People with ADHD claim Adderall is ‘different’ now

“My Adderall’s not working.”

Videos of people who claim that their medication is no longer effective have recently catapulted through TikTok. In one, someone clutches a prescription bottle, rattling the pills as she shakes her fist. “They’re giving us ‘fake’ Adderall during the shortage,” the caption reads. “The adderall isn’t adderalling,” another user claims in a video.

Some people urge their viewers to submit complaints to the Food and Drug Administration about what they believe is a “new” Adderall being distributed and to call for the agency to run lab tests of the medication. Videos related to the phrase “adhd meds not working” have been viewed more than 15 million times on TikTok.

For nearly half a year, many people with attention deficit hyperactivity disorder have struggled to obtain their medication amid a nationwide shortage. The F.D.A. first announced the shortage in October, and Adderall is still in short supply. Among the patients who do manage to find Adderall, health care providers are left fielding their questions, though some say the concerns aren’t new. Danielle Stutzman, a psychiatric pharmacist at Children’s Hospital Colorado, estimates that up to a quarter of her patients over the past few years have said their medication seems less effective, a trend she said began around the start of the coronavirus pandemic.

“To date, the F.D.A. has not identified safety or quality issues with Adderall products, or signals indicating a loss or change in efficacy,” a representative for the F.D.A. said in a statement. A representative from Teva Pharmaceuticals, one of the largest manufacturers of Adderall, wrote in a statement that “all Teva manufacturing processes and practices are the same (and we continue to distribute the same brand and generic Adderall products).”

There’s no clear-cut explanation for why some people believe their prescription is “different,” but a combination of factors could potentially explain the phenomenon, pharmacists and A.D.H.D. experts said.

Tolerance buildup

Some children and teenagers who take Adderall may build up tolerance to the medication over time as they grow into adults and eventually require higher doses, Dr. Stutzman said. Both adults who were diagnosed as children and those new to the medication can also build tolerance, though that is less common, she said. Those who have developed a tolerance to their A.D.H.D. medication may struggle with managing their symptoms. They may have a harder time concentrating at school or work, feel more impulsive and hyperactive, and become more fidgety.

But most people do not develop a tolerance to prescribed stimulant medications, and many stay on the same, stable dose of Adderall for years, said Dr. Frances Levin, a professor of psychiatry at Columbia University and an expert on A.D.H.D. “It’s not like somebody’s on 20 of Adderall and then the next year you’ve got to have them on 50 or 100,” she said. “That just doesn’t usually happen.”

Switching medications

The brand name Adderall and the generic version of the medication are pharmaceutical equivalents, Dr. Stutzman said, so patients should experience the same level of relief even if they are prescribed the generic version. A tiny subset of patients could be sensitive to slight variations in how a medication is manufactured, said Dr. Anish Dube, the chair of the American Psychiatric Association’s Council on Children, Adolescents and Their Families. Even the substance used to coat the pill could potentially change how your body absorbs the medicine, he said.

This means that, theoretically, obtaining a generic form of Adderall from a different manufacturer could alter how you feel while on the medication. However, the differences between generics are so small that an overwhelming majority of patients wouldn’t feel any change from their previous medication. “It’s not supposed to have drastic differences,” Dr. Dube said.

If Adderall is out of stock, prescribers may recommend that a patient start taking a different A.D.H.D. medication in the interim, such as Vyvanse; people may experience varying responses to new types of medication.

“What we’ve seen over the recent years is there’s been a ballooning of available stimulants in the marketplace, and they’re not all equivalent,” said Sandy Mitchell, a clinical pharmacy specialist at Virginia Commonwealth University Health.

As the shortage slogs on, it has become increasingly common for clinicians to prescribe, say, an extended-release version of Adderall to a patient who used to take a shorter-acting tablet, or for prescribers to switch medications for patients based on whatever drugs are available, Ms. Mitchell said. Those changes can affect the way a patient feels throughout the day.

Starting and stopping medication

The shortage has forced some patients to go weeks, or even months, without Adderall. As a general rule, the higher the dose of medication and the longer a patient is on Adderall, the more likely it is that the person will develop withdrawal symptoms after going off it, Dr. Dube said. Patients may also struggle to readjust to the drug once they do resume taking it. Those who jump back into taking a large dose of the medication without incrementally working toward it from smaller doses may feel jittery and restless; some may even have heart palpitations, he said.

Disruptions and other factors

“You can’t diagnose A.D.H.D. in a vacuum,” Dr. Levin said. People with A.D.H.D. can be particularly sensitive to disruptions in their day-to-day lives; symptoms can flare up or intensify when a person grapples with the stress of a new job or a move, for example, or when there are changes to a routine. That’s why many patients with A.D.H.D. have struggled during the pandemic, Dr. Stutzman said. As more people return to the office or spend more time in public spaces with fewer masking guidelines, their daily habits may change and symptoms may worsen as a result.

Sleep also plays a critical role in how effectively medications like Adderall might work, Dr. Levin said. The consequences that come with sleep deprivation, like a foggy memory or difficulty concentrating, can overlap with A.D.H.D. symptoms. People who struggle to get a good night’s sleep may feel as if their A.D.H.D. is worse, or that their medication isn’t working as well.

Around a third of patients with A.D.H.D. have another mental health condition, Dr. Stutzman said. Symptoms of both can overlap with each other — the jitteriness that can come with anxiety, for example, may look a lot like hyperactivity. Patients who think that their A.D.H.D. has become worse, or that their treatment is not sufficient, may also be grappling with multiple disorders at once.

Cognitive bias

If you feel that your Adderall prescription isn’t working as well as it once did, Dr. Dube recommends that you ask your prescribing doctor if there was a change in the manufacturer or dosage of your medication. “It’s also possible that nothing’s happening,” he said, noting the power of cognitive bias: People who keep hearing that Adderall doesn’t work anymore may become inherently more skeptical about their medications.

Through online platforms, particularly TikTok, patients with A.D.H.D. have connected with one another over the last few years, Dr. Stutzman said, finding comfort and solidarity. While that has helped many people via support and resources, she said, medical misinformation can also spread through these channels. “I do wonder how much of it is suggestibility — wanting community around a diagnosis,” she said.