Cyclic Dosing for ADHD Medication

I am not a doctor or a medical professional. All information provided in this episode is meant to act as a springboard for you to do your own research and speak to your prescribing practitioner about cyclic dosing of your ADHD Medication.

Resources mentioned:
Study: Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage
LetterLife Blog: ADHD Medication Across the Menstrual Cycle
ADDITUDE article: The Menstrual Cycle Impacts ADHD Symptoms
Study: The female side of pharmacotherapy for ADHD - A systematic literature review

Article I wrote for LetterLife: "Empowered to get cyclic dosing"

Episode  "ADHD and Estrogen 101"

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Transcript

 Okay friends. So this week we are talking cyclic dosing

I'm going to attempt to keep this concise. And to break down what cyclic dosing is. Remind you also a little bit about our cycle, but if you want to know more, you can jump back to the ADHD and estrogen 1 0 1 episode. I will link that in the show notes.

And I'll give you a few tips about how you can track and also then advocate for yourself for cyclic dosing with your prescribing provider. And this is actually going to be the first longer form video. That I've put up on YouTube. So if you haven't yet head over to YouTube go to attempting motherhood and subscribe, to get all of the videos that are to come. 

Let's jump in with what our cycle is and why we would even want cyclic dosing.

As females, we have a monthly cycle, right? From the time you hit puberty until menopause, which again is that one day when you have not had a bleed for 12 months, That whole timeframe in between.

Is when we are experiencing a monthly cycle now. Of course. Some are not always to a calendar. There are a lot of different conditions that can impact your cycle. 

And it is a bit different if you are on hormonal contraception, because that removes ovulation and in theory, Smooths out.

Your hormonal fluctuations that would naturally happen. Over the course of your cycle over the month.

What we know is during our cycle, our hormones. And the one that we really want to focus, the emotion on here is estrogen. So during the month, our estrogen peaks and troughs, it rises and falls. 



It starts at a baseline low on day, one of your cycle, which is day one of your bleed. 

And it slowly starts to rise. 

And it comes up and it peaks at ovulation, which is typically around a 14 in a 28 day cycle. Obviously everyone's cycle may be variable and it might not be exactly 28 days, 

but that is the commonly accepted kind of average for a cycle.

For the purpose of this discussion, it's also a nice round four weeks. 

So after that day, 14 peak of ovulation of estrogen. At that point, it is going to drop down. I often say it plummets. And you will get then another slight uptake a few days later. Anywhere between kind of 19 to 22. Where it drops again and comes to that baseline to where you restart a cycle. 

Okay. That's great. What does this mean as far as dosing and why we should adjust or stimulant medication?

We know our stimulant medication works in large part with our dopamine receptors in our brain.

And the reason that our cycle matters is because estrogen helps dopamine be synthesized. By your body. What does that mean? It means it helps dopamine work better in your body. So when you have low estrogen, there is not as much of it to go around to help the dopamine work well. 

And this is going to be the case, whether or not you are on medication, but it is. Exacerbated, if you are on medication, because through the month, assuming you take your medication every day. You are having this assistance from your stimulant medication that works on your dopamine receptors in your brain. When you have low estrogen, that dopamine is not able to work as well.

Unfortunately, a lot of doctors, not just male, but we will also say a lot of male doctors.  But a lot of doctors in general seem to be unaware of this relationship between estrogen and dopamine, which is a shame because there's actually studies out there to back it up. 

One of them, which I will put in the show notes. Available for free on pub med.

Titled pharmacological therapy in ADHD, pre-menstrual adjustment of psychostimulant dosage.

And that's a lot of big words to say. There has been someone who has done a study to figure out if it is beneficial to adjust for.

Change your dosage. During that period menstrual phase. Of your cycle.  Most of us know that as week four or your PMs week.

And as I've just broken down. We know that estrogen is not just low in week four. It remains low for at least the first few days of week one.

What that means is it could continue to be beneficial to adjust your medication to a slightly higher dose to offset that low estrogen state in your body

during those first few days of week one.

 I have posted about this a number of times on the different social media platforms. If you don't follow me, it's SamAttemptsMotherhood.  And I always get people saying.  My doctor won't do this. Or how do you get this? Because it's a controlled substance, because keep in mind, we are specifically talking about stimulant medication. 

So that's going to be something like.

Dexamphetamine Liz dexamphetamine methylphenidate. Anything that falls under the stimulant umbrella and they all have different brand names. You may use the brand new made, use generic, but he essentially is all the same thing.

But very much how your doctor is able to titrate you and find a dose that feels adequate and sufficient for you. They can do this. With the medication. To be variable. 

Through the month.

As an example, this may look something like the regime that I have that I've come to with my doctor. Of I take a extended release, a Vyvanse. Every day. And then on those days where I feel like I need more.

I add an immediate release. Medication as well. Alternatively, I could just take slightly higher dose of extended release during those days, but for me, 

because my day to day can look very different from month to month. I've decided that using the immediate release only for those times when I really feel like I need that extra little oops. Is the best course of action for other people, you might have a much more predictable day to day to week to week to month, which means you might know that absolutely. 

On days 22. To reset up to day four and your next cycle, you might want all the time. A higher dose of say extended release.

So the nuance and the specifics of it are going to be something that you and your doctor or your you and your prescribing practitioner have to come to an agreement on, but. The baseline, being that as our cycle, specifically, estrogen peaks and troughs, that's going to mean our stimulant medication works better and not as well.

During the month.

 As we approach this conversation with our prescribing practitioners. It could be very easy for them to dismiss you. Either because they are not educated in which case simply provide them with the studies linked in the show notes, but also. Ask them to go away. And do more research because the studies exist and by them dismissing you and telling you that it's simply not an option or even worse than I've heard. Being told that your hormones make no impact at all. They need to continue their own education. 

What we're looking for here is much more precision medicine instead of a blanket approach to everybody because we know our hormones impact our ADHD. And we know.

Then a one size fits all approach does not work for us.  How can you advocate for yourself? Well, like I said, there's studies linked in the show notes. I also use the letter life app to both cycle track an ADHD symptom track.



So you may have noticed through some of the content as well as the ad that runs during this podcast. 

I have a relationship with letter life, but unlike most ads that run during podcasts, this is a bit of a unique one. Because they don't pay me. Instead, I'm using my platform to help amplify.

Their reach, because I think it's such a genuinely good product. It is something that I use. Every single day. I love that it is developed by ADHD people, specifically, ADHD women. Who are researchers, scientist, psychologist, gynecologist. And the list is growing as far as the professionals that are involved on the back end.

 And unfortunately for my bank account. I believe in authenticity above all else. So I would rather. Promote something that I actually believe in, even if they're not paying me versus promote something that I don't believe in just to get a bit of a paycheck.

As I said in LetterLife you can both cycle track. And. Bonus. It is super ADHD friendly. It will prompt you and say, Hey, you were supposed to start your period today. Did you? And you put yes or, oh, I started it yesterday or, oh, no, it hasn't come yet.  

They also send reminders. She actually do the check-in daily.

Which absolutely helps me because there are so many times where I forget, but the insights that I get from it is genuinely valuable. And in that check-in, you are gauging your symptoms. So while we know that low estrogen can add to brain fog can potentially add to irritability, 

can mean that our medication isn't working as well. On the flip side of that high estrogen. Remember that comes at that peak at ovulation, typically around day 14. That's going to mean that our ADHD symptoms, especially around things like impulsivity and if your. Are a little bit more of the hyperactive presentation around hyper activity might be.

A bit amplified during that time. 

 So being able to track that and have those check-ins I find is really valuable. You can also use. The health app on apple, you can use something like wild AI, there's natural cycles. There are a ton of apps that you can use just for cycle tracking. So you can have a better way to keep track of. Oh, okay. 

I'm going into week four. I know my medication's not going to work as well. I know

my cognitive symptoms might present a little bit more intensely. And so on.

And if I'm being really honest and really realistic,   When we look at cyclical dosing. If we're truly, truly coming at it from a precision medicine standpoint, it most likely wouldn't be toggling between one of two doses. It would probably be much more variable throughout the month, but.

That's not realistic for most of us, especially because you have ADHD. And that executive functioning that would be required in that alone is an absolute nightmare. Just even let myself think about.  



So, however you do decide to track this is going to help be that evidence, or I guess as like the hip kids were saying your quote unquote receipts, when you go to the doctor and say, I want cyclic dosing, and this is why here's the history of how effective or not my medication has been through my cycle. 

Here is how my symptoms have been presenting worse or more controlled. 

And even if that simply just looks like a handful of notes, either on actual paper or in your notes app, having that information is invaluable in trying to figure out the best strategy and the best medication plan for you as an individual with ADHD.  

 As I said, this one is short. If you want a more in-depth breakdown of specifically how estrogen impacts our ADHD. And that's regardless of whether you're medicated or not. Jump over to the ADHD and estrogen 1 0 1 episode. If you have any questions, please feel free to contact me. This is obviously something that impacts my life, but also something that's become a bit of a special interest. 

So I have spent. Hours and hours, hours. Researching and would love to continue spending more hours researching. And better understanding this very nuanced. But also able to be simplified interaction between estrogen and our ADHD.

 I so appreciate you taking the time to listen today. If you haven't yet. Subscribe. And if you have someone you think would also find this information beneficial, go ahead and share the episode with them.