ADHD medication rebound

ADHD medication lessens symptoms for most people with ADHD. So why would symptoms suddenly flare up — at the same time each day? If it happens around the time the medication is wearing off, it’s probably a “medication rebound.”

Medication rebound can happen to both kids and adults. It doesn’t mean that ADHD symptoms are getting worse, or that the medication isn’t working. But it might mean the medication needs fine-tuning.

Here’s what you need to know about ADHD medication rebound, and how you can stop it.

What rebound is

Rebound is the brain’s reaction when a stimulant medication is wearing off. When the medication leaves the system too quickly, it causes ADHD symptoms to return. And the symptoms may be especially intense.

The good news is that for some people, this reaction usually lasts for only about an hour. Sometimes an adjustment in medication can help reduce rebound.

Why rebound occurs

Rebound is directly linked to how fast a person’s body processes a medicine. The rate at which the medication wears off isn’t the same for everyone.

Stimulant medication starts working within 30 to 90 minutes, depending on the drug. For some people, a long-acting (“all day”) stimulant medicine may work for 10 hours. For others, it may last only for six.

The medication is filtered through the kidneys or liver as it’s released. Then it’s gradually eliminated from the body. Usually, most of it is cleared out by later in the same day.

These medications are designed to wear off evenly. But in some people, they move through the filtering process very quickly. And that causes a steep drop-off in medicine level as it wears off.

That’s when a rebound usually happens. ADHD symptoms flare up suddenly as the medication is wearing off. And for a brief time, they’re more intense than they usually are without medication.

Rebound typically lasts for about an hour — until the medicine has completely worn off. Then you’re likely to see a return to the usual level of symptoms.

How to tell if it’s rebound

Many people experience some side effects when they first start taking stimulant medication. They may have stomach pain or headaches. Or a decrease in appetite. Those side effects usually clear up within a few weeks as the body adjusts to the medicine.

But sometimes people will show a different set of symptoms. They may become:

• Extremely wired
• Very irritable
• Tired, sad, and subdued

In some cases, the symptoms appear during the time the medication is supposed to be active. They begin soon after the first dose and last for a few hours. And they decrease only as the medication wears off.

That may be a sign that the dose is too high and needs fine-tuning. It may also be a sign that the medicine isn’t right for that person.

In other cases, the person is fine and the medicine is working for most of the time. But then symptoms suddenly appear toward the end of when the drugs are active. That’s a sign that the medication is dropping off too fast. This causes a rebound effect and means the medication needs to be adjusted.

Watch as an expert explains how to figure out the timing of ADHD stimulant medication:

How to stop and prevent medication rebound

When rebound symptoms appear repeatedly over a number of days, it’s a good idea to speak with the doctor or prescriber. They may prescribe a “booster” to eliminate them.

A booster is usually a small dose of the same medicine. But it’s a version of the drug that acts immediately and then wears off quickly. People take it shortly before their regular medication is set to wear off.

The addition of a small amount of medication usually makes the drop-off more gradual. And that keeps the rebound reaction from happening. 

When it’s not rebound

A sudden return of ADHD symptoms isn’t always about rebound, especially in kids. Symptoms may flare up when kids get home from school. This could be because kids feel like they can be themselves at home. They know they’ll have the support of a loved one, regardless of their behavior. But if they act out at school, they’ll get in trouble or risk harming social relationships.

They may also just be worn out. The ADHD brain gets tired during the day from having to monitor itself. Stimulant medication greatly reduces symptoms. But it never fully makes them go away.

Learn more about ADHD in the brain. Listen to an expert explain ADHD on our ADHD Aha! podcast. And find out how one family wrestled with the decision to put their child on ADHD medication.

Understood is not affiliated with any pharmaceutical company.