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#43: ADHD and Medication | Guest Dr. Sarah Cheyette

#43: ADHD and Medication | Guest Dr. Sarah Cheyette
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It's one thing to digest and go through the emotions of a late in life diagnosis of Adult ADHD but then comes the big question of "should I take meds or not?".   I have heard so many different viewpoints of ADHD medication from - it's a big pharma conspiracy, it takes away your creativity, they don't work, I am scared to try them, to they have been the best thing for me and this list goes on. 

So I decided to bring on an expert in this field and have a candid conversation about ADHD and medication.  In the episode, Dr. Sarah Cheyette paints a very clear picture of this topic.  From when you could consider meds and ADHD to why it may not work for some and works well for others.   I could have talked to her for hours on this topic as she is a wealth of knowledge. 

So if you are considering and have questions about Medication and ADHD treatment this episode is a must listen to.



Sarah Cheyette, M.D., is a pediatric neurologist who specializes in the diagnosis and treatment of ADHD and Autism. She has a private practice in Palo Alto, CA where she counsels and treats kids, teens, young adults, and adults. She also writes about ADHD on Psychology Today and has authored two books on the subject: Winning with ADHD and ADHD & The Focused Mind, with the goal of helping young people with ADHD learn to become independent, strong, and successful. She brings a powerful professional perspective on the benefits and limitations of ADHD medication, and the many behavioral adaptations people with ADHD must embrace to thrive with their condition. She is a popular author and speaker on many topics including ADHD, Autism, the brain, teens, adults with ADHD and Autism, physician updates, neurology, focus issues, and recommendations. Download her free copy of Move From Unfocused to Focused Thinking

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Mhm. In this episode I want to talk about 80 HD. And medication. Well I have a special guest with me and I'm always about bringing in the experts to talk about it. Rather than me giving you my research and studies. Sometimes I like to just go to the source on good important Topics such as this one. So I am excited to be sharing this interview with you. I have brought on dr sarah. She yet she is a pediatric neurologist who specializes in the diagnosis and treatment of A. D. H. D. And autism. She also writes about 80 HD. And on psychology today and has authored two books on the subject. Winning with A. D. H. D. And a PhD and the focused mind with the goal of helping people with A. D. H. D. Learned to become independent, strong and successful. She brings a powerful professional perspective on the benefits and limitations of A. D. H. D. Medication and the many behavioral adaptations people with A.

D. H. D. Must embrace to thrive with their condition. So in this episode it's a packed one. We talk a lot about when should you take the medication? Why should you consider taking medication? I also bring up my own personal story. So without further ado let's get into it. Let's talk about a PhD and medication. Okay welcome doctor She yet thank you so much for accepting my invitation to be on my humble little show. You have a great show. Thank you so much for having me Kathy. Thank you. It's a pleasure. So let's get into it. As I mentioned before. There's a couple of topics I like to cover and we're going to split this conversation into a few segments so that we can keep our audience engaged and keep listening because we're going to talk about some big stuff and I think you know we don't want to throw too much at their brain sounds good to me or something. So the very first thing I want to talk about is A D.

H. D. And medication. This is very topical, personally for me right now and for the listeners, I just want to give a little bit of a 32nd if I could on my own history of it. And then, and as you hear that doctor, I want to kind of, let's dissect that, let's use me as the guinea pig and see what that could have been like. Okay. So basically when I got diagnosed with H. D. I went into meds and I said, look, I'm in place of overwhelm my whole life was just not moving, Everything was at a standstill, had a little baby and just, I couldn't cope. And so we started with, after all, and then I was one day on it and I'm like, nope, not liking it, what the heck is this? I don't even want to touch it the next day. Then we went back to the doctor and I have this amazing family physician who has been on my show also and she said, okay, let's go to the next one. Next one is considered to. Then we went on to consider to and again, the whole notion around see what it's like, see what it does to you, see how it works.

And for me, there was always question around how would I know if it works? Because I used to be on antidepressants and they did nothing for me. I feel like it was even worse. And that was at the time when I didn't even know I had a PhD, I was diagnosed with mild depression, right, which is such a typical here and those antidepressants were awful and I was worried about, you know, the effect of how do you wean off of it? Is this like what if I forget to take it for a couple of days? Am I gonna you know, have icky feeling? So she was like, no, none of that should happen with A D. H. D. So then concert a tried it for two weeks, I was feeling like I was drinking Vietnamese coffee or Turkish coffee. That's strong coffee, isn't it? Yeah, major heart palpitation, right? And it was always a small dose. Her philosophy as you start with a lower dose and the new taper off or taper on. So that didn't work. So then violence enter violence And violence at 20 mil.

I was starting to feel good. I was like and feeling good meant I was able to focus at my work. I was able to manage one project at a time and not be scrolling like oh I got this to do, I got a dad to do so throughout my work I'd be a lot more focused and I was finding even I'm like wow, this is a neat feeling. I've never been focused on one task at a time, this is like what a treat! You know, for 40 years of my life, I was always like triple tasking, wow. So yeah, exactly. So it was great. House management was coming along, things were good What I find with me personally and now 2.5 years into this journey with medication and 80 HD of knowing that, I have. I go on and off of it. So I was on it for six months then I learned new techniques. I got into coach training program, I learned more about my A. D. H. D. Than the natural and you know, supplements eating healthy. All of that kicked in. So I felt like I need to just kind of try the other stuff.

I was curious. I didn't want to be dependent on pharma all the time. That's just my personality. So then I went off of it, went back to treatment and so forth, natural treatment, just coping mechanism, all the other strategies. Then I went back on it again. I went back on it again and then I started losing weight rapidly because it does that kills your diet or whatever. So then the medication I was getting worried I was losing like I was 100 and £5. I was liking that. It was like four and five ft four. That's just not the right way for me. Pretty skeletal. Yeah. Yeah. I was like, I'm like, okay. And my mom is like, you're fixing your brain, but you're losing all this yourself. I'm like, okay, so back to the natural stuff. Then, Covid happened. Cool. It happened. I'm like, okay, I got to keep up with my little one. And for me, doctor with the thing with me is my fatigue. It's, it's this like dip of like tiredness that happens. So with Covid, I said, okay, I got to get back on meds just to keep up with my little four year old at the time, 3.5.

And so soviet. So we did that at this time, there was a bit of acceptance of Kathy. We're going to do this. And I believe in that bit of mindset around things. Right? As I'm taking this medication, there's a reason for this. And whether it's wu whether it's mindset, whether it's just accepting it, mindset makes a difference. Yeah. Yeah. So this time when every time I took that pill and you know, it's interesting, I didn't lose weight this time I was like, huh, okay, we're getting this Covid seems to work against people losing weight. It was like, okay, no, so fast forward. Three weeks. I've been off of it again. This time I've been off of it because of a few things. I went to a natural path, got to kind of check my hormones, all of that stuff. There's a female, there's certain things that I felt like I was off with me and also I bumped up my vitamin D. Some getting more vitamin D.

And I kind of had this feeling like I don't need this right now. So the last three weeks I've been off of it, I've been doing pretty good, energy's going good, all of that stuff. So that's my little journey Two medication. And I'm sure based on what I was saying to these themes that that I was explaining, I'm sure it's not the first time you've heard them. No, it's not the first time I've heard it, your story touches upon so many interesting factors when people are considering medication and the effects of medication that I, you know, I started taking notes because I was like, oh my goodness, this is a great story. It talks about a lot of different things. Yeah, one of the things was when he said when you started the medication, it was after having kids or a kid, and, you know, so many factors go into that focus, I should say means paying attention to one thing and not paying attention to other things and and that's what you were having a hard time doing and why at that time when you could do it before?

Well there's probably a lot of reasons. One is sleep deprivation and that that affects people whether or not they've just had a baby or whether they have sleep apnea. People who have A. D. H. D. Are more likely to have a sleep disorder of some kind. It could be problems getting to sleep. It could be problems falling asleep. So sleep deprivation may have tipped you from being not focused. Two more focused, so excited. It. The other way speaking of which sleep desperation probably you know you have this basic level of focus and then when you don't sleep that could get you into more unfocused time. That's one factor too is you were having a lot to do. And not all anything you could set your clock by because babies are unstructured to say the least. So we all of us, you and me and everybody with the working brain moves between a focus ST, which is, you know, you bring this prioritizing the one thing above all the other things to a not so focused state, which is as you described before, when you start to do one thing and then you see another thing and then you see another thing and it's like your brain has everything equally important to it.

And so your brain jumps from thing to thing. And so, you know, when I explain it to my patients without being able to use my hands. So when it's kind of like when, you know with your podcast audience picture, a desk focus means you have one thing on the desk and everything else is kind of underneath the desk. And when you're not focused, It's like you have 20 things on the top of your desk and they're all kind of equally important to your brain. So your brain goes from thing to think. And you Kathy when you had your baby you had way more things competing for your attention and it was all like do me do me do me do me all over the place. And so the thing is that you the more people have to do the more things on their plate are on their desk or whatever metaphor you'd like to choose, the harder it is to focus on any one thing.

Plus for you, you know having a baby it may change your brain chemistry for a while. We do know that estrogen has you know some effects on your thinking and so you know post baby there's changes going on too. You know this isn't cancer. So what the A. D. H. D. Medicine does and what the point of A. D. H. D. Treatment is is to move you from the unfocused state to the more focused state more of the time. So you know it's to make it more automatically. The point of medication is kind of like the point of me wearing my glasses so I can look at you and squint and I can walk around all day squinting but I don't want to do that. You know it's kind of a lot of trouble hurts my head when I put my glasses on everything is just more focused more automatically. And that's the point of the medication and in that time in your life you like so many other people we're having a harder time focusing and so you know because you don't have to be on a medicine it's not cancer it's not diabetes, you will not die with it.

You know, without the medicine unless you're an unfocused driver or other similar dangerous situation. So because you don't have to be on the medicine. You know, why start the medicine is an important question for many people. That makes sense and thank you for pointing that out because and as you're saying it, I'm like, oh I see the times where I would take her off of it or not take it were times where life was a little bit more organized, more or structured. So and the reason I went back on it was because of covid. I'm like there's too much ambiguity here. I have no idea what's going to happen. So I'd rather be armed and ready before you know it overwhelmed. Now I see both women and men but I would have to say there's a difference in sort of the purposes of them being on the medication or why they start on the medicine, I should say. So there's a big difference. I think between a structured environment like work and an unstructured environment like home.

Mm at work and at home you might look or think like two different people at work. There is a structure. Everyone's doing the same thing. There's accountability. There are huge consequences if things don't get done on time. There's teams, you know, people are depending on you and there's just sort of, you're supposed to just do work at work. Then there's home where everything is unpredictable laundry. If it doesn't get done today, it will be done. You know, it's still there tomorrow. You know, there's less of a set. Everything has to be at a certain time. It's a much more unstructured environment and there's 50 things that you could do at once that, you know, just by looking around, you can see that. So it's often the case I think for women where it's the construct, they can pull it together for work.

Generally, I have very few women coming to me saying that they can't pull it together at work. It's the home life that bothers the women, the men, It's more of the work unless sometimes it's that their wives or partners are saying that they don't listen or that they're irresponsible around the house. But you know, it seems like for men, the driving factor is more that they're not performing at work as much as they want to. Mm hmm. And you do you see the difference in there. Do they come back and say, yeah. The minute I started taking medication, work has been easier or well when, when it works well. So you touched on other things when you were saying that you know your first medicine did not work. Guys, we have a bunch of medicine out there because there isn't one that works for everyone. I would love it. If that were the case, I would say here try this and somebody would go great that works terrific.

And then I would do the same thing over and over again. A little boring but you know make my job easier. But there isn't one medication that works for everyone. But the great news is I have a lot of different medications, even the same molecule released different ways can make a difference. So for example concert to is one of many forms of long acting methylphenidate which is commonly known as Ritalin. And you know, I could give you concert and you might think I'm trying to poison you and then give you a riddle in L. A. And you're like yes this is what I was looking for even though it's the same active ingredient their release differently. So even tiny little differences can make a big difference for you as a patient. So I love it when I can guess right both in terms of medication and dose but because of individual chemistries both in our brains and in like liver metabolism and you know it's very hard to know for sure what will work for you.

So if you don't have the right outcome in the first medication then you want to try to see you know is it something that you just need to increase the dose on? And we're always trying to balance the benefits of the medicine with the side effects. So you know the benefits of the medicine are things like you described where you were able to stick with one task. That's the major way people will say it's working instead of hopping from thing to thing. Which actually takes longer and which causes you to have more mistakes. It makes any one thing look more overwhelming. When your brain has lots of things it's seeing so it can impact starting. So when you can start with one thing finish it and it takes the right amount of time and effort.

You feel great. People say Kathy you are awesome And you walk around saying yes I am an awesome Kathy right. And then what happens is you keep doing that thing mm hmm. So that's when you know medication is working well when you have that feeling because then when you walk around with that feeling, if something goes wrong and inevitably something will go wrong, then you can deal, you can say, yeah, okay, that went wrong, but because I am awesome, Kathy, I can deal with it, it's not me, I just will fix it. I'll work harder, I'll work differently whatever it is, if you're walking around anxious and depressed, which that brings up another point, I'd like to talk about two, then when things go wrong, it just validates your feeling of there's something wrong with me and then you don't want to do that thing.

So when medication works well, you have a feeling of being good, okay, You brought up that I think you were initially diagnosed with depression and anxiety, depression or depression, sorry, but many people are have both aspects depression and anxiety, so there's a lot of people walking around with depression and anxiety where probably the root cause is the difficulty with focusing and for me, just, just a point that that diagnosis came at a time where I was at the peak of my career, I had a large team, I was doing a lot. So what would happen is I'd be going hard and fast and furious and then I would crash from exhaustion and then the crash would be, oh, you should be still doing more, Why are you crashing? You should be starting your own digital agency, look what everybody else.

So, so it was the rumination that I would get stuck in whenever you want to call it. And you know, there's there's a lot of names you could put on what you described, but that feeling of not being good or good enough, we're not working up here potential. So that is something that both men and women who come into the office will say I felt like I could be doing better. I feel like I could do more and you know, sometimes it's true, sometimes that's not true. You know, sometimes you just feel that way, but you also have to think about the context. And this is where I'm lucky because I see pediatric and adult patients so far, I new these people from when they were kids, not literally for most of my new adult patients, but I see so many kids and I see what they struggle with and when they are built as an adult, you know that those kid feelings are still there where kids have heard a lot of negatives about themselves and many will have very fragile self esteems as a result of the attention issues.

They always felt like impostors like they were doing things kind of at the last second by the skin of their teeth. And it's not a good feeling for them as adults, they have shaky self esteem and so, you know, for people who have emotional issues, it's important for you to know that when you're anxious or depressed or whatever the bad emotion is, that worsens your ability to focus. Um and then of course, when you're not focused, what happens, you get more anxious or depressed or otherwise, you know, filling the bad emotions. So you can easily get into a negative feedback cycle where the anxiety depression worsens your focus and where your focus worsens your anxiety and depression in turn, that's a difficult cycle to get out of, and sometimes it's hard to know where to intervene with medications.

For some people, they're so down and they're so beaten and they're so worried that intervening with medications for depression or anxiety makes sense for other people. They'd like to treat the focus first and see what happens to their anxiety and depression. But that cycle is difficult to get out of until you start seeing real results. I see. So it's like a chicken or the egg thing. So in my case it was mild depression, but also it was an undiagnosed A. D. H. D. The doctors didn't look at it right right. In a way that didn't help the depression pills. The antidepressants really didn't do much for me, right. And so it sounds like you have a wonderful primary care doctor and there are so many wonderful primary care doctors out there, but they do have some limits in their time to, and if somebody comes in saying I am depressed or I am worrying too much or I'm angry or whatever, you know, okay here have the no depression stuff.

It takes a while often, especially with intelligent and high achieving people to consider A. D. H. D. And you know like historically we only considered A. D. H. D. In Children and particularly hyperactive Tasmanian devil boys. And then it became oh you can be pretty inattentive and you know girls. And then finally it became it became something where you could you would think about a PhD in adults because the adults started to come in and say hey I'm still having issues with this. But it's really only only in the last five or 10 years that what I'm going to say about 10 years. But really the last five years things have really taken off I think for adults with A. D. H. D. Yeah. Which makes sense because it's interesting.

I was in two different parts of Canada when I got my diagnosis. Yeah two different parts and two different time frames, right? It was In my you know in my late 30s. It was the oh it could be depression and then it's like then I come western Canada have a baby and my family physician is seeing all the signs connecting all the dots and then she says this. So there was something about I wanted to ask you about when would one realize that that this is working the medication and when would they? You know, there's a point where it's like if you're too sensitive but can you give it another week? Let's see how it goes because your body has to adjust to is there a sweet spot of give it a week, give it two weeks, give it a month or like well so let's talk for a minute about the different kinds of medicines there are for A. D. H. D. Because the kind of medicine you choose is an important consideration in answering that question.

Here's the deal. There are two different kinds of medication for A. D. H. D. Or that are FDA approved for A. D. H. D. one kind are the stimulants and those are things like Ritalin, Adderall Violence and focal in those are sort of the four main categories of stimulants. Ritalin and focal in our related to each other, Adderall and violence are related to each other. These stimulant medicines Probably are used in about 95% of people who are medicated for A. D. H. D. They overall seemed to work the best. Now they work for the day. They work for a certain number of hours per day and some people love that about them and some people hate that about them. I'd say more people love it than hate it. But you know that's a major distinction between the stimulant medicines and the non stimulants.

Which is the second category of A. D. H. D. Medicines stimulant. The non stimulant medicines are more like antidepressants, how they work in that they go into your system and they have to build up over a week or two. You usually don't start seeing benefits until a few weeks out. These medications are in your system 24/7 which again some people, like some people hate. So if you're talking about the stimulants which was the first category and the most commonly prescribed category of medicine, you generally see benefits right away. Like usually people can tell within the first few hours if this one is a winner or not now in terms of how they work the they work when the benefits far outweigh the side effects. And the benefits would be keeping one thing in your brain and being able to finish that okay for for hyperactive, like for physically hyperactive people, it's also that they can more easily sit still or not interrupt people as much.

So you might, you know, you're doing very well today, so you know, interrupting people moving a lot and but keeping your mind on your work is the main thing. When you go to do something, you finish it, you don't get distracted, you don't get taken down a different path by your brain. Again, nobody is focused all the time and I don't think I'd want to hang out with anybody who is focused all the time. That's no fun. But the idea is to get you focused enough more of the time so that you feel good about yourself. That's a theme that's such a critical thing. It is, I mean, and you know, before you start on medication, that's a great question to ask a doctor. Like, how how would I know it's working and that's something to explore. You can have measurable benefits so you might finish your work faster, you might have fewer deadlines missed, you might hear from people that you're listening more, you know, think about the benefits that you want in your life.

And I'm a big believer in writing them down and seeing if you are achieving those benefits, these medicines being optional, then you really want the benefits to be obvious. You know, you don't want to be uh maybe there's possibly a little difference. No, I mean, I think it should be a measurable good difference. Okay. But you also have the possibility of side effects and the medication is not a success if it carries significant side effects. You mentioned weight loss, that's one of the more common, the more common side effects When I tell people what to expect in terms of side effects, it's basically worse sleep, worse appetite or worse mood being the most common calls back that I get. So usually a harder time falling asleep, less of an appetite for lunch.

Which is usually when the medicines are strongest in your system. And worse mood could cover a lot of ground. Worse mood could be sad or worse mood could be matter worse mood could be more irritated. Yeah. The irritability one for me went up the roof with cancer to see and I could give concert to to your twin sister. Yeah. And she would be less irritable. Yeah. It's just it was like oh darling should've could've would've worked right. So you know I think there's some people I can give anything to but there's some people who are like the princess and the Pea, you know, it has to be this one little particular thing and you know that's normal and that is just the way you're built. I should mention that. I think the next frontier of a DhD medicine will include some sort of test you could take to see which medicine is the right medicine for you. And there are a couple of these tests out on the market.

But the problem with these tests is that they tend to check one or two sort of like jeans that represent one little facet Of metabolism of these medications. So these medications may be metabolized by 10 or 20 or 100 different enzymes whatever the right number is. And the genetic test can't check these things. Plus the medications have different effectiveness in different people because in your brain you have little tiny receptors on the brain cells and we're all built with a different combination of these receptors and your combination does influence how you respond to the medication. And that is something we can't test. We can't see it on an MRI we can't do a biopsy, not that you'd want a brain biopsy for this, but you know, it is try and see at this point And also the whole notion of the person and their mindset and their how they feel about the medication.

I think it really, really does. And I've experienced that in many cases I'm a cancer survivor. I had lymphoma, Hodgkin's when I was 35 and for me when they said you're going to do chemo and radiation, I'm like, I'll take the chemo radiation and I'm going to do positive talk and the doctor kind of spiraled, I'm like, you'll see. So I never did radiation because it's a common that they do. And it was just the chemo part. So I like to emphasize on that even for me this last time around when I took the med, I'm like I'm accepting this right now and it is what it is. So then the weight loss, I didn't go into it with fear. I went, yeah, this is my survival mechanism. Right. Right. Right. And so again, you've managed to touch on a number of important issues with what you said mindset is huge. So let's again say we all moved between focus and not focused. Right? So all of us focused.

Sometimes all of us are not focused, sometimes A. D. H. D. Essentially means that you're in the not focused state too much of the time. That's more of your automatic default. And you know, when you take the medications, like I said, they're supposed to move you from not focus to focus. But there are other things that do that. And I talk about those a lot in my book A. D. H. D. And the focused mind about different things that move you from not focus to focus. And these are things that athletes do in order to get their own best world class performance and these are the things that will influence your focus to. So mindset is key mindset is what moves you from. Not focus to focus. Mindset includes believing in yourself, mindset includes setting goals.

Mindset includes physical measures like I am not going to have my phone next to me when I'm in the meeting, mindset includes physical measures of putting your eyes on the people you're talking with. You know, so there's a lot of things that move you from not focus to focus, not just the medicines, I like it. So I want to interrupt you for one second because you're teasing our next topic on kind of mindset. So I want to I want to conclude this one with a couple of other questions and then stay tuned folks because there's going to be the next episode on the whole mindset and focused mindset with with doctor She yet. So Back to the meds thing, one question, Why is it that some people can't take it? It just doesn't do anything for them. Okay, so I'm going to answer that question but I also wanted to say a couple of other things too in terms of like you mentioned you didn't want to be dependent on them and I'm going to try to tie this all together.

So these medicines all carry warnings that you could get addicted to these medicines. Yeah, at the doses that doctors give them to you, you will not get physically addicted to them anymore than like caffeine and just because you can't see us, Kathy and I are both sitting here drinking coffee just for the record, you know, and so you can go on and off these stimulant medicines with the same ease as people go on and off coffee and sometimes I think it's easier to go on and off the medications you mentioned not wanting to get dependent on them. So in terms of like a physical craving thing, not going to happen if taken as directed in terms of a psychological thing, it's sort of like, you know, some athletes need their lucky socks on in order to you know, make the goal or whatever it is or they have kind of superstitious regiments that they're kind of dependent on.

So it's important to think about what you're bringing to the table, not just the medication, because when you stop the medicine, you can remember that you're bringing stuff to the table and it's always reasonable too. Stop medicines in different parts of your life if you don't need it anymore. So what you do during the day, like what the plan for the day is and what you have on your plate influences how the medication works and that some things you don't need to take medicine for it and you will not notice much of a difference if you do. So, if you're going to Disneyland, just go to Disneyland and have a good time, You don't need medicine for that. You know what I mean? Would you notice a difference? I guess maybe you might, I don't know. Mhm. I don't know what you would do, but there's time to, you know, that's not how you would judge medicine works and so to, you know, you would you would need to judge a medicine, working with doing something that requires focus.

So I just wanted to make that point on the medications. Now, let's see, I've completely forgotten the last question you and why wouldn't it work for some? Oh right, okay. So you know why doesn't the medicine work for some? Because they're just doesn't so there are many many medications. So you know, I could probably name 20 right now without breaking a sweat. And so people, you know, you need to know that sometimes I have these people who are like super metabolize ear's where I'm giving them really high doses and they're like, I don't feel like I'm taking anything. Conversely, I have super sensitive people. So like your family care doctor, I'd rather start low and not give people side effects. And you know, some people will be impatient or they will say oh this is no good, this medicine is no good. Well the medicine is good for some people that's why it exists but it might not be the right dose for you.

So there are people who have, you know, I feel like I'm pouring it in by the bucket load to get it to work. So there is that's one reason the second thing is there could be other factors like you know, if you're very emotional, the emotional part of your brain turns off the focusing part of your brain. So it's like your brain has two pieces to it. It's got the emotional part which you know involves things like the amygdala and there's all these, you know, technical terms, but and and then there's the thinking or the focus part. If the emotional part of your brain turns on. For whatever reason, it turns off the focusing part. This is a evolutionary mechanism where I think, you know, the people who survived were the ones who went tiger and they didn't overthink it like, well maybe that's a tiger, I don't know. You know, I wonder if it's coming my way, whatever.

So evolutionary forces have caused our emotional brains to turn off our thinking brains. And so that is another reason why the medicines don't work is because the emotional part of your brain is overwriting it. Some people truly have too much to do. That's another reason why the medicines quote unquote don't work. It's not it's not that you're not focused enough, you're focused, but you have, You know, 1500 emails to get through every day. I'm sorry, I'm not a magician here, you know, thank you for saying that, because for for some of us who are high achievers who are constantly go, go, go and we put all of that on us and it actually, it's, you know, a bit of adrenaline junkies if you will. Yeah, I was like, no, I need to have all of this on my plate or else I feel like so right, that's a valid point. It's such a self fulfilling prophecy too, because it's like, it makes you feel good to know that you're pushing yourself hard and all that stuff and it's hard for people to let that go, but I have been astonished and I, you know, I'm a working woman, I do a lot, I've had four kids, blah blah blah, you know, so I'm used to being the one who's the high driver too, but I am astonished at how much people have to do and so, you know, I can get you focus, but I can't get you a reasonable life here.

You know, there's some things that that, you know, are beyond medication and that and that's one of them, so, and you know, things like burning out or not really wanting to do your job that influences your focus and your mindset, and that would be another reason why the medicine may not work for what you're trying to do. Like if you really hate your partner and you don't want to listen to them, I could maybe get it a little better with the medication, but you know, you're still with the part that you don't want to listen to. So which brings up the point around managing a PhD or managing your rain holistically as a coach, as someone who's, you know, professionally trained in this field. There's techniques that I use with my clients to make sure like how much of this is really important, how much of this is really you have to do is that a little bit of ego coming through a little bit of unresolved issues of the past that you just feel like you need to keep and boundaries, God Boundary thing for 88 years is huge, right?

And then, you know, the nutrition that all of that stuff, all right. And it's, it's often hard for an A. D. H. D. Here to follow somebody else's plan, but they don't buy into necessarily. So they're more like do it myself. I'm just going to get it down myself and get the, the, the bang that way. And so there's a big tendency for people to take on too much and not realize that it's like the old adage about if you throw the frog into the boiling water, they'll jump right out. But if you put the frog in the pot and put the pot on the stove and slowly heat the water, the frog will get cooked. Well, that's what I'm told. I can't say that. I've done Disclaimer, no frog torturing was on this program in actual life. That was an analogy, folks. So, you know, it's one that I think about, you know, a lot.

I don't even know if it's true, but that's what they say. Well, it brings it home though. It does make sense, right? It's those pressures. So I appreciate that because I do get sometimes the clients that are like, well the meds are not working, I'm just going to give up on this, then. It's not about the meds, look at what's in front of you, what's happening here, this Yeah, yeah. And so, you know, there's a lot of factors and holistic involves a lot of things, you know, I'm a big believer in sleeping and you know, sort of getting your emotional stuff in gear and you know, managing electronics and other sort of non medication techniques are super important. I think nutrition is important in that a reasonably good diet helps your brain, your brain pound for pound is the most metabolically active part of your body. So there are more pounds of muscle muscles, therefore use up more fuel, but on a per pound basis, your brain is the act of metabolize er so, you know, garbage in garbage out and if you eat reasonably well, that may be helpful for your focus.

Unfortunately, the medications that have been sort of promoted for focusing, they they don't work as well. Did I say medications, the vitamins and you know omega fatty acids and all that. They don't seem to work as well as the medications. So it's a focus on a good healthy diet. I'm not a big believer in the supplements for at least the level of issues that people come to me for. But I would say the main thing in terms of holistic is sleep and emotions and managing your electronics. Love that. I love that. Is there anything that we missed that they should know about meds and A. D. H. D. Oh my goodness! I mean your brain is like an encyclopedia. Uh Let me let me rephrase the question a little bit differently. Late in life diagnosed I do imagine or not.

Where am I at? What would you tell me? Well you know that comes back to why did you come see me in the first place? Uh is it that you need some meaningful change in your life? You just wanted to get educated? Are you on the verge of being fired in two weeks if you don't get certain things done? So when you come to me, I would try to help you puzzle that out and point out that you have lived whatever the number is, 50 years, 40 years or up or down without medications. And what do you want medications to do for you? I should also say that for adults, there's not many long term studies in terms of, you know what medications is okay in long term, in an adult body, we've basically taken these Children's medicines and given them to adults and it's worked out great. But I'm sure there's more work that needs to be done as to should there be any adults who shouldn't be on them or should there be a limit amount of time that people should be on them?

The big difference between adults and pediatric bodies is like their cardiovascular system and that adults are more likely to have issues with blood pressure going up on these stimulant medicines anyways. And I should say that very. You know, I can almost count maybe on the fingers of one hand where cardiologist had said, don't put the patient on the medicine because of a heart condition. The blood pressure is an issue for many adults. On the stimulant medicines. They can raise your blood pressure. I've seen them lower blood pressure because people are less upset. But you know, we want to monitor for increased blood pressure and you know that the jury is still out. Do we need to do EKGs or other cardiovascular studies for adults? But if you have other medical conditions, then that would be a consideration for adults.

Awesome. Perfect. Well, we covered so much ground. I appreciate all of this brain power that you have in all this knowledge that you have. Thank you for for the medication topic Kathy. Yeah, you bet. And and for for the listeners, I'm gonna put all of the contact information for dr shot here on on our show notes. And we're going to have another topic on the whole focused mind and that that athletic mind of how do we tap into that genius and and manage our brain So until the next episode with our awesome doctor. Keep on shining people. 


Dr. Sarah Cheyette Profile Photo

Dr. Sarah Cheyette

Sarah Cheyette, M.D., Pediatric Neurologist

Sarah Cheyette, M.D., is a pediatric neurologist who specializes in the diagnosis and treatment of ADHD and Autism. She has a private practice in Palo Alto, CA where she counsels and treats kids, teens, young adults, and adults. She also writes about ADHD on Psychology Today and has authored two books on the subject: Winning with ADHD and ADHD & The Focused Mind, with the goal of helping young people with ADHD learn to become independent, strong, and successful. She brings a powerful professional perspective on the benefits and limitations of ADHD medication, and the many behavioral adaptations people with ADHD must embrace to thrive with their condition. She is a popular author and speaker on many topics including ADHD, Autism, the brain, teens, adults with ADHD and Autism, physician updates, neurology, focus issues, and recommendations. Download her free copy of Move From Unfocused to Focused Thinking