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Does our brain adapt to stimulant medication over time, develop tolerance, so that we require higher doses to achieve the same effect?

When patients tell us their stimulant doesn't seem as helpful (after working well for a while), could this be tolerance? ... or could it be something else? 

To answer these questions, Dr. Elise Fallucco chats with Dr. James Waxmonsky, co-PI for NIMH-funded study: Examining Tolerance to CNS Stimulants in ADHD. 

00:00 Introduction of Dr. James Waxmonsky

01:26 What Is Tolerance?

02:10 Clinical Evidence for Tolerance

02:57 Longer-term Tolerance to stimulants

03:40 "The Brain Moves Its Targets"

04:16 Clinical Considerations in evaluating when "meds not as helpful": Changing Life Demands or true tolerance?

06:30 Management of Stimulant Tolerance

06:56 Clinical Pearl: Ask about increases in executive functioning and life demands

07:40 Taking a break from stimulant medication

08:14 Waxmonsky Longitudinal Study

09:00 Weekend Holiday Design

09:32 Recap - Do weekend holidays matter and reduce the need for higher doses?

11:46 Quicker dose escalation in continuous vs. holiday groups

14:00 Weekend Dosing Tradeoffs

15:45 Growth vs Dose Myth and Mg/Kg Dosing

17:35 Recap of how to Manage Tolerance

17:57 Toolbox for Recapturing Effect

18:37 Closing Thoughts

19:04 Final Recap

Dr. James Waxmonsky is the Division Chief of Child Adolescent Psychiatry at the Hershey Medical Center, the University Chair in Child Psychiatry at Penn State and a Professor of Psychiatry at the Penn State College of Medicine. He serves as Co-PI for an NIMH-funded study, Examining Tolerance to ADHD Stimulants.

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On-demand CME Course online at:  Pediatric Mental Health CME Toolkit - Cracking the ADHD Code: Essentials for Pediatric Clinicians.