Left with Less on the Weekends

Note: the question was edited for context and clarity

Dear Dr. Deb,

My husband is currently struggling with executive functioning and emotional dysregulation disorder related to ADHD. He’s been working with his doctor to get his medications just right, and finally, after several combinations, it looks like he’s found one that works really well.

By well, I mean that when he is on his meds, he is a conscientious, loving, patient man. But when he misses taking them, he is short-tempered, has no filter, and can’t concentrate. The trouble is, he says the meds make him feel “not like himself,” so he only wants to take them during the week when he needs to work. On the weekends, he often skips them or “forgets” to take them until it’s too late (he gets insomnia if he doesn’t take them early in the day). My kids and I are then left dealing with his issues.

I feel like it’s unfair that we never get his best self on the days we spend with him. But he feels like his family should understand that he doesn’t want to be medicated 24/7. When I try to explain that it’s hard on us deal with him when he’s scatter-brained and temperamental, he gets defensive and says I only “love him when he’s on drugs.” 

What should I do?

Yours,
Deprived and Disappointed

Dear Deprived,

There’s no question that the distractibility, disorganization, and impulsivity of attention deficit hyperactivity disorder (ADHD) can cause problems in many areas of adult life. These symptoms, however, can be particularly damaging when they affect your marriage.

The good thing is that your husband’s ADHD disorder has been properly diagnosed and he has found medication that works for him so he can function at work. For many people with ADHD, the trial-and-error with treatment is a lifelong struggle and highly frustrating.

The downside is that he feels like he needs a break from his meds on the weekends when he’s at home with you and the children. Which means he’s probably prone to emotional overreaction and irritability.

As frustrating as the experience is for you and the kids, there are two things to consider:

1. you and your husband both feel misunderstood by the other, and
2. your dilemma and your husband’s ADHD are both complex issues, and so is the process for resolution.

Your husband does have a responsibility to you and your children. You need his positive presence as much as he needs you all to understand and adjust to his situation. When you’re part of a team, your actions affect the team. If the team’s success is in jeopardy and there’s a way to improve it, wouldn’t it make sense to do everything you can? This is a major factor for him to consider when deciding whether to take his medication.

But as I said, the resolution isn’t that simple. It’s a strong statement for him to say that you only “love him when he’s on drugs” with the pain he is causing his family when he is off his meds.

Here’s where you come in: it may be worth asking him what specific side effects he’s feeling whenever he takes his meds. As you mentioned, he said that he doesn’t feel like himself when he’s on them. Why not offer to consult his doctor together to show your support? You both need to ask the doctor about alternatives that will make your husband feel more comfortable, and, most importantly, ask whether it’s safe for your husband to go off his medications on a whim.

In a nutshell, transforming your relationship depends on several things.

For your husband, this means acknowledging that his ADHD symptoms are interfering with your relationship. He must learn how to better manage his symptoms.

For you, step one is reminding yourself that you can’t control your spouse, but you can control you own actions. While I don’t have an idea of how you deal with confrontations with your husband, I recommend that you avoid any verbal attacks or nagging, as neither will get positive results.

Finally, I urge both of you to explore other effective ADHD treatment options. Neurofeedback, biofeedback, neurostimulation technology, and cognitive behavioral therapy are techniques that treat ADHD without medication.

Just because your husband has ADHD doesn’t mean you can’t have a balanced, mutually fulfilling relationship. The key is to work together as a team. A healthy relationship involves give and take and being “all in” on the partnership.

Sincerely,
Dr. Deb