Tolerance to Stimulants?

Main Chapters:
00:00 Intro - Tolerance to Stimulants?
00:19 Take home message
02:26 Effects of Substance Usage Over Time
05:17 Dopamine Systems
06:50 ADHD and Dopamine
08:30 2013 Study on ADHD and Dopamine
18:32 Clinical Experience
21:59 Conclusion
22:37 Outro

Stimulant medications consistently outperform other treatments of reducing ADHD symptoms. Many individuals take stimulants for years. ADHD experts consistently say that, after some initial titration, most individuals find a dose that works for them, and that dose will continue to work well for years or decades.

In contrast, addiction experts claim the opposite. They say that almost everyone quickly develops tolerance to stimulants, and that dosage escalation is the standard, not the exception.

A 2013 study by NIDA chief Nora Volkow and colleagues is often cited as evidence for tolerance. A group of 18 individuals with ADHD showed a 24% upregulation in dopamine transporters after a year of treatment with methylphenidate. But not all research is consistent with this study, which has some methodological weaknesses.

In my own practice, the majority (80% or more) of patients continue to do well on the same dose of stimulant medication for years at a time. Simultaneously, however, I do frequently hear people report that their AHD symptoms are "much worse than before" if they skip their medication for a day or two, which could well reflect upregulation of dopamine transporters, or other systems in the brain.

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Free link to my Medium Article on Tolerance to Stimulants:
https://medium.com/wise-well/toleranc...

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References:
Long-Term Stimulant Treatment Affects Brain Dopamine Transporter Level in Patients with Attention Deficit Hyperactive Disorder (2013)
https://journals.plos.org/plosone/art...

Consequences of Acute or Chronic Methylphenidate Exposure Using Ex Vivo Neurochemistry and In Vivo Electrophysiology in the Prefrontal Cortex and Striatum of Rats
https://www.ncbi.nlm.nih.gov/pmc/arti...

Genetic imaging study with [Tc-99m] TRODAT-1 SPECT in adolescents with ADHD using OROS-methylphenidate
https://www.sciencedirect.com/science...

Responsivity of the Striatal Dopamine System to Methylphenidate—A Within-Subject I-123-β-CIT-SPECT Study in Male Children and Adolescents With Attention-Deficit/Hyperactivity Disorder (2022)
https://www.frontiersin.org/journals/...

Full Chapter List:
00:00 Intro - Tolerance to Stimulants?
00:19 Take home message
02:26 Effects of Substance Usage Over Time
02:49 Sensitization and Tolerance
04:05 Tachyphylaxis
05:17 Dopamine Systems
05:27 Dopamine Transporter (DAT)
06:50 ADHD and Dopamine
08:30 2013 Study on ADHD and Dopamine
10:34 Study Results
12:20 Study Analysis
15:56 Comparison with Other Studies
18:32 Clinical Experience
21:59 Conclusion
22:37 Outro

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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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