Ep. 41 - What It Really Means When You Can’t Shut Your Brain Off

This is a conversation that keeps coming up, both in the office and in everyday life, especially as more people start to question whether what they’re experiencing is ADHD or something else.

Dr. Andrew Rosen and Dr. David Gross walk through what they often see when someone comes in convinced they have ADHD, only to realize the picture is more layered. Difficulty focusing, unfinished projects, feeling mentally scattered… it can all look the same on the surface.

But when you slow it down, there’s a difference between a busy mind and a stuck mind. Racing thoughts that jump from one thing to another don’t feel the same as repetitive what if loops that won’t let go. And that distinction starts to matter when you’re trying to understand what’s actually going on.

They also talk about how often ADHD and anxiety overlap, how one can feed the other, and why it’s not always clean or easy to separate. Treatment isn’t one size fits all, and quick fixes are rarely the answer.

The conversation moves into intrusive thoughts too, including the kind that feel scary or out of character. The kind people don’t always say out loud. And what it means when your brain goes there.

At the center of it all is a simple but important idea. Not every thought is meaningful. Sometimes it’s just noise. And learning how to recognize that can shift the way you relate to your own mind.

Contact the Docs:

Email: twoshrinksandamic@gmail.com

Transcript

SPEAKER_00 0:05

Hi, I'm Dr. David Gross, psychiatrist. And I'm Dr. Andrew Rosen, psychologist, and welcome to two Shrek.

SPEAKER_01 0:24

And this is something that I find very interesting. I see a number of individuals who come into my office saying they think they have attention deficit hyperactivity disorder. You know, I happen when people look at me uh look at me up online, they see that I have a lot of interest in ADHD and treat a lot of adults with ADHD. Um they'll come in thinking that uh they have attention deficit disorder, and I'll I'll ask them, tell me what makes you think that. Well, they'll say I can't finish projects and I get easily distracted, and I stare out into space at times, and I get stuck in my head. And, you know, theoretically, ADHD is a disorder that starts uh in in early or late childhood or early, early teens. And generally speaking, it's not something that starts in adulthood. And so I'll ask people to be more specific about what they mean by that. And and a lot of them will then begin to talk about the fact that they get in stuck in their heads with lots of what if this, what if that thinking, and that distracts them from the world around them. And that distraction makes what I call pseudo-ADHD the issue. They don't really have true attention desert hyperactivity disorder, but what they're dealing with is an obsessive anxiety disorder that they really haven't been able to get a handle on.

SPEAKER_00 1:38

Yeah, imagine, and it could be in everyday kind of situations. Imagine, well, we're doing this podcast, if I had the thought that maybe I parked in the wrong space and I might get my car towed. Well, if if that's playing around in my thoughts, it might be hard for me to focus and concentrate on our conversation. And there's so many examples of that where uh our brains are kind of in two places at the same time. We're focused on one thing externally in the situation, but our thoughts might be somewhere else. And that uh is what goes on with ADHD, but it also is what goes on with this overthinking obsessive uh mechanism that is associated with anxiety. He shouldn't have reminded me. I did park my car in the wrong spot today.

SPEAKER_01 2:25

And did and did have a little bit of a worry about getting either a tick or a toad, but not enough to get it in the way of my coming here to provide this podcast. I knew you were thinking that. But you know, it it's it's uh uh individuals often believe that it's a lot easier if I have ADHD because here's a pill and I'm fine and goodbye and don't need to come back again. And I wish it was that simple, but it's not. But once I begin to help them understand that this is really an obsessive, what if anxiety disorder that gets them stuck, um, then they're beginning to have to think about the need for a different form of treatment. Uh medication can be helpful for obsessive uh anxiety disorders. Uh we do know that the medicines that work on uh serotonin tend to have anti-obsessive properties. And the antidepressants that we use most commonly, this day and age, which which are the SSRIs, the selective serotonin reuptake inhibitors, examples of which are Prozac and Zoloft and Solexa and Lexapro and Paxil are very effective for this type of problem. But also the serotonin and norepinephrine reuptake inhibitors uh tend to be effective as well. Uh from my perspective, uh biochemically, it becomes a bit more confusing because the serotonin and norepinephrine reuptake inhibitors also have a norepinephrine component. And I don't think we really understand yet whether or not the norepinephrine contributes uh itself to anti-worry, anti-obsessive benefits, but these antidepressants are prescribed successfully for obsessive anxiety disorder and obsessive compulsive disorder, and the FDA has approved some of these for OCD. Um, individuals then get confused and puzzled as to why I'm prescribing an antidepressant, and I have to explain to them that you don't have a primary depressive disorder. It may be true that uh your obsessive anxiety and your OCD symptoms are wearing you down and getting you depressed and getting you unhappy and getting you frustrated in life. But I'm giving you these medications to help you with uh the obsessive anxiety and the OCD type anxiety. Uh, but I let them know right from the get-go that this is not a silver bullet. Uh it can it can help prepare uh your brain for the cognitive behavioral therapy that needs to ensue. The way I describe it is to let people know that it builds a foundation upon which you can then do the cognitive behavioral work, it makes it easier to do it. Um I do tell people that if they say to me, you know, Doc, I'd really like not to be on the medication, I tell them I respect that. And you could pursue the cognitive behavioral therapy without the medication. I'm I'm okay with that. And and uh as long as you see somebody who is a cognitive behavior behavioral maven, I'm I'm I'm perfectly fine with that. The only thing I ask of you is if you're if you're if your psychologist or your cognitive behavioral therapist tells you that we've done a lot of work together, but you've reached a plateau and you're not continuing to progress at that point that I'd like you to reach out and let's talk about adding medication to help uh increase the success and the the ability to get an outcome that you want for yourself.

SPEAKER_00 5:40

You know, it's it's really difficult for us very often to make a decision as to whether or not this person is primarily suffering from ADHD or is it an anxiety disorder? And it's that much more difficult for the person who's got this problem to decide is this uh anxiety or is this something else? But the common denominator is that the person will typically say, I can't shut my brain off. It's always thinking about something or something that's extraneous or not what I'm trying to focus in on. I just can't shut it off. It's always going somewhere. And the that's a common denominator for certainly for ADHD and for anxiety. And you know, very often over the years we've seen people who come in with a diagnosis, a pre-existing diagnosis of ADHD. And then we will look at them and say, well, wait a minute, you know, you've only gone so far with your treatment for ADHD, whether it's medication or not. Uh why don't we look at anxiety medicine, including an antidepressant? And very often that makes the difference. And vice versa. Sometimes somebody will have the diagnosis of anxiety disorder, they may come in with it from somebody uh that's given it to them, or we may see it, or the patient may think I have anxiety, and it turns out it's because of ADHD. Because if you have ADHD and you can't really stay focused, and you have a lot of things on your radar screen, and you know you have too much going on, that's anxiety provoking. How can I be managing everything when I I can't stay focused on anything? That creates anxiety. So very often the ADHD and anxiety disorder uh uh issue come together and they're uh very often not separate. Most people I think will have some kind of uh hybrid. And so it again, like we were talking before, it takes a real a lot of expertise and experience as a clinician to know how to differentiate these two things and put together a plan to address both components sometimes.

SPEAKER_01 7:57

You know, if you if you talk to uh uh pediatric child mental health professionals, um they'll often tell you that they see a common combination of obsessive compulsive disorder and ADHD in these kids. And I see them when they grow up and become young adults and adults, and and and there is a a big comorbidity, a common uh overlap between the two. Um, one of the ways that I try to separate um the uh obsessive anxiety thinking of OCD from what can occur in ADHD is the individual with attention deficit hyperactivity disorder will describe uh a busy head, almost like racing thoughts. So they're not reverberating loops. It's not, you know, the old old days of having a vinyl disc that you play on your turntable and it gets stuck in a in a pick particular channel and it's just repetitive. That's what the OCD anxiety is like. It's repetitive cyclic thinking, uh. Whereas the attention dense hyperactivity disorder thinking is often just a mishmash of racing thoughts and nothing specifically that is broken record thinking as in OCD. Um and it's helpful to really differentiate the two. Um what a lot of people describe who have ADHD, and this will be a topic we'll talk about in the future, I'm sure, is that once they get on uh medication for that, suddenly their brain is quiet. So it's almost like static with ADHD versus a broken record for obsessive compulsive disorder.

SPEAKER_00 9:28

And the hard part is, you know, you can have both. I mean, it's just like we can have a stomach problem and a back problem. I think some people can have both ADHD and an anxiety disorder that uh interact with each other. And um it then the treatment is really uh very important to come up with a good plan because you could be the person who goes to somebody and they say, Oh, it's ADHD, let's treat your ADHD, and it can sort of partially get better, but not fully, and you wonder, well, like, well, maybe it's who knows, maybe it's the medicine or something. So they didn't get really much better because the other component, if they have anxiety disorder, it wasn't addressed, and vice versa. So it it it's a it's a significant problem, and I believe, I don't know if we have any data to support it yet, but with the overuse of screens where everything is two-dimensional, the person with ADHD, I think will have a greater problem in differentiating stimuli. And I think the person who has anxiety disorder will also have that problem because the it's a looking at a screen or two-dimensional, we're starting to find out, and you know more about this, David, than I do, about how the brain works differently in two-dimensional uh stimuli. So you put all that together, and I think you're gonna get a uh increase in the population where you have both these problems together.

SPEAKER_01 10:54

Well, you're also raising the concern that a lot of uh uh mental health professionals have about uh the impact over time of uh internet and uh cell phone preoccupation uh uh impacting how the brain functions, because we're retraining our brain for 10 to 20 seconds of information, and all of these websites um have been developed so that basically you can scroll from one thing to another. So the idea of spending 10 minutes on a topic um is no longer present. So the real fear and concern is will the brain of a of a of a 15-year-old 30, 40 years from now be different in how it functions from a brain of a 15-year-old uh in this modern times, um, because we're gonna re- be changing the way our circuitry works. Uh and you add to that the whole concept of artificial intelligence. I know we're getting off on a bit of a philosophical bent, but it's it's it's important. Artificial intelligence may get people to begin to use that for reasoning rather than using their brains. And what happens when you don't use an organ? It doesn't work as well in the future, and you begin to get atrophy and and loss of use. And that's a real concern. Um uh for all of you who may have seen that movie Wally from years ago with a cartoon about what happened to the earth after we polluted it so badly that we had to send uh robots automatically down to the surface to uh clean it up. There are scenes in there of people living in huge space stations in uh uh anti-gravity wheelchairs, basically, who didn't do much of anything. They they everything was solved for them, and and they basically their brains were useless. And that's a bit of an exaggeration, and I don't get people scared, but there is a concern in for the future.

SPEAKER_00 12:51

Well, you know, there's a term that they use in in all of this called an algorithm, which it means that a lot of these uh websites and and uh electronics have algorithms which get you to keep tuning in and giving you more information that you'll want to see. And oh yeah, that looks familiar. That makes you want to keep going. And you know, it's like why don't they just call it addiction? Why don't they just call it a drug rather than an algorithm? Because it is a drug, it's addicting. And so you know it it the effect that it has upon the ADHD brain or the obsessive brain is gonna be different, probably, than the person who isn't susceptible to that as much, like somebody who doesn't have ADHD and somebody who doesn't have an obsessive disorder. But um I think we probably ahead of the curve on our in our discussion today about it. But um it's important because we're discussing ADHD andor uh anxiety disorders and and uh lots and lots and lots of people out there will have some exposure to it or have some of it. And we're our job as as professionals is to educate and to hopefully come up with good treatments. So that's why we're talking about it.

SPEAKER_01 14:04

Trevor Burrus, Jr. You know, we really can't finish a discussion about OCD unless we talk about one of the worst aspects of OCD and most painful aspects of OCD, which is the the presence of what we call horrific thoughts. I know we mentioned that the last time, but basically horrific thoughts are intrusive, horrible thoughts that are very scary. Uh they relate to um either danger, like I could do something bad, I could harm somebody, um, or health. Um I could have, do I have a cancer inside of me? And I have these thoughts that pop into my head telling me that I have this. And oftentimes when people have horrific thoughts, they're crazy. And they misinterpret the horrific thoughts for even hallucinations. You know, it's almost like somebody's talking to me, telling me that uh I'm gonna pick up this knife in a uh uh in a business meeting and stab my neighbor. Um and they're terribly frightening, and because they're ha they're so scary, people often keeping them keep them uh private to themselves, fearful if I tell anybody they're gonna tie me up and take me away to a mental health, mental hospital. Um uh but these are these are aspects of OCD that that can't be ignored and need to be addressed.

SPEAKER_00 15:19

There's another piece to that as well, that um in these horrific thoughts or intrusive thoughts, uh very often there's a shame and embarrassment feeling and a feeling of I'm a bad person. I must be a bad person to have thoughts like this. And um the the quandary is how do I find out if I'm a bad person? I can't tell anybody because that may get everybody I know to know I'm a bad person. So how do I how do I deal with the fact that I might be a bad person? Well, maybe maybe I can find a way to not have these thoughts anymore. If I cannot think these things, then maybe that means I'm not a bad person. Well, of course, none of us can control our thoughts. And typically the thoughts that we don't want to have are the thoughts that will occur faster. And so very quickly a person can feel like not just scared about what might happen, but feel like they're a bad person and they shouldn't be here any longer. That they don't belong to be, they don't belong here, and then that opens up the whole uh issue of um self-worth and and self-harm and suicidal thinking, which then unfortunately interfaces in our current world with AI and some of the horrific things we've heard about people listening to AI, it's it's it can be really tough.

SPEAKER_01 16:40

You know, the the um the aspect of horrific thinking that is uh uh needs to be shared with individuals is the fact that it you're really looking at something that's brainstorming. I use the analogy of dreaming at night. When you're in the middle of a dream at night, it's very, very real. Um you don't second guess it, even though it's it's a it's a uh supernatural type of dream and things are happening that make no sense in real life, but you're in the middle of the dream. You wake up in the morning and you realize that this was just a dream. But it what what it was was a manifestation of how your brain is working at night in a very normal way. Well, horrific thoughts uh probably represent uh brain static in certain areas of the brain that generate these thoughts when they shouldn't be generated. Um it's almost like a uh a belch that you don't have control over. And it it doesn't help decrease the thoughts themselves, but for somebody to recognize that this is a manifestation of my brain and it's not part of who I am or what I will do, terribly important because that helps to to some degree normalize it and then it can be addressed in treatment.

SPEAKER_00 17:46

Unfortunately, and you brought up the issue before of some of our older uh theories, our psychoanalytic theories. Do you know where and I was when I was in my psychoanalytic training, it's not your mother's fault. Very often Oh, it's all my mother's fault. But very often it was if you had a thought, uh I mean a dream, and uh particularly an upsetting dream, if you had a particular thought, the idea was it may be not just a fear you're having, but it may be your wish. So if you had a dream about, you know, somebody that you loved was was killed in an accident, very often the interpretation was it's a manifestation of your anger towards your whoever. What? You know, I I don't I don't want I don't want anything bad to happen to her or to him, but that was the orientation then that would make a person, you know, kind of believe that. Now we know that's nonsense now, but that wasn't too long ago that that was a a real part of our uh therapeutic understanding of people. So obsessive-compulsive disorder and the thoughts you have, whether they be in your dreams or the intrusive thoughts, it's an aberration. It's a glitch in your brain. It has nothing to do with who you are, what you want, what you don't want, or or anything uh other than it's just a thought. And most thoughts that we have, especially in our sleep, are nonsense and I call them junk thoughts. Or today I call them spam. We get all these phone calls that come through, and sometimes it's labeled as spam, well, and we dismiss and disregard them. We don't pick up the phone. Same thing with thoughts. These are spam thoughts, and we're best off just knowing that and just disregarding them.

SPEAKER_01 19:27

You know, the reality is that uh we have parts of our brain that prevent these types of intrusive thoughts and do a very good job in inhibiting them. Uh the individual who has horrific thoughts, that part of the brain or those parts of the brain, not doing an adequate job in preventing them. Uh and with that, uh hopefully you'll have send your questions to us and raise concerns so we can learn from you all. But I'm Dr.

SPEAKER_00 19:53

David Gross and I'm Dr. Andrew Rosen, psychologist. But I just wanted to add one thing. I always tell people that you can't make yourself not think a thought. It's it's only when you you kind of get distracted with a conversation or move on to something else that you forget. Oh, you know, that idea of don't think about purple elephants. Well, it's only you'll stop thinking about them when you're doing something else. But I was just thinking, probably you forgot about your car until I reminded you right now. That is true. Thanks. So I'm glad we were able to do this podcast today at Two Shrinks in a Mike, and we'll see you next time. Bye-bye. The Two Shrinks in a Mike podcast is for informational and entertainment purposes only. The views expressed are those of the hosts and guests and do not constitute medical, legal, or professional advice.

SPEAKER_01 20:44

Please always consult a qualified healthcare provider before making any medical or wellness decisions. Our content is not a substitute for professional medical guidance, even though our mothers tell us we have the best advice possible.