Harold Robert Meyer
The ADD Resource Center · Reviewed July 23, 2026 · Published July 27, 2026
A reader’s reference to the adverse effects most often seen with the psychotropic medications used in ADHD care and its common comorbidities – and to the difference between an effect that settles, one that stays, and one that is an emergency.
Most people start a psychotropic medication with a single question in mind: will it work. The question that actually determines whether they are still taking it in six months is a different one: what is this going to feel like, and how will I know whether what I am feeling is normal. Nobody hands out that map. The result is that a person quits in week two over nausea that would have resolved in week three, or waits four months to mention a symptom that needed a phone call the same afternoon.
⚠️ READ THIS BEFORE THE TABLE BELOW
This article tells you what to look for. It does not tell you what to do about it.
Every single one of the responses described here belongs to your prescriber, not to you. Do not adjust a dose. Do not skip a dose. Do not split, stop, add, or re‑time a medication on the strength of anything you read here or anywhere else online.
Report every change to your healthcare provider, immediately and without filtering it. Not the changes you think are important. Not the ones you can prove are drug‑related. Every one – physical, emotional, cognitive, sexual, sleep‑related, appetite‑related – that begins or shifts after you start a new medication, change a dose, change a formulation, change a manufacturer, or stop one. You are the only person who can observe these. Your clinician is the only person who can interpret and act on them.
Never stop a psychotropic medication abruptly on your own. Several of the drugs listed below produce serious rebound or discontinuation effects when withdrawn suddenly.
Key takeaway
Adverse effects fall into four groups, and the group matters more than the symptom: effects that resolve on their own within a few weeks, effects that persist as long as the drug is taken, effects that emerge late, and effects that require contact the same day. Knowing which group you are in is a clinical judgment, not a reader’s judgment. Reporting is yours.
Why this matters
Attrition from psychotropic treatment is front‑loaded, and tolerability is a large part of why. Cortese and colleagues, in the largest comparative analysis of ADHD medications, treated tolerability as a primary outcome rather than a footnote precisely because acceptability drives whether a drug is still being taken. A person who understands that nausea usually resolves and that emotional blunting usually does not is in a position to make an informed decision with their prescriber. A person who understands neither simply disappears from care.
Key findings
- Early gastrointestinal effects, headache, and jitteriness typically settle within one to three weeks across most classes.
- Appetite suppression, sexual dysfunction, emotional blunting, and antipsychotic‑related weight gain typically do not settle on their own.
- Some of the most consequential effects appear late (tardive dyskinesia) or only on withdrawal (rebound hypertension, discontinuation syndrome).
- Meta‑analysis does not support the long‑standing belief that stimulants cause or worsen tics.
- If you are uncertain about whether to contact your prescriber, call.
The ten
1. Methylphenidate‑class stimulants
Ritalin, Concerta, Focalin, Metadate, Daytrana, Jornay PM, Azstarys
Common: reduced appetite, delayed sleep onset, headache, stomachache, dry mouth, irritability or tearfulness as the dose wears off, small increases in heart rate and blood pressure, a flattened or “muted” emotional feel.
Usually settles (1–3 weeks): headache, stomach upset, jitteriness, mild nausea.
Usually persists: appetite suppression during the hours the medication is active. Sleep‑onset delay tracks timing and dose rather than duration of treatment. Growth trajectory in children warrants ongoing measurement; the MTA follow‑up found a small average adult height difference among consistently medicated participants.
Not what people expect: a meta‑analysis of 22 placebo‑controlled trials found the rate of new or worsened tics on stimulants essentially identical to placebo.
Same‑day report: chest pain, fainting, breathlessness, new hallucinations or paranoia, severe agitation, cold or discolored fingers and toes, prolonged erection, rapid weight loss.
2. Amphetamine‑class stimulants
Adderall, Vyvanse, Dyanavel, Adzenys, Xelstrym, Evekeo
Common: as above, generally with more pronounced appetite suppression and, for some people, more insomnia and irritability.
Usually settles: headache, nausea, early jitteriness.
Usually persists: appetite suppression, dry mouth, late‑day rebound if coverage does not match the day.
Same‑day report: everything in the methylphenidate list, plus any new psychotic symptoms or manic activation, which are uncommon but require prompt attention.
3. Atomoxetine
Strattera
Common: nausea, reduced appetite, sedation or insomnia, dizziness, dry mouth, early irritability. In adults: sexual dysfunction, urinary hesitancy, modest blood pressure and heart rate increase.
Usually settles (1–3 weeks): nausea and sedation.
Usually persists: appetite reduction, sexual effects in adults, small cardiovascular changes.
Expectation to set: full benefit commonly takes four to eight weeks, so side effects arrive before the effect does. This mismatch is a major cause of premature discontinuation.
Same‑day report: new or worsening suicidal thinking (this carries a boxed warning in children and adolescents), right‑sided abdominal pain, jaundice, or dark urine.
4. Viloxazine extended‑release
Qelbree
Common: sleepiness, fatigue, decreased appetite, nausea, headache, irritability, insomnia, blood pressure and heart rate increase.
Usually settles: somnolence and fatigue often ease over the first weeks.
Usually persists: appetite effects.
Interaction worth naming: viloxazine strongly inhibits CYP1A2, which affects caffeine metabolism and several other medications. Tell your prescriber and pharmacist about everything you take, including caffeine intake.
Same‑day report: new or worsening suicidal thinking (boxed warning), manic activation, marked blood pressure rise.
5. Alpha‑2 agonists
Guanfacine ER (Intuniv), clonidine ER (Kapvay)
Common: sedation and daytime sleepiness (the most frequent effect, usually heaviest in the first two to four weeks), fatigue, dry mouth, low blood pressure, lightheadedness on standing, slowed pulse, headache.
Usually settles: sedation, in most people.
Usually persists: dry mouth, mild cardiovascular effects.
Critical: these must never be stopped abruptly. Sudden withdrawal can produce rebound hypertension and agitation. Any taper is directed by the prescriber.
Same‑day report: fainting, chest pain, very slow pulse, confusion.
6. Bupropion
Wellbutrin, Aplenzin, Forfivo
Common: insomnia, dry mouth, headache, nausea, early anxiety or agitation, tremor, sweating, reduced appetite.
Usually settles (1–2 weeks): early activation, headache, nausea.
Usually persists: insomnia in some people, dry mouth.
Constraints: bupropion lowers the seizure threshold and is contraindicated in seizure disorders and in current or past eating disorders. It is less associated with sexual dysfunction than serotonergic agents.
Same‑day report: any seizure (emergency), severe agitation, new suicidal thinking, rash.
7. SSRIs
Sertraline, escitalopram, fluoxetine, citalopram, paroxetine, fluvoxamine
Common: nausea and other gastrointestinal effects, headache, restlessness or heightened anxiety in the first one to two weeks, sleep changes, sweating, sexual dysfunction, emotional blunting, weight change over months.
Usually settles (1–2 weeks): nausea, headache, early activation.
Usually persists: sexual dysfunction and emotional blunting. These are among the most under‑reported effects in all of psychiatry, largely because people assume they are unmentionable or permanent. They are neither, and there are options – but only if the prescriber knows.
Late or situational: low sodium in older adults, increased bleeding risk with NSAIDs or anticoagulants, discontinuation symptoms on stopping. A 2024 meta‑analysis put the incidence of discontinuation symptoms attributable to the drug itself at roughly 15 percent, with severe symptoms in about one in 35.
Same‑day report: new suicidal thinking (boxed warning applies under age 25, particularly early and at dose changes), manic activation, and the combination of agitation, fever, muscle rigidity, tremor, and confusion, which can indicate serotonin syndrome.
8. SNRIs
Venlafaxine, desvenlafaxine, duloxetine
Common: the SSRI profile, plus dose‑related blood pressure elevation, sweating, and constipation or dry mouth with duloxetine.
Usually settles: nausea, early activation.
Usually persists: blood pressure elevation, sweating, sexual dysfunction.
Distinctive: discontinuation symptoms are more pronounced with venlafaxine than with most SSRIs, and can appear after a single missed dose. If missing a dose produces dizziness or sensory disturbance, report that pattern rather than waiting until a planned taper.
Same‑day report: sustained blood pressure rise, signs of liver problems on duloxetine.
9. Second‑generation antipsychotics
Aripiprazole, risperidone, quetiapine, olanzapine, lurasidone
Common: sedation, increased appetite and weight gain, metabolic changes in glucose and lipids, akathisia (an inner restlessness that is frequently mistaken for ADHD hyperactivity or anxiety), tremor or stiffness, lightheadedness on standing, constipation, and, with risperidone, prolactin elevation producing menstrual or breast changes.
Usually settles: sedation, postural dizziness.
Usually does not settle, and may progress: weight gain and metabolic change. Consensus guidance from the ADA and APA calls for baseline and scheduled monitoring of weight, blood pressure, glucose, and lipids for exactly this reason. This is not a wait‑and‑see effect.
Late‑emerging: tardive dyskinesia, which may not fully reverse. Early reporting matters more here than almost anywhere else.
Aripiprazole specifically: the FDA warns of compulsive gambling, eating, shopping, and sexual urges, which in reported cases stopped when the dose was reduced or the drug discontinued. Family members often notice before the person does.
Same‑day report: high fever with rigidity and confusion (emergency), any new involuntary movement, fainting, new compulsive urges.
10. Mood stabilizers
Lithium, lamotrigine, valproate
Lithium. Fine hand tremor, increased thirst and urination, nausea, weight gain, acne. Requires ongoing blood level, thyroid, and kidney monitoring. The therapeutic window is narrow, and dehydration, illness, or NSAIDs can push levels into toxicity. Coarse tremor, vomiting, diarrhea, slurred speech, unsteadiness, or confusion is an emergency.
Lamotrigine. Titrated slowly for one reason: serious rash, including Stevens‑Johnson syndrome. Any rash during the titration period requires immediate contact, not a wait‑and‑see. Also headache, dizziness, double vision.
Valproate. Weight gain, tremor, hair thinning, sedation, liver and pancreatic risk. Carries substantial teratogenic risk, which makes it a central discussion point for anyone who could become pregnant.
Not in the ten but worth naming: benzodiazepines (sedation, cognitive slowing, tolerance, and a withdrawal syndrome that must never be self‑managed), z‑drugs, trazodone, and melatonin. Each has its own profile, and each belongs in the same reporting discipline.
What to actually do with all of this
Keep a log for the first eight weeks of any new medication or dose change. Four columns: what you noticed, what time relative to the dose, how bad on a one‑to‑ten scale, and how long it lasted. Bring it. Recall over an eight‑week interval collapses toward the last fortnight, and a prescriber reading your log makes a better decision than one reading your memory.
“The people who do best on medication are not the ones with the fewest side effects. They are the ones who report the most, the earliest, and let their prescriber do the adjusting.” – Harold Robert Meyer
Report to whoever prescribed it. If you cannot reach them and the symptom is on a same‑day list, use urgent care or an emergency department. Bring the medication name, dose, and start date every time.
Bibliography
Cohen, S. C., Mulqueen, J. M., Ferracioli-Oda, E., Stuckelman, Z. D., Coughlin, C. G., Leckman, J. F., & Bloch, M. H. (2015). Meta-analysis: Risk of tics associated with psychostimulant use in randomized, placebo-controlled trials. Journal of the American Academy of Child & Adolescent Psychiatry, 54(9), 728–736.
Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., … Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 5(9), 727–738.
Henssler, J., Schmidt, Y., Schmidt, U., Schwarzer, G., Bschor, T., & Baethge, C. (2024). Incidence of antidepressant discontinuation symptoms: A systematic review and meta-analysis. The Lancet Psychiatry, 11(7), 526–535.
Swanson, J. M., Arnold, L. E., Molina, B. S. G., Sibley, M. H., Hechtman, L. T., Hinshaw, S. P., … Kraemer, H. C. (2017). Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: Symptom persistence, source discrepancy, and height suppression. Journal of Child Psychology and Psychiatry, 58(6), 663–678.
U.S. Food and Drug Administration. (2016, May 3). FDA Drug Safety Communication: FDA warns about new impulse-control problems associated with mental health drug aripiprazole (Abilify, Abilify Maintena, Aristada).
U.S. National Library of Medicine. (n.d.). DailyMed: FDA drug labeling.
Resources
From The ADD Resource Center
- Common comorbidities associated with ADHD, along with typical ages of onset
- Is there a definitive test for ADHD?
- When ADHD isn’t ADHD: the Cushing’s syndrome connection you need to know
- ADHD and Polypharmacy: Essential Questions to Ask Your Doctors
External
- DailyMed – current FDA labeling for every medication above, including boxed warnings and full adverse‑reaction lists (U.S. National Library of Medicine; carries no advertising)
- FDA Drug Safety Communications – safety updates issued after approval
The next step
Print the four‑column log described above and start it on the day you begin or change a medication. Bring it to the next appointment, and to the one after that.
About the Author
Harold Robert Meyer is the founder and Managing Director of The ADD Resource Center, established in 1993. A Senior Certified ADHD Coach, author, and international speaker, he co-founded CHADD of New York in 1989, served on CHADD National’s board and executive committee, including as VP Finance, and was elected to lead the Institute for the Advancement of ADHD Coaching. Reach him at [email protected].
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