Research Recap: Discontinued Use of ADHD Meds

Welcome to Hacking Your ADHD. I’m your host, William Curb. Today, I’m joined by Skye Waterson for our research recap series, where we dive into a single research paper to find practical takeaways. In this episode, we’re discussing a paper called "Adherence, Persistence and Medication Discontinuation in Patients with Attention Deficit Hyperactivity Disorder: A Systematic Literature Review." This study asks: what’s happening in the real world with medication adherence? Are people taking their meds, and if not, why? I found this paper through a presentation by Bill Dobson at the 2025 ADHD conference in Kansas City, and it really blew me away.

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William Curb: Welcome to Hacking Your ADHD. I’m your host, William Curb. Today, I’m joined by Skye Waterson for our research recap series, where we dive into a single research paper to find practical takeaways. In this episode, we’re discussing a paper called "Adherence, Persistence and Medication Discontinuation in Patients with Attention Deficit Hyperactivity Disorder: A Systematic Literature Review." This study asks: what’s happening in the real world with medication adherence? Are people taking their meds, and if not, why? I found this paper through a presentation by Bill Dobson at the 2025 ADHD conference in Kansas City, and it really blew me away.

Skye Waterson: Yeah, it was such an interesting paper. When you told me what they found, it literally blew my mind.

William Curb: The majority of people don’t adhere to their treatment regimes. Within a one-to-three-year period, only 25% of people stayed on their medication.

Skye Waterson: It’s incredibly low. To not bury the lead, this paper is largely supported by people who receive funding from medication companies. This isn't a conversation about anything other than: how do we prevent this from happening?

William Curb: Exactly. If people are getting benefits, they want to know how to ensure they stay on it—and if they aren't, maybe things need to change. Most of the authors are connected with the group that produces ADHD medication, but it makes sense why they’d be looking into this.

Skye Waterson: It’s a real problem. The introduction mentions that over half of all patients fail to adhere to guidelines or discontinue treatment within two to three years. They compared it to other treatments, but it's not something I'd ever heard before you brought it to us.

William Curb: This paper was a meta-analysis of 127 relevant studies. Most were focused on children, though they did find a good number on adults.

Skye Waterson: The reasons for discontinuation are slightly different between the two groups, but children are often easier to study.

William Curb: Adherence in adults is an especially important conversation. Bill Dobson mentioned that, historically, many adults didn't seek treatment of their own volition—it was often a family member saying, "There’s a problem, go get help." That external pressure often isn't enough; you have to want to do it yourself.

Skye Waterson: Right. If it's just for a spouse or for work, it’s harder to stick with. Then there are the side effects. Out of 41 studies, 30 cited "adverse effects" as a reason for stopping, and 27 cited "ineffective symptom control." They didn't detail exactly what those adverse effects were, which is unfortunate, but those were the two big reasons.

William Curb: With both stimulants and non-stimulants, there are a lot of potential side effects. Oftentimes, when people first start, they aren't on the proper dosage yet, so they feel those side effects more acutely. This is why looking at that first year is so critical.

Skye Waterson: It gets complicated with titration—adjusting the dose—and switching between different types of medication. That process really dictates whether someone stays on the plan long-term.

William Curb: There's also the issue of "drug holidays." Some doctors suggest planned breaks, but it’s not actually recommended by ADHD organizations. Unless you have severe side effects, you should generally take it regularly because ADHD affects every aspect of your life—not just your productivity at work. I’m "more myself" on medication because I can actually focus on my hobbies and be present.

Skye Waterson: It speaks to a weird relationship some medical professionals have with ADHD. You don't see "medication vacations" for schizophrenia or bipolar disorder. It creates a stigma, as if you should only be on it to get work done for other people.

William Curb: Exactly. I had a friend mention a child who took "vacations" from his meds during trips, and because of the extra stimulation and lack of medication, he almost ran into traffic. There are side effects to not taking the medication, too.

Skye Waterson: It’s a personal decision, but it's interesting when the doctor is the one recommending the holiday.

William Curb: Those holidays also make the data hard to track. If someone doesn't refill over the summer because of a "holiday," the study might just mark them as having stopped treatment entirely.

Skye Waterson: Interestingly, the study noted that ADHD medication adherence is actually comparable to other psychiatric and non-psychiatric disorders. It's not just an ADHD thing, even though we struggle with the "admin tasks" of refills.

William Curb: There's so much social stigma. I saw a documentary recently that focused entirely on side effects and stigma without mentioning the benefits. Plus, the logistics are a nightmare for some. Some pharmacies make it difficult, or pharmacists are critical of patients. I’m lucky it’s easy for me, but for many, it's a battle.

Skye Waterson: I work with clients who move states and have to "prove" they have ADHD all over again just to get a script. If a psychiatrist leaves a practice, you might have to start the whole system over.

William Curb: I’ve moved cities and still drive 45 minutes to my old doctor just because I don't want to risk the inconvenience of switching and losing my prescription.

Skye Waterson: One last thing: the paper discussed "expert opinion" versus "original studies." Experts thought the main reasons for stopping were dosing inconvenience and social stigma, but the original studies didn't always reflect that. There's a conflict between what experts think is happening and what patients report.

William Curb: Social stigma is hard to self-report. It’s easier to blame side effects than to admit you feel judged. Interestingly, the cost of medication was actually near the bottom of the list of reasons people quit.

Skye Waterson: That's a surprise.

William Curb: One positive note from Dobson’s presentation was that more women are being diagnosed now and seeking treatment for themselves. Because it's their own choice rather than something forced on them, we’re seeing better adherence in that group.

Skye Waterson: Exactly. If anyone is struggling with these decisions or the logistics of refills, they can find me on Instagram; I’m happy to share the paper or a prioritization filter to help get focused.

William Curb: We want medication to be easy and effective. There are so many options out there, and if one doesn't work, another might—or you might find a non-medication route that works better for you.