How to Optimize ADHD Stimulant Treatment for Children and Adults (w/ Thomas Brown, Ph.D.)

[@lschlosberg]

I am 62 and was diagnosed with ADHD 2 years ago and have been trying to find my correct medication and dosage, and this was really helpful. I’ve been working with an excellent psychiatrist fine tuning my medications and this presentation will help me be a better detective in the process especially with the timing and drop-off/rebound effect. I want to comment on the substance abuse concerns. I was a heavy drinker most of my life, needed 2+ glasses of wine every night to ease my anxiety and relax, and as soon as I started on dextroamphetamine I stopped drinking overnight! I simply didn’t crave for it, or need it, and that was significant and immediate. Also, I experienced a lot of anxiety-that fight or flight feeling in my stomach. I’d have it when I woke up, throughout the day, in the middle of the night, and once I started the adderall, all of my anxiety went away completely! My biggest side effects are severe dry mouth and sleep issues.

[@DominionMovementDotOrg]

how do you deal with the rebound?

[@jonathanberry9502]

I wonder how many addictions are just people self-medicating, and that the correct therapy (substance or otherwise) would knock the addiction out.

[@RavenVapor873]

​@@jonathanberry9502what do you consider an addiction to be? I've heard varying answers. There's only one true definition. Are you close to it?

[@RavenVapor873]

​@@jonathanberry9502I think that word has been greatly overused the past few years. It doesn't mean what they think. Or there's a lot of confusion about it.

[@gaurikasirohi]

Personal experience: 37 yo, been diagnosed with AuDHD just 3 months ago. Tried Methylphenidate for 2 months. I already had an anxiety disorder from being undiagnosed for so long. The stimulant made my anxiety 10x worse, made me suicidal. I lost 4 kg in 3 weeks due to a complete loss of appetite. I was crying every single day for weeks. My personal hygiene went down the drain. I finally took a second opinion, and after informing the doc about everything that was going on, he immediately stopped my stimulants and changed it to atomoxetine. I’ve been 2 weeks on that now, and everything that was happening has been completely reversed. On top of this, I stopped smoking, drinking, have more energy than last month, and no more crying from anxiety. It’s absolutely true that each medicine affects each individual differently. What works for others didn’t work for me. But the lesson here was to not stop trying ❤

[@RavenVapor873]

It's great that you found a med that helps you! I'm not able to do that. So many of them are too expensive for my budget. There's no way I could see a psychologist or psychiatrist. My therapist has never been trained to help people like me. She could confirm my suspicion that I have ADHD. She doesn't know even half of what I've learned by listening to these podcasts. I'm happy for you!

[@3monkeysandamoose]

@@RavenVapor873 Don't give up. I have yet to find a Therapist that knows anything about ADHD. Don't know where you live but in the US I had to use several not for profit agencies til I was eligible for medicare 2 yrs after SSDI Benefits. Most ADHDS stimulants have been around forever and are inexpensive. Good RX has great coupons for most medications.

[@3monkeysandamoose]

Shame on your provider for not switching to another stimulant. I just switched from Vyvanse that had caused too much weight loss and increasing my anxiety which I already struggled with. I started methylphenidate last week and within days my appetite came back. My anxiety level is good . 1st physical reaction I noticed with both was my pulse going down. I'm sharing this to concur. I'm tired of all the warnings of high blood pressure and anxiety related to stimulant meds when they are often beneficial and yes, everyone is different. I started with atomoxetine which kicked in week 3. I just got out of bed one day & cleared my dining room table filling a 13 gallon trash bag. It felt magical. Unfortunately I had a rare side effect, UTI's

[@ispartali3210]

​@@RavenVapor873 change your therapist

[@RavenVapor873]

​@@ispartali3210my therapist isn't the one I talk to about my ADHD meds. My PCP is and they also have ADHD and are well versed in the topic. Did you miss the part about me not being able to afford someone working in the field. I'm in Medicare, alone, disabled, etc. It can be complicated.

[@TheModernAlchemix]

This man has provided such a level of guidance. THANK YOU for touching on symptoms of meds and how to determine when dosage is way off vs almost optimal ❤😊

[@KaareneRNHealthLifeCoach]

We didn’t realize my daughter was ADHD until she was about 17 and she at that point was doing pot and drinking to self treat. I wish we would have known sooner and got her on treatment. She is now 22 and an alcoholic. Very tough road. She still hasn’t t found a good therapist and hasn’t gotten the treatment she needs. She has had 2 DUI’s now and she is really struggling. I’m trying to learn everything thing I can about ADHD now. Thank you for the videos!

[@Cnsalmoni]

Did you search the ADDitude directory for recommended therapists? That may be a good place to go.

[@Handle8844]

I'm so sorry. That sounds terrible. My heart goes out to you both.

[@johnthicks8568]

Have her try kratom. It completely stopped me from wanting alcohol or even feeling it at all.

[@TraciBinIT]

Consider getting her to an AA meeting. They help with alcoholism, I’ve been sober for 13+ years, dealing with depression and anxiety. Our bodies change over the years and sometimes medications need to be adjusted. Good luck

[@3monkeysandamoose]

I'm so sorry . I struggled with substance abuse and alcoholism. I had 2 OWI's. I'm 20 yrs clean and sober this month. My Adult son was in a 2 day coma after Fentanyl overdose and continued to use for another 2 yrs. He's doing well now on MAT. I questioned ADHD when he was in school but unfortunately he was just labeled as troublemaker. I was diagnosed @ 65. I have a granddaughter diagnosed @ 5. I see her struggles and the risk of substance abuse with ADHD. MY family wasted a lot of time and money trying to fix me. I watched my son go in and out of rehabs. There is a lot of good current info about the need to treat ADHD with recovery, They both need to be addressed @ the same time. You can't get your daughter to go to AA or get sober til she is ready. My 2nd OWI saved my life when I got involved in the legal system. Speaking as a MOM who's been there may I suggest ALANON. There are many different meetings and groups where you can find support for taking care of yourself.It's difficult for me to put in words but that support was essential for me as my son found his way.

[@JohnnyU.S.A]

An excellent guide for how to best utilize stimulant medications.

[@jonathanberry9502]

🎯 Key Takeaways for quick navigation: 03:01 🧠 *Understanding ADHD Beyond Behavior* - ADHD is not primarily a behavioral issue but rather a challenge in the development of the midbrain's management system, affecting executive functions. - The misconception of ADHD being just about behavioral issues was prevalent until recent decades. - Executive functions are critical for tasks like driving a car, where one needs to focus, utilize short-term memory, ignore distractions, and manage multiple tasks simultaneously. 06:22 🎼 *ADHD as a Brain Symphony* - ADHD can be metaphorically understood as a symphony where executive functions act as conductors, coordinating and integrating various cognitive functions. - The absence or inconsistency of these executive functions can disrupt the brain's harmony, leading to ADHD symptoms. - Proper understanding and management of ADHD require recognizing its multifaceted nature beyond mere behavioral observations. 10:27 🧪 *ADHD Treatment and Brain Chemistry* - ADHD is fundamentally tied to the brain's chemistry, particularly the neurotransmitters dopamine and norepinephrine. - Stimulant medications have been shown to effectively address ADHD symptoms in a majority of cases by modifying problematic brain chemistry. - Adjusting medication dosage and timing can minimize adverse effects while optimizing treatment outcomes. 23:07 💊 *Individualized ADHD Medication Titration* - The effective dose for treating ADHD varies based on individual sensitivity rather than age, weight, or symptom severity. - Careful titration is crucial to adjust doses according to individual responsiveness and needs. - Medication adjustments are also influenced by the specific tasks and timeframes when the individual requires the medication. 24:15 🚫 *Addressing Concerns about ADHD Medication and Substance Abuse* - Parents often express concerns about ADHD medication leading to substance abuse in their children. - Evidence suggests that untreated ADHD can double the risk of substance abuse or misuse. - Properly treated ADHD with medication can potentially reduce the risk back to normal levels, emphasizing the importance of effective treatment. 27:30 🧠 *Addressing Myths and Misconceptions about ADHD Medication* - Common concerns include worries about children becoming "zombies" or experiencing permanent personality changes due to medication. - Potential side effects like appetite loss, motor tics, and sleep disturbances are typically temporary and can be managed. - Adjusting medication doses and types based on individual responses can help mitigate adverse effects and maximize benefits. 31:00 📊 *Understanding ADHD Medication Categories and Responses* - Two primary classes of ADHD medications are dextroamphetamine (e.g., Adderall) and methylphenidate (e.g., Ritalin). - Individual responses to these medications can vary significantly, with some individuals benefiting more from one class over the other. - Factors such as age, task requirements, and individual responsiveness play crucial roles in determining the most effective medication and dosage. 36:02 ⏰ *Exploring Medication Duration and Delivery Systems* - Various ADHD medications come in different delivery systems, including short-acting, long-acting, and extended-release formulations. - Duration of action and onset time can vary significantly between individuals, necessitating careful monitoring and adjustment. - Understanding the specific characteristics of each medication and its delivery system is essential for optimizing treatment outcomes. 39:07 🔄 *Addressing Rebound Effects and Fine-Tuning Treatment* - Rebound effects refer to symptoms re-emerging when medication effects wear off, requiring specific adjustments to the treatment regimen. - Differentiating between dose-related side effects and rebound effects is crucial for optimizing medication efficacy and minimizing adverse effects. - Fine-tuning ADHD medication involves careful monitoring, dose adjustments, and considering alternative formulations or classes based on individual responses. 45:23 💊 *Medication individualization based on patient needs* - Understand the individual nature of medication responses. - Not all prescribers have extensive training in ADHD treatment; therefore, patients need to provide detailed feedback. - Monitoring medication effects at different times of the day and environments (school vs. home) can guide dosage adjustments. 48:01 🔄 *Combination and anxiety considerations with stimulants* - Combining amphetamines and methylphenidate can be considered for individualized treatment. - Stimulants might not always exacerbate anxiety; some even find reduced anxiety on stimulant medication. - If anxiety does increase with stimulant use, adjustments in dosage or adding an SSRI might help mitigate it. 50:33 🛑 *Breaks, tolerance, and changing medications* - No strict necessity for weekend breaks unless specific side effects like appetite reduction are problematic. - Over time, some individuals might develop a tolerance to a particular medication, requiring dose adjustments or changing medications. - Decision-making for medication changes should consider both benefits and side effects experienced over time. Made with HARPA AI

[@SuperMegaWoofer3000]

Lecture starts at 3:53 :)

[@hanskraut2018]

Not for me im gona take in all of it since this topic taken seriously by someone like brown is so rare!

[@inkblot101]

Punishing to sit through the preamble Thankyou

[@Vendetta1543]

Thanks for the time stamp brother 👍

[@Handle8844]

Would love to learn more about how oestrogen and stimulants impact each other.

[@madgepickles]

It's frustrating that stimulants can't be advertised as treating anxiety, because undiagnosed untreated ADHD manifest anxiety because we are constantly chastised for failing to do the things that were supposed to do. So the anxiety develops as a coping mechanism to help us get the dopamine needed to complete tasks. Same goes for depression. Stimulants completely disintegrated my chronic lifelong depression since puberty. Where ssris never helped me. Turns out I just needed help getting out of the hole that downregulated dopamine causes. So to act as though anxiety and depression are unrelated conditions rather than potential downstream effects of untreated ADHD is malpractice imo

[@ModMINI]

A year after diagnosis and treatment, I'm learning that stimulants are not a magic bullet.They help to focus the mind but you still need to decide what to focus on. The anxiety problem is best addressed through self-care and therapy if you can find it. If not, there are self-directed dialectical behavioral therapy workbooks and tons of video on KZbin for self-education.

[@barbh1]

I had chronic fatigue coupled with ptsd back in the days when we were told it was all psychological. Being told that by so many experts, made me crazier. Finally I got treated for panic and depression with zoloft, and it changed my life for the far better. Now, I'm elderly, and forget why I walked into the kitchen. I can really relate to the working memory problem of my little great grandson.

[@dianeryan7241]

You are excellent, can totally relate. I am 75, too late for me but struggled with jobs, time management, makes life tough. Live alone, couldn't do relationships very well. Ritalin wasn't successful for me. People say your not listening, not great when it's your kids. Makes life really tough.

[@darrellleeper7534]

I am now 68 I get to see my Dr 6-15 2023. Im excited. 😊

[@hanskraut2018]

:) Somethimes very hard to find the right dosage tho if meds are what would help and you have adhd, good luck. Or finding someone that understands or cares to put in the effort therefore to finetune it at all. Eventho th most common/ussed/effective meds are out since the 19 hundreds and society would benefit greatly from people not feeling demotivated and terrible and therefore be forced to act like pack of starving pigens or humans fighting over a peace of bread. (more criminal/less giving/ less happy/ less perceived a s friendly/ less patient/motivated/helpful/sympatic/also the PFC is said to be a social organ/most recently evolved part of brain.)

[@mral4381]

This video is not great but YT algorithms favour it. If somebody shares this video with you they are probably lazy when it comes to research. Treat such people with appropriate caution because they are not researching things deeply.

[@LH-fp8kr]

I am the same age and still can't get an appointment for a diagnosis.....here overseas, I think they fell it is too late and medication isn't a good idea. Also, all the Clinics (Dr.'s offering this diagnosis are booked out till spring 2025.!) I am, to say the least, very frustrated. Glad you found help.

[@bystandersarah]

My whole life I have thought I’m just lazy, pathetic, careless and bad somehow. Extremely smart, talented and yet stupid and absent minded all at the same time. If a prescription on adhd drugs could help me finally realize my lifelong ambitions (like being more normal) I do not care if people think I’m just a pill popper. I don’t have to keep those people in my life. Even if they are family, I can love them from a distance. Maybe with medicine I can finally end the lifetime struggle of poorly coping, masking and repeatedly failing at simple things.

[@darrellleeper7534]

Oh how interesting. I found this fantastic !

[@Handle8844]

Walt Karniski wrote about a great book about ADHD meds for kids about a year ago. Highly recommended.

[@hanskraut2018]

Underrated topic! Medication is totally different depending on what dosage and does not seem to be linear. Eventho they exist since the ~ 1950… Data science/ machine lerning and A.I. should be used for personalized medicine. The world and people less or not affected will profit indirectly! Just like democracy and freedom profits even the rich business people not only the poor slaves/workers in the medical times/europe Great choice, Dr Brown and Barkley are in the top of my researchers altho they are probably man great ones but those are definitely good experts in my assessment. Gj ADDitude

[@RavenVapor873]

One of the biggest problems with prescribed meds that work for ADHD (and many other conditions) is the high cost of most of them. I'm not able to use different meds because of the cost. I am not concerned about abusing or misusing meds of any kind. I'm not predisposed to addictive behaviors. Maybe people need to understand what addiction is first. I think it's overused greatly.

[@ic_0129]

My first week of 18mg Concerta was amazing at 32 years old. I did notice my anxiety vanished an hour after my first tablet. It only lasted about 6-8 hrs though so my doctor advised me to try 18mg in the morning and 18mg in the afternoon but that's been giving me anxiety and heart palpatations for 2-3 hrs in the evenings. I've gone back to 1 18mg today but don't really notice anything different other than I feel less tired than when I don't take Concerta.

[@RavenVapor873]

I have a co-morbidity of OCD with ADHD. I had been able to control the OCD symptoms but they're back since adding a stimulant. I've tried non-stimulant meds and they didn't work for me. I don't know what to do now. There's not much written about this. Any recommendations? IDC if you're a professional or not. I'm desperate.

[@krombopulosmichael6280]

I had the same issue and unfortunately I think most if not all stimulants are not going to work well by themselves. You could try atomoxetine (I never found it effective but may work for you), or you could try combining a stimulant with an antidepressant (eg Concerta + Lexapro) to help counteract the OCD and anxiety. I was told to do this but instead just dropped the stimulant and am managing my ADHD as best I can without medication.

[@ThriveCollective1188]

I would love to talk with Dr Brown. I’m in Western Australia and on a waitlist for even definitive diagnosis in a country that so tightly regulated ADHD medication that drug testing is part of the agreement to prescribe and Adderrall is not imported or approved due to the US statistics on its widespread abuse as a street drug. From my own experience of undiagnosed ADD I have wandered through the online topics and discussions wondering where anyone is talking about the incidence of sexual assaults in the young female ADD population. Young ADD & ADHD folk miss red flags, we can focus on one thing at a time, we are impulsive and a propensity to trust and go with the flow must be common and a all heightening risk factors. Just another reason why inattentive type needs to be screened in schools. The focus on the more disruptive hyperactive type (as with all learning and behavioural disorders) leads to our systems failing those that don’t raise hell but do experience their own sensitive version of it. To be sure

[@sashawhispers3480]

I have Autism and ADHD without the H. Do you know if ADHD medication takes away the boredom that comes with having ADHD? As we know, boredom effects work, etc. If it does, which medicines are effective in I have Autism and ADHD without the H. Do you know if ADHD medication takes away the boredom that comes with having ADHD? As we know, boredom effects work, etc. If it does, csn you please tell me which medicines are effective in this?this?

[@lisatavolacci7061]

I had to get off my add meds because I was experiencing weird mouth movements as it was falling off about 4 hours . Has anyone experienced this.? The medicine really helped me it’s so hard without it

[@hanskraut2018]

A lot of known information would be great to have some more of the how to dose adjust and signs for dose toohigh / too low and studys about that. Also choosing medication a little more indebth/advanced. :) Gj tho! Great! Need more ^^ with novel or rediscovered research. I am sure it is in the research, but finding the information and controlling for bad methodology and having the right understanding of ADHD and then also being motivated enought AND being able and known enought to make presentations is rare. Thats a lot that needs to come together, ill do it when im rich / motivated and have my life in order right now im still struggling with the basics like enjoying my most loved hobbys or whatever and feeling discomfort for no reason especially when doing usefull things like, cooking and buying healthy food, planing, working, education, taxes, anythign adhd things longterm non immediate good feel, that needs my brain to work, feel like someone gave me a adrenalin injection 24/7 otherwise exept somethimes where it goes away or my brian is not blocked as if i was in fight or flight mode. Also relaxed motivation/drive/brain strange even when i just did hours of meditation warm bath and have no stress far and wise or when i do or even when i did cray amounts of sports (altho lots of sport where you are torturing yourself and do thing else exept gym nothing 0) then after month your brain works temporarely better. But no effect when normal gym that feels terrible and quite a lot (only when following perfect protocoll and documenting anything like a maniac perfectionist) otherwise maybe even more. Havent tryed jogging 1-2 hours consinstantly every day or maraton running maybe that works better idk just feels way worse than on good medication dosage it feels like playing videogame on medication like videogame without medication

[@aliasjon8320]

bookmark 13:00

[@BoswellLeif-d5u]

Hall Matthew Davis Larry Jones Laura

[@Handle8844]

So very many "umm"s and "uh"s in the introduction.