Episode 82 - The Impact of ADHD Medications on Older Adults

In this episode, Jami Shapiro sits down with nurse practitioner and ADHD specialist Maggie Alexander for an eye-opening conversation about ADHD medication, especially in older adults.

For many people, ADHD has long been misunderstood, misdiagnosed, or simply overlooked, particularly in women and those diagnosed later in life. And when it comes to treatment, there’s still a lot of confusion, fear, and misinformation around medication.

Maggie brings both clinical expertise and real-world experience to the conversation, breaking down what ADHD medications actually do, how they work in the body, and why age should not be a barrier to treatment.

What You’ll Learn

• Why ADHD is often mistaken for anxiety or depression
• The truth about stimulant medication in older adults
• How to know if a medication is actually working for you
• The real difference between Adderall and Ritalin
• Why dosage has nothing to do with age or body size
• What “start low, go slow” really means
• The overlooked emotional side of ADHD (RSD)

Why This Matters

Many adults spend years, even decades, being treated for the wrong thing.

This episode sheds light on what happens when ADHD is missed, and what becomes possible when it’s finally understood and supported properly.

The ADHD Button Question

Jami asks every guest: If there were a button that could remove your ADHD forever, would you press it?

While Maggie doesn’t have ADHD herself, the conversation reinforces a powerful theme heard across the podcast, that ADHD, while challenging, is also deeply tied to creativity, intuition, and how people experience the world.

About the Guest

Maggie Alexander is a psychiatric nurse practitioner specializing in ADHD. She has worked with hundreds of patients and focuses on precise, individualized treatment. She is the author of Shine with ADHD.

About the Host

Jami Shapiro is an ADHD coach, speaker, and founder of Silver Linings Transitions. Through her podcast Grandma Has ADHD, she brings awareness to ADHD in older adults — especially women — helping listeners better understand their brains and navigate life with more clarity and compassion.

Resources

• Shine with ADHD by Maggie Alexander
• ADHD Self-Report Scale (ASRS)

Links & Support

Website: https://www.jamishapiro.me

Silver Linings Transitions: Support for downsizing, organizing, and life transitions

Book: This Explains So Much by Jami Shapiro

Enjoying the Podcast?

If this episode resonated with you:

• Leave a review
• Share it with someone who might need to hear it
• Follow Grandma Has ADHD for more conversations on ADHD, aging, and understanding your brain

Thank you for joining us for this episode of Grandma Has ADHD! We hope Jami's journey and insights into ADHD shed light on the unique challenges faced by older adults. Stay tuned for more episodes where we’ll explore helpful resources, share personal stories, and provide guidance for those navigating ADHD. Don’t forget to subscribe and share this podcast with friends who might benefit. Remember, Make the rest of your life the best of your life.

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Transcript

 Hi, I'm Jamie Shapiro and welcome to Grandma has ADHD. I'm a certified senior move manager and owner of Silver Linings Transitions, where I help people navigate life's big transitions. But here's the thing, I spent years helping families move through change while completely missing the pattern that was running through my own life.

I'm the daughter of two ADHD parents, the mother of three ADHD children, and yep, I have ADHD too. For years I didn't have the language or understanding for what that meant, but becoming an ADHD coach and specialist, that's been absolutely game changing, not just for how I work with my clients. But for how I relate to my family and honestly for how I understand myself.

I even wrote a book about it called This Explains So Much. This podcast is for all of us who are discovering ADHD later in life. Each week I bring new conversations with industry experts and people sharing their own ADHD journeys. Real stories, real strategies, and often a little too much information.

If you're loving what you're hearing, please share this podcast. Leave us a review and find me@jamieshapiro.me. That's J-A-M-I-S-H-A-P-I-R o.me, whether you're over 50 and just getting diagnosed. Or you're recognizing patterns you've lived with your whole life. This is your space to navigate ADHD with others who get it.

So grab your coffee and get comfortable, and let's dive in.

Hey, here's a quick heads up. Before we dive in. You may hear me mention the Sparkler Society in this episode, talking about it. It's happening right now, and here's the truth. My ADHD brain got so excited about this community that I may have jumped a little bit enthusiastically, a lot enthusiastically before everything was actually ready.

Classic ADHD move, right? We know what that's like. So here's what's actually happening. We've hit pause to make sure the Sparkler Society launches the right way because this is going to change lives, and I want it to be everything you deserve from day one. We're officially launching in July of 2026, and here's what you can look forward to.

Live group sessions every week, including support around decluttering and downsizing, body doubling, and ADHD group coaching. We are also addressing some of the big challenges of ADHD, worrying over spending and starting crafts only to lose steam. Membership in the Sparkler Society is going to save you from paying the ADHD tax.

We're talking real dollars back in your pocket, and most importantly, we are building a community of women who want to get their shit together. Together. Here's the exciting part. We're starting a wait list right now@jamieshapiro.me. That's J-A-M-I-S-H-A-P-I-R-O dot. Me and the VIPs who join early will get free access to shape the community before we officially launch in July.

You'll help us build this thing together. So if you hear me talking about the Sparkler Society, it's happening tomorrow. Just know it's coming in July and it's going to be worth the wait. Let's get to today's episode. I.

Welcome to the latest episode of Grandma Has ADHD. It's going to be a little bit different this time because I'm having even bigger technology problems than I normally do, and normally I cut and paste all of my little notes and I stick them into the chat so that I can read it and bring it to you.

But my mouse isn't working on my computer, and so I couldn't do that. So I asked today's guest, Maggie Alexander, who is a nurse practitioner. If she wouldn't mind introducing herself, but before she does, I just wanna give you a little bit of background. I met Maggie at the International ADHD conference.

She, as I said, she's a nurse practitioner. She doesn't have ADHD, but she is surrounded by it in her life and she works. With ADHD as a nurse practitioner. She just released a book and she has the great privilege of working with Dr. Is it Bill Dodson? I dunno. That's right. Dr. Dodson who was the keynote speaker at the conference.

So, Maggie, I appreciate your flexibility and willingness to introduce yourself and, and we'll take it from there. So, hi. 

Hi. Well, my pleasure to join you and I love talking about ADHD, especially in women, and particularly with older women, so this is a real privilege. So thanks a lot, Jami, for inviting me.

And we had a fun little walk up the hill at the conference. That was, it was lovely. This girl was wearing a bright orange shirt. I remember I even snapped a photo of you there. 

 It was an orange tree. Remember that the tree was magnificently orange. And I'm like, oh, can you take a picture?

But yes. When you and I first started speaking, I said I had to have you on the podcast, and so thank you for saying yes. So tell us a little bit about how you got into the ADHD space and what you do, and we'll go from there. 

Well, the quick story is that I'm actually a nurse midwife. I've delivered about 1500 babies and in my mid fifties, I realized I didn't wanna stay up all night anymore and work in the hospital, in the middle of the night.

So I switched and became a psychiatric nurse practitioner. I thought I would be working with depressed and anxious pregnant women, postpartum women. And that's not what happened. What happened was that this guy who I call, Matt, came to see me. His doctor sent him for a psychiatric evaluation 'cause he was suicidal and I discovered that he had this thing that I didn't believe in, which was ADHD.

And there's a whole story about that in my book, but it is even now, brings tears to my eyes to recognize this gentleman, who his life was totally together, happily married, three kids, good job. But he was a very, very depressed person because he wasn't able to actualize himself because of his ADHD, which he thought was depression.

And I really, by pure accident, wound up giving him the exact right medication, which was a tiny dose of Ritalin. You all recognize that word? Long-acting Concerta. And it really, it saved his life. It turned his life around and it woke me up to the fact that this actually exists. And lo and behold, I've helped raise four kids.

Three of the four kids that I've helped raise have ADHD, and at that time they were like teenagers. Now they're in their twenties, thirties, and forties, but so it was a big wake up call for me. I realized that I had to learn about it, and I did. Jumped right in. And Dr. Dodson, as you mentioned Jami, was

just a whirlwind of information and tremendous like availability to help me. And I studied with him and learned everything I possibly could. And that was 13 years ago, so not that long ago. Now, I guess it's 14 since we're in 2026. I've seen about six to 700 people for ADHD and I do prescribe.

So that's my specialty is that I work very carefully and very precisely with stimulant medications. 

 I love that. So first of all, and I definitely wanna talk about that because that has definitely been a big thing that I keep hearing is that we don't give medication to older adults. So we're definitely gonna talk about that, but I think it's really important that we introduce who Dr. Dodson is. 'Because a lot of the people who are listening to this aren't in that ADHD space. They're just coming to that conversation. So I know he was the keynote speaker at the conference, but I would love it if you would just talk a little bit about Dr. Dodson and his work since you trained under him, and then we'll go from there.

Absolutely. Yeah. He is just a lovely human being, first of all. And secondly, a psychiatrist, board certified psychiatrist. He worked at the University of Colorado in Denver. and he had a private practice for. Oh gosh, 30, 40 years. A long time. He just retired a couple years ago and he is well known to people with ADHD because he's written 120 articles for Attitude Magazine, which is such a great resource.

And his specialty is the precise use of medications, and he's working on his own book, which hopefully we'll see that in the next year. A textbook that'll be really helpful to students of medicine and nurse practitioners. 

One of the things that I do remember from his keynote was, that we really haven't studied ADHD in girls enough.

We haven't studied it enough in women and in adults and also definitely in older women. it's gonna be missing. Would you agree with that? 

Absolutely. Yeah. It's very underdiagnosed in women in general, but particularly older women. And it is not uncommon for me to see people in their fifties and sixties who've never been diagnosed before.

I just interviewed Dr. Michael Lens. I don't know if you're familiar with him yet. You're nodding your head. So he actually shared because I told him that my mom's psychiatrist told her that they don't give medication to older adults. And he shook his head when I said that. So I would love to explore that conversation and I've deliberately stayed away from that medication conversation because I am not a doctor.

I coach and didn't feel that I could go into that but since you were here and do prescribe, I would love to hear a little bit about it from you, a lot about it from you. 

Yeah. No, I would be delighted to, and unfortunately, we don't have enough practitioners, even the best psychiatrists, nurse practitioners, physician assistants who are well educated, there's no class in, universities on ADHD.

There's no textbook on ADHD. So the poor souls who are trying to treat it are really learning from each other or shooting from the hip, I have to say. And the only reason I got to be expert at doing this is 'cause I did it over and over and over again, and I learned, from my clients.

And, it's not rocket science, fortunately. And it's absolutely okay for people over 50 to take stimulant medications even over 65 and beyond. You do have to be aware of, if somebody's got a cardiac condition or some other contraindicated medical conditions, but for the most part, most people are gonna do fine on a stimulant medication.

And I think the thing that Dr. Dawson talks about a lot is that you want to prescribe it as you would, I love this analogy, eyeglasses, right? Which is i'm an and 68-year-old, tall and heavy set, white lady. Does that mean if I had ADHD that I would need, a higher dose?

'cause I'm a big girl. Absolutely not. And the guy that I started with, Matt, he was six two, a hundred and maybe 200 pounds. And I gave him what was a baby dose of Concerta, the smallest amount you can write for 18 milligrams. And that by pure accident was exactly the right dose. And he still had that dose right.

So for any of us, we wanna make sure that we start out low and we go slow in terms of dosing.

And there are just those, the two drugs, right? Adderall and Ritalin. So it's not really that complicated. The confusion is that people are not educated about it and they don't necessarily have a lot of experience, and there's a lot of myths.

When I first treated Matt, I didn't wanna give him Adderall because I thought that was dangerous, right? This is after two years of graduate school and someone that pays attention and, tunes in pretty well. But I had this idea that Adderall was a dangerous medication. I didn't wanna give him Adderall, even though he's been given it as a high school student, which is what clued me into the fact that he might have ADHD, the thing I didn't believe in at the time. 

I was gonna tell you, my mom was told that they don't give, stimulant medication because it's addictive. And I was like, that's, 

Yeah 

 I have not heard that for an ADHD person, from what I understand, it's not addictive because we don't have the same reaction to stimulant medication. Is that a correct statement? 

That's right. If you give it at the proper dose, right? people that are abusing stimulants, they're using, Sometimes hundreds of milligrams.

We're prescribing this in the maybe five or 10 or 20. A maximum dose is generally 40 to 60 milligrams a day. Occasionally people need higher than that. I have about 40% of my clients are taking more than 60 milligrams a day. So there's a wide range. 

 it's really interesting, like a small woman, 110 pound woman in her fifties, sixties might need the highest dose of Vyvanse, which is amphetamine, a long-acting amphetamine, 70 milligrams twice a day, kind of unheard of, but I see this a lot in my practice. And then Matt, the 200 pound six foot two guy, he's on a baby dose of Ritalin, of long-acting Ritalin. What we would think would be the right dose for like an 8-year-old child. So it really is not age or weight or gender related. 

I love that eyeglass analogy. I had never heard that. Actually, that's one of the wonderful things about doing a podcast is that I get to learn all the time. I do wanna reiterate something that you said. Dr. Michael Lin said that if you meet a practitioner, a medical practitioner who knows about ADHD, they're almost always self-taught because there just isn't a lot of information out there. 

And for those of you who are listening and not here seeing, Maggie just nodded her head yes. 

Absolutely. Yeah. 

I think it's super helpful for especially, 'cause I haven't talked a lot about medication. If you could share some success stories.

I know you shared about Matt in the beginning and how. That little bit of concern, made such a big difference. I know even Dr. Lens said in his podcast that he's found that people see a reduction in fibromyalgia when they take ADHD medication. I'd love to hear some of your success stories.

Yeah, that is fascinating, that it affects connective tissue in other parts of the body. the most common success story is the first one that I experienced, which was the Matt story, which essentially, an intelligent, he, in his case he was athletic, he was good looking, he was married, happily married kids.

 He had a good job. But he just was spinning his wheels a lot during the day. He said, Maggie, in an eight hour day, I'm doing like an hour of work, right? So it was so smart that he could hyperfocus and get enough done to not lose his job in an hour, which is stunning. And then he'd come home and he'd take a two hour nap and he would be really depressed because he knew he wasn't producing at the level that he was capable of.

He was so tired he couldn't play with his kids. And he was just going down this deeper and deeper path of depression. So when he started on that one 18 milligrams of Concerta, he actually called me three days later and. I said, Hey, how are you? And he said, oh my God. And I said, good heavens, what happened?

He said, you're not gonna believe this, but in the last, two days I've worked all day. I worked all day, Maggie. And I said, oh my God, what do you mean you worked all day? He said, yeah, I told you I only worked an hour a day. I worked all day. And I was like, that's fantastic, Matt.

And then he said, but the best part, instead of going home and taking that two hour nap, I went home and I played with my kids. 

Imagine midwife Maggie. I was practically in tears on the phone with that phone call, and that's why the football field of floodlights went off. in my head I was just like, I gotta learn about this thing that I don't believe in.

I was the midwife, right? I was the broccoli love and exercise girl. Like not just get some good nutrition, some little more better relationships, a little exercise, and we'll all be okay. Well, right. 

Yeah. Better parenting means that you don't have a ADHD Right? That's what I've heard. 

Yeah. Right. 

 I'm sure you've heard that myth.

It's ter it's a terrible thought. Yeah. 

Horrible. 

So that's one success story. And then women, very often I would say. At least 50%, if not more, of the women that I see, somebody in their life told them they were depressed and somebody gave them an antidepressant. And sometimes it's three or four or five antidepressants and sometimes it's worse than antidepressants.

They've been given antipsychotics, they've lost jobs. they've lost relationships. And. They don't often present as Tigger, right. We think of ADHD as that the hyperactive Tigger, they present more like Winnie the Pooh, you know? Like kind of Eeyore, exactly. A little depressed, a little, lose things easily.

Or maybe Piglet, like really sweet and anxious and cute, and wondering where, his friends are. So it's wonderful to be able to recognize that this is not depression and anxiety. This is ADHD, and we're dealing with a problem with focus and not necessarily depression. If you think about like the 12-year-old kid who has been told multiple times that she's forgotten you whatever, to hand in her homework, or she left her sweatshirt at school, or why didn't she take the trash out like mom asked.

At this point, there have been, thousands of incidents of this kid being told you're messing up. So she's walking in the world. I'm shaking my hand like anxious, right? She's feeling like, oh boy, when's the next time someone's gonna yell at me or be disappointed in me? By the time that kid is 14, 15, 16, and she's had tens of thousands of incidents of being told, what's the matter with you?

She's depressed. And now she's thinking, what is wrong with me? And maybe somebody notices and takes her to a counselor or takes her to her doctor and they say, oh, honey, let's give you some Zoloft. Let's give you a little Prozac. That's gonna help. That story is so common. And then it just tumbles forward from there.

 it snowballs. Yeah. 

Yeah. My, my mom is the poster child and that, and again, why I even got into this because I knew I had ADHD for eight years before I ever even explored what it meant to have ADHD. 'cause when I realized my mom had it, and, we had whole generations that had been ignored.

Um, there's a meme that I absolutely love, and I used it in my presentations and I'm sure you remember Scooby-Doo. And remember at the end, they would always take the mask off the villain and see who it really was. And there's It says anxiety and depression, and then you take the mask off and it's undiagnosed ADHD.

Isn't that perfect? 

That is perfect. Yeah. I, okay. I am going to pause. I wanna check in with you, take a sip of my tea. And then, when we come back, I want you to talk about your book and, anything else you feel like our guests need to hear. So, if you are listening to this podcast, which obviously you are, otherwise you wouldn't be hearing me speak. I just wanna let that we are not funded and so this is something that I do as a labor of love, for my own education and to spread awareness.

But I have also written a book as a result of my coaching, and I have created a new community called The Sparkler Society. so you're gonna hear a little bit about that, when we take that break. And of course, if you like this podcast or you're learning about this podcast. This is especially one that I hope that you will share with your friends and family and also leave a review and, that is what we're having to do as a very grassroots way of giving this population the attention that they so deserve and are completely, really being for the large part ignored. And that's Every time a new person listens, then it gives more opportunity for people to find it.

So we're gonna take a pause and come back with Maggie Alexander.

I used to dread visiting my mother because of the clutter. The piles, the chaos. We all experienced clutter differently. For me, it was a source of anxiety and stress. I'd try to help and she'd get defensive. We were both frustrated and it was destroying our relationship. Then we discovered something that changed everything.

My mother had ADHD, and she'd been living with it undiagnosed for over 76 years. Suddenly it all made sense. The clutter wasn't laziness. The disorganization wasn't a choice. Her brain was wired differently and no amount of willpower or traditional organizing advice was ever going to work. That discovery became my life's work.

It's why I started. The grandma has ADHD podcast. It's why I became an ADHD coach and specialist, and it's why I am so passionate about helping women like my mother and maybe like you, because here's what I know, clutter affects us emotionally and physically. It damages relationships, it creates shame, spirals, and the overwhelm of not knowing where to start keeps you frozen.

But it's okay to ask for help. In fact, it's brave. If you are in the San Diego or Coachella Valley area, my team at Silver Linings Transitions can come to your home. We'll help you tackle the clutter with compassion, not judgment. I also work with women virtually through one-on-one ADHD coaching, and if you are overwhelmed with clutter.

I can connect you with trusted resources in your area. Visit Jami shapiro.me to get started or grab my book. This explains so much on Amazon. My mother and I got our relationship back. You can get your piece back too. That's J-A-M-I-S-H-A-P-I-R-O.me.

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Hi, I'm Jami Shapiro. I am an ADHD coach and the founder of Silver Linings Transitions, where we do home organizing and move management. And you know, I did not know that I had ADHD for years, and I remember personally hiring an organizing company to come in and help me because I could just never get it together.

And it really wasn't until I understood. ADHD and its impact that I realized why, and so I wrote a book. This explains so much understanding undiagnosed ADHD, because I just feel like there's so many answers that people don't even know that they're looking for, especially generations of women who. Grew up thinking that ADHD was just for the hyperactive little boy.

It turns out it's not only a body that can be hyperactive, but it can be a mind that's hyperactive. So you can have a wonderful day and you can have something wonderful happen. And then that one negative thing that happens is gonna be that thing that takes you into that spiral and it's gonna be keeping you up at night and you're gonna be ruminating on it.

And I think that, we as women, carry so much shame and so much how it's supposed to be. I'm supposed to have it together and I remember that was the case for me. I, I remember how is it that all of these women have so much consistency and their kids get the sticker charts and everything seems to run well and I'm the one that's missing parent teacher conferences and my house, you know, is always in chaos.

And, and then again, that negative self-talk. So I, my mission is really to educate people who have no idea that ADHD has the impact that it does. And it's to connect you to other people who get it and who will make you feel that you aren't alone, you're not crazy, you're not lazy, you're not stupid, you're not too much.

You just have a brain that was wired differently and I can't wait for you to join me in the community that I'm building. The workshops that I'm creating, the book club that I'm hosting, because I know that I am going to make a profound difference in your life.

So we are back with Maggie Alexander, a nurse practitioner. We were just discussing, how both of us are feeding our dogs to keep them quiet as we chat, just keeping it real for our listeners. So, you wrote a book recently and I would love for you to talk about your book and, who you wrote it for and all of that good stuff.

 I'd be delighted to. It's actually going to be officially released on the 14th of January, so this is very timely. The title is Shine with ADHD and I discovered after choosing that title, there were several books about ADHD with the word shine in them. So just look for the one that has a really colorful cover.

Blue and green. It has a person standing on the hilltop, kinda looking out at the valley below them. I wrote it for the public, I wrote it for you all. It's also useful for practitioners 'cause there's quite a bit of good medical information in there, but it's really meant to be a positive exploration of what ADHD is and isn't.

We got into a little of that when we were talking about Tigger and Eeyore and his friends in the a hundred acre woods. everybody in Winnie the Pooh's; world has ADHD with the exception of Kenya. And of course, Christopher Robin does not 

have, I didn't know that.

It's a matter of interpretation. but it's important to think about it in terms of that we don't all present, right? Tigger and some of us are. Usually a mix. Like somebody might be a little Tish at times, but then got a little er or a little rabbit, if they're irritable kind of some of the time.

So it's what it is and isn't how you diagnose it. Some very simple tools. There's like one form that you can use to look and see whether or not you have it or ADHD, adult self-report scale, and then really the meat and potatoes. The thing that makes this book stand out is the discussion of the precise use of stimulant medications. And we've mentioned before Adderall and Ritalin, and like I said, it's not rocket science. You basically wanna try one or the other. For most people, adderall's gonna be the right drug. About 70% of the time, it's gonna be the more effective. So that's a mixed amphetamine. That's also Vyvanse, Mydayis or a few other brand names out there.

They're all the same drug. It's a mixed amphetamine and you just wanna start low, which means like five milligrams tablet, and then go up really slowly. And the book talks about how to do that. And then you will get a, you'll get a side effect, mild side effect. And that'll be like, oh, here's my feedback that I've gone a little too high and I want it back down to whatever yesterday's dose was.

And then once that you can extrapolate from that and go to an extended release so you can cover 12 hours a day. 'cause we wear our glasses whenever we need to focus. So we need to wear, we need to use our medications whenever we need to focus, which is literally from morning till night.

Yeah. And. Life just becomes so much more exciting and interesting and powerful and productive and happier when you can focus all day long. So most even well practice prescribers will give their patients a long-acting Adderall extended release or long acting Ritalin, Concerta, and that's it, right? And that'll last in the case of Adderall, about six hours in the case of Concerta.

That's gonna last about. Eight or 10 hours, but most of us are awake like 16 hours a day. So we need more coverage. That's a really important point. Other aspects of the book that I think stand out are, there's a whole discussion of what's known as integrative or functional medicine.

So of course the meds are really helpful in terms of improving our dopamine levels, but there are other things that contribute to our ability to focus like minerals and vitamins.So my tenet that broccoli, love, and exercise is really all you need. There's some truth to that in terms of the broccoli part.

You do wanna look at lab tests that tell you, Hey, are you anemic? Do you have a low vitamin D level? Maybe your thyroid's off a little bit. So I do a panel of tests. Those are all listed in the book. Not complicated. We, use a specific, what we call optimal range, that is a little more narrow than the regular reference range you'd get from LabCorp.

Again, hoping to get people's vitamin D levels in a perfect range. Um, make sure they're not anemic, make sure they're thyroids okay. All of that helps boost your ability to attend, and of course, mood as well. So that's a bit of it. 

Yes. Okay. I've got two questions for you. One is, because to your point, there aren't a whole lot of knowledgeable practitioners.

Is this a book that someone could read and then take to their practitioner and say, I'd like you to look at this and this. 

That's a great question, Jami, and yes, I hope that they will do that. That was my intention. And hopefully by the 14th when the book is released, Maggie Alexander will have some protocols on her website.

So I'm in the process of writing those. They'll be just simple, very simple protocols that will be easy to read by the general public that they can print off and take to their doc or their nurse practitioner and say, Hey, here's this local expert. would you consider following, her guidelines.

I've taken the test. It looks like I've got ADHD. She says we could just start with a little bit of Adderall. Would you be open to doing that? And I have done that quite a bit for clients where I'll just do a quick assessment. I don't have, I'm not on their insurance panel and they'll take my notes to their doctor and so far, a hundred percent of the time, the docs are just grateful to have that information.

And they will go ahead and start the person on whatever medication I recommend, which is gonna be either Adderall or Ritalin. 

 I would love it if you wouldn't mind, because truthfully, I haven't explored the difference in medication because as I said, I've definitely steered away from that conversation in my podcast.

Mm-hmm. And we don't really learn about it in coaching. So if you would just explain a little general idea of what the differences between the two major ones. Mm-hmm. And what would be the most effective typically for somebody who's older? And then I would love to just hear your, opinion of Wellbutrin or, bupropion.

or use that because actually that's what I am on. and 'cause I, I've heard it's a, could be an off-label for ADHD. And so anyway let's explore the two main drugs, classifications first, and then go from there. 

Absolutely. So again, this is sort of empirical learning, like you said, most of us have are self-taught, and in my experience of treating 600 plus people, starting in 2013 when I didn't believe in ADHD and was afraid to prescribe Adderall, I learned, person after person after person.

And these are mostly adults and some teenagers. I don't treat children. That seven outta 10 times. Adderall was the drug that worked the best for the person I was working with, and Ritalin was the drug. 20 to 30% of the time, about five to 10% of the people that I see, they don't respond to either drug, and then we need to look at other ways to treat them.

Wellbutrin being one option, but also functional medicine being a third option. 

So, Adderall, it's a mixed amphetamine. it boosts dopamine and norepinephrine. We don't really know how these drugs work, we see that they work, we don't really understand what the mechanism is. If you like I said, start low, go slow.

 very few side effects. If a person has maybe some agitation, irritability, anxiety, on the low doses, then we might be thinking, okay, here's our 20 to 30%. This woman needs to go over to the other side and try Ritalin. If. You have a history of maybe in college or some other time in your life, somebody giving you, an Adderall or Ritalin, a lot of people have tried it or they have some knowledge in their family that their son or their cousin or somebody did really well on Ritalin and they didn't do so well in Adderall.

Then I would go with, the drug that worked in their family. Because generally with, certainly with children and parents, I have never seen a parent and a child be on different medications. It's always the same drug. 

Oh, that's interesting. 

Yeah. 

Another one. Yeah. and how quickly will someone A, feel the effects and B, know, hey, this isn't gonna work for me.

It's pretty fast. Unlike an antidepressant that takes weeks it's days. 

 if you're gonna have a really strong negative response, you'll probably know within a few days, like, this is making me feel anxious or irritable. That can be with either of the two drugs, you can feel that way on Adderall.

You can feel that way on Ritalin. so you'll know, within a few days if it's not causing harm. And then I would say within a couple of weeks what the right dose is. And we, Dr. Dodson and I talk about the Magic Mountain, which is my term, but it's his chart, which is basically, if you can think of just like a sharp Mount Everest.

Peak, you're kind of going up the sharp peak. So if you start at five milligrams and you think of it like eyeglasses, like let's say I need to, a 2.0 reader and someone says, Maggie, you're squinting, you should wear these things called eyeglasses. And they hand me a 1.25. I'm like, wow, this helps.

Right? 1.5 even more. 1.7. Oh my gosh. I can see the fine print 2.0 like, oh, so clear. Beautiful. Right? Mm-hmm. And then 2.250, I can still see better than without them, but it's a little blurry. And then 2.5, I'm like, Ugh, I hate glasses. they make my head hurt. Similar are the same. They're exactly the same, which is like a little bit more, and then bingo, and then whoops.

Way too much. 

I love that. 

Yeah. 

That's a good way to visualize and to think of it, which again, I hadn't thought of. 

Yeah, and a lot of times people will have had the experience of having been given the standard starting dose, which is 10 milligrams of Adderall or Ritalin, and find it's too much and they don't like it and they're having side effects and they don't know that all they need to do is just go down.

It might be just a little bit, it might be like go down by 25%. It doesn't have to be a lot, and they might have that hit that, that perfect Magic Mountain ideal dose. So yeah, generally Adderall is gonna work more effectively just because higher percentage of the population does better on it.

And that's something to know about children too, which is that often they will start the kids on methylphenidate, Ritalin 'cause it's the milder of the two. But it'll be the wrong drug, right? so it, they might have some benefit, but. Unfortunately, they might not do as well as they could if they were on the right drug.

So if you've got a kid that's on Ritalin and they're not, they haven't improved a lot or they're a little irritable or something on it, you might have the provider switch over to to Adderall. So, and then your question about Wellbutrin, off-label. I mean, it's a antidepressant. it's an activating antidepressant, so it helps people to have more energy to be able to focus in terms of attention and energy.

It's not a stimulant in terms of. Being able to raise up the dopamine and norepinephrine levels the way that stimulants do. A lot of people find it very effective. The downside about Wellbutrin is that it increases anxiety. So if you're running hot already, you tend to be an anxious person with ADHD.

And your doc says, Hey, let's try some Wellbutrin. It's probably gonna make that anxiety worse, so you have to be watchful of that. If you tend to be more of an Eeyore, a little more depressed and less of a Piglet, then Wellbutrin might be a good choice for you, but it's just not nearly as effective as a stimulant is.

Interesting. Well, thank you. Okay, so a couple questions I wanted to also run by you is what would be the challenges in addition to attention that you could see or you do see in your older adult patients? Like how is it impacting them where they might consider going on medication?

 that's also a great question. we think about attention as being the primary thing along with hyperactivity. And we sort of, the stereotype of somebody with ADHD is their, they're kind of hyperactive. Maybe they have trouble remembering things. they're, they have trouble tuning into one thing at a time.

I would say the number one thing that people don't associate with ADHD, that is the second most devastating symptom of ADHD. And this again, is our friend, Dr. William Dodson. Is something called rejection sensitive dysphoria. RSD. Yeah. Right. Do you 

see me nodding my head? 

Yes. I see you nodding your head.

Yeah. Yeah, 

it's is 

real. Which is mood dysregulation. And I'm actually gonna read, 'cause he says it so well, and I can't possibly remember these words, but I'm gonna read this because even now when I read it for the hundredth time it's so moving. He says rejection sensitive dysphoria rSD is unbearable emotional pain.

Unbearable emotional pain caused by rejection or criticism, perceived or real. And unfortunately, often it is perceived.

And not really intended. 

It is not relieved with therapy. So someone can be in therapy for years and still have this experience of this deep pain that's caused by somebody maybe just giving them some feedback or maybe just saying a short text that says, can't make it tonight, sorry.

Or something like that, and they feel deeply rejected. While not a formal diagnosis, RSD is a very common expression of emotional dysregulation. A brain-based symptom of unbearable pain, often seen and misunderstood. In adults, the individual's response to RSD is often disproportionate. This is the big.

Point disproportionate to the triggering event. So they're super upset, they're super hurt. They can't stop thinking about it. They feel flooded with feelings about why did they send me that text? Maybe they don't like me. Maybe I did something wrong. I shouldn't have said that thing the last time I saw them.

Could be external criticism, including constructive or rejection, including teasing or perceived disrespect or internal. This is really painful self-criticism or negative self-talk. 

When I first start seeing somebody, and unfortunately I'm only telehealth now, but when I used to have a lovely office with my couch, I would go sit next to my client and I would open up Dr. Dodson's description. We'd read it together. By the time we were done, we were both in tears because it's just so profound. So there's one more short paragraph. He says, this pain can feel physical like the person has been punched. It can start in the teen years and lead to suicidal thinking. 

And mood disorders.

Conversely, it can also be expressed outwardly presenting as rage toward anything or anyone that appears to be at the root of the pain. This may wax and wane many times a day, so it goes up and down. People will often be misdiagnosed with bipolar disorder because they have these periods of being rageful or highly depressed or highly agitated.

And it's RSD rejection sensitive of dysphoria. 

I can I, as you're giving that description, I'm thinking of both being a parent and what I've gone through as with my children, but also people that I know, a lot of people that, when you have ADHD or you're aware of it, you see it in people, even though that they haven't come to it yet, and you can see, you, it's clear the child has it, so then you gotta look, look at the parent and, 

I, you can see some of these parents that are reacting in this way. So it's just, 

yeah. 

He, and I don't remember if Dr. Dodson has ADHD, but he certainly wrote that as someone who experiences 

mm-hmm. It's close around him. 

Yeah. 

I'm not at liberty to, to say if he does or doesn't, but 

Sure.

Yeah. I mean, but I did a whole episode on rejection sensitivity. I will get a phone call from somebody, Hey, Jami, I need to talk to you, and I immediately go to, something is wrong. Something happened. I, it's. It's just that natural leap. And I agree, it's probably for me, the worst part of ADHD 'cause I've kind of figured out what I need to do for the attention and I learned those tricks.

But yeah, to your point, I, I actually was just in the car with my 17-year-old daughter crying the other day to me about, what's going on in her life and I. And thankfully I have these tools now that I didn't have with my oldest child to understand and say, this is a lot of, this is what you're putting on yourself.

But, it's hard to hear that when you're feeling those feelings in that time. 

Yes. Yeah, absolutely. 

I agree. 

yeah, so there's a nice chapter in the book on rejection sensitive dysphoria with some good concrete suggestions in terms of what to do about it. But I think just knowing that it's a thing is helpful to recognize that this is part of ADHD.

And I, I do wanna put a plug for the positive part of ADHD, which is, it creates people like Jami, who have this creative impulse to share, teach, help others. Some of the really, the greatest scientists, artists, thinkers, leaders, JFK have been diagnosed with ADHD.

You all, and I don't have ADHD, but as I said, I have children and the people in my life with ADHD, you're very bright, you're very intuitive. You are really good at coming up with new ideas, ways to solve all problems in a new way. Sometimes it's a little tricky to implement that, solution.

So it's nice when you're paired up with somebody who can cross their T's and dot their i's and get stuff done. But you might be the one who has the brilliant idea of what needs to happen in order to solve this problem. So, and rejection sensitivity, it's a downside. It's ugly, when you're in that pit and you feel like you're being criticized or you've done something wrong and the other person's like, dude, just letting you know I couldn't show up.

 something came up. you still love me. Of course. You know? Right. So. It's a mixed, mixed bag for sure. 

 I'm, I love Brené Brown. I think she has A-D-H-D-I can't remember if I've heard confirmation. But she says, when she's, when she goes to somebody, she says, the story I'm telling myself is 

That someone can understand, oh, that's not what's going on at all for me. That vulnerability is really important. Right. Embrace your ADHD and say, Hey, this is what I'm making up, 

Yeah. 

 that's been so freeing for me. 

that's very well said. the, one of the things that I see a lot of is that folks with ADHD are some of the most compassionate, empathic humans on the planet.

You guys. You walk into a room of other humans that you've never met before, and you pick up on the person who's having a hard time. Right? 

Yeah. we read the energy.

You're generous. you'll pitch in, you'll work hard if there's a crisis. But if it comes, if the mirror is flashed around to you, you're looking at it and trying to recognize that maybe you need some empathy or you need to ask for some help or, made a small mistake and it's okay.

Unfortunately, the empathy does not reflect back on yourself, and that it's as a provider, as someone who cares so much about my own children and my clients who I loved dearly. It's hard to see that because you're overly hard, right? You are overly critical of yourself. So maybe knowing that you could, like you said.

Brene Brown says the story I'm telling myself like, this is real. Right? Maybe this isn't real. Maybe it's okay. So I, I'll tell you, the one thing that I've been doing, uh, and it's been really good with this podcast too, is, would you talk to a friend the way you talk to yourself and,

Alan P. Brown of ADD Crusher was one of the very first people that I interviewed and he said that he gave that voice in his head a name in a New Jersey accent so he can sort of pull it away. And that's such a good way of thinking of it. 

I can just imagine. Yeah. 

I'm really proud, I have to say that I'm really kind to myself.

I knowthat's one of the big struggles of people with ADHD. And that is, I hope that, and I make mistakes all the time, and I do not beat myself up over it. And, I, I'm very much into the perfect as the enemy of done and with my, my book, and by the way, I wanna say kudos to you because writing a book.

Is it's like having a baby. It's a, actually, I think writing a book is harder than having a baby because when you have a baby, you just, you don't really have to do much, but just sit down and write that book and get those ideas out. It's a big thing. And especially I would imagine in your space where you are a medical practitioner.

You're gonna have to crush your T's and your I's. Or I could be like, Hey, this is my story. It might not be perfect, but if I don't get it out there now, you may never get it if I have to keep editing it and, so I just first of all, wanna acknowledge that, remind us again the name of your book.

I'm actually gonna get your book and there's so many ADHD books out there, but that is one I need to read. Okay. 

So the title is Shine with ADHD. It has, it looks like young adult novel. It's got this lovely human on a hill looking out over the valley, and it's got sort of dark blues and some golds in the cover.

You can get it on Amazon. It's available now. It's in paperback and hardback, and it's also in e book format, so you can get it on Kindle. If you've got an Amazon Prime membership, I think it's free, so. Yeah, there you go. And eventually it'll be out in Audible, but that's gonna take me some time to that.

I have so many people and I'm also someone that prefers to listen to my books and I keep being asked, I would read your book if you would have it on Audible. I would listen to your book and, but that's a whole other thing to like record your book and I wanted to be in my voice. But anyway, we're going down a squirrel rabbit hole.

I'm sure you're familiar with those, right, Maggie? 

I am a little bit familiar with those. Yeah. Sometimes I catch myself. I'm looking out a window right now, and I have squirrels right outside my window. So there's, 

there's an 

expectation to watch those squirrels. Yeah. 

So any, any parting gifts or, words of wisdom for the people that are listening to this podcast?

Again, I'm, every day people are discovering or thinking, Hey this applies to me and this might be the first episode. they're gonna hear. What would your, words, your words be for them? 

Well, I think I like to joke with my clients to say, there's the four legs of the stool of treating ADHD are number one, education number two, education number three, education number four.

Education. So, learn and there are a lot of books out there. Not to toot my own horn, but I do think this one, first of all is positive. It's factual. It's very user friendly. there's nothing complicated in it, and I think you can take the advice in terms of the specifics around precise use of medications and also the nutrients, the micronutrients, the testing to your provider and hopefully.

You have someone that's kind enough and open enough to prescribe medication for you, you can download online the A-D-H-D-A-S-R-S test. It's just a 18 question form. There's an even shorter one that's only six questions. A-D-H-D-A-S-R-S five. it's a little harder to find, but they're both listed in the book.

 The first thing would be learn about it. Realize that you're a fabulous human, who is just now discovering that you have ADHD or maybe thought you did all along, but haven't been properly treated. Not to disparage antidepressants. Sometimes they are really helpful, but generally you need one of those two drugs, Adderall or Ritalin, and you need the right dose.

And so you start with Adderall and you start, and I just described, start with five milligrams twice a day. And most people will have a really positive experience if you don't switch over to Ritalin. If you don't have a good experience with that, read, keep reading the book because there's micronutrients, there's other things that you can do.

As an older adult, there's just gonna be a lot of misinformation. And if you, unless you've got some major cardiac thing going on, or there's a few other, you can google, counter indications to stimulant medications. They do often list antidepressants. That is not true. So when they say you can't take an antidepressant and SSRI and a stimulant, that is absolutely not true.

I have plenty of people who take both of those drugs, so don't be shy if you are on, Prozac or one of the other SSRIs, it's okay to combine the two. So learn. there's lots of strategies out there. There's several chapters about, women, students, parents, genetic testing. I haven't even touched on that, but 70% of my clients have A-M-T-H-F-R deficiency fondly known as the motherfucker gene.

Methylene tetra hydro folate reductase. we have trouble, and I say we because I have the worst possible presentation of it myself. We have trouble manufacturing something called L Methylfolate, which is a precursor for norepinephrine and dopamine, the neurotransmitters. So if you don't have the raw ingredients, then you might not be able to focus or be in a good mood.

So, and it's an easy, substance to. To replace. So you can take a supplement and it can help a lot, both with attention and mood disorders. So all of that is in the book as well. what else would I say? I would say if you wanna get something done today and you're having trouble getting it done.

My favorite tip is tell a friend text, not your partner, not your mother, but a friend that you wanna, whatever, clean out your closet, by five o'clock this afternoon? Because you've got company coming. They're gonna use your bedroom and you want them to have some space to put their clothes or something.

you got a reason for cleaning out the closet. And you just text Susie, Hey Suze, I'm gonna clean out my closet today. Can you text me at three o'clock and see how I'm doing? Right? Or even better, would you come over this evening and see how my closet looks, right? Guess what? You'll clean out your closet.

Right? 

Right. 

So 

having the company is that incentive. I'm always like, if I wanna get my house done, all I have to do is plan a party. 

Exactly. 

Yeah, 

perfect. Yeah. So yeah, engage somebody else, right?

Has been definitely one of those episodes where I have learned along with our listeners, and I'm so appreciative of your talent and your time and your dedication to, to taking care of people that you didn't even think needed your help.

 15 years ago, 14 years ago. Yes, 

it's true. Yes. Yeah. 

So I always like to end my podcast because, and I share this, that a lot of people, when I start, not a lot of people, but a few people that are close to me when I said, I'm gonna do a podcast for older adults with ADHD, or I'm going to get involved in this space, the question was, why does it matter?

 why are you doing that? And I love to say there is no point in our lives where we should cease to matter. We where we should. Cease to stop learning. And as you said, how do you understand ADHD, you educate yourself. So, that is my mission. I'm so grateful to people like you who are helping those of us out here who are sledding along in this ADHD space.

One more thing I wanna say, just 'cause I meant to say it and then I've forgotten and I wanted to say it. So, I always ask my guests who have ADHD if they could press a button and not have ADHD, get rid of it. Would they? And I will tell you that I've had more than 70 interviews and so far only one person said they would get away with their, they would get rid of their ADHD

So speaking of, yes, it's got its negatives, but it's really got its positive. So I'm really glad that you brought that up. So thank you all for listening. Thank you Maggie Alexander, nurse practitioner, and author of Shine with ADHD. The opinions expressed on Grandma has ADHD podcast are those of our guests and hosts and are intended for informational and entertainment purposes only. This podcast does not provide medical advice, diagnosis, or treatment. The content discussed in this episode is not a substitute for professional medical advice, diagnosis, or treatment.

Always seek the advice of your physician, mental health, professional, or other qualified health provider with any questions you may have regarding a. Medical condition or mental health concern. Never disregard professional medical advice or delay in seeking it because of something you have heard on this podcast.

If you think you may have an medical emergency, call your doctor or emergency services immediately. The host, guests and producers of Grandma has ADHD. Do not assume any liability for the content of this podcast. Listen at your own discretion.