Can ADHD symptoms resurface despite medication?

[ZoomedOut]

DH is on medication for ADHD. The medication has made a huge difference to his ability to focus and his impulsiveness has toned down. Recently however it's like he's having a relapse to the pre-medication days. He had a spending habit prior to medication which seems to have resurfaced, and he's just made an impulsive decision on something quite major that needs to be thought through properly and not just done on a whim. I'm concerned something is out of kilter again.

Do relapses happen or do the medications lose their effectiveness over time? Does stress or anything else make symptoms worse? Sorry if relapse is the wrong phrase.

Sorry, dodgy WiFi means this has posted twice.

The medications aren't magic - they can help with executive function but someone still has to be at the helm to steer the ship!

Medication won't prevent someone from doing something if they choose to do it. Is he just using medication or is it alongside CBT or similar? Habits of a lifetime are really hard to break without help, so medication alone seems unlikely to be a complete solution here. The way I see it, ADHD medication gives someone the ability to control their thoughts, and CBT teaches them how to control them to achieve their goals.

Stress can impair executive function, so it seems feasible that it might lessen any positive effects of the medication.

Thanks for replying Longines. He is on medication only, no CBT. I don't think CBT was ever mentioned to him or if it was, he hasn't told me. Would he get it on the NHS?

I guess to some extent it would depend on the doctor and what services an NHS clinic can offer.

My private doctor who diagnosed me offered the options of CBT-type help, meds or a combination of the two but seemed to have no strong opinion either way (so I just took the meds), whereas I've since seen an NHS doctor who said there was no point in taking meds on their own and that they're never going to change habits of a lifetime so he referred me for CBT. But they have it within their service and he obviously had it available to offer, so it would depend on what's available in your area, I guess.

Or DH could ask his private doctor about other support - they can usually recommend someone even if they don't offer that service themselves.

How long has he been on the meds? Is he on the maximum dose or a low dose? Does he still have reviews with the local ADHD team (even just annual)?

I was diagnosed last year, started Elvanse in November, was upped in January and am about to go up to the next dose tomorrow after I had an emergency review earlier this week due to realising the dose I was taking is no longer effective. My understanding for Elvanse is I should eventually reach a dose which is my optimal dose, but at the moment I am still working up to that point (due to other medical conditions both myself and the clinicians are cautious about increasing the dose unless totally necessary). So they can appear to become less effective over time, if they are not the right dose, and what you have said about increased impulsivity - along with decreased focus and other ADHD issues becoming more noticeable - are my indicators that the meds need a review.

That being said, if life is different at the moment, if your partner is on furlough, or under extra pressure at work, or anything else very different to usual, it may be a reaction to that (I can be more impulsive when extremely stressed or very bored).

I would suggest a discussion with whoever is responsible for the medication he is taking, and requesting that review sooner rather than later, as they are the ones best placed to work out what is happening.

no point in taking meds on their own and that they're never going to change habits of a lifetime
I've found out he is has some money coming his way soon. This will be why he's over spending again, even though he doesn't know how much he will get or exactly when. So what you've said above about underlying habits would make sense. He spends money before it's in his pocket.

under extra pressure at work, or anything else very different to usual, it may be a reaction to that
Yep it could be this too.

Thanks for your help, I think it's mostly the underlying habits surfacing. He can't see the problem though so I can't see CBT being any help until he accepts that his behaviour is a problem. He is in denial.

He can't see the problem though so I can't see CBT being any help until he accepts that his behaviour is a problem. He is in denial.

Absolutely - there's very little you can do about his treatment as it can only be driven by him.

Is he blaming the ADHD when things go wrong, and/or is he expecting that if the medication were working, he wouldn't need to exercise any willpower at all?

He spends money before it's in his pocket

TBH, OP, if he's spending family money recklessly without discussing it or in a way that's detrimental to the family, then neither of you should be wondering if a tweak to the medication will solve it. It won't.

I'm on the right dose of meds for me and I can still think 'fuck it' and decide to eat too much or waste money on frivolous things if I want to. If my decisions affected someone else and I cared about that, I would take that into the equation too. Unless my own desires were more important to me than screwing over a loved one, of course. The meds still let me be an arsehole when I want to be!

ADHD meds aren't going to make him less selfish. And they can't cure addiction - if this is an addiction, he will need help to tackle it when he faces up to it, just like anyone else.

That said, it sounds like he doesn't know how to budget (which makes perfect sense with a lifetime of ADHD, as it's very common to just bury your head in the sand and live in the chaos).

I had to sit down and actually take the time to learn how to budget. He will obviously need to do that too. Medication can't teach skills!

Google YNAB - that's what I use for budgeting- it teaches you to only spend what you actually have and it's great. You could always frame this budgeting issue as a joint problem and something you both need to learn and solve together - then he might not feel he has to defend his fuck-ups by blaming meds or saying 'sorry, it won't happen again' (until it does).