Question: Do medicines retain their effectiveness over the long term? 
  
  After diagnosis at 35, I've found Ritalin to be very effective, but it's quite tedious to manage doses. And I need to have a break every 5-7 days and have low or no dose. As such, sometimes it feels great, and sometimes I feel like it isn't working.
  
  Is it common for medicines to become less effective over the medium/long term, or is it more likely that one simply gets a better feel or awareness for when their brain is and isn't concentrating or focused, and is able to more effectively be self aware of inattention?
Answer: Many stimulant-treated people with ADHD report that, after some time on the medication, it seems to not work as well. Despite this observation, physiological tolerance to stimulants has not been convincingly demonstrated. Physiological tolerance occurs when signaling molecules in the brain change in response to the medication in a manner that makes the meds less effective. There are several reasons why stimulants may lose their effects over time. As we age, especially through adolescence and young adulthood we face larger and more complex challenges to our executive functions. These increased challenges can worsen ADHD symptoms. For others, they may have had a very good initial experience with medications improving symptoms but may not have realized that some milder symptoms remained. As patients learn about ADHD and their situation, they come to become better observers and see symptoms or impairments they had not noticed before. The best way to deal with this issue is to describe your experience to your health care provider and ask them what is best for your unique situation.
content: Q: Do medicines retain their effectiveness over the long term? 
  
  After diagnosis at 35, I've found Ritalin to be very effective, but it's quite tedious to manage doses. And I need to have a break every 5-7 days and have low or no dose. As such, sometimes it feels great, and sometimes I feel like it isn't working.
  
  Is it common for medicines to become less effective over the medium/long term, or is it more likely that one simply gets a better feel or awareness for when their brain is and isn't concentrating or focused, and is able to more effectively be self aware of inattention?
   Ans: Many stimulant-treated people with ADHD report that, after some time on the medication, it seems to not work as well. Despite this observation, physiological tolerance to stimulants has not been convincingly demonstrated. Physiological tolerance occurs when signaling molecules in the brain change in response to the medication in a manner that makes the meds less effective. There are several reasons why stimulants may lose their effects over time. As we age, especially through adolescence and young adulthood we face larger and more complex challenges to our executive functions. These increased challenges can worsen ADHD symptoms. For others, they may have had a very good initial experience with medications improving symptoms but may not have realized that some milder symptoms remained. As patients learn about ADHD and their situation, they come to become better observers and see symptoms or impairments they had not noticed before. The best way to deal with this issue is to describe your experience to your health care provider and ask them what is best for your unique situation.