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  • Aviva Nirenberg

What's a drug holiday and should I take one?



As an ADHD coach, I’m often asked by clients whether they or their child should take a medication vacation also known as a drug holiday. A drug holiday is an intentional but short term break from medication. Warning: A drug holiday should never be taken on a whim and should only be taken after a discussion with your prescribing physician. That being said, let’s explore the pros and cons of a drug holiday.


Pros:


· For someone who has invested effort in adopting ADHD friendly life style habits and worked with an ADHD coach and/or therapist to improve their executive function skills and behavior, a break from medication is an opportunity to evaluate how well you or your child manage without medication.

· For some a medication vacation is also a break from unwanted side-affects like appetite suppression, sleep difficulties, or headaches. For example, if while on medication the side effect of appetite suppression results in unhealthy weight loss, a 2019 study showed that a drug holiday improved weight gain in a group where stimulant medications decreased BMI.

· Pausing medication may also be a financial consideration.

· A drug holiday also carries the possibility to increase tolerance of the medication without raising the current dosage. In other words, explains Dr. Michael Craig Miller, Assistant Professor of Psychiatry at Harvard Medical School, “it gives the body a chance to recover systems that have been suppressed by the drug.”


Cons:


· Research shows that remaining on medication consistently 365 days a year reaps overall better treatment results and success.

· ADHD medications not only affect performance and the ability to regulate behavior and emotions at school or work but also affect behavior at home and in the social arena. The potential negative impact of pausing medication on family and social relationships needs to be seriously considered.

· The damage to self-esteem is another potential pitfall for children and adults alike who may struggle unsuccessfully with tasks and behaviors that were easier while on medication. One mother describes shares her that son was considered a soccer star by his coach and peers. However, while on a summer drug holiday his performance and his ability to get along with his teammates fell markedly as did his self-image.

· For children or adults who struggle to control impulses, a stopping medication can pose real danger. A young adult client describes his risky driving while off medication and quick realization that meds were essential for his own safety and the safety of others on the road.


Overall, unlike the joy of a spontaneous beach getaway, a medication vacation is serious business and involves a serious conversation with your practitioner about its risks and benefits. Also, it should be noted that non-stimulants medications need to be weaned from gradually and can only be paused with guidance from your doctor.


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