How Do I Know When I’ve Got the Right Dose of ADHD Medication?

I recently received an email from a man who finally got an adult evaluation for ADHD because:

"…like the chapters right out of your book, I couldn't keep all the plates in the air. Work got more challenging. Three kids made life more challenging. And what is most important of all, my relationship got more challenging. I forgot stuff more
than ever. I procrastinated like it was an Olympic sport and I was going for
the gold. Life was too much for my brain to handle."

Once it was confirmed he had ADHD he started medication, which helped.  But how to know when he had the right dose?  Here’s my answer:

I'm delighted that the medication seems to be working for you.  How to know if you have it right?  That is a process of experimentation, as well as seeing what other non-medicinal things work for you.  The best approach is to set target symptoms (those couple of things you most want to work on) then select a wide range of treatments specifically to address those symptoms.  Medication can help, but using a bunch of different strategies helps more.  To find out more about target symptoms and treatment options, I suggest you download my free treatment e-book from the home page of my site.

Your goal should be adequate meds (i.e. a low-ish dose that does make a difference) PLUS behavioral and interactive strategies so that your target symptoms are well managed.  If you can't put that together, then up the meds a bit and see if that helps without getting negative side effects.

Which medication might work best depends upon your target symptoms and whether or not you have co-existing conditions such as anxiety or depression.  My treatment e-book provides more information on this, and your doctor should be able to help you narrow your options, too.

Dosing is very important when it comes to meds - research done with Vyvanse suggested that finding the right dose for each individual provided very significant improvement over just a 'standard' dose that was the same for all research participants.  Research with kids suggested that the most effective combination for managing symptoms was lower doses of meds combined with solid behavioral strategies (vs. higher doses of meds with behavioral strategies or without behavioral strategies.)

So think of this as a process:

• set target symptoms
• find a medication that seems to help balance out the brain chemistry without negative side effects and get to a dose that seems to help without it being too high
• add other (non-medicinal) strategies that target brain performance, such as improved sleep habits and exercise
• add behavioral strategies to help you better address, though actions, your target symptoms (ex: calendaring systems that help you stay organized)
• work with your partner to develop helpful interactive strategies (ex: verbal cues; chores meetings)
• assess and refine as you go along

This process is more of a marathon than a sprint - it can take a year from when you first start until you feel pretty secure in your choices...and as your life changes, you may need to refine again (for example getting more sleep or adding a small afternoon dose when under greater stress).

The good news is that 50-70% of adults with ADHD can find a medication that helps them manage their symptoms extremely well without side effects, while another 10-20% can find one that helps them manage symptoms well.  So chances are that a real effort in this area can make a big difference in your life.

Remember, though, changes take time.  While medications, particularly stimulant medications, work right away it takes time to set up the behavioral changes that really impact your life.  Better focus is great, but not all that useful in your daily life unless you apply it to take actions that improve your reliability, work, or relationships.  In other words, the improved focus stays inside your head (and invisible to others) unless you use it to do things more effectively.  You, of course, get to define 'effectively.'