stimulants and reaching tolerance levels

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My DS has been on Concerta for well over two years. LOTS of Concerta. His dosage is higher than anyone I have ever read about. It took a year to figure out the right configuration of meds (stimulant plus anti-depressant plus ant-tic medications, etc.), then DS had a full year of bliss -- school was manageable, he paid attention in class, he did homework in a timely fashion, and he was HAPPY.

This year, all of that fell apart. He does relatively well in school, but with massive amounts of support from his parents. He has gone from finishing most homework before dinner, to taking hours to finish each assignment. His doctor insists that if the Concerta has worked for him in the past, it will still work for him. I admit that he does fairly well in school, but it is only with lots of support from us as his parents. He seems zombie like now, though, and is slow to make decisions, has zero opinions about anything, basically has shifted from what seemed like a more typical teenager back to a younger parent-directed child.

We have witnessed over the years that our son builds up a tolerance to his meds. In years past, it seemed that this was due to low dosages -- but we have now experienced very high dosages, that have worked, but obviously he builds up a tolerance to this dosage as well.

My questions for any of you with similar experiences are:

1) Have you built up tolerance to your medications? If so, how have you solved the problem?

2) Have any of you solved the problem of tolerance by cycling meds, i.e. if Concerta worked for a while, but then stopped -- did you go back to a previous med (adderall, vyvanse, etc.) that used to work but also stopped? I'm wondering if cycling through two or three meds over time, maybe one med one year, another med another year, would work better for those who build up tolerance.

3) If you build up tolerance too much to your meds, have you ever decided to quit meds altogether? How have you adapted to life without them?

Currently, I can't see how using all of these meds is any different to the past when my son wasn't on meds. When the meds work, they are life-changing, to be sure. But when they DON'T work, it seems ridiculous to be spending hundreds of dollars and watching our son struggle. At least without meds, he wouldn't be a zombie, he'd be back to his regular personality.

I have fortunately not had the experience of building tolerance to meds. However, I have experienced times when changes in life circumstances can overwhelm my meds.

So, in addition to med tolerance, I might wonder if there is some new or different life circumstance he is now facing that might be behind the behavior change. Maybe he is experiencing some bullying or other unkind social situation. Or maybe as he is growing he is experiencing some new frustrations at overall social limitations. The teenage years can be emotionally rocky in that regard, like for example if he is experiencing dating frustrations. Or maybe the school subjects he is now studying are boring or otherwise not of interest.

These are just some thoughts based on my personal experience.

The one change he has had was a change in math classes, where he went from a standard math class to honors pre-calculus. I would think that was part of the problem, except he has done fairly well in that class.

He can do well academically, it's just that he takes FOREVER to do anything -- his homework, decisions, walking, etc. This was not the case when his meds worked well last year.

Other than that one class, he has no other issues -- he is uninterested in dating, so that's not an issue. He has friends at school (he's just finishing his junior year), so I don't think bullying is a problem. He is very naive and innocent, and so maybe there are issues with the difference in maturity between himself and his peers -- but he sits with a table of nerds who have similar issues.

I just can't see how he can go to college at his current level of functioning, whereas last year, I was confident in his ability to handle college. I'm absolutely open to the fact that I may be blowing this out of proportion, but his father agrees that the meds don't seem to be working. The odd thing is that my son doesn't see this as much as we do. He is a people pleaser, and always looks on the bright side -- so he is inclined to think that everything is fine. I try to tease out of him what his perspective is on the meds, but he honestly doesn't have enough of an ability to tell me how he feels to give me reliable information. He waffles back and forth on whether or not he feels the meds are effective. It's incredibly frustrating.

An example that makes me think he is just not getting much from his meds -- we were out of town this week seeing his sister graduate from college. His grandmother was with us, and we took a trip to the mall to shop for DS for his birthday. Grandma wanted to buy him something for his birthday. We were in a clothing store that also carried stuff like skateboards, etc. There was plenty of stuff to look at and buy that were age and gender appropriate. He just had no clue about what he wanted. He had no opinions. He had no sense of what he likes. He just was a zombie. If we picked out something for him to look at, he just said "sure, that's great."
If grandma picked out something he probably didn't like, he was so afraid of hurting her feelings that he couldn't come out straight and say "yeah, that's really not my style." He was just an amoeba.

I'm very tempted to take him off all the drugs, during the summer, just to get a baseline of what his personality is currently really like off of meds.

Also, he is gaining weight. This seems very interesting to me, that in all of the time that he has been on stimulants (almost a decade) he rarely has the side effect of loss of appetite. He is not overweight, but he has gained noticeable weight in the stomach area (probably due to lack of activity and just sitting around playing video games when he isn't studying). I just find it strange that other kids I have known who take stimulants for ADHD are always fighting the fact that they lose their appetite -- when my son has only had that problem on Adderall (and only to a very minor extent).

^ This ^ Marky9

A lot of my personal problems started when I left a small town middle school, where every one knew each other, to a large comprehensive school. At the same point in time we moved house, so I was in a different part of the school to the guys I grew up with. This change was more than enough to start a vicious downward cycle for me.

Try to find out what could be causing extra stress if anything.
If there is bullying it may be well hidden or undefined, even coming from an adult.
It may be that he is finding a new level of working, perfecting things to the point of OCD?

Most people become tolerant of what is in their system, whether that is alcohol, drugs or medication.

We all will react differently to any given substance, it's very hard to compare one persons reactions with another and caution is very strongly advised.

I would prefer to not be on any medication myself but unfortunately that is not the case. Personally, the side effects are only slightly less disturbing than the emotions I have without. When I recently stopped taking my course I experienced no withdrawal symptoms but with 6 weeks my depression was re-forming and it has taken me 4 months to find a balance again.

If you are going to cycle meds then you need to be as scientific as possible. List positives, side effects, time to become established and any withdrawal effects. Keep all this and records in a journal, make informed judgements. Turn it into a special interest.

Good luck.

Hey, this is very good advice to turn it into a special interest. I will suggest this to my son...

I've never developed tolerance to a medication, but some doctors advise taking "medication holidays" with ADHD meds to prevent tolerance from developing.