ADHD Medication and Your Period: What Women Need to Know About Treatment, PMDD, and Changing Symptoms

Medication works well, I ovulate, and now it's a slowed downhill slump. During the luteal phase, we have a drop in sex hormones, including estrogen. And if you have a drop in estrogen, you're going to have a drop in dopamine. People online get really afraid of taking medication because the research in non-ADHD populations makes you have worse oxidative stress. And in ADHD populations, we actually see improvements in oxidative stress. We also see improvements in magnesium stores, improvements in brain iron, improvements in cortisol. What do they not tell parents of ADHD kids of medications that you wish that they told them? When the medication is wearing off at the end of the day, there are some kids that experience. Does that also happen in adults, definitely? Ultra running shoes are all about space, the space to go further, to feel better, to do something you never thought possible. And this space starts with ultra-fit. Unlike traditional running shoes, ultra-fit gives toes more room to move naturally. So every step is strong, balanced, and comfortable. Whatever you're leasing up for, stay out there with ultra. Shop now at ultra running.com. To bring music and style together, and they want you to be part of it, grab your friends and head to the tabby tour, hitting cities around the country with live performances from special artists, exclusive experiences, and personalized products. And discover custom playlists on Spotify, but just for you based on who you are and how you listen. Live your story with coach. Learn more at coach.com. What is the biggest mistake women are making when they assume their ADHD medication is not working? Dr. Simone, I'd like to start with you. Give up on ADHD meds altogether. Okay. And what do you see, Dr. Lockhart? They think it's a character flaw of some sort. Hmm. And Anika? Honestly, have you tried doing a basics? All right. Well, welcome back everyone. You are watching the Dr. Brighton Show. And this is our ADHD series where we are focused solely on women, supporting women, but also changing the narrative of what it means to be a woman with ADHD. Today, I am surrounded by brilliant experts, and we are going to be talking ADHD medications fails, or what seems like fails and maybe aren't fails, alternatives, and we're also going to get into the topic of PMDD, which is something that ADHD women often struggle with. I'm your host, Dr. Dr. Jolene Brighton, and board certified in notch-pathic under-cronology. I'm an nutrition scientist, and the author of the book, ADHD and Women. And if you can take a quick moment, hit the subscribe, show this with a friend, or leave us a comment, and let us know what brought you here. We would be so delighted to have you as part of this community. I'd like to have everyone at the table introduce themselves, and I'm going to start with you, Anika. Hi. My name is Anika Joya. I am the author of the e-tipocus cookbook, and I have my Master's in Health Psychology, so I do science communication online for ADHD nutrition. Hi, I'm Dr. Agnes Kwansemon. I'm a board certified psychiatrist. I have two practices in California, my general psychiatrist, your practice, and my woman's midlife mental health focused practice. I share evidence-based information on social media. I'm Dr. Ann Louise Lawcard, I'm a pediatric psychologist, board certified in clinical child and adolescent psychology, and I have a practice called A New Day Pediatric Psychology in San Antonio, Texas, where we help parents understand their kids and teens better. And you're also the author of a book that helps parents navigate the teenage years. Yes, it's called Love the Teen You Have. Amazing. So, we're going to talk a lot about medications, and here's the thing that comes up. You finally get your ADHD diagnosis, you start medication, and then comes the question nobody seems to answer very well, at least as evidence by how many people are asking this on the internet. And that is, how are you supposed to know your medications actually working? So Dr. Simone, why should people feel an experience when they start ADHD medication? There are very high expectations when it comes to ADHD medications. People have this expectation that you take a medication, and then all of a sudden, all of your ADHD symptoms are well managed, or they go away. And that is just not how ADHD medications work. So first, we always talk about what are the expectations? What should we expect with the medication? How you know a medication is working really depends on the individual. For example, if you are not able to focus for even 30 minutes, but now you're able to focus for 30 minutes, then that means your medication is working. If you want to focus for longer than 30 minutes, then perhaps your medication dose is wrong or maybe your medication just needs to be changed. And would you also say that maybe sometimes it's not realistic for your brain to focus for 30 minutes beyond, for more than 30 minutes, I should say, without a movement break, a water break or something else? Definitely. We always talk about behavioral changes as well in terms of ADHD treatment. Medication is just one tool in the big toolbox. Anika, I'm curious, what did you think was going to happen when you started ADHD meds and then what was the reality? Truthfully, I really hoped that it was going to completely change my life. And then it did for the first two days. And after that, it turned into something that was just something that I could take and then some days it worked, some days it didn't, and it sucked. So working with kids and teens, what are the parents expectations of what the medications will do and what's the reality for kids? Yeah, so it really depends on why they're taking it in the first place. So if they start taking the medication and their kid or their teen is not paying attention, for example, in school, then they're expecting that they should be able to pay attention. Or if they're hyper, that they should now be calm, that they are really just expecting the opposite of whatever problematic behavior they're seeing, and that it will last and it will be consistent regardless of how old they are and how much weight they gain over the years as they're growing. So they're just expecting a quick fix, honestly. Dr. Simon, what are the realistic things that medication can help improve in terms of the symptoms of ADHD? In terms of the stimulant medications, realistic goals include improved focus or attention for maybe 30 minutes longer than you usually focus for, or maybe an hour longer. Again, it really depends on the individual, but it's unrealistic to think that a medication is going to make you focus perfectly all day long. I mean, people without ADHD struggle with that. So being able to focus 9 to 5, 9 to 3 pm for people who are at school, it's just totally unrealistic. But yes, I do believe my patients when they tell me that it does help them focus for, again, 30 minutes longer, 45 minutes longer, an hour longer. And also just being able to sit still, instead of fidgeting all over the place, it helps with that as well. I have also heard that it improves task initiation and just being more focused on the task. What should we not be expecting a pill to do? Fix all ADHD procrastination and high management are probably the most difficult things to treat with medication because those are more of a behavioral concern. Dr. Lankhart, I want to make this distinction real. So if medication makes it easier for me to pause before reacting, does it automatically teach me what to do during that pause? No. That's why the problem is that parents and kids thinking on teachers that it's going to be a quick fix. The medication does one thing, it's interacting with the kid in their brain to help them do or not do certain things, but it's not giving them any skills. So we really want to focus on whenever I work with a kid with ADHD, it's always about skill building along with the medication because whether they have depression, anxiety, ADHD, the medication doesn't teach you any skills. It just helps regulate whatever the thing is that you're getting treated for. So the skill building is a very important piece. So the parent came to you and they said, "I want my child to start medication." What other therapies, treatments, maybe lifestyle, recommendations could you offer them so that the medication is most efficacious, but also that for the time that they're on it, there are building the skills. You're taking advantage of that focus, that attention, that ability to sit still. Yeah, absolutely. So there's a lot of evidence-based treatments that are out there depending on the specific co-occurring diagnoses, the age of the kid, the problems that are being seen. So for the little ones, play therapy is amazing and it's not just a therapist playing with your kid. There's evidence-based treatments in terms of cognitive behavioral play therapy. And so that could really teach them through books, through worksheets, through play, what to do in terms of certain situations, how to interact when there's an impulse control issue or frustration tolerance or anything like that. As they're older and they can do more talk therapy, that's when cognitive behavioral therapy can be very effective, solution-focused therapy can be very effective. But basically teaching them like this is what your brain typically does and cognitive behavioral therapy is really effective because it's looking at what you're thinking, what you're feeling and what you're doing, and then changing some of those core beliefs so that you can interact with other people differently, interact with yourself differently even. So yeah, CBT or cognitive behavioral therapy can be very effective for ADHD along with the medication piece. So in a bit, we're going to talk about one of the biggest frustrations, which is when women saying, "Bang that a kid." working great, except for like once a month something happens and we're going to solve that mystery today. But Anika, you know, there's going to be people listening right now who're going to be like, I don't want to use a medication. I don't feel good on a medication. It's just not for me. What nutritional advice would you offer them that are like some levers they could pull in their day to day life to help support their operating system and their brain? It really depends on where you're feeling this. So using myself as an example, I have tried so many different ADHD medications and I just think my body's really sensitive and the one that has worked the best is the extended release Adderall. Eventually, I want to try the new one that's coming out because I think it's going to be good for me. We're going to talk all about that in this episode. So I'm glad that you're hinting at it now. Very excited as a person who also has, you know, a history of anxiety and depression and all everything together. But nutritionally, if you are experiencing while in the middle of the day, you feel like you're not actually focusing well. You've taken your medication like, oh my god, why isn't it really working? Why do I just feel shaky and not really motivated? That is an indicator that you are probably not eating enough, especially not enough protein. So the first thing I would say, what did you eat? Did you actually eat breakfast? Really, really fun fact. ADHD is the only mental health condition associated with not eating breakfast. So if you take me to the comments, let us know. Phil called out right now. And the hard thing is with our black and white thinking, we're going to be like, I have to have the perfect breakfast. And if I don't have the perfect breakfast, I should just never eat breakfast. I'm just going to skip it. I'll take my meds. It's fine. Or now that I heard this, if I don't have breakfast, I'm going to skip my meds now too. So remember, we don't have to have a black and white thinking blinders on right now. Have just something. Whether that is a drinkable yogurt that we talked about in a previous episode, that was so helpful because it's really easy to get 20 grams of protein with that and just don't hatch. Whatever you can do to find something that's really easy, that takes low effort in the morning. Now, if you are having difficulties at the end of the day, what I see is two different things. Usually it is a really bad blood sugar crush, essentially. That's the one that I experience. And it can be really scary because you can eat throughout the entire day. And you can basically be perfect. Well, I'm going to go with your intake. But you get really bad shakes or your brain feels like it's completely shutting down. If that's what you experience, talk to your psychiatrist, talk to a nutritionist, dietitian, doctor, obviously, but around 4 pm, make sure you eat something, especially something ideally protein, but also carbohydrate. Because your brain is basically all the energy is going away. If we want to simplify it, yeah, so give yourself the energy. Also do that at like 6 pm too. Yeah. I think someone listening right now, it's going to be like, no, I know I should eat, but that's the problem. So I'm just curious, what are some of the strategies that you have found helpful to make sure that you eat? I know we hate the thing. However reminder, it can be helpful. Switch up where you're eating or your reminders. If you're noticing that you are not following your reminder, you can switch up the app that it's telling you from or the location it's telling you from. So I had to recently switch to I kind of hate this chat GPD. I told it remind me every time at 4 pm to I don't even know to do that. I don't think that either because my like reminders app is not working for me anymore. This is why we had to have a 20 something on the panel. You're going to see some of the things I did not know. I also think externalizing the food. So we had great episodes where you talked about putting food on on the desk, putting food out where it's visible, where you see it. I also think like if you're someone who carries a purse, like when you have the snacks in the purse and every time you reach into the purse, it's like, oh, I've brushed across this. Externalizing that can really help. Since you brought up medications and we started this with medications, I want to talk about the difference between stimulant versus non-stimulant because if you come across the internet, people make it sound like you're just deciding between the difference between Pepsi and Coke, right? Where they're like, it's just personal preference, but it's so much more than that. So want to go further into how do you decide what to use for who? But first, let's just get everybody on the same page. Stimulants versus non-stimulants, what are they? Stimulants are medications that stimulate your central nervous system. They increase dopamine and nor epinephrine, which are two neurotransmitters needed for executive function, like focus and attention. They are controlled substances because they do have a risk of misuse and abuse. So they are monitored by the DEA and non-stimulants do not stimulate the central nervous system, but they do help with attention and focus in different ways. They are not controlled substances. There is no risk of misuse and abuse. And the second part of your question was how do I choose? It's a very thorough discussion with every single patient that I meet with. I know that the stimulants are always going to be more effective than the non-stimulant medication. So I tell my patients that there's no point of starting a non-stimulant first if you're okay with starting a stimulant and if there's no contraindication to starting a stimulant medication. So some of those reasons to not start a stimulant medication include cardiovascular problems, uncontrolled hypertension, a risk for psychosis and mania because there's already a risk for psychosis and mania with the stimulant medications. And some patients have a fear of being on a controlled substance so fear of addiction, fear of misuse and abuse. So there are some reasons that people absolutely want to stay away from stimulants, but I always tell my patients that these medications are going to be more effective than the non-stimulants. Ultra running shoes are all about space. The space to go further, to feel better, to do something you never thought possible. So every step is strong, balanced and comfortable. Shop now at ultra running dot com. That's a-l-t-r-a running dot com. Hey, it's Kelly Rowland. You may not know this, but I have eczema. So I get how it can still your time. But why let eczema take over when you can talk to your doctor about epglyce? Epglyce, lubricism app LBKZ, a 250-mg/2-mL injection, is a prescription medicine used to treat adults and children 12 years of age and older, who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema. Also called a topic dermatitis that is not well controlled with prescription therapies used on the skin, or topicals, or who cannot use topical therapies. Epglyce can be used with or without topical corticosteroids. Don't use if you are allergic to epglyce. Allergic reactions can occur that can be severe. I-problems can occur. Tell your doctor if you have newer, worsening eye problems, you should not receive a live vaccine when treated with epglyce. Before starting epglyce, tell your doctor if you have a parasitic infection. Paid partnership with Lily. Respect your time. Ask your doctor about epglyce and visit epglyce.com, or call 1-800-LilyRx, or 1-800-545-5979. There's so much stigma about ADHD medications, and one of those is that it's always like somewhere on the internet. Why are you putting your kids on meth? Listen, Jim Bob. Let's hear it from a psychiatrist. It's definitely not meth. These are well-studied medications. They are safe for most people when taken carefully and appropriately. One of the risks of stimulants is increased blood pressure and increased heart rates. Of course, there are risks of taking these medications, but when you're taking it as a doctor prescribes it to you, you really shouldn't have problems in terms of safety. Of course, some people cannot tolerate side effects, but in general, they are relatively safe. Anika, what do you say to people on the internet who say these medications are addictive, and all ADHDers get addicted to their meds? I mean, of course, the first thing is, have you ever talked to a person with ADHD who's tried to take their medications consistently? Doesn't usually happen. The second thing is, in the research, we see the complete opposite. It actually decreases our substance use disorder tendencies, which is by one third, it's incredible. And so it is the complete opposite because, of course, we have different brains. And jumping in on the same similar concept here, I see a lot of people online get really afraid of taking medication because they see a lot of the research in non-ADHD populations about how it depletes magnesium, or it makes you have worse oxidative stress. And in ADHD populations, we see something different. We actually see improvements in oxidative stress. So the, essentially, like the garbage in our brain reduces. We also see preliminary evidence in boys, so really hard to generalize, but improvements in magnesium stores, improvements in brain iron, improvements in cortisol, it increases cortisol, and that's something that people are afraid of. But guess what? People with ADHD have lower baseline levels of cortisol statistically, right? So of course, all of this statistics, but will what's interesting is we're going to talk about PMDD, and what we see is that ADHD and PMDD have a big crossover, but PMDD can actually have blunted cortisol, and that same phenomenon we see in some ADHD years as well. It really helps regulate, that's the word I like to use whenever I talk about what medication does metabolically for us. It helps regulate how our body uses and understands nutrients, and how it can help us. Yeah. And the other interesting thing too, because people, I think cortisol is one of the most misunderstood hormones. I'm a big fan. I'm a big fan, because it's the most anti-inflammatory hormone, like it's incredible at helping with inflammation, but also you may be living life with ADHD, and you may have a stressful period, and your cortisol system doesn't respond in the way you expect. So that's part of that blunted cortisol picture as well. So we have these null adaptations, really, to living in this modern society, where the HPA axis will basically be like, you know what? We already did that cortisol test, so we're not doing it. And we see that in chronic stress populations, and ADHD years are a chronic stress population. In the same way that left-handed people are chronic stress population, trying to navigate a right-handed world that doesn't give them accommodations. The really interesting thing is that a lot of us don't think that we're stressed. And then, when we look metabolically, a lot of the signals are stress signals, like what it looks like when a person is in chronic stress. And so that's what I love to tell people, is you might not feel like you are stressed because this has been your normal. If a different person was in your body, they'd be like, what the heck? I cannot handle this. Can we talk about your progesterone episode? Okay. So you were prescribed progesterone, and they didn't tell you to take it at night. No. Agnes and I straws dropped. We're going to call them else. Because it can be sedating. A big one that I hear often is when the medication is wearing off at the end of the day. But there are some kids that experience significant emotional dysregulation, sometimes like rage outs or just like kind of like bouncing off the walls. And parents are like, oh, my goodness, I didn't know this part. They know a lot about the appetite suppression is an often a common side effect. But that when the medication is coming offline is really a switch for a lot of kids. And parents aren't usually prepared for that. Does that also happen in adults? Definitely. Actually, Onika mentioned the kind of crash at the end of the day around 4 p.m. I hear that all the time for my patients. And my first question is, did you drink enough water today? Did you eat enough today? Yes. Electrolites. I have found that taking electrolytes at 4. I should have added that in there, too, is the difference usually for me to tell my patients. Yes. It is genuinely, I don't know. I mean, I do know because it's electrolytes, but at 4, taking it at 4, I usually take it at 4 p.m. Yeah. We know that stimulants cause low appetite. So I tell this to every single patient you need to eat enough throughout the day, even if you don't want to, you have to because you're going to feel like crap at the end of the day if you don't. The hardest part is when you have basically like anodonia of food, that is the, that's really difficult. So like bypassing that, try your hardest to be around people. I found this the easiest way to bypass that. Like body doubling for food, basically for eating. Yeah. I'll call my sister. We're going to eat lunch now. Love that. For people who don't know what anodonia is, can you describe that for them? What is the experience to actually have that when you're on medication? I struggle with this even without medication, which is why medication is just hard for me in general, too. But some days, I will try to eat my food and I can look at the food and know that this is so good and it tastes amazing. It's like what pizza or ice cream, and then I just can't bring myself to it. I cannot swallow it because I just don't, my brain just doesn't want it. Like I can logically want this. I logically know that this is good, but swallowing is almost impossible. The anodonia is like this lack of desire perhaps to eat. It's not necessarily a low appetite. It's like this lack of desire to want to eat. Well, how I've often described it, too, is like even people who want to exercise more regularly or when I hang out with people and socialize, like I want to want to do this. I want to want to exercise. I want to want to socialize, but I just cannot bring myself to do it, to call, to text, to get out of the house. It's painful. What does monitoring look like for you? So I try to see my patients about two to three weeks after starting a new stimulant or changing the dose, definitely within the first month I need to follow up with them. I also allow messages between patient appointments like they can check in with me and say, hey, I really don't like this. I'm having side effects. I think I need a dose increase like we talk a lot through messages, too, but it is really important for a doctor to follow up with their patient to make sure they're not having any adverse side effects. Earlier I mentioned there's an increased risk for mania and psychosis. It's unlikely at such a tiny dose and if somebody actually does have ADHD, but it's still important for me to screen. Oh, and monitoring symptoms. I honestly don't ask my patients to monitor day to day because that's another task for them to do and I feel like I'm just adding more homework to their day and I really don't want to do that. So I say, you know, you don't have to monitor so closely every day, but I will ask you the questions and then we can talk about it. Now, there's something that happens sometimes when you start medication and that's ADHD symptoms get better, but then it uncovers other conditions that have been riding along with ADHD. You ever see this in your practice where someone starts it, they're like, my ADHD is going right, but maybe now I'm so anxious or I'm feeling something different and you're like, that's worth paying attention to. Yes, but I typically do such a thorough evaluation that I would probably pick up on that before even giving them the stimulant. For example, I always rule out anxiety disorders, depression, OCD and so on, so I typically don't see something be unmasked because of the medication. However, if someone has uncontrolled or unmanaged anxiety, the medication can kind of worsen that anxiety feeling. So I want to talk more about ADHD and depression coming up, but I do want to talk about the phenomenon that women report all over the internet that we have very little research regarding and that is medication works well. I ovulate and now it's a slowed downhill slump in too. I'm not getting out of my chair, maybe not out of my bed. I'm not motivated. I can't focus on it because over here being like word, one good week, so what's happening there? So during the luteal phase, the week or two before your period, we have a drop in sex hormones, including estrogen and we know estrogen and dopamine are besties. I think we might have said that before in an earlier episode, but estrogen will increase dopamine. So if you have a drop in estrogen, you're going to have a drop in dopamine. Your medication's supposed to increase that dopamine, but now you're at a deficit from your baseline medication. And so the medications can feel like they are less effective during that time. Now, there's a new ADHD medication on the market. The new medication is called some trio. Generic is sent in tenafidine. It is a brand new mechanism of action. It's actually very exciting because we've never seen this in psychiatry before. It increases in norepinephrine and dopamine, which is the same as stimulants, but it also increases serotonin. And in different ways and kind of like different affinities for each neurotransmitter receptor. So again, this is a brand new medication. It was just FDA approved in July and it's not on the market yet. So it will be hopefully later this year. It needs to be scheduled by the DEA because they are classifying it as a stimulant medication. It's considered a stimulant because it does increase norepinephrine and dopamine. It stimulates the central nervous system. What about this makes it so novel and exciting for ADHDers? So because ADHD has this emotional dysregulation piece that we discussed in an earlier episode, which actually I should probably clarify now. So we know that ADHD is an attention regulation problem, an executive function problem. But the name ADHD doesn't encompass the emotional dysregulation, the RSD rejection sensitive dysphoria that many, many patients with ADHD experience. So when you look at the actual medication for the current medications for ADHD, they only increase norepinephrine and dopamine. So that's really focusing on the executive function piece, but not the emotional regulation piece. So this new medication increases norepinephrine, dopamine and serotonin. And we know SSRI selective serotonin, reuptake inhibitors, treat anxiety disorders and depression. So I am very curious to see if this increases serotonin enough to actually treat that emotional dysregulation piece. Now SSRI's going to all hate these days. And so what I want to reframe from our listeners as well, is that serotonin's also really important for neuroplasticity. And so we've seen neurologists will sometimes use this in traumatic brain injuries to help the brain heal. And I think this, why this is important for people to understand is that there's been a lot of stigma around SSRIs and, you know, there's the cytokine theory of depression. So people are like, why even bother with SSRIs, well, cytokines in the brain and going down the wrong pathway. So instead of going serotonin, melatonin, but instead taking a trip into neurotoxic metabolites can be incredibly damaging for the brain. I want you to talk about the mechanism as we're starting to understand SSRIs as well. But what I think is interesting is that yeah, there's a lot of ways that we can heal naturally, right? So this is, you know, I have used with my listeners before I started testosterone therapy because I had knee surgery, I started losing all this muscle mass. I couldn't get discharged because my surgeon's like, you're losing too much muscle and I was faced it across road. Yeah, I could probably get my testosterone levels up over the next couple of years, but I'm in 40s. Can I afford a next couple of years and not having that muscle mass? No, I can't. So I was faced with, you know, what just feels like the shortcut to people? Do I go on testosterone therapy or do I just try to do it naturally? And I went on testosterone therapy, I gained a centimeter circumference of muscle muscle my thighs within three months of doing the same exact thing I was doing. And why I share that story is because I wasn't at a place where doing everything naturally, I didn't have the time for that. But also the risk of muscle wasting at my age is tremendous. Like I'm looking at if I have a hip fracture in the next 15 years, I probably won't but still be here with us after six months. And so what I why bring all of this up is because I think it's really easy to get dogmatic in our minds that like we wear a badge of always do it naturally and drugs are the enemy. But drugs are a tool. And they're one tool in a toolkit and why this panel's here is because not a single one of you would be like everything, everything is going to, I'm going to use my hammer on it, right? Like you're not going to say this is the only tool for everyone, but I want you to talk a little bit more about what we've discovered about SSRI's because we're going to go into a depression and ADHD here. And then we're going to talk about PMDD as well. But what have we discovered? We used to think like, oh, all we're doing is boosting serotonin. Yeah. Well, first of all, I appreciate that you bring that up about SSRI's antidepressants being one tool in a toolbox. That's exactly how I explain it to my patients. It's just one way that we could potentially improve your mood, anxiety, OCD, whatever it is that you're struggling with. The old belief is that there was a serotonin deficiency in people's brains, and that's what was causing depression and anxiety. But there was a paper that came out a few years ago that looked at the brain and saw what exactly is happening when someone takes an SSRI, the selective serotonin we have taken in the inhibitor antidepressants. And actually, yes, it does increase serotonin, but that's just one part of how it works. It actually can cause downstream effects in the brain by increasing BDNF, which I kind of like to think of it as like a fertilizer for our brain. You mentioned miracle grow. You mentioned miracle grow, baby. Yeah. So imagine you're giving fertilizer to your brain. What can happen? You increase neuroplasticity. You make new neural pathways. So now, instead of being completely rigid and unable to change your depressed mood or your anxious thoughts, now it's more flexible. And that's where therapy and lifestyle improvements can really make a difference. And this space starts with ultra fit. Unlike traditional running shoes, ultra fit gives toes more room to move naturally. That's ALTRA running dot com. So I get how it can steal your time. Epglyce, lubricismab, LBKZ, a 250mg/2ml injection, is a prescription medicine used to treat adults and children 12 years of age and older, who weigh at least 88 lbs or 40kg with moderate to severe eczema. Also called a topic dermatitis that is not well controlled with prescription therapies used on the skin, or topicals, or who cannot use topical therapies, epglyce can be used with or without topical corticosteroids. Allergic reactions can occur that can be severe, eye problems can occur. Tell your doctor if you have newer, worsening eye problems. You should not receive a live vaccine when treated with epglyce. Paid partnership with Lili. Respect your time. Ask your doctor about epglyce and visit epglyce.com or call 1-800-LiliRx or 1-800-545-5979. Mm-hmm. And, you know, estrogen is another thing that helps increase BDNF. And so as you talk about this new ADHD medication, we know that women going through parimenopause, so we have the ADHDers, which is much harder on them. But also women in parimenopause can have up-regulation of reactive oxygen species in their brain. They can have a decrease in BDNF and they can have lower serotonin. And this is part of why we see parimenopause being so vulnerable and so many women experience anxiety and depression. And so as this new pharmaceutical has come out and been developed, I'm like, there might be something here for the parimenopause of women because there have been studies like violence was one that they used in parimenopause, non-ADHD women. And they're like, who am I again? I remember her. Like I'm so happy to have me back. And I think, you know, that's the first thing that got me so curious in what's happening in that brain that's so much like ADHD, that an ADHD drug would help. I'm just curious, you know, your thoughts in terms of working with a parimenopausal population, we see that stimulant medications are not always effective. What are your thoughts about this new drug in terms of, you know, is it hopeful specifically for ADHD or just in general parimenopause? I think, well, it's not approved for parimenopause, right? Yeah. So like, we have D-A licenses that we're not like us being like, off-way, well, yes, on a brand new drug. No, I do think it's, I think that's what I'm just putting out in the ether or someone's study this. That's what I want. Yeah. That's what I'm going with that. But no, for ADHDers, especially in parimenopause. Oh, yeah. I'm definitely going to be trying if a patient of mine wants to try it, but I'm very interested in that serotonin. We already know how numb and effort and dopamine may work in these ADHD medications, but I'm really excited to see the serotonin piece. Like, is it enough to make these downstream effects of increasing BDNF? We'll see. We talked to us about SSRI side effects because this is why I think the internet's so mad and patients are rightfully so mad because they go into a PCP's office and in seven minutes, they're like SSRI sent you on your way, and they didn't get the true informed consent. Not because their doctor's evil and hates them because the system is really broken. And then they go home, they have these side effects and they feel betrayed. Nobody warned me. And they suffer through them thinking, this is a knee issue. I think, you know, probably which one I'm hinting at right now. But what side effects do you think people should be aware of and report to their doctor immediately? Absolutely. Always report any side effects to your doctors. Again, I'm very thorough. So I always go over all the side effects before I prescribe a medication. I think this is part of here. This is part of informed consent, right, and shared decision-making with the patient. But in general, side effects include loose duels or diarrhea and somnia, headache when for starting appetite changes, but the more the more the ones that people really struggle with include sexual side effects, sexual dysfunction, so low libido difficulty with orgasm or delayed ejaculation, some emotional belunting. If your dose is too high, sometimes you just feel like completely in the middle, like you're not super happy or excited or motivated, but you're also not depressed or sad. So you're kind of just like stuck in the middle. And of course, there's an increased risk for kind of flipping into mania. If you have undiagnosed or unmanaged bipolar disorder. And we're going to talk about saffron. You know you and I love some saffron. I love saffron. I mean, there was a great study, and I will say that like herbs have limitations in how they're studied and herbs are not replacements for medications. That's not how they're designed to be used, but there was a great study showing that when you struggle with an orgasm, the inability to orgasm and low libido, saffron was safe to take alongside an SSRI and it actually helped mitigate that. In another episode, we talked about how saffron, in one trial of methylphenidate, should help the medication work better. And I'm kind of like, can someone tell me what saffron doesn't do? We're going to talk about it in the context of PMD Dean. But Dr. Lockhart, I want to ask you when it comes to depression, how often is depression missed in kids who have ADHD? Good often, because one of the symptoms, well, there's several symptoms of depression, the acronym that we used when I was in primary care was CIGI CAHPS. So just a great way for parents to remember or people to remember. So sleep, interest or the anodonia, loss of interest, guilt, low energy, poor concentration, the type changes, either increased or decreased, like a motor. retardation, which is like the slowness. - Do I say it on ID? - Yes, suicide ideation, thank you. Or thoughts, you just kind of increase in those thoughts. And so those are the things that often are present in depression. However, some of the overlap with ADHD could be sometimes the anodonia or the loss of interest can sometimes pop up where they just have no motivation for anything or things that are important to the parents for them to be motivated for, or for themselves. And also the concentration, concentration can be significantly impacted when you're depressed. And so that often can be missed if there's ADHD or if there's depression vice versa. So those things can go co-occur. The other thing too is that with a lot of individuals who have ADHD, they have this sense of what's wrong with me. I can't ever do anything right. Everything is hard for me and it's easy for everybody else. Or I'm being pulled out of class or have accommodations at work and everybody else is normal. Those kinds of things and that can affect you because you just feel different and you just wanna feel like you're typical. - I remember being extremely depressed in high school and I think one of the things that I always said was, I'm just tired. Though if you're hearing your teens say that, that might be a really big sign. - Yeah, absolutely. - Do you see this depression more in your male population or your female population? - The, I think in the male population, it comes out more as anger and defiance and ODD, misinterpreted as ODD. And with the female population, the depression is either just kind of sad depression or an irritable depression. Like I'm just agitated and irritated and annoyed by just be quiet. You're being too loud or whatever. So it's the depression is often misinterpreted by parents as you're having an attitude when it's maybe an irritable depression. And I often see that in teens is the irritability that is part of depression but is mistaken for an attitude problem. - We're actually taught in psychiatry that irritability is a very common sign of depression in kids and adolescents. That's just how it comes out. - Absolutely. But a lot of parents don't get that memo. - How would they know? - Exactly. - But how would they know? How would they know? - No, how would they help them out? - Because no, I mean, it was a, how would they know? But then I'm like, wait a minute, how would they know? Let's help them out because there's the irritability, but I think there's probably more signs and maybe the irritability is obvious, right? But there's probably some subtleties that maybe are getting missed. - Yeah, absolutely. A big one is changes in functioning. So if you have a child teenager and their sleep is almost up all of a sudden or they've lost interest in hanging out with friends or the type of people they're hanging out with has changed or their hobbies or interests have significantly changed and then their irritability or their attitude has popping up. Like people they wanna quickly go, "Oh, they're just being hormonal." But again, it's still a shift. So whether it's hormones or not, they're still a shift. So we have to pay attention to when there's a shift in functioning or being adapting to situations, adaptable to pay attention to those things as well too. So that's, you don't always know because how would you, but it's that shift. Like a lot of parents tell me like, this is not the kid that I remember. The kicker though is that when you go from having a kid to a teen, they change anyway because it's that individuation is that developmental process. So I get a lot of parents who bring teens in that think something is wrong with their teen and they think they may have depression and really they don't. They don't have a diagnosis. They're just growing up and changing and they're shifting, but the parent doesn't know how to parent this new stage of development. And so a lot of it is parent training and helping them understand their new kid. So, but it's that that's a really tricky part. It's okay to consult because sometimes you might need to talk to your PCM and or a psychologist to get a referral with a psychiatrist, social worker. But if you're concerned, just talk about it. Sometimes it's just a natural, normal development and it's typical. You just don't know how to parent this kid in front of you. And for people listening, ODD is oppositional, defiance disorder, we will link in the show notes to the episode where we covered that. So whenever I'm teaching clinicians about prescribing birth control, this is one of the things that I say to them, especially in the teen population. This is the most vulnerable population for not just depression, but suicidal ideation with the initiation of birth control. And it's typically within the first few months of using it. And I say to ask the teen to ask their friends to look out for them. If I'm dodging your text messages, if I used to be really into volleyball and I'm not showing up anymore, if I always talked about this one cute boy on like was all into the, you know, Chizmay, the tea. And now I don't care. I literally don't care what's going on. Have their friend alert them or alert a parent or whatever that teen feels comfortable with because I think you wrote a book. It's up there right now. How to get your teens to talk to you, right? Raising teens who will talk to you. You like how I just like I'm going to paraphrase a book title so no one can find it? That's a fail. But that doesn't mean your teen will talk to you. And especially sometimes girls are getting on birth control and their parents don't know about it. And so having a friend or somebody else that is their touch point can help so much because sometimes it's as simple as changing the pill formulation and that all goes away. And sometimes it's like that's not right for you. And we're in a medication episode. And I mentioned this before, the double edge sort of ADHD. We've had one study. We need to repeat studies so that we truly understand it. But there's a significant increase risk of depression and it's an association, I should say, because we have no causal studies that are quality right now with birth control and depression. But we see ADHDers are so at risk for this. And at the same time, they are at much higher risk for unintended pregnancy because of the risk taking. But as Anika was saying, when your ADHD is treated and managed, risk taking behaviors go down. We have less car accidents. We have less teen pregnancies. We have less self-harm. We have, and whether that's intentional or unintentional, right? That's good. That's good. I mean, whenever people are like these medications or the devil, I'm like, you don't know how many people they're keeping on the planet. It really is the reality of that. With that in mind, I do want to talk about depression versus PMDD. When we're talking about keeping people on the planet, I think this one deserves a place in the conversation. So could you walk us through that, Dr. Simone, and just how does someone know the difference between the two? So Dr. Lockhart already went over the diagnostic criteria for depression, the SAGI CAPS acronym. And it needs to last for at least two weeks and cause functional impairment. PMDD is only during the ludial phase, again, the week or two before a woman's period. And it must resolve within one to two days after bleeding. I've talked to who have PMDD because it's so connected with ADHD. When, like I talked to them, they share that they do have those ups and downs. And I really wonder if there is a connection between cognitive glucose sensitivity as well as PMDD, like them together. Yeah, especially because some ADHDers can have that glucose sensitivity, that poor glucose utilization within the brain. And it's ADHD. They're three times more likely to have PMDD. And the other thing I'll say about Safron that I have seen is, and I need a study on this, so bad. anecdotally, what I've seen in my clinic is that putting patients on Safron to support their PMDD symptoms, we're not treating with Safron, has helped their ADHD medication work better. And it was so interesting when that study came out on methylphenidate. And I was like, oh, yeah, because here I am listening to these women, and I'm like, I believe you, but no one's funded this study yet, like it doesn't exist. I want to ask the question about what you see with teens and PMDD because PMDD actually does get missed quite often. Yeah, absolutely. And again, it's the misinterpreting that they're just having an attitude. I just find it so often, teens get dismissed so often, and kind of just chalking it up to just having a bad attitude, lazy being unmotivated. And it's just, I think we take so many of their behaviors as this character flaw and as part of their identity. And I just think that's problematic. And I mean, even when I'm online, and I talk about respecting your teens and listening and getting curious, people get offended by that stuff. I don't need to respect my teen. They need to respect me, that kind of thing. And I'm like, it needs to be both. Why are you so offended by that? Why do you resist that so much? And a lot of it is because people are speaking from their own pain. They didn't feel hurt and understood and respected as teens themselves. I'm like, well, then break the cycle. And so I think a lot of these, this PMDD that teens experience, a lot of times what I'm hearing is medical doctors, their primary care physicians being very quick to dismiss. Well, let's just wait and see. Let's just wait and see. Or just putting them on birth control and thinking that's the solution. Or putting them on pain medication or antidepressants without doing a full workup. So I think we have to be really just listen to them and have them track and noticing over time. What does it look like in believing what they say? The space to go further, to feel better. To do something you never thought possible in this space starts with ultra-fit Unlike traditional running shoes ultra-fit gives toes more room to move naturally So every step is strong Balanced and comfortable whatever you're leasing up for stay out there with ultra shop now at ultra running dot com That's a L-T-R-A running dot com Hey, it's Kelly Rowland. You may not know this, but I have eczema so I get how it can steal your time But why let eczema take over when you can talk to your doctor about epglyse? Epglyse, lubricism ab LBKZ a 250 milligram per two milliliter injection is a prescription medicine used to treat adults and children 12 years of age and older who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema Also called a topic dermatitis that is not well controlled with prescription therapies used on the skin or topicals Or who cannot use topical therapies ebglyse can be used with or without topical corticosteroids Don't use if you are allergic to ebglyse allergic reactions can occur that can be severe eye problems can occur Tell your doctor if you have newer worsening eye problems You should not receive a live vaccine when treated with ebglyse before starting ebglyse tell your doctor if you have a parasitic infection paid partnership with Lily respect your time ask your doctor about ebglyse and visit ebglyse dot com or call 1-800 lily rx or 1-800-545-5979 Well, and there's doctors who believe that Period pain is normal. Yes being uncomfortable is a normal. Yes being emotional is just part of being a woman And you know, what I really take issue with with the birth control prescription is that it could work, right? But then this girl finds herself later in life and let's say she's 28 and she decides to come off birth control And she wants to start a family and now she's struggling and she's like Why am I so broken? What is wrong with me? And we've missed something like we've missed Something that we could have managed that we could have supported her with that could have helped her immensely and so you know I'm not against Using the treatment that works, but it's also like if we jump too quick to the treatment without knowing what we're actually treating We can sometimes mass things or we can miss the mark on things and I would love more research on this But the way we talk to ourselves can influence inflammatory proteins the way that we are treated the way that we are interacting So this community and this like this self cultivation and care can also raise inflammatory cytokines And so when you talk about like a child who's in the PMDD or the ADHD model or the depression model where The cytokines are involved in disrupting neurotransmitters and brain function Cortisol is going down in the evening. So this is why like anyone who deals with chronic pain is like why is my pain worse at night? Because your anti-inflammatory hormone is doing what it's supposed to do and you need that melatonin is part of healing It's very healing, but it's also I think I Just want to give language to like why does that happen? So you know that this is normal physiology. It's not a my stupid body is betraying me again, right? So I want to ask in terms of monitoring PM2D. You start someone on the medication. I'm assuming with you It's not just like take the medication. You'll be fine. You're gonna go on your way. What does the follow up look like? I always follow up after the next cycle So I try to see them while they're on their period or even in their loodial phase to see if it's working And I have honestly have had so much success with either birth control or antidepressants Some people just cannot tolerate birth control so they would prefer the antidepressants or vice versa and Implementing lifestyle improvements eating enough drinking enough water Movement so important, but yes, I try to meet with them within the next month. When is combined Medication therapy warranted in your opinion. I always like to stagger my prescriptions otherwise I just won't know what's actually helping and what's causing side effects if one doesn't work or Doesn't work enough then we'll add on the second prescription I just love that that's your approach. I think you're such an empowering psychiatrist because You are in partnership with your patients and at the same time you're very invested in What are the outcomes? What is happening and also being able to understand what variable is working for the individual? There's very good marketing behind SSRIs and PMDD and so sometimes clinicians are like no this does work for everyone, right? And you are so in tune with your patients, but also keeping on top of the research that you've come to understand that like It's a dance sometimes. I want to go into the protocol playground So she said I started medication two months ago. I do not feel dramatically different But I'm missing fewer deadlines. I'm interrupting people less, but my house is still a mess Is my medication working or is it not? The medication is partially working not enough though It's not fully effective, but I also wonder if there needs to be some behavioral changes in terms of the messy house The medication's not going to make someone completely neat all of a sudden You think it goes back to a talk show a lot of heart was saying is that like the medication doesn't teach you the systems It doesn't teach you the executive function. It gives the brain the ability to execute on the executive functions But not necessarily know how to do that And I think it's really is the best time to then seek therapy is when you get on the medication your brain It's it's almost more like like spongy. It's more open to learning just like I like when I see people who Choose to get on anti-anxiety medication or antidepressants and then they come to therapy and are ready to learn the skills because before Maybe their their motivation level wasn't there or their mood wasn't there So I think it's tapping into that resource and allowing yourself to know like yeah, it's it's not a magic quick fix But you bring in the tools with the medication. I recommend therapy ADHD therapy to every single person that I Diagnose and treat for ADHD because I explain just that the medications can only do so much. You really need to learn the skills Well, and sometimes like you know also having occupational therapy um or you know in the medications are not going to help with sensory sensitivities and that might be something that is Distracting you right is like the way that you're close fill and it's not actually the medication It's not actually necessarily your ability to focus. It's not like why do we have to put tags and clothes and seams on socks like it's 2026 cut us a break, right? Oh my god. Yes Okay, Anna. This one's for you The person writes my medications suppresses my appetite during the day Then it wears off and I'm ravenous at night. I'm starting to feel completely out of control around food. What can I do? First off, I completely feel you it is so normal to experience Not having hunger in the middle of the day What I would say is How do you notice that you are not hungry? Because that's the first question. Are you actually not hungry or are you using your medication and now you are In flow state and you are bypassing all of your interception cues because unfortunately Your medication it can help us Learn our bodies better because we can sit with our bodies a little easier But at the same time if we're not practicing learning how to listen to our bodies You're not going to get to that point of knowing you're hungry So developing your interception, which is really difficult If you don't know how to do that, but the first thing I always say is Give your body the building blocks to developing Interception and to do that you have to train it to know When am I supposed to eat? So Dr. Lockhart Medication can reduce symptoms, but it can't prevent every emotional trigger What do you want women to have in place before that PMDD window begins? I think having a system that works for them To make sure that they know that if a week or two weeks before your period you Go into a rage monster. You're more irritable. You're more Brain foggy whatever is going on with you to know like what do you need in place support system Whatever more exercise more social interactions. What do you need more of during that time frame to help support yourself One of the most powerful things when I used to work in in a primary care clinic is I would work with Young adult women who were experiencing a lot of this PMDD or ADHD symptoms Combined and just having them be able to track in their own way whatever works best for them So that they can see the cycle and often times because they kept saying there's something wrong With me. I don't know what I it just comes out of the blue And then we would look as like well, it's not really coming out of the blue It is kind of predictable and then when they can see that okay Well, you know that around this time is when you feel like a rage monster What do you need during that time? Oh, well social interaction helps or you know a movie night with my girls or you know Taking time off from work on this particular day like whatever it is that you need and making sure you have those things in place Or exercising more or whatever it is But knowing what your body needs listening to that and then responding to it in a way that helps you and that makes a huge difference If I can add it also Recognizing and giving yourself that grace that this is a really metaphorically intensive experience You're so much Your body is just under constant stress essentially and so So I think it's one of the really cool studies that has come out of 2026 is this study with a very high dose, broad spectrum, multi nutrient. And they gave it to teenagers, placebo or that one they found that essentially got rid of oppositional advice disorder or DMDD or it was better than placebo by 50%. It's like knowing like maybe sometimes your body has just been depleted for too long and it's okay to get more nutritional therapy through that too. Absolutely. Dr. Lockhart, is there something that you would like to say to people about having realistic expectations when they enter into therapy so that they can have better outcomes? Oh, absolutely. I think one of the big ones is to know again, just like medication isn't a quick fix, therapy isn't a quick fix. And I see a lot of times by the time a lot of evidence has shown that by the time people reach out for therapy, like they're at their last, last, you know, and they, so they want something to change because they're finally motivated for change, but that's not how therapy works. There's not this flight into health. And so to come in, whether it's for your teenager or for yourself to know like, okay, these are the problems that I'm having. These are the goals that I have and talk to your psychologist, talk to your therapist and what your goals are. A big thing is ask your therapist, okay, what is my diagnosis? What's the treatment plan and collaboratively come up with a treatment plan? And a lot of times I've met with clients who've seen previous psychologists and they did not know what their diagnosis was and they did not know what the treatment plan was. And what I have seen in some of the research is that a lot of psychiatrists and psychologists are afraid of sharing the diagnosis with the client or the patient because they don't want to stigmatize or label the client and it's like, well, but that's why they're there. So they need to understand what's going on. And the, the, and now the comparison I often use with my clients is a member years ago I was feeling exhausted and tired and moody and when I went and got my blood work, I was vitamin D deficient. I was working in a hospital. I was there before the sun, left before the sun. And so when I saw, I said, oh, vitamin D, what do I need to do? Got on a supplement, got more sun, and I increased. I'm like that to know what the label was wasn't stigmatizing and helped me to make different decisions. So I think they just need to come in and understand what is their diagnosis, what's the treatment plan and to be a collaborator with your therapist. I actually always end every assessment with here is my assessment. Here are the diagnoses if you want to know and here is the treatment plan. I use the exact same wording treatment plan. And I think it, I think patients appreciate that you're taking the time to educate them because then that will help them feel more comfortable with the treatment plan. Absolutely. Mm-hmm. And normalize what they're going through. Yeah. I mean, what you just described is that collaborative care. Mm-hmm. And that's what I think we really need more of so that we can get more patients to trust in providers and to get the support that they need. Can I share one more thing too? Yeah, of course. I had a client years, years ago, the mother came in, brought in her teenager and she said, "I need you to help my teenager. She's dead inside." And I was like, "Oh, my gosh." That's horrible. So I'm thinking. That's the first thing to say. It's a serious thing to say. And so as I'm meeting with this teenager, what I had discovered is that she was highly introverted, mom was very extroverted, younger sister was very extroverted. And so she was so overstimulated by this loud, overly social family that she would get to a point where she would shut down and withdraw into herself. And her parents, her friends would see the same thing. They were just like, "We, you're hanging out with us and then like hour and a half in, you like glass over and you like check out and we were like, where does she go?" And so at the end of that session, I was like, you know, assessed her everything. She did not have any clinical diagnosis. She's just introverted and didn't understand that about herself. So I educated her on her personality, her temperament, what stimulates her, how she recharges. And it was like this, like this light. And I explained that to her mother as well. Your daughter is not dead inside. She has just a different temperament than you. She does not have a clinical diagnosis. She just has a temperament that you don't understand or appreciate because that's not who you are. And so it was really cool to help them understand that not every apparent impairment is actually impairment. It's just a misunderstood person. I love that. Thank you for adding that. Well, thank you all so much to our wonderful listeners. You know, the message I want to leave you with is that women are expected to DIY enough. We are expected to take care of everything, take care of our health, solve all of our problems, and a lot of times, why not go it through life because heaven forbid we get any kind of support. I hope this episode has helped end some of the stigma that exists out there and would encourage you to meet with a medical provider and get the support that you need. It may look like a medication and it may not, but you're more equipped now after listening to this episode to know how to go into an appointment, what to expect, not just the realistic expectations about medication, but what to expect from your provider and ensure that you can get the treatment plan that's going to work best for you. As always, if you can drop us a comment like subscribe, we are moving into burnout next, which is an ADHD phenomenon that I don't think gets enough attention and if I had to guess disproportionately affects women. So join us there and you can hit the subscribe button and I'll notify you so you don't even have to worry about remembering it. And we will see you next time. Thank you so much. Thank you. Thank you. Pink Panther us here, coach and Spotify are teaming up to bring music and style together and they want you to be part of it. Grab your friends and head to the tabby tour, hitting cities around the country with live performances from special artists, exclusive experiences and personalized products, and discover custom playlists on Spotify, but just for you based on who you are and how you listen. Live your story with coach, learn more at coach.com. Your heart can tell you a lot about your health. Apple Watch Series 12 measures your heart rate every five seconds, with the most accurate heart rate sensing and awareable. So your vitals app, now with heart rate variability, can tell you when something is off. And your readiness score can let you know when to rest and when to push. 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