ADHD Medication: Myths, facts, and finding the right fit

Welcome back to Thriving with ADHD, where we share practical tips to help ADHD adults thrive. In this eye-opening episode we dive deep into ADHD medications with our special guest, Meredith Rappaport, a compassionate and dedicated physician assistant from Animo Sano Psychiatry.

Meredith has a rich background in social work, psychotherapy, and medical practice since 2008. She brings a holistic approach that combines medication management with mental health therapy, ensuring comprehensive and empathetic care for her patients. Join us as we bust myths, delve into the facts, and explore the nuances of finding the right ADHD medication.

Key Topics:

- Comprehensive overview of stimulants, non-stimulants, and their effects

- Detailed discussion on safety, side effects, and efficacy

- Alternative treatments and complementary therapies

- Insights into managing ADHD symptoms through lifestyle changes and supplements

- Importance of education and support for patients and families

Whether you're an adult living with ADHD, a parent seeking advice, or simply curious about the topic, this episode is packed with valuable insights.

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Thank you for listening to Thriving with ADHD. This show is produced by Animo Sano Psychiatry. For more information about our clinic, please visit animosanopsychiatry.com.

Animo Sano Psychiatry has introduced new services for enhancement of our patients' mental health - ASP Concierge and Health & Wellness Program. Please visit our website to learn more.

Animo Sano Psychiatry is constantly looking for the talent in behavioral health. If you are a psychiatrist, nurse practitioner, physician assistant, or mental health therapist, we'd love to hear from you. Visit our Careers pages to learn more about the available positions. https://animosanopsychiatry.com/careers/

Transcript

   📍     Welcome to Thriving With adhd, a podcast we'll share every day practical tips to thrive in life as an adult with adhd.  This podcast is brought to you by Animo Sano Psychiatry, a behavioral health practice with a specialist ADHD clinic based in North Carolina. And this is your host Nada Pupovac.

Welcome to Thriving with ADHD, dear ADHD community. This month, we talk about ADHD and medication, myths, facts, and finding the right fit.  I'm really excited to introduce our guest speaker, Meredith Rappaport. She is Annie Monsano's physician assistant, and we haven't had the pleasure of having her on the show yet.

So I only hope it's just the first time. of many.  Let's learn more about Meredith before we jump into our conversation with her. Meredith Rappaport is a dedicated and compassionate physician assistant who feels incredibly fortunate to contribute to the mental health field. She has a strong curiosity and profound interest in how people think, feel, and grow. 

Since 2008, Meredith has been dedicated to the mental health field, initially working as a social worker and psychotherapist. She later returned to school to become a physician assistant, continuing her work in mental health field as a medical practitioner and prescriber. 

Her holistic approach combines medication management with a deep understanding of psychotherapy, ensuring comprehensive and empathetic care for all her patients. She continually strives to provide the best care possible. Meredith also offers child and adolescent psychiatry services besides the services for adults.

 Meredith, welcome to Thriving with ADHD show. I am really happy to have you here because it's your first time and I know that our patients love you and I know that you have a lot of knowledge. From social work, psychotherapy, now physician assistant, just your experience is so rich within the mental health field.

So  that's why I think you would be a perfect person to talk about some of the topics that interest our ADHD audience  and this time you came to the show to talk about ADHD medication. Very important topic. We're here to bust some myths, to talk about, uh, facts and finding the right fit.

So welcome. Welcome. Welcome.

 Yeah. Thank you. Thank you for that intro. 

Yeah, that's no problem.  We can jump right into our questions. So my first question for you would be, can you explain the different types of medications available for treating ADHD, including stimulants and non-stimulants and how do they differ in their mechanisms and effects

okay, so  we have several things we can do for folks that are struggling with ADHD and have tried. Um, a lot of behavioral, um, hacks, if you will, and are still struggling, um, it, it's kind of different than what we do with kids and adults, but, um, generally the, the, the classes are the stimulants, um, the  alpha agonists,  and, um,  then there's also some supplements, uh, that can be used. 

But, um, for stimulants, there's kind of two main groups, the methylphenidate group and the amphetamine group. And among them, colloquially, you probably hear them referred to as the Ritalin group and the Adderall group.  And then you have the, in the alpha agonists, you have clonidine and guanfacine are the two main ones that we use for various things, ADHD among them. 

And then there's, uh, there's also, uh, things you can do cognitively because you have to remember your brain is a biochemical machine. All right. And it needs the right fuel. So there's, uh, all kinds, there's things in the brain that we, nutrients we need to get to make neurons and to keep neurons healthy.

So there's also supplements. And among those that I use would be omega 3 fatty acids and acetyl cysteine and vitamin D, as well as, um, uh, there's some small studies that support, uh, using American ginseng.  for adults. And then for kids, there's a couple more things that I could I could mention, but they're not the medications, which is what you asked about the, um,  mechanisms and effects.

Um, the alpha agonists, which I'd like to start out with in kids, because if they're real young, we really don't like to give stimulants as much as we can avoid it due to the side effects.  They They were developed to be blood pressure medications, and  they just seem to increase the executive function in the frontal cortex and prefrontal cortex.

And we're not, I don't think exactly sure why. But they help especially good with, um, hyperactive kids, boys in particular, impulsive, hyperactive and kind of helping slow them down a bit, um, helping them, um, function it better in terms of, like I said, that executive function. So cognitively,  uh, the guanfacine is the typical one I would use.

Um, they both cause sedation quantity is also used as a sleep aid, um, frequently in mental health and then the stimulants.  These are reserved for, you know, when people have impairment in function,  if you really can't function socially or in school and like for kids, you know, we don't necessarily want to give stimulus to kids because they suppress the appetite, they suppress sleep. 

So sometimes kids will end up being on, you know, multiple medications because of insomnia and because of loss of appetite, we want them to hit their growth curves, but stimulants.  The amphetamine kind of pumps dopamine from the brain, so it pushes the brain to create more dopamine and it also modulates norepinephrine.

And these chemicals seem to be  involved in ADHD.  I wouldn't say lacking, but somehow, you know, the brain's really complicated, but what the amphetamine will do is it'll kind of push the brain to make more,  kind of like in a diabetic medication. You got a sulfonylurea,  a sulfa drug. Sorry, that's hard to pronounce sulfonylurea drug.

Um, They will pump the pancreas to make insulin.  So this will pump it. And that's kind of, you know, it's a lot for the brain to take sometimes. So, um, if you take that medication, you may feel it's the reward system. So dopamine is your reward system. Uh, it'll make you feel good. Initially, that eventually goes away at any dosage initiation or increase.

And that's part of why it's considered habit forming. I think  So for the first few weeks or month, maybe you have better mood. Um, you have more energy, you have, you're more talkative, more outgoing, a lot of some of those things that people like or suppressed appetite, those things will eventually fade.

But what you should be left with is still these other benefits from the medication, which is, um,  improved initiation of tasks, motivation, concentration, attention,  the methylphenidate.  It's not quite as.  Simple is sort of pumping the, uh, dopamine from the brain. It's sort of, um,  I wouldn't say prevents reuptake, but it's it's a little bit different than the amphetamine.

And I'm not sure that I'm the one to explain that, but it doesn't pump it as much. We have that evidence for  kids taking it long term without detrimental effects. We don't necessarily have those studies with, uh,  that show. We don't really know necessarily the long term effects. Taking, uh, the amphetamine as much, but the methylphenidates, uh, a good medication too.

That's the Ritalin family and it just helps improve and create, uh, more dopamine and, um, norepinephrine in the brain. And, uh, it does seem to help improve attention, focus. And the same things as the amphetamine group. It does tend with kids sometimes, which is the one we, sorry, medication of choice for kids, the methylphenidate.

And it does sometimes unfortunately, produce 'em.  emotional breakdowns or crashes at the end of using it, because these things are so short lived. So the stimulants are short lived, take them in the morning, and they're fading from the system all day, as would your normal attention. Um, then you have non stimulants  that are also  not, they're called, sorry, I forgot to mention these, the uh, norepinephrine dopamine, it's norepinephrine reuptake inhibitor, and that would be Calbary and Stratara.

Stratara is the old one,  um, that's been around forever, it's also called adamoxetine, and  You know, I'm not, I don't find a ton of efficacy with it. A lot of my colleagues will use it and seem to have patients that like it. I personally have found that it's pretty in general, not very effective for my patients.

So they had a newer one now called Calbary. It was FDA approved for children several years ago. That's Q E L B R E E very odd name. But, um, it was then approved by the FDA. A few years. Subsequently, they were approved for adults as well. Major side effects would be sedation and children and insomnia and adults, um,  counterintuitively. 

So Calgary is FDA approved for and Esther Tara FDA approved for, um, ADHD. It's a one a day adults in the morning, children at night, not controlled substance. That  is probably a little more subtle than taking a stimulant where you feel like you've taken a drug.  This  just seems to work. Um,  again, it's kind of more like an antidepressant in that it prevents reuptake of these. 

Which is kind of like recycling, if you will, it prevents the recycling of the, uh, medic of the brain chemicals, dopamine, norepinephrine,  and then supplements. That's a whole nother podcast.

 Okay. We can save that for another time. You know, uh, how they, they do. They say you knocked it out of the park straight away. And just with the first question, Uh, so many great things that you shared with us. I will also like to mention that. Um, and they have this in our intro that you specialize in the child and adolescent psychiatric services. So I'm really delighted that you're making comparisons between medication for kids, and then for adults. I think this is where you bring your expertise and.  As well as making comparisons between these two groups, which is amazing. So I really, really appreciate that. 

And I'm sure everyone who is listening to this and maybe they're adults with ADHD, parents with ADHD have children.

Um, I think, uh, this will be very helpful and useful for them as well.

Exactly. 

So my next question would be how effective are ADHD medications in managing symptoms? Uh, and what are safety concerns, considerations and potential side effects.

Well, stimulants are very effective. In fact, uh, they're going to be effective for just about anybody, whether you have ADHD or you don't, um, they're going to force you to hyper focus  and, um, it used to be thought that, um,  there was a paradoxical effect that they would, you know, You know, only how not paradox.

Well, that they could make people with ADHD more tired or, you know, not as as stimulated, um, or that if you responded to the medication, you have ADHD, but it is not a diagnostic tool. They work for everybody. Kind of like alcohol works for everybody  in that same way. If you, if you drink enough, you will get drunk.

Uh,  if you take a stimulant, you will benefit in that you have. Hyper focus and attention. Um,  most people respond the same way in my experience, and  that would be, um,  that, you know, it tends to just like I said, get you to motivate it to get things done to focus. Unfortunately, ADHD develops  for different people in different ways.

And we don't talk a lot about where does ADHD come from? That'd be another good podcast. Um,  people just assume it's genetic and you have it or you don't. And that's not the case for everyone. But, um, when you take a stimulant, sometimes it can make you more anxious. If. For instance, you developed ADHD as a coping mechanism from having a chaotic childhood or a chaotic mind full of anxiety.

If you developed  the coping mechanism of suppressing attention to the things that are going on, whether inside your mind or out, then this strips you of that. So it can have the side effects sometimes.  of increasing anxiety  in some people. Um, but it does tend to act more centrally in the brain than peripherally in the body.

So it's not like you can't take it if you have anxiety disorders or that kind of thing. Um,  they,  let's see. So the big side effects with that, the stimulants would be, uh, insomnia, loss of appetite, um, dryness, dry mouth,  dry membranes.  Excuse me,  and I suppose there are some rarer things that I've seen, but  those are generally what you would see. 

I don't see.  I don't see a lot of stomach upset or things like that, but most side effects, you know, you just maybe want to take it with food. Um, and the safety considerations are, you know, especially in kids, like we use this only if we have to, because it can suppress their growth. Uh, if you're not eating properly and sleeping properly, you may not be meeting your growth curves.

And, um, so you want to make sure we're finding the right medication that doesn't, uh, suppress pediatrician's okay with as well.  Um,  the non stimulant  As I was talking about Kalonidine and Guanfacine, they, the big thing there is going to be  sedation and these again are meds we're typically using in children.

For some reason, Guanfacine doesn't seem to continue to work past adolescence for most people. I've seen maybe a handful of people taking it as adults. But the big thing there is somnolence. I have to really do a lot of expectation management and understanding of symptoms and side effects or how these things work.

because parents will often say my kid is a zombie. So we have to really initiate it slowly. And we have to know that side effects like that do fade over over short periods of time, usually just a few days.  Um, the non stimulant medications in the, uh, Norepinephrine, dopamine reuptake, inhibition, uh, the Calbary, and this Trutera.

Uh, they can have side effects like, um, upset stomach, uh, for children, the big one is insomnia.  Um, for adults, the big one, I'm sorry, for children, the big one is somnolence, sleepiness, and for adults, the big one is insomnia. I'm  not really sure why. Um,  and  let's see, they kind of, like I said, operate more kind of like a, um,  antidepressant.

So you may have things like, upset stomach,  um, headache.  Fatigue. I already mentioned decreased appetite can happen to you can get a little blood pressure spike and oh, that's I'm sorry I did not mention with the stimulants as a big one is that we can have increased heart rate, increased blood pressure and things so we we really don't want to use these with somebody who has cardiac issues or is hypertensive.

And the same thing for, for the, um, the, um, Calvary and the struttera. Now the guanfacine and clonidine do reduce blood pressure, as I mentioned before.  So those are some of the potential safety risks and side effects. 

 Okay. Okay. So we all have these in mind. How do you determine which medication is right fit for a particular patient?

Yeah, um,  Well, first of all, age is a big one. If somebody is five years old, six years old,  I really seven years old. I don't love to give stimulants. So I'm probably going to start with the alpha agonists, even though, um, the textbooks would maybe tell us to go for the stimulant.

I think that's a big, uh,  Risk and, you know, it's a, it's a big, you really weigh risk against benefit when you start with a stimulant at a very young age. And so I was trained by, uh, in the neuropsych profession, uh, by a doc who had, um, board certifications in the, uh,  Psychiatry and neuro neurology. And that's how I was trained was to start with the alpha agonists because you, um, you don't necessarily want to initiate those side effects.

Things are habit forming things that are habit forming. And so we start with guanfacine typically in the young kids. And if they're really, really hyperactive, like I said, that can be good boys that are hyperactive and actually Calvary is good for that one as well.  And so I'll use that. Like I said, I don't typically use stratera or adamoxetine, but again, that would, another colleague could probably tell you more about that.

I was trained that, uh, you know, it's not that effective for people. And I've also seen that people have it on their med list of meds tried, so, um,  that, uh, weren't effective necessarily, but, uh, not here to, uh, I'm not bashing this medication. This is just my experience. Um,  so I would probably choose, uh, one of the non stimulants for a little, little kid first.

And we could even do Calvary, but a lot of times, you know, it's  we try guanfacine first. The stimulants are good for people, kids that are inattentive. Um, they can help curb some hyperactivity depending on the child. I will choose for, you know, adults, the first line therapy according to the algorithms in the textbooks is going to be, um,  an amphetamine.

It's going to be the Adderall family and there's many, many meds. That are in each one of these families that are similar and,  uh, but also dissimilar in some ways. Uh, so that's what they would have us do, but I give people all this information I'm giving you so they can make a choice that's right for them.

Because again, there are risks involved like medication becoming habit, habit forming with the stimulants, having DEA, um,  only being given 30 day prescriptions, things like that.  Um, I think that, um, Most people are familiar with those stimulants and their side effects to some degree and are interested in those medications because they do like some of the side effects, which are appetite suppression and not necessarily insomnia, but, um, and they know that they're effective.

So a lot of times, like I said, we start there methylphenidate more so in kids is where I'll start is with the methylphenidate group, because  I used to give these challenges in my last job of giving. And I'll do this occasionally a week or two of one and a week or two of the other I prescribe both and then have people come back in and talk about what they like, what they didn't like, and this has some benefits in that, um,  if insurance cafe, if we're going to a more classy med after this, the insurance company would like to know that you've tried both.

And now we've already tried both.  But, um, often I would find, I'd say about  You know, every, there's a handful of people that are adults that do well, better on the methylphenidate. Uh, it's not as much as who approve, who appreciate, uh, the benefit more from the, uh, Adderall family or the amphetamine family, but there are, it's less, but there are those people.

So I can do those challenges sometimes with people as I could, or trials.  with a stimulant medication. And, uh, for people who don't want a stimulant, who don't want a controlled medication or who have failed these medications or who would prefer to try something starting somewhere else, we can do Calgary. 

And I have had good results with that for adults and kids. It, uh, it seems to work pretty well. And I think this is one where, you know, primary care is happy to pick it up. If you had to move or something, a lot of times primary care will not prescribe, uh,  controlled substances. So it can be an easier med, um,  It's just one that I present to people.

I don't necessarily say, okay, this one's better for you. Although I do think it's pretty good for like I said, young boys who are very hyperactive.  Um,  and this one, uh, it's just one that sometimes people prefer because of that. And or if they're kids, maybe they failed the others. 

 That's really, I'd say. Important in smart what you're doing, just trying things out. Gaging what works for people? I think it's just brilliant. So, um,  To connect to that conversation.

What are alternative treatment or a complimentary therapies that can be used in conjunction with the medication to manage ADHD symptoms effectively.

Yeah. I listened to, um,  a lot of, um, podcasts from the Carlat psychiatry folks.

And, um,  they cite studies, uh, better than I probably would do right now. My, you know, they, they had, if you want to look at studies about what is helpful in conjunction or for ADHD, that's a good place to go, uh, to get. you know, evidence based information. And one thing that they have talked about on there is, um,  exercise is really important, uh, for for people, especially I've had a lot of patients who have managed their ADHD  particularly hyperactive type for their life by playing sports, being very active.

Um, and that helps not just them feel happier, but it also helps with  brain  cognitive function in terms of other things that help that cognitive function. I mentioned before, there are some supplements and there's, there's even conjecture. There's theories that there may be a zinc and copper imbalance, uh, in, in people or children with ADHD.

That, um, I don't,  you know, so some people will, you know, take one one or the other, but I think you'd want to do that with a practitioner pretty well versed in that, but things you can generally do. Like I said, you know, we, our brains need the right fuel because they have to build and maintain a Cells, which are the cells of the brain neurons and neurons, you know, are  things like vitamin D  amino acids.

Omega threes are necessary in order to build and maintain those cells. So, if you don't have enough vitamin D, it has everything to do with with serotonin. Um, as well, but you see if people are low in vitamin D depression, anxiety, suicidality, inflammation, inattention comes with all of these things.  So that one's really important.

Um, and actually the vitamin D cutoff for primary care is probably lower than what we need for our brains to function well. Ideally it should be 40 to 60 optimally,  uh, somewhere in that range.  Then, uh,  The omega 3 fatty acids are great for the brain. We've got studies that show, you know, they help people with Alzheimer's.

Um, they just really help maintain that cognitive function. Then they're naturally found in foods like eggs and seeds.  Um, but a lot of times we don't get enough in our diet. So, um, I give, I tell people the brain, pretty much the brain health triad would be N acetylcysteine, omega 3 and vitamin D. I take all of these myself and I have noticed quite a, quite a robust difference. 

Although you may not think so. I don't know. You have to tell me. But, uh,  uh, the N acetylcysteine is an amino acid,  and we need amino acids, um, to build protein. And protein is what, you know, we need to build cells. So,  The amino acid ethyl acetyl cysteine is used for various things,  all kinds of different things, but  it does seem to help, like I said, improve, um, you get results in that you see, you know, that, um, one thing I use it for is trichotillomania.

So people who pick eyelashes and they pick, uh,  their eyebrows or their hair out. It can help with that. It is liver protective.  Uh,  and acetyl cysteine is what you'll be given if you go to the hospital and you have an overdose on Tylenol or something that's killing your, uh, your liver. So it is liver protective.

It, um,  also can be used for slowing cravings, reducing cravings of things like people who want to reduce or stop their marijuana use. This is an interesting thing, but I guess because we need maybe,  you know, we need to see amino acids, there's several essential ones and there's some that the body create and there's some you have to get from diet and we often don't get what we need from our diets. 

So this one, it's got to be taken at fairly high levels, unfortunately, and, you know, three times a day for whatever reason you have to, you know, when you want to get up there to, you know, 1200 to 1800 or more. So that one is a lot. And the omega three is you want to get up there to know, but not go too far.

So something to do with your prescriber. Okay,  then there's also.  American ginseng that I mentioned earlier, there have been some studies that have shown, uh, this is effective for adults and children kind of taken the same way stimulants are taken and taken in the morning and then a second. Additionally, again, if you need to do homework, things like that.

Uh, so some folks, and it doesn't have very many side effects. Um,  Which is nice. That's another consideration or side effects. So American ginseng is not going to have much in the way of side effects at all. Doesn't interact. I don't believe with other medications and it can be taken, like I said, multiple times a day has shown in some studies that it's been effective for improving cognitive function, helping you think,  think things through just in general, better executive function.

And it's been described by people as I've heard on the car last psychiatry is going from like a. Tube TV, The High Def.  So those are some things also just getting the right amount of sleep and energy. I mean, there's treating your other, uh, treating any other coexisting problems like depression, anxiety, these things take away our attention and focus as well, if we're focusing on other things.

And then there's, um,  for kids, there's a few other things. There's some stuff that, you know, like I said, would be another podcast, but I'll just mention them briefly. Um, Rodeo, Rodeo, La Rosea.  Um,  then there's, uh, oh, pycnogenol, which is a French pine bark.  And I think I'm missing one to think on that, but get back to you, but there are several things for children that have shown in studies to be effective.

No, I believe those were the only ones I wanted to mention, but not so much in adults. And I could talk about, you know, that at length, but I won't.

 That's fair enough. We'll. We will save that for the next time. And yeah. We always put an emphasis in the show on education for patients and families with ADHD and the same applies to a medication for ADHD. So. Um, what would be your key points for people? And families that deal with ADHD and what are the things that they should be aware of?

Well, they should be aware of other therapies because, you know, a lot of times psych medications,  They provide some relief of symptoms, but they don't change your life. They don't do the things for you. So we have to decide what we're going to do with that, that feeling of relief and doing better. So one thing is just living the feeling better thing.

So like, The more you engage in the activities you once avoided or, or weren't doing because of the disorder that helps train the brain and that's a good thing, but  also there are groups and podcasts and support groups and things like that and books patients have brought to me so many books that they like and they use or dire certain types of planners. 

Exercise, you know, finding that effective, but there also are therapies that are that are given and  one in particular that's terrific for kids and parents is  parent child interaction training or PCI and that can be done by psychotherapists and you basically will have a  therapist or psychologist,  some type of practitioner who watches you interact with your child and then will teach you or coach you on how to understand what that is.

It's like for them mentally, cognitively and how they experience the world and how to have effective strategies because there can be a lot of getting butting heads in family when this happens, which is why one of the realms we considered, you know,  impairment in this disorder. If you have problems with your social life and your family life.

So that's a good therapy. There's some, some others I, the, my supervising physician would probably suggest this one's among above others and then there's going to be.  In terms of what you do outside of the home, in terms of in the school, there's lots of different things that, um, that can be done. There's different types of educational psychotherapeutic module, um,  modalities that are used sometimes in the school setting.

I'm not. I'm not really well versed on those because I'm not in the school setting, but I know that they also one thing we do is accommodations for people. We may write letters to let people know that accommodations are available and all the I mean, needed and necessary. Sometimes people need more time on tests or to take a test in an isolated situation or to have things in written materials as well as audio. 

So different things. But education. Uh, for patients and their families about medications, uh, is important and you often get that from your practitioners. And, uh,  you know, I think that  everything you get online or, um, that's just sort of generally out there. You have to kind of be skeptical about. It's wise to, you know, You know, check with others and see, you know, is that, is that really valid?

 Education is just important in life in general for everything, everything we go through. I think it can be so, you get more control over something the more that you know.

And so it's, it's essential. I mean, you, you definitely want to people sometimes suffer with things and it's difficult to know what to do if you don't know what you're dealing with. So educating ourselves is key. It's very essential. 

 Yeah. Yeah. I mean, you gave us, uh, uh, lots of food for Toth and, uh, I'm sure we will meet again to the. Discuss some other topics here that you just touched on, but. If there is a one thing that you would like our listeners to take away from this episode, what that would be.

That, um, maybe we should be looking and talking about where ADHD comes from, not necessarily just that it is. And that's something I'm pretty passionate about. But also that, um, stimulant medications are, have come with a lot of risk. And one of the things that can happen is people become dependent on them, think they can't function without them.

And then, then they feel like a really sick person. Um, there are ways to function and cope And, um, that are not medication based. There are also, you know, medications can kind of augment those things as well as, um, you know, provide relief for people who are really, really suffering. So they shouldn't be taken lightly, um, taking a stimulant medication is a, um,  comes with a lot of risks.

And one of the things people think a lot is when they don't take their medication for a day or two, that This is how they're going to be. This is their baseline. Wow, I'm really useless without this medication, but that medication, if it's a stimulant has been pumping the dopamine and your brain needs a few days to get back online doing that itself.

So, remember that that is not your baseline and that, um, you know,  medications can help, but, um, again, not to be taken lightly because of the potential to feel that you can't function without them.

 Thank you so much. This was eye opening conversation, I say, and it was useful. And I hope it was useful. Uh, two people who have ADHD and potentially children with ADHD. And.  I'd love that you gave us a great comparison between different age groups and what works for one and what works for the other. So again, I think this is a great benefit to this conversation.

So, thanks again, and I hope we will have you in the future soon

well, thanks so much, Neda, for having me. 

No problem. You're welcome.



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