It’s common to have concerns about taking medications for ADHD. “I don’t want to be medicated every day” is a common theme, as are concerns about side effects. But not taking medications also has side effects. Today I thought that I would try to cover some of the pros and cons of this difficult issue.
I will reiterate, as I do whenever I talk about medications, that I am not a doctor, so any specific questions you have about specific medications need to be reviewed with your doctor. That said, I’ve been around the ADHD world long enough that I can share with you in a general way what medications may be able to do for you and, importantly, what the side effects of not trying medication can be. This is something that few people think about, but which is really important to consider.
First, it is my firm belief (and that of Dr. Hallowell) that no one should be forced to take medication. It’s their body, and they should have control over it. I also see, however, ample evidence that people who should at least try medication often shy away from it from fear or, in the case of marriages, anger.
The dynamics of choosing whether or not to take medications are different when it’s two adults than when it is a parent helping a child decide. Whether or not a spouse is willing to try medication can become a power struggle in a couple that is having difficulty around ADHD symptoms. This is because the request that one try medication when it is one spouse to another, is almost always embedded in a history of already expressed disappointment in that spouse’s behavior. Deciding to take the medication, then, may feel like agreeing with the disappointment that has been expressed to date. When I first approached my husband to consider taking medications after he was diagnosed with ADHD he became irate. “I don’t need medications! I LIKE myself this way. YOU’RE the one with the problem with me, not me!” He correctly interpreted my requests that he try medications as a comment on his behavior which also included my doubt that he was a person with whom I could stand to spend more time unless something about him fundamentally changed. At that time, I wasn’t clearly differentiating between him as a person and his symptoms. My anger, frustration, and despair were all contained in my request, making it a complex one for him to respond to dispassionately.
I know a lot about the positive effects of medication in helping treat ADD and, to be fair, so did he at that point. He did eventually rethink his position and decide to see if medications could improve our situation. His original response was emotional – and his response was about ME, not about my request. When your spouse says “I don’t want to have anything to do with medications” it may well be the case that what they are really saying is “I can’t deal with the complex emotional issues underlying that request”.
So, what can medications do for someone with ADD? Note that every person responds differently to medications so you (or your spouse) might find that some, all, or none of these responses holds true for you. Medications may:
- Increase focus and patience
- Improve ability to connect and disconnect from tasks, even those you aren’t so interested in
- Improve symptoms of anxiety
- Diminish depression
- Increase or decrease interest in sex
- Help control outbursts of anger
- Help control impulsiveness
- Provide a starting point for changing key behaviors
- Help you “get things done”
Generally speaking, trying medications gives your spouse a signal that you are genuinely interested in change, thus providing him/her with renewed hope and a willingness to “try harder” to modify behaviors of her own that are getting in the way of your relationship. (And, as you know from my other posts, it is clear that the breakdown of these marriages is a two-way street, so having a non-ADD spouse commit to change is also important.)
The side effects of not trying medications are very real, too. They include:
- Spouse anger and frustration builds
- Communication breaks down
- Resentment builds when spouse doesn’t “give the ADD person a break”
- Bad feelings on both sides lead to further disintegration of marriage
- ADD symptoms continue unabated
Don’t misunderstand this last group of points. A person with ADD whose marriage is falling apart does not need to try medication. Medication is just one avenue for treatment. He or she can also try non-medicinal alternatives, and doing so would also provide hope and incentive for a partner to participate help move forward. But medications are helpful to more than 70% of those who do try them. It’s important hear this statistic. (In less emotional circumstances, most people would jump at a 70% chance to really improve their lives...) The ADD spouse needs to take seriously the concept that not seriously acting in some way to treat his ADD symptoms may well result in a progressively worsening relationship with his spouse ending, possibly, in divorce.
Given those stakes, putting aside the emotional baggage and trying a medication has few drawbacks. I would like to quote some of Dr. Hallowell’s writing from Delivered from Distraction (p. 244):
“…the effects of stimulant medication are immediately reversible by stopping the medication. Depending upon which stimulant medication you take, the effect of the medication lasts from four to twelve hours – then it’s gone…In other words, giving one of these medications is not like doing surgery. Surgery is irreversible. And yet, many people think of taking medication as an irreversible event. “What if it takes away my creativity?” many of my adult patients ask. “Well,” I reply, “in that case your creativity will come back in a few hours.” Whatever the medication does – good or bad – it will not last more than twelve hours…”
Dr. Hallowell spends a full two chapters in “Delivered from Distraction” writing about whether or not to take medications and, if so, which one. I strongly recommend that anyone debating this issue read these chapters (as well as the rest of the book, if possible).
If you are an ADD spouse who thinks things will “just get better” or that things are "good enough" in spite of your spouse's pleading for change, please consider the effect that your decision not to try medications (or some other active form of treatment) will have on your relationship. Chances are extremely good that your decision will hurt your relationship further, as well as become a roadblock for getting to the positive, healthy and supportive relationship you want. It is your responsibility to address the symptoms that your ADD brings to your marriage. For more on how not treating ADD can play out in a marriage, see my post about how both spouses can use ADHD as an excuse - The ADHD Marriage Balancing Act.