What happens if you stop taking Adderall (amphetamine and dextroamphetamine) abruptly?

What Happens If You Stop Taking Adderall Abruptly

Abruptly stopping Adderall after regular use will cause withdrawal symptoms including extreme fatigue, mental depression, and sleep disturbances, but these symptoms are not medically dangerous and do not require tapering in most cases. 1

Withdrawal Symptoms from Abrupt Discontinuation

The FDA drug label for amphetamines clearly states that "abrupt cessation following prolonged high dosage administration results in extreme fatigue and mental depression; changes are also noted on the sleep EEG." 1 These withdrawal effects are distinct from the life-threatening withdrawal seen with substances like benzodiazepines or alcohol.

Expected Symptoms Include:

• Extreme fatigue and lethargy - the most prominent withdrawal symptom 1
• Mental depression and dysphoria - can be severe but temporary 1
• Hypersomnia - excessive sleeping as the body rebounds from chronic stimulation 1
• Increased appetite - reversal of the appetite-suppressing effects 1
• Psychomotor retardation - slowed thinking and movement 1

Timeline and Duration

When stimulant medication is discontinued, its effects cease relatively quickly given the short half-life of amphetamines. 2 The immediate-release formulations have pharmacodynamic effects that are gone within 4-6 hours, meaning withdrawal symptoms can begin within hours to a day after the last dose. 2

The withdrawal symptoms typically resolve within days to weeks, though the exact duration depends on the dose used and duration of treatment. 1 One study found that ADHD symptom reduction from 15 months of dextroamphetamine treatment continued even after the drug was stopped, suggesting that not all patients experience severe rebound. 2

Return of ADHD Symptoms

Beyond withdrawal effects, patients will experience a return of their underlying ADHD symptoms. 2 This includes:

• Hyperactivity and impulsivity - may return within hours to days 2
• Inattention - may take longer to become apparent, particularly for the inattentive subtype 2
• Functional impairments - difficulties at work, school, or in relationships that were previously controlled 2

The American Academy of Child and Adolescent Psychiatry notes that monitoring for return of symptoms may require an extended period, as some symptoms manifest more slowly than others. 2

Key Differences from Other Medications

Unlike benzodiazepines, opioids, or antipsychotics, amphetamines do not require gradual tapering for safety reasons. 2, 3 The withdrawal syndrome from stimulants, while uncomfortable, is not medically dangerous and does not include seizures, severe autonomic instability, or life-threatening complications. 1, 4

This is in stark contrast to medications that act on GABA or opioid receptors, where abrupt discontinuation can cause severe withdrawal requiring medical management. 2, 5

Chronic High-Dose Use Considerations

The FDA label specifically mentions that tolerance and "extreme psychological dependence" can occur with amphetamines, particularly with prolonged high-dose use. 1 In cases of chronic intoxication or abuse at doses "many times that recommended," additional manifestations may include:

• Severe dermatoses 1
• Marked insomnia and irritability 1
• Hyperactivity and personality changes 1
• Psychosis (rare with oral amphetamines, but can be "clinically indistinguishable from schizophrenia") 1

Practical Management Approach

For patients discontinuing Adderall:

• Abrupt discontinuation is medically safe for most patients on therapeutic doses 1
• Warn patients about expected fatigue and mood changes to prevent alarm 1
• Plan discontinuation during a period with reduced demands (e.g., not during exams or major work deadlines) 2
• Monitor for return of ADHD symptoms over weeks to months after stopping 2
• Consider non-pharmacological interventions such as behavioral therapy or environmental modifications to manage ADHD symptoms without medication 2

Common Pitfall to Avoid

Do not confuse amphetamine withdrawal with the need for gradual tapering protocols used for benzodiazepines, antipsychotics, or opioids. 2, 3 While those medications require slow tapers over weeks to months to prevent dangerous withdrawal, stimulants do not carry this same risk. The discomfort of stimulant withdrawal, while real, is self-limited and not medically dangerous. 1