ADHD Meds Holiday Question

[Anonymous]

My DD has been on focalin since April for mild ADHD inattentive type. In June, we added Zoloft for anxiety. Our psychiatrist suggested we give her a med holiday from the focalin, since school is out, and see how she does just on Zoloft. So over the long July 4th weekend we did just that, and everything was fine. We had already noticed a significant improvement in her with the Zoloft. It was like a light had turned on and she was able to enjoy herself without that heavy blanket of anxiety. In fact, I said to my husband that maybe the focalin wasn't even necessary, b/c without the anxiety, she seemed happy and focused and relaxed.

Fast forward about 8 days and many of the behaviors that led us to getting her a neuro-psych are back in full force. She's just ADHD all over. Impulsive, aggressive, disruptive, etc. I started the focalin again this morning because it's really been bad the last few days. So here's my question: if focalin and other ADHD drugs metabolize in 8-12 hours and leave the body, why would it take so many days for us to see this change in behavior? I have to admit, I'm disappointed. I was hoping we could avoid the ADHD meds altogether and focus on the anxiety piece but it seems like that's not to be. I have a call in to our psychiatrist to get more info as well, but everyone here has always been extremely knowledgeable and helpful so I'm turning here for some advice.

Thanks.

[Anonymous]

Excellent question.

Perhaps it has to do with progressive sleep deprivation - when she's not on meds, the quality of her sleep may be affected, and it takes a week to accumulate and show?

Or more generally, she took it upon herself (perhaps unconsciously) to mimic the on-meds behavior, but can't sustain it beyond a week because the neurotransmitters just aren't there.

My 11 year old with severe inattentive ADHD is on 20mg Focalin during the school year, and his psychiatrist advised us to halve the dose (by opening the capsule, taking roughly half the granules and swallowing them in something like yogurt) on summer weekends, to get him to eat more, since he's at the 3rd percentile for weight.
It has worked well - clearly he's not on meds by mid-afternoon, but as long as he doesn't need to pay detailed attention, it's fine. And he does eat more!

[Anonymous]

I think dosage of Zoloft needs to be adjusted upwards. What you are seeing is not the stimulant wearing off gradually, but brain chemistry adjusting to Zoloft.

[Anonymous]

Anonymous wrote:I think dosage of Zoloft needs to be adjusted upwards. What you are seeing is not the stimulant wearing off gradually, but brain chemistry adjusting to Zoloft.

OP here, can you elaborate? She's been on 50 mg for the last 3 weeks (started with a week of 25). Will this continue to happen, requiring upward adjustment periodically?

[Anonymous]

It probably will. 50mg is pretty low dose. Is she old enough to articulate when she feel anxiety is coming back?