped stimulants after several years of use. An immediate increase in ADHD symptoms upon stopping the medication was interpreted as showing that the stimulant still provided a benefit after prolonged use. But these were studies of “absence of effect” rather than looking at withdrawal syndromes. They also highlight the fact that other than testing someone off their medication, we don’t have any good ways to determine whether individuals, particularly adolescents, should continue their medication regimen indefinitely or not.

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Free link to my Medium Article on Stimulant Withdrawal:

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References:

Clinical management of psychostimulant withdrawal: review of the evidence

THE NEUROBIOLOGY OF SUBSTANCE USE, MISUSE, AND ADDICTION

Stimulant Medication Withdrawal During Long-term Therapy in Children With Comorbid Attention-Deficit Hyperactivity Disorder and Chronic Multiple Tic Disorder (1999)

Role of pharmacokinetic and pharmacodynamic parameters in neuroadaptations induced by drugs of abuse, with a focus on opioids and psychostimulants (2019)

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Streamed live November 15, 2023

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Psychiatrist, neuroscientist, and author John Kruse, MD, PhD presents practical, actionable, well-researched information about treatment options that scientists and clinicians recommend for adult ADHD and other mental health conditions.

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