Before You Cut Bangs
Hosted by Laura Quick and Claire Fierman, “Before You Cut Bangs” is full of hilarious conversations about real life, common and uncommon crises, and possible cosmetic errors that come along with it. Through storytelling and therapeutic wisdom, Claire and Laura share how to NOT fuck up your hair (and life) while walking through similar situations,
Produced by Will Lochamy
Before You Cut Bangs
26. Your ADHD and Adderall Questions Answered (by an expert) pt.2
This is the second installment with Dr. Rachel Fargason, who demystifies ADHD in all its forms—from hyperactive and inattentive subtypes, to the lesser-known sluggish cognitive tempo. We also touch on the long-term safety of these medications and question if it's actually harmful for some people to not take them.
Welcome to, before you Cut Bangs. I'm Laura Quick and I'm Claire Fehrman. I am a professional storyteller and I'm currently working on my first book.
Speaker 2:I have worked in mental health for many years in lots of capacities and this is a really important time to tell you our big disclaimer this is not therapy. We are not your therapists or coaches or anything like that.
Speaker 1:Yeah, I mean you shouldn't really trust us very much at all, unless you want to and it turns out well, then you can trust us, that's great.
Speaker 3:So I had a guest come in the studio for the radio show and she was like oh my gosh. And her colleague was texting her saying I've made a huge mistake. I cut my own bangs this morning and now I have a mullet. And I was like whoa wait, what I was like is she's going pictures please?
Speaker 3:well, I said I was like if there, if it's funny, you gotta send me pictures. But I was like is she going through something stressful? Or? And she's like, well, yes, as a matter of fact, her child is leaving for college and she's upset about it. And I was like listen, I produced this podcast. And she's like wait what?
Speaker 1:and so anyway, I love that will's out there marketing on our behalf to women who are in crisis, cutting a mullet I told her she had to come on the show too.
Speaker 3:I was like you need to come on and tell the story about you cutting your veins legitimately.
Speaker 2:Legitimately cutting veins yeah, we haven't embarrassed ourselves or the audience in ages. We've been so psychologically responsible, just feeding people information.
Speaker 1:I have a recent story of just losing my shit on a random stranger who was at my house.
Speaker 1:So, after buying like $700 worth of groceries for 4th of July, which is already stressful- I know where I know, okay, there's a girl I've never seen in my entire life, ever, who's at my house and she's helping all of these children. They're like 20 something. They're helping me unload the groceries but the refrigerator is 60 degrees because they've left that open. The inside of the house is 84 degrees and I'm like I'm on the edge and she, literally while unloading my groceries. The girl, I don't know her name. She's like I'm a vegetarian and I I just haven't like.
Speaker 1:I'm a vegetarian where my options are oh yeah, I don't know if Clay told you, but I'm a vegetarian and I was bitch, get out my kitchen right now. I like spiraled visibly, so much so that my son's like you good, and I was like I'm not good, you need to ask her to go to Dollar General, get her on shit. Because she was like do you want me to cut this fruit up and make a fruit salad? I'm like, nope, need you to leave all my shit alone? Please get out the kitchen, thanks, yeah, so I have embarrassed myself recently. That was a bad mom, you're sorry. No, okay, I will. I'm sorry if you're listening. Now's your opportunity. She had bangs, if you're listening. Jeez, laura, I'm so sorry, I'm just kidding, take that out if you're listening.
Speaker 3:Uh, also, you probably heard the last episode where we had dr rachel farguson from uab on. Uh, she is the professor of psychology in the psychology department there and she was incredible and it lasted a lot longer than we anticipated. So this is the second installment.
Speaker 1:And she does talk about irritability, how that's a side effect of ADHD. That's right. So I think we can all see and have compassion on the version of Laura that lost her shit, on the girl who said she's a vegetarian, while I'm unloading the $700 worth of groceries that I bought for them. Okay, on to the interview.
Speaker 1:Okay, can you talk to me a little bit about the difference between? So I am definitely the H in ADHD, for sure, but my husband, who I also believe has ADHD or ADD, has something right. I don't know, he hasn't been diagnosed, but I will tell you some. Like, I've seen some drastic changes recently. But the difference in someone who shows up even as an adult, with a ton of energy, a lot of like got to move it around, got to do something with it, I think those people are so fun. Oh well, thank you, thank you. Thank you for that. But, like, tell me the difference between those two things because I think one is over and one is a little more covert and how it shows up very good.
Speaker 4:It's a very good, uh, very good point, um, so, um, in the dsm5, which is sort of psychiatry's Bible of diagnosis, the official diagnosis is attention deficit, hyperactivity disorder, adhd. And then there's the inattentive type and there's even a subtype called the sluggish cognitive tempo. So there is the dreamy, the dreamer, you know who's really maybe a little more sluggish, and then there is the hyperactive impulsive subtype.
Speaker 1:Okay, and again, as I was saying, earlier, so this person might accidentally marry three people.
Speaker 4:Exactly.
Speaker 3:Exactly, and there's a combined type, so you could have both.
Speaker 4:Yeah, I'm just kidding. No, that's exactly right.
Speaker 1:That's good to hear, because I think sometimes it's really easy to go oh, that person has ADHD. But then it's really difficult to understand how someone who maybe is a little bit more slow moving, a dreamer type, could have the same exact thing. That's just showing up cognitively different, right cognitively different right?
Speaker 4:Absolutely. I mean, I have been treating people with adult ADHD for 30 years and I still have friends or neighbors or somebody I've known a long time totally surprised me by telling me they got an ADHD diagnosis.
Speaker 2:Okay, One of our listeners says basically nature and nurture. I know technically it's genetic, but I see so many ways in which I could be creating this in my children because I feel like such a mess. So nature versus nurture.
Speaker 4:Okay, so the heritability of ADHD is about 75%, so it is a highly heritable condition and, as we were just talking, it can show up in different ways. But remember, not every child who has ADHD has persistent symptoms into adulthood, so a third of people completely outgrow it in childhood. Okay, so is it nature, or nurture.
Speaker 4:So if you and your husband had a child together, there's probably one in four chance one of them will have ADHD and another one might have some symptoms, you know. So I think that's the way to go, okay, so getting on to nature versus nurture. So, that being said, a lot of things make a big difference, like one of the things we've been talking about is structure. So a person with ADHD in a highly structured environment might not need treatment, right? So, for example, what I was talking to Laura about, about testing If somebody does very well with structure and they're in a very structured job, they may do just fine and not need their ADHD treated. So one of the things that happened during the COVID pandemic is that people started working from home and they don't have their boss looking over their shoulder and all of a sudden everybody's going out and getting diagnosed with ADHD. So that's kind of a nature nurture thing. The environment sort of created the need for people to structure themselves, created a need for the ADHD to then be treated, whereas the external environment was controlling it.
Speaker 4:Now, getting back to your person who asked the question, it is a pro, so it would be helpful for her child if she could find a way to put some structure in their family. It's not going to change her child's genetics, but obviously the more coping mechanisms and the more good habits and all those kinds of things that the child has, the better they're going to do. I would strongly encourage her to get with her husband and the two of them together come up with a really good structure, and he's probably going to have to help maintain it and everything is done in a kind, non-emotional way. I always say run your house like a, like a kinder, not like a kinder. Run your house like the military. Or if you got a bunch of little kids, run your house like a daycare. This is what we do. You know we have breakfast. This time we have a snack, then we have lunch.
Speaker 1:We journal, we do this. Yeah, we do a little Exactly. We do a little Exactly. How was your day at dinner Exactly?
Speaker 4:Even if it's adults, because a lot of my patients will self-select themselves into the military because on some level they're craving that structure. We rise at 0600 hours, we make our bed, we you know, and it's very clear what you're doing all day, and so a lot of people might not need their ADHD treated. I cannot tell you how many parties I've been to where some CEO of a company and his wife find out what I do for a living and the wife says, oh my gosh, he has ADHD and he's whatever 60 years old and he's very successful. And when you talk to him, he's got a couple of secretaries who manage him and keep him on track. He's got his wife at home that keep him on track and he's doing fine. He's doing fine. I mean so it's not a diagnosis, it's not a disorder, unless it's one causing dysfunction in an, in at least one area, or it's causing a lot of distress. Well, he's, he's not in any distress.
Speaker 2:So helpful to look at it that way. That's so good.
Speaker 1:Yeah, that's so good. I was diagnosed in my 20s. I mean obviously definitely had it as a child. I got in trouble all the time. In first grade I either got a dollar or a spanking every day because I was such a daydreamer and I'd talk too much. I a daydreamer and I talk too much. I got mostly spankings. By the way, in case you're wondering, it was a rough year for me, but when I was diagnosed in my 20s I was prescribed a stimulant and maybe I just never. I turned into like kind of a raging bitch. Oh, dang it, sorry.
Speaker 1:You can technically say that Okay, anyways, and I didn't like how I was showing up and so you were over medicated. I was probably over medicated and I don't think I had the patience to even like sustain going back to the doctor and figuring it out, and so just came off of the medicine and since then, understand, I know exactly when I'm going to have a great day versus when I'm not, because I'm either in my routine or I'm off my routine, and if I'm in my routine, everything's going to be fine, and if I'm off my routine, I'm going to have to be apologizing a lot to people. I'm so sorry. Oh, I booked three meetings and the two of them didn't make it on my calendar, and could you move these three things Because I didn't start my day the right way.
Speaker 1:It's crazy what just even starting my day in a really grounded routine does for the rest of my day.
Speaker 4:Well, and when you start, when your day starts off. But so I always say, if you're stressed it's going to come out in an ADHD way. So if you start your day and it doesn't go off that well, then then you're anxious and kind of off and then every it's going to make your attention and your focus worse. So there is a sweet spot when medicating people that shouldn't make you irritable. So we always start people very low on medications and work them up to their perfect sweet spot dose. So if you were irritable and angry then you were overmedicated.
Speaker 1:I was a supreme human being. I was like I know everything. I felt like I was on the matrix and I took the right pill. But then I was like I'm better than everyone. I was like so what would?
Speaker 2:you say to people who are like gosh, or they've maybe been going through this with their kids and no medication. It's like we have all these side effects where the kid doesn't feel right, or I'm overstimulated, or you know, that's probably not the right word.
Speaker 1:Or my kid's a zombie, which we hear a lot Is it just like you keep going, keep going.
Speaker 2:Or what would you say to those, maybe parents?
Speaker 4:Well, the first thing I would say to the parents is all those things you said sound to me like the dose isn't right, okay. So it's very, very important and this is what I teach the residents psychiatry residents who I train is you've got to get the dosing right of the medications and you've got to get the intervals right. So, in other words, a common thing is somebody is prescribed Adderall and they are great all morning and then they just crash at noon and maybe they are irritable and cranky or napping, and then the rest of the day they're off. Well, I always say I don't treat anything else just half the day. We need to treat you all day. Right, that's good, but we also have to figure out when you're crashing so we get the next dose in before you crash. So these little things are very important.
Speaker 4:And, that being said, there's two major psychostimulants that we prescribe. You guys have heard there's all these different names. It's overwhelming how many prescription stimulants are out there. Well, I'll oversimplify it for you. There are really only two classes. There's the methylphenidate agents, the ritalin agents in long acting and short acting, and various forms, and then there's the amphetamine agents within long acting, short acting, different distributions, and I will say one thing I don't know what you had, laura, when you took something, but the amphetamines can be a little more, can cause people to get a little more irritable, so it is possible you had a side effect of that and you really did need to go to something like. The methylphenidates are a little gentler.
Speaker 1:I'm in the process of writing a book right now and I know I'm going to have to do something to like stay in. It's just really hard for me to, even in a structured environment even if I give over my devices, I'm still having a hard time like staying there with it. And so I was just talking to my doctor about like what that looks like and telling her about the my previous experience and just being like okay, so if I were to consider something else, like what would you recommend? And she was talking about the same thing.
Speaker 4:Right, and there are also two FDA approved non-stimulant agents for ADHD and one is adamoxetine stratera and that one is, and both of those are more 24-hour drugs, they don't work right away, and the other one is long-acting guanfacine, the brand name is Intuniv, and both of those work very well. They may even be better for hyperactive impulsivity. Adamoxetine slash stratera is very good for anxiety too.
Speaker 2:Locking that in? Okay, I hope this is my last question. I just am so grateful for your time. Yes, thank you so much for being generous with your time. Are there negatives? I mean, let me say this the expectation sounds like when you're, let's say, diagnosed as an adult, you get on medication totally improves your life. The expectation would be this two-part question this is how you live. Now you're going to be taking these meds and if that is the case, are there potential, um long-term side effects okay, or dangers?
Speaker 4:um, I'm glad you're asking these questions because I do want people to know what the relative risks are. If you do not have a history of tics or Tourette's, a structurally abnormal heart or any kind of psychosis or a risk of substance misuse disorder, substance use disorder, these are one of the safest medications you can take, right, okay, wow, that's good, and I think they have been really because of the addiction potential. They have been really given a bad name and some people argue they shouldn't even be scheduled to drugs. These are really safe. Okay, obviously you have to watch for elevated pulse, elevated blood pressure with the stimulants and but there was there was A very large study on cardiovascular risk in stimulants in adults and children with ADHD and what they found is that actually, compared to the controls, the people with ADHD had better cardiovascular outcomes.
Speaker 2:So what they found.
Speaker 4:it's interesting, though. What they found was that people with on stimulants had more cardiovascular like side effects, like palpitations or feeling like their heart was racing, but in terms of true bad cardiac outcomes, it was actually the people who were not treated had worse cardiac outcomes, and I do like to remind people that there's a lot of studies on what happens if you don't treat ADHD. Okay, so there's, there's risk. There's a lot of risk with untreated ADHD in terms of outcomes. I can I just list a couple of them Sexually transmitted disease. Substance abuse risk is much higher if the ADHD is is yes, in fact, um, the the the risk of substance lifetime substance abuse in untreated adhd is 40, whereas when the adhd is actually treated, it reverts to about 16, which is the same as the general population is there a correlation there, like of what what's causing?
Speaker 1:I mean, I could obviously infer what I would think would be driving that, but like impulse control well and not just that, but maybe even soothing like right I?
Speaker 4:I don't know that it's been well studied, but I think a lot of people are self-medicating and I have seen people who have come in and said to me I'm a cocaine addict. I was like, well, tell me how you're using cocaine. Well, I just take a teeny bit, just a teeny bit like four times a day and I'm like do you do it?
Speaker 1:I did cocaine once and I loved it, it was actually the best I've ever been. Well, that's what.
Speaker 4:I'm saying I said do you do it to get high? No, I do it so I can get my work done. I was like you're self-medicating yourself with cocaine. Now.
Speaker 1:I am not recommending that. Yes, please, hello, problem, please. Everyone know that we are not recommending you do cocaine. Okay, please do not do that.
Speaker 4:However, what I'm saying is that a lot of people who think they're addicted are actually doing some form of self-medication, and so they're far better to go, because you still can become addicted to cocaine. It's a very highly addictive agent, and so it's not good to use that recreationally or to soothe right and and so um. But yeah, so it's, it's um very important.
Speaker 3:So I depression is that other risks.
Speaker 4:I just wanted to go on a few other risks Car wrecks. There's more risk of car wrecks, not in everybody, but in some people. There's more risks of unplanned pregnancies. I mean, the list goes on and on of not treating ADHD. So you know, we you can't just balance the risk of taking medicine versus not taking medicine. You have to think of the risk of treating the ADHD versus not treating the.
Speaker 1:ADHD. That's such a good reframe. I mean truly.
Speaker 2:Yeah, that's so good. Is there anything we missed that you feel like might be important for people to know?
Speaker 4:Wow, I think you guys have been very thorough with your questions.
Speaker 2:I've had to like shut some stuff down in my mind. I just this has been amazing.
Speaker 1:Yes, thank you so much. It's so insightful and I feel like we will one. It's just helpful to hear. It's also helpful to feel seen and not alone. I think that so many of our listeners are walking this either with someone they love or personally, and are want to make sure they're doing it well or playing it safe and taking care of their people, you know, and so it's really helpful.
Speaker 4:Yeah, and one parting thought is you know we talked a little bit about medications and stuff, but the medications, even at their best, only get people partway there. The rest is kind of on the individual to develop good habits and routines, like you were describing your routine. I had one man who told me he would have to have 18 things on him when he left the house and that included like his shoes and his tie. And if he didn't count his 18 things he would forget something like his tie and have to go back to the house and get it. So I mean, that's sort of an extreme example and a funny one, but it worked for him and this guy functioned very well.
Speaker 1:I live my life off of Post-its. Like truly, I only make a list big enough to go on a Post-it and then, once that one's done, I'll make another one, Right?
Speaker 3:All right. So, like we said, that was just one session of questions that you guys had and that we had as well. We split up into two. There are going to be more, so we'll leave it for a little bit, but then we're going to have her back, and so send us more questions if you have them, because, dang, she's good.
Speaker 1:This is a hot topic. We're changing the name of the podcast, guys.
Speaker 2:Yeah, and I am curious Like we get feedback on every episode, which is super helpful Texts, text, instagram messages, all of that Super curious if having an expert that actually has an expertise in something was interesting or helpful Like we would love to hear from you on that?
Speaker 1:Yeah, since these are the first two episodes that we've ever done where we included a guest and I think we have been cautioned by our producer named Will Lockamee, to be careful about bringing on guests but this felt like a role that an expert had to play, and so we're really thankful that she shared her expertise with us and she just brought so many good tools.
Speaker 2:And I was tired of listening to us.
Speaker 1:Honestly, we're so annoying.
Speaker 3:Well, with this whole guest thing going forward, we've set the bar pretty high.
Speaker 1:God, seriously, I will say my angry brother is itching to come on and tell some terrible Laura stories, that is high risk Extremely. I will never be able to run for public office if we do that.
Speaker 3:I'm here for it, as if we could run for public office. I would never be able to run for public office ever.
Speaker 2:All right, thanks for listening to Before you Cut Bangs, and we'll see you next time.
Speaker 1:Before you Cut Bangs is hosted by Laura Quick and Claire Fehrman and produced by Will Lockamy. Follow along with us everywhere. Please subscribe to the podcast. Find us on Instagram. We're constantly doing polls. We want to know what you think, and I know that you probably know this, but reviewing us and giving us five stars matters more than anything, and we are so grateful to have you here, thank you.
