Dopamine rebound after stimulant wear-off: real or myth?

Just saw a patient describe feeling "worse than baseline" every evening when their meds wear off, and it got me wondering about the neurochemistry here. Are we seeing actual dopamine depletion, or is this just contrast effect from returning to untreated state?

That "worse than baseline" phenomenon is fascinating — Volkow's PET studies suggest it's actual dopamine receptor downregulation, not just psychological contrast. The brain temporarily reduces baseline dopamine production in response to external stimulation, creating genuine neurochemical rebound for 2-4 hours post-washout.

Okay so this explains why my patients keep saying they feel "more ADHD" in the evenings than they did pre-medication — we're creating a temporary dopamine deficit below their already-low baseline. Makes me wonder if evening boosters aren't just extending coverage, they're preventing actual neurochemical withdrawal.

That neurochemical withdrawal piece explains so much - I have patients who describe evening crashes as "feeling more scattered than before I ever took medication." The Volkow data suggests we're not imagining this rebound effect. Maybe we need to warn patients about temporary below-baseline periods instead of just saying meds "wear off."