Areas › Focus, starting, and ADHD › Medication and how it works
More of the medicine is not automatically better. What you are looking for is a level that sits inside the working range, and going past it usually brings side effects rather than sharper thinking.
It is a natural thought that if some helps a little, double would help twice as much. In practice people describe the higher dose as flat, or wired, or oddly narrow. If your dose feels like it is not doing enough, take that to your prescriber as information rather than as a request for more, since the answer is sometimes different timing or a different molecule instead.
This explains how treatments work. Never start, stop or change a medication because of something you read here.
Qur’an and Sunnah
So that you may not exceed in the balance (Quran 55:8). A measure that has been set is something to stay inside rather than to push past.
أَلَّا تَطۡغَوۡاْ فِي ٱلۡمِيزَانِ
so that you may not exceed in the balance
Qur’an 55:8read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
What the research says
A review of medication for adults with ADHD reports that stimulant effect sizes come close to those seen in school age children when adequate doses are used, with atomoxetine and bupropion as second line options. Adequate is the operative word there: the target is a dose that reaches the range, not the largest one you can tolerate. It is a review rather than a trial of dose escalation, so it describes practice rather than settling it.
Santosh PJ, Sattar S, Canagaratnam M. (2011). Efficacy and tolerability of pharmacotherapies for attention-deficit hyperactivity disorder in adults.. CNS drugs doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Why it works
The aim is a level of signalling that sits within a usable range, and too much overshoots it just as surely as too little falls short.
When not to
Never change a dose on your own, since that decision belongs with the person who prescribes it.
This one is still a draft. It is waiting on a scholar and a clinician to read it before it is published.
Near this one
Do not compare your dose with anybody else's. Two milligrams of one medicine and a hundred milligrams of another can both be perfectly ordinary, because strength per milligram differs from molecule to molecule.
It is a fair question to ask of anybody telling you about a medicine: what is their interest in it. Good clinicians answer without flinching, and some have said the unwelcome thing to a room that paid for their flight.
Notice which word somebody reaches for. Protection sounds like a shield against loss, while what the studies describe is closer to a little extra growth, and those are not the same promise.