Tolerance: Normal Treatment Response
A decreased response to the same dose of medications is not always abnormal or indicative of a problem. In my experience there are two phases during which dose requirements often increase. Between about 4-12 weeks of treatment patients may find that their dose requirement increases slightly, usually by 10-20 mg per day. This is a common pattern as the body adjusts to the new medication. One may also see a need for increase at the end of the first year of treatment. Again, this is part of the normal pattern and should not be cause for alarm.
However, one must be cautious of the following pitfall. Most patients who have a positive response to the stimulants also find that within the first month they are not only more effective and better focused, but have a mild sense of euphoria and optimism as a result of the medication. This is a common, but temporary effect. Almost all patients lose this after about a month or so. Fortunately, most retain the benefit of increased focus, decreased distractibility, and less tendency to procrastinate.
It is important for patients to understand that they should not expect this initial excitement and optimism to last indefinitely. Patients’ efforts to sustain these are often fruitless and generally lead to their taking higher and higher doses of medication. Therefore, it is useful to bear in mind the distinction between how the medication makes people feel and what it allows them to do. By focusing more on the latter they will be less prone to the mistaken belief that the medicine has stopped working.