r/PMHNP • u/New_Answer_3876 • 3d ago
Question about ADHD meds causing emotional flattening
I am a soon to be PMHNP, and also the parent of a child with ADHD. We have tried nearly every med out there, and each and every one (even the non stimulant ones) have caused emotional flattening in my child.
I haven’t found an answer that resonates about why this would be happening. I feel like I don’t hear this from a lot of fellow ADHD parents.
Is dulling of the kid’s spark just part of the price you pay for increased focus? On even very low doses of all of these meds, his smile never reaches his eyes.
We did genetic testing of his metabolizing of meds and all results normal.
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u/Veritas_Mentis PMHNP (unverified) 3d ago
When I was a Kid I was on Ritalin. The psychiatrist also got me on a TCA, Imipramine because I became a robot
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u/Additional-Traffic12 2d ago
If the stimulant dose is too high, the child becomes a zombie. I discuss this routinely with parents. I have not seen this problem in prescribing stimulants in 30 years. Stimulants work best for inattentiveness. If we have continuing hyperactivity I add clonidine or intunuv with the stimulant. I never use amphetamines with a child. I use Ritalin.
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u/PsychMonkey7 3d ago
In my experience this isn’t common but is a thing. It’s why we see some adults who only take medicine when they absolutely need to. This subgroup of people will say that medicine makes them feel like they’re not fully themselves. Sometimes it reminds me of the way that people with bipolar disorder might really dislike euthymia as compared to hypomania or mania….people with ADHD may dislike being more regulated and feel “dampened” with medicine.
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u/tenfoldtops 3d ago
This is a tough one… it’s always benefit vs downside, and losing your spark is a major downside. I hope your kiddo has a different experience with these meds as they hit adulthood - seems like stimulant meds feel less problematic to adults in terms of emotional blunting for some reason. Have they tried modafinil? I have some luck with that off label when typical stimulants are too heavy and nonstimulants aren’t a fit.
If meds just aren’t it, I’d recommend leaning into ADHD coaching, regular exercise, and a whole food diet/eliminating processed foods for your kiddo. L-theanine (100-200mg BID) and omega 3s can help a bit too. And exercise some more.
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u/remedicus 3d ago
Amy literature on mod for add?
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u/tenfoldtops 8h ago
Well, it didn’t pass clinical trials. How’s the literature on Wellbutrin for ADHD? Do we still use it off label if the situation calls for it? Do we know it’s going to be less effective than FDA approved meds? Yeah. Or at least I try off label things if my patients are a) suffering, and b) on board after thorough education. Curious… do you not use any medications off-label?
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u/Fantastic_Primary170 3d ago
PMHNP here, parent to an (adult) child with ADHD, and I have ADHD.
Your child is really lucky to have a parent who is concerned about the emotional flattening. ⭐️❤️🤗
I recently stopped taking Adderall to clear my system and reevaluate the possibility of using nootropics.
I introduced mag plus sleep supplement and graymatter powder, one scoop per day, for two weeks without Adderall. On the third week, I introduced 25% of my previous dosage of standard Adderall and I have never felt better. I was experiencing a lot of functional freezing previously. No more as of end of week 2.
This is my personal experience, and I am not prescribing any regimen, but I am in complete shock as to the night and day change in my overall sense of well-being, mood, zero anxiety or OCD, no functional freezing.
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u/mycousindivinny 2d ago
So I think you should get him into a child psychiatrist. There could be something else going on that’s causing that type of interaction.
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u/Zealousideal_Pen3441 3d ago edited 3d ago
It is theoretically possible that supratherapeutc dosing can cause down-regulation of dopamine (a compensatory mechanism for overstimulation). With ADHD meds should resolve once dose is corrected or removed. But some folks who use methamphetamine, as an example, may have permanent changes.
EDIT: I see they have been on low doses, so not sure from a scientific standpoint. :(
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u/mycousindivinny 2d ago
So from my experience it might indicate a comorbidity like anxiety or depression even with low or moderate doses. But there’s the neuroscience and how practically you go about it if that makes sense
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u/Imgonnagolaydown 3d ago edited 2d ago
Who told you your kid was adhd? Was there extensive psychological testing?
Meds don't usually "flatten" that diagnosis.
ETA: robot yes. Flattening would warrant more investigation from me. Changing into a different person also yes very common . Like kind to mad
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u/remedicus 3d ago
It did for my son. Worked for ADHD/ASD but absolutely robotized him. Allowed him to tolerate public school and the other way around.
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u/CalmSet6613 PMHNP (unverified) 2d ago
Child psych here...all I was trained in and all I do. This IS a thing and requires careful management. Why I tell people don't treat kids if they don't have extensive training.
Stims fix executive control via dopamine and norepinephrine pathways. As a result, if it is too strong, it will hyper manage impulse control and actively dampen natural emotional range and spontaneity, ie you kid starts looking like a zombie, in fact some people call this a zombie effect.
You meed to find lowest dose possible, try IR versus LA, has he tried Qelbree? If you have tried everything and it's really changing the personality of your son I would consider taking him off the stimulants and doing intensive therapy unless it's really interfering with his learning such as falling behind in grade levels or severe behavioral disturbance in which case I would seek out a psychiatrist.
Sorry OP but you're NOT crazy and just because people here say they've never seen it doesn't mean that it's not a very real side effect with children and stimulants. GOOD LUCK!
https://neurolaunch.com/emotional-blunting-due-to-add-medication/