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Concerta Withdrawal Symptoms, Timeline, and Treatment

This entry was posted in ADHD Medication and tagged on by .
Medically Reviewed Fact Checked

Last Updated on May 22, 2023 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

The FDA approved Concerta in 2000 to treat attention deficit hyperactivity disorder (ADHD). The active ingredient, methylphenidate, is a stimulant that has a high risk for abuse and dependency, especially if taken in high doses, and over a long period of time.

Concerta is different from some other ADHD drugs because it is a time-released, rather than an immediate-release medication. We invite you to use this guide to understand more about safe Concerta withdrawal and the best ways to avoid Concerta withdrawal symptoms.

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Concerta users may be interested to know that Alternative to Meds Center has provided nearly 20 years of drug-free and science-based natural remedies for those looking for effective, natural remedies rather than continuing to be medicated. Our medically supervised programs are aimed at medication reduction combined with strategies to lessen original symptoms. We have answers for you here. You may also be interested in our independently researched evidence showing the remarkable outcomes of our clients, over nearly 2 decades now. Many of our staff have found relief in similar ways, and are dedicated to providing these life-changing treatments to our clients.
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What is Concerta?

concerta's effects on central nervous systemThe prescription drug Concerta stimulates the central nervous system (CNS). The FDA approved this medication to treat ADHD for those aged 6 to 65. Concerta works as an extended-release medication so that a dose may last up to 12 hours. Often, this medication is prescribed for very long periods of time. Unfortunately, few studies exist addressing the long-term use of Concerta or what happens during and after Concerta withdrawal.1,18,19

Concerta targets 2 main natural neurotransmitters: dopamine and norepinephrine. Dopamine is the “reward” chemical that increases electrical conductivity in the heart, resulting in increased heart rate and blood flow. Other functions of dopamine include focusing attention, memory, planning, and executive functions like decision-making and organizational skills. Falling in love, hugging a baby, physical exercise, and winning the lottery are examples of things that can initiate a pleasurable surge of dopamine.15

Norepinephrine is a form of adrenaline, a natural hormone that at low levels increases blood flow, and at higher levels, constricts blood flow. Adrenaline activates the “fight-or-flight” response when acute stress occurs. Adrenaline also causes bronchial dilation, allowing for the expansion of the lungs, and increased oxygenation. Meeting a bear in the woods would signal a surge of adrenaline so you’ve got the oxygen and energy necessary to quickly run away from the danger. An extremely high volume surge of adrenaline could also initiate cardiac arrest if the shock is severe enough.16,17

The mechanics of methylphenidate, the active drug, act in similar ways as cocaine and other stimulants. Over time, users can build up a tolerance to the drug, requiring them to take additional or higher doses for the same effect. Long-term use causes dependence to develop. Like many other stimulant drugs, with or without a prescription, there is a high risk of developing acute tolerance, drug dependence, and addiction over time. The black box warning advises of the risk of marked tolerance and dependence, psychotic episodes, with varying degrees of abnormal behaviors.1,2,14

Hence, the DEA classified Concerta as a Schedule II controlled substance because of these risks.3

Concerta Withdrawal Symptoms

A person may have been prescribed Concerta beginning in childhood and continuing through adolescence, even into adulthood for long-term treatment of ADHD or other uses. During that time, the body becomes accustomed (tolerant) to the effects of the drug. Taking methylphenidate over time hijacks the body’s own response systems which now rely on the drug to manipulate accumulations of dopamine and norepinephrine.

However, if the drug is discontinued abruptly, the body can have a difficult time adjusting, almost like turning off the house lights and disrupting the entire electrical wiring system.4 The drug’s label reports that Concerta withdrawal can cause a person to experience a wide range of reactions, and some studies have reported specific examples including what are termed rebound symptoms that are listed below.1,18

Concerta withdrawal symptoms and effects can include:
  • concerta withdrawal symptomsSevere depression
  • Involuntary movement disorder
  • Psychiatric adverse events
  • Psychomotor agitation (pacing, rapid talking, etc.)
  • Priapism — lingering, painful penile erection, sometimes requiring surgery
  • Paranoia
  • Fatigue
  • Scattered attention
  • Lack of motivation
  • Decreased energy
  • Insomnia
  • Vivid, unpleasant dreams
  • Hypersomnia (sleeping for abnormally long periods of time)
  • Irritability
  • Melancholia
  • Increased appetite
  • Suppressed growth rates begin to catch up in young persons*
  • Weight normalizes if weight loss occurred under medication

*According to the National Institute for Health and Care Excellence (N.I.C.E.) weight loss and suppressed growth can begin to normalize by stopping the medication.19

Concerta Withdrawal Timeline

Not everyone experiences withdrawal syndrome exactly the same way. However, withdrawal symptoms such as severely depressed mood, heightened anxiety, and fatigue typically start within 24 hours of the last dose. The withdrawal timeline is similar to amphetamine withdrawal because methylphenidate and amphetamine share some pharmacological properties. The withdrawal syndrome will depend on many factors such as general health, age, dosage, length of time used, and others. Protracted or post-acute withdrawal symptoms (PAWS) such as dysphoria — a profound state of dissatisfaction or unease — can continue for much longer.4

The most severe symptoms, including intense anxiety, mood swings, and irritability, are most likely to appear from the second day onward. According to published research, Concerta withdrawal symptoms and rebound symptoms may persist for weeks or months after cessation.18

Within 24 hours of taking the last dose

  • After dependence has developed, rebound and other symptoms may emerge following abrupt cessation. (See list above and references below.)

2-7 days

  • Concerta withdrawal symptoms may worsen for some and may become milder for others. Studies have shown increased anxiety and sensitization of neuron responses in certain parts of the brain after sudden withdrawal of methylphenidate.11

8-21 days and on

  • Withdrawal symptoms such as dysphoria may continue past seven days especially if methylphenidate was used or abused at high dosages and for long periods of time. Please beware that other psychiatric symptoms can include extreme depression, psychoses, episodes of panic, manic states, delusions, heightened anxiety, and other schizophrenic symptoms. For those with suppressed growth and weight, these factors have begun to normalize after appetite and other factors begin to improve.19

For more info see the research of Morton et al., and Ferreira et al at the end of the article.11,20

Concerta Withdrawal — the Concerta Crash

Although people use the phrase “Concerta crash” interchangeably with “Concerta withdrawal,” the terms refer to a phenomenon where the effects of a daily dose can begin to diminish. The term may have been borrowed from colloquial literature on methamphetamine abuse, where a “crash” involves days of sleeping after a days-long binge episode. Although there are similarities, the term does not accurately describe a “Concerta crash” as Concerta is not typically used as a “binge” drug but is used on a once-daily basis.

Concerta Crash Symptoms

concerta crashIn medical literature, stimulant drug withdrawal is often described in 3 phases: the “crash,” “withdrawal,” and “extinction phase.” Concerta withdrawal follows a somewhat similar pattern. First is the immediate “crash” which may cause symptoms to rebound suddenly and often at a higher intensity than prior to medication, as the level of active ADHD medication or the CNS response to it diminishes.

Some immediate-release ADHD medications, such as Ritalin, require several doses each day, but other stimulant drugs, such as Concerta and Adderall XR©, provide an extended release of the medication with just one dose daily. The effects of Concerta may last up to 10 to 12 hours, or the drug may “wear off” much sooner than that. This is also called inter-dosing withdrawal. Symptoms may rebound before the next dose, when the response of dopamine, norepinephrine, or other neurotransmitter levels drops off, often steeply.4,13

As a drug’s effects on the CNS wear off, withdrawal symptoms can surface. In the case of Concerta, these can emerge rapidly and unexpectedly, even though it has been designed to be a long-lasting drug. This phenomenon is thought to occur because the body and the CNS have the capability to adapt to the presence of drugs in the system and this adaptation can leave the CNS in a dysfunctional state after Concerta withdrawal.

Both tolerance (diminished effects over time) and withdrawal are the results of neuroadaptation over the course of drug treatment.

Some of the symptoms you might experience include:

  • Anxiety
  • Cravings
  • Difficulty focusing
  • Fatigue
  • Irritability
  • Sadness

Concerta Crash Timeline

Because Concerta is a timed-release prescription medication, Concerta releases gradually into your system over a period of hours. The biggest portion of that release occurs at the outset, with 22 percent of the drug entering the system in an immediate release and the rest at a controlled rate.6

Depending on how your body reacts, the drug’s effects may continue for 6, 10, or 12 hours. The drug effects may wear off much earlier, and one may experience rebound symptoms that may be more intensified than the original symptoms prior to medication.

Obtain medical advice about your options with a trusted healthcare provider before altering your routine, including changing dosage and timing. You may wish to discuss different treatment options with your physician that are drug-free.5

Adverse Side Effects of Concerta

Patients are sometimes not informed of reactions they may experience while taking the drug. Adverse effects occur while taking the drug. A massive review of studies published in the Cochrane Database of Systematic Reviews found that more than half the study participants experienced one or more adverse effects. Animal studies as well as human studies have helped isolate the longer-term effects of methylphenidate, which are important to understand in treating Concerta withdrawal safely and effectively.10-12

There is a wide range of potential adverse effects of Concerta. Some of the most commonly reported reactions are listed below.1


  • Cardiac disorders, such as tachycardia and palpitations
  • Difficulty breathing/shortness of breath
  • Gastrointestinal disorders, such as constipation, vomiting, and nausea
  • Lethargy
  • Increased blood pressure
  • Seizures and tics
  • Vertigo
  • Dizziness and blurred vision


  • Anxiety
  • Depression
  • Insomnia
  • Agitation
  • Aggression
  • Irritability
  • Nervousness
  • Restlessness
  • Panic attacks

Concerta Withdrawal Treatment Options

holistic concerta withdrawalMany people find it difficult to stop using Concerta without the support of a properly managed treatment program in place. Experts recommend gradual withdrawal from Concerta in an inpatient setting, where professionals are on hand to closely monitor the client, and avoid further health risks.

Alternative to Meds Center offers treatment that provides careful and gradual withdrawal for adults who wish to discontinue Concerta or other drugs safely, in a relaxed and compassionate inpatient setting. Over forty highly trained staff members, including medical doctors, nurses, practitioners, and other caregivers remain on hand for round-the-clock client care.

Our medically supervised Concerta withdrawal program is based largely on the principles of Orthomolecular Medicine, which refers to the correction of diet and nutrition needs, and we focus on lab testing for developing the best way forward for each unique individual. You can review the wide range of holistic treatment modalities used at the center on our services overview pages. Neurotransmitter rehabilitation, neurotoxin cleansing, proper diet, exercise, and many other protocols are used for comfortable, and effective Concerta withdrawal and recovery.

Final Thoughts

Concerta is associated with a high potential for tolerance, and adverse and unpredictable reactions during withdrawal, including psychiatric adverse events.

Please remember, one should not stop taking Concerta or any stimulant drugs like methylphenidate suddenly. Alternative to Meds Center offers holistic, caring treatment under medical oversight for a comfortable Concerta withdrawal experience. Call us today to find out more about how our Concerta withdrawal program may be the one you have been looking for, for true recovery.


1. FDA drug label Concerta (methylphenidate HCI) extended-release tablets [initial approval 2002] [cited 2023 May 19]

2. National Institute on Drug Abuse. “Prescription Stimulants Drug Facts.” [cited Mar 17, 2022]

3. DEA publication, Classification of Methylphenidate. [published July 2019] [cited 2023 April 6]

4. Grau-López L, Daigre C, Mercado N, Casas M, Roncero C. Dystonia in Methylphenidate Withdrawal: A Case Report. J Addict Med. 2017 Mar/Apr;11(2):154-156. doi: 10.1097/ADM.0000000000000279. PMID: 27926589. [cited 2023 May 18]

5. Caye A, Swanson JM, Coghill D, Rohde LA. Treatment strategies for ADHD: an evidence-based guide to select optimal treatment. Mol Psychiatry. 2019 Mar;24(3):390-408. doi: 10.1038/s41380-018-0116-3. Epub 2018 Jun 28. PMID: 29955166.[cited 2023 April 6]

6. National Center for Biotechnology Information, U.S. National Library of Medicine. “A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder.” [cited Feb 9, 2022]

7. Morton WA, Stockton GG. Prim Care Companion J Clin Psychiatry. “Methylphenidate Abuse and Psychiatric Side Effects.” [cited Mar 17, 2022]

8. Prousky J. “The Treatment of Pulmonary Diseases and Respiratory-Related Conditions with Inhaled (Nebulized or Aerosolized) Glutathione.” [cited March 20, 2022]

9. Tomkins DM, Sellers EM. CMAJ. “Addiction and the brain: the role of neurotransmitters in the cause and treatment of drug dependence.” [cited March 20, 2022]

10. Storebø, O. J., Pedersen, N., Ramstad, E., Kielsholm, M. L., Nielsen, S. S., Krogh, H. B., Moreira-Maia, C. R., Magnusson, F. L., Holmskov, M., Gerner, T., Skoog, M., Rosendal, S., Groth, C., Gillies, D., Buch Rasmussen, K., Gauci, D., Zwi, M., Kirubakaran, R., Håkonsen, S. J., Aagaard, L., … Gluud, C. (2018). Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents – assessment of adverse events in non-randomised studies. The Cochrane database of systematic reviews5(5), CD012069. [cited 2023 April 6]

11. Ferreira R, Bassi GS, Cabral A, Nobre MJ. Withdrawal from methylphenidate increases neural reactivity of dorsal midbrain. Neurosci Res. 2010 Dec;68(4):290-300. doi: 10.1016/j.neures.2010.08.009. Epub 2010 Sep 9. PMID: 20832433. [cited 2023 April 6]

12. Schmitz F, Pierozan P, Rodrigues AF, Biasibetti H, Grunevald M, Pettenuzzo LF, Scaini G, Streck EL, Netto CA, Wyse ATS. Methylphenidate Causes Behavioral Impairments and Neuron and Astrocyte Loss in the Hippocampus of Juvenile Rats. Mol Neurobiol. 2017 Aug;54(6):4201-4216. doi: 10.1007/s12035-016-9987-y. Epub 2016 Jun 21. PMID: 27324900.[cited 2023 April 6]

13. Lerner, A., & Klein, M. (2019). Dependence, withdrawal and rebound of CNS drugs: an update and regulatory considerations for new drugs developmentBrain communications1(1), fcz025. [cited 2023 April 6]

14. Swanson J, Gupta S, Guinta D, Flynn D, Agler D, Lerner M, Williams L, Shoulson I, Wigal S. Acute tolerance to methylphenidate in the treatment of attention deficit hyperactivity disorder in children. Clin Pharmacol Ther. 1999 Sep;66(3):295-305. doi: 10.1016/S0009-9236(99)70038-X. PMID: 10511066. [cited 2023 May 18]

15. Sonne J, Goyal A, Lopez-Ojeda W. Dopamine. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: [cited 2023 May 18]

16. Smith MD, Maani CV. Norepinephrine. [Updated 2022 May 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: [cited 2023 May 18]

17. Dalal R, Grujic D. Epinephrine. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: [cited 2023 May 18]

18. Boesen, K., Paludan-Müller, A. S., Gøtzsche, P. C., & Jørgensen, K. J. (2022). Extended-release methylphenidate for attention deficit hyperactivity disorder (ADHD) in adultsThe Cochrane database of systematic reviews2(2), CD012857. [cited 2023 May 18]

19. National Institute for Care in Health Excellence, Recommendations: ADHD diagnosis and management [2018 Mar 14] [cited 2023 May 18]

20. Morton, W. A., & Stockton, G. G. (2000). Methylphenidate Abuse and Psychiatric Side EffectsPrimary care companion to the Journal of clinical psychiatry2(5), 159–164.  [cited 2023 May 19]

Originally Published July 28, 2021 by Diane Ridaeus

This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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Concerta Withdrawal Symptoms, Timeline, and Treatment
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