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Episode 11: Stimulant medications and ADHD

Transcript

Lindsay Guentzel (00:01):

You’re listening to episode 11 of Refocused with Lindsay Raafia.

Lindsay Guentzel (00:26):

My name is Lindsay Guentzel and I have ADHD. Attention deficit hyperactivity disorder. And it’s a new thing for me. At least it’s a new thing knowing about it. ADHD has always been with me, but I wasn’t diagnosed until about a year and a half ago, two months shy of my 35th birthday. A lot’s changed for me over the last 18 months. There’s been a lot of growth and a lot of learning. And I credit those wins to a lot of different things.

Lindsay Guentzel (00:57):

Self-realization, education, therapy, a regular workout routine and medication, specifically stimulant medication. I take Vyvanse every morning. And a few things I’ve noticed since I started taking it, it helps regulate my energy levels. The 3:00 PM slug fest I used to battle every day, is now something I deal with only when I’m over-stimulated. Taking stimulants also made me realize I’ve battled brain fog for my entire life. And I just assumed that was something everyone felt. Note, it is not.

Lindsay Guentzel (01:35):

The use of stimulant medication for treating ADHD goes back to the 1930s. And in the late sixties, the National Institute of Mental Health awarded several grants to researchers to study the effectiveness of stimulants for children with ADHD symptoms. Since 2000, 26 stimulants have been developed. But what’s important to note is that most of them use the same main ingredients. These active ingredients go back to the earliest days of ADHD research. But despite their regular use, stimulant medications are still very controversial and they aren’t right for everyone. So if you’re interested in learning more about how they might fit into your ADHD treatment plan, your first step is consulting a physician. You can speak to your primary care provider or use your patient portal to set up a conversation with a provider through ADHD Online.

Lindsay Guentzel (02:34):

On last week’s episode, Keith Boswell, the vice president of marketing for ADHD Online shared a bit of his own ADHD journey and mentioned he had an appointment scheduled to speak to a provider about adding a stimulant medication into his treatment plan. And in a few minutes, we will get a update from Bos. But first I want to bring Dr. Raafia Muhammad into the conversation. She’s the division chief of medicine and interim chief medical officer for ADHD Online. And she’s going to give us a little bit of background on why stimulant medications are so important for treating ADHD and the symptoms that come along with it.

Lindsay Guentzel (03:15):

Hi, Dr. Muhammad. Welcome back.

Dr. Raafia Muhammad (03:17):

Hi Lindsay.

Lindsay Guentzel (03:18):

I’m hoping we can start with the basics. I want to know a little bit more about how stimulant medications work and why it’s what is so commonly prescribed for ADHD. I think that would be a great place for us to begin. So for me, when I started taking Vyvanse, the first thing that I noticed was this brain fog was gone. And I didn’t know I had brain fog. I thought that was just how I was supposed to live. And I remember it was like three in the afternoon on the first day. And I was like, “Oh, I’m not exhausted.” And it does make sense once you think about it. It’s not that I am doing a lot more things during the day, but my brain is working overtime. So it makes sense that I would be exhausted at a point in the day where I shouldn’t be.

Dr. Raafia Muhammad (04:10):

So when you have ADHD, the ADHD affects the brain. What happens in that, there is a imbalance of certain neurotransmitters. We have dopamine, we have norepinephrine, we have serotonin. And sometimes the imbalance of this is what precipitates these symptoms of ADHD. So these medications work on the prefrontal cortex. Now, medications like amphetamines, for example, the shorter-acting or the more immediate release will be Adderall, and then there’s longer-actings like Adderall-XR or like Vyvanse. These work on increasing dopamine and norepinephrine and some serotonin. Then there are medications like the methylphenidate family, which is the immediate release is Ritalin. And then the longer actings are Concerta and stuff. They work on increasing levels of dopamine. And at the end of it, we’re trying to fix that imbalance a little bit, so that’s how those medications work.

Lindsay Guentzel (05:02):

I’m curious about the balancing, because what works for me is going to be different than what works for another patient. It can take some time. I feel very lucky that the first medication I tried is something that worked really well for me. But I hear from a lot of people that you have to try things and see what works. And I think one thing that’s frustrating sometimes, is you might feel better in your scenario, but there could be a better option out there.

Dr. Raafia Muhammad (05:33):

So I always tell patients the end result for all these medications is the same. Whether you’re on Ritalin or Vyvance, or Mydayis or JORNAY PM`, the end result is the same. So if you feel like you are getting what you need to get done with Ritalin three times a day, that’s fine. If you feel like you need to be on the highest dose of Mydayis to be able to tackle your day better, that’s fine. That’s specific to your day. So there is no, there is really no right or wrong. There’s no way that someone can tell you, “Well, because you were diagnosed at this age and you have this, this, this, this, this, it has to be Vyvance, 15 milligrams.”

Dr. Raafia Muhammad (06:14):

So at the initial visit, we kind of go through a typical day. Based on that, if somebody has like two young kids and I wake up at six o’clock, I drop them off at school, then I start my work, and then by the time I actually get to bed, it’s like 11 o’clock. So my day could be over 12 hours. Maybe in that case, Mydayis may just be a better option for me, because that is the longest medication we have. That’s about 14 to 16 hours long. So because the other medications, whether it’s Adderall, which is a shorter acting tablet, that has a half-life of four to six hours. By taking it twice a day, I’m going to get, best case scenario, 12 hour coverage. But my day is longer than that. So there’s no way that it can cover me for that entirety. Vyvance is a 12 long medication, so in a prodrug form has to be ingested to be activated. And so it has a very slow, steady release for at least a good 12 hours.

Dr. Raafia Muhammad (07:04):

So to find the right medication depends on each person’s specific day. So for some patients, it’s like, if your day to day changes, if there’s no specific routine, sometimes once they’re on a medication, they realize, “I do a lot of my work in the daytime. I don’t do much in the evening. So a long-acting is really keeping me up at night.” So then we’ll go and transition to, “Let’s see what else we can do at that point.”

Dr. Raafia Muhammad (07:27):

So once a patient comes and sees us, we see them again in a month to see how they’re doing at that point. And if we change medications or change a regimen, then we’ll see them back again next month. But say, at that second month they’re doing fine, they’re doing well, then we’ll see them back in three months. But patients can come back at any time during those intervals. They can just go online, go onto the portal, make an appointment. Because at that point they can say, “You know what? The first month I liked it, second month I liked it, but now things are changing. I just got a new job, I just moved, it’s not having the same benefit.” Well of course, let’s come back, let’s talk about it and see what works now.

Lindsay Guentzel (08:07):

It’s interesting, I started my treatment in January of 2021 and I was unemployed because of the pandemic. And then in April I started at Minnesota Public Radio and very fast-paced, it’s news, it was in the middle of a crazy news cycle here in the Twin Cities, and it was a lot of engagement. And I remember, probably right after the first week, was driving back home, it was like three o’clock and all of that exhaustion, all of that brain fog, was back.

Lindsay Guentzel (08:36):

And I said to myself, “Well of course, I went back to work. My brain is overwhelmed.” It’s like in so many cases, knowledge is power. But once we start to realize how our brains work and what affects us, I think all of us can go back and go, “Well yeah, that’s why this scenario didn’t work for me,” or “That’s why this scenario didn’t work for me when I didn’t know how I was going to respond.”

Lindsay Guentzel (09:01):

And so I made it an appointment. I went back in, we had the conversation, we changed the dosage and then it was perfect. So now I know in those scenarios where I’m going to be in front of people a lot, and I’m going to be with people all day, I have to, for my own benefit, be very aware of what I’m taking on.

Dr. Raafia Muhammad (09:25):

I mean, it’s amazing how you’re able to put that for yourself. You realize you’re like, “Well, I can do this and I can’t do this,” or “I can do this, but I need to be careful how I do the other stuff.” So it’s just beautiful, how once you know what you have, then only can you understand how to make things work for you. You know?

Lindsay Guentzel (09:46):

Yes, absolutely. Let’s dive into the different types of medicine. So I mean, I’m just going to be completely and totally cliche. I think when most people to think of ADHD, the first two medications that come to mind are Ritalin and Adderall.

Dr. Raafia Muhammad (10:01):

So there are two classes of medications, there’s the amphetamines and then you have the methylphenidates. Under the amphetamines, the shorter-acting medication, the most common one, is Adderall. Adderall has a half-life of four to six hours. It is in a tablet form. Most adults have an average of about eight hour days. So you’ll take Adderall at least twice a day to give you an average about 10 hour coverage. And then under that, we have the longer-acting medications and that is the Adderall-XR. This is a capsule form. The way this is formulated is, first half of the medication is an immediate release, so it comes out in a fast push. And then the second set of six hours is extended-release, slow and steady. And that’s slowly in the system for the latter six hours. So it gives you an average of a total of 12 hour coverage. It’s one capsule that gives that full coverage.

Dr. Raafia Muhammad (10:51):

Then there’s my Mydayis. It’s an amphetamine, but it’s in a triple-bead, extended-release. The way this works is, this gives us an average of 14 to 16 hour coverage. The longest one we have, this is extended-release with a triple-bead response. The triple-bead response is an immediate-release push. What that looks like is, let’s say breakfast it’ll be 10 out of 10 push, then lunchtime seven out of 10, dinnertime two out of 10. So if you have a long, busy day, you have that reserve for when you get home to do those home chores and home tasks.

Dr. Raafia Muhammad (11:22):

And then there is a Vyvance. Vyvance is also a long-acting medication. It’s in the amphetamine family, but it’s the actual medication is called lisdexamfetamin. This is in a prodrug form, so it has to be ingested to be activated. Vyvance, it doesn’t have an immediate-release component. It’s extended-release the whole time through, so it takes about an hour or so to take full effect and it should be taken with something rich in protein, but it slowly releases throughout the day and gives you a 12 hour coverage.

Dr. Raafia Muhammad (11:52):

In the methylphenidates, we have the shorter-acting medication, which is commonly known as Ritalin. Ritalin has a very short half-life, about one to three hours. So Ritalin is typically taken, for adults, this is information is for adults, it’s typically taken at least three times a day. Because most adults have busy days, long days, and you’ll just stagger those doses throughout the day. Then there’s an intermediate-acting medication called Ritalin-SR. And this has an average of about eight to 10 hour coverage. And this also has, this is released in a…

Dr. Raafia Muhammad (12:29):

Hold on, let me start that one again. So, because I don’t know if I should do the intermediate-releases because there’s different formulations of it, they have different peaks. I don’t know if that’s important. So maybe I’ll just do Ritalin and then I’ll just do, consider that, because those are the more common ones.

Dr. Raafia Muhammad (12:46):

Okay. So the other category is methylphenidates. Under the methylphenidates, there’s shorter-acting medication. The most common one is Ritalin. Ritalin has a half-life of one to three hours. Because it’s so short-acting, for adults it’s taken at least three times a day in divided doses to give a full day coverage. And then there is a longer-acting medication called Concerta. Concerta gives you 12 hour coverage. In the first hour, 12% pushes out in a more immediate-release component and then the rest slow and steady throughout the day. So it kind of works in the background of your day to day. And that’s how it gives you the full 12 hour coverage.

Dr. Raafia Muhammad (13:29):

There is another medication under methylphenidates called JOURNAY PM. This is a 12 hour long medication, but this is taken at nighttime. So it’s between seven to nine, so after dinner, and it activates in the colon and gets activated 12 hours later. So you wake up with the medication on board and this also gives you the full 12 hour coverage. So one thing I do want to mention is, the medications that we are talking about here and the regimens mentioned, these are for adults, not for children.

Lindsay Guentzel (14:03):

I’m curious what suggestions you give your patients when they’re considering adding a stimulant medication to their treatment plan. What’s important to know, going into I?

Dr. Raafia Muhammad (14:13):

When you have ADHD, it is important to build structure, to build a routine. So if you take your medications in the daytime, make sure you’re taking them at the same time every day, make sure they’re in the same place. So say in the morning you wake up, you make some coffee, as your coffee is brewing, you make some oatmeal or something, have your medication right there and take them at the same time every day.

Dr. Raafia Muhammad (14:35):

Just so you know you’re doing it. You want the medication to be part of your routine. A lot of patients who have ADHD, and this is mainly information for adults, they drink a lot of coffee because they’re highly used to a coffee in the morning, but then throughout the day, just to keep themselves mentally stimulated. But when you’re on a stimulant medication, if you continue to drink the same amount of coffee, it can have an opposite effect. You can start feeling more anxious, more little bit short of breath. It can have that presentation. But also coffee is very dehydrating, and with a stimulant, it can also decrease your appetite, also give you dry mouth if you’re not drinking enough water. So you’re also dehydrated.

Dr. Raafia Muhammad (15:13):

So I always tell patients to be careful with the amount of caffeine you’re taking. If you have to have the cup of coffee in the morning to wake up, that’s fine. But then maybe throughout the day, just drink more water, eat more hydrating fruits and vegetables. If you still like coffee, maybe just do some decaf. But limit the actual amount of caffeine, just because how that can work with the stimulant could be very different. Also eat food that’s rich in protein. If you’re on a long-acting medication like a Vyvance or a Mydayis, it is important to take it with something rich in protein.

Dr. Raafia Muhammad (15:47):

Protein kind of stays in your stomach a little bit longer and the medication is sort of breaking down slowly as well, so it gives you good, sustained energy. And it’s also important to know that these medications can decrease your appetite. So the idea is not that I don’t want to eat anything all day and then we eat a really big meal at lunch or after work. But by then you’ll be super tired because you have insulin surge kicking in and then it’s like, we just feel like, “Oh, well the medication’s not working. Because I’m tired now.” It’s important to eat a little bit throughout the days. So don’t go too long without eating or drinking anything.

Lindsay Guentzel (16:20):

Yeah, that was something that I noticed. The dry mouth, having to drink more water, adjusting the caffeine, and eating smaller meals throughout the day and just being aware. But for me, this is the first time in my entire life I’ve had a healthy relationship with food. I think part of that is the ADHD diagnosis. But I also know that the majority of that has come from taking Vyvance, being consistent with it, therapy, identifying what was pushing me to either overeat or not eat. And it’s crazy how much I look back and I’m like, “Ugh, that took over way too much of my life.” You know?

Dr. Raafia Muhammad (17:04):

Yeah. And interesting you say that, because Vyvance is FDA-approved for ADHD and also for binge eating disorder. So if patients who have ADHD, at times they may have this loss of impulse control. And that could be seen, in relations to food, it’s seen in binge eating. So it’s eating larger amount of food in a short period of time, eating really fast, and these episodes occurring quite frequently. After each episode, it’s like, “Ugh, I feel gross that I did that. Why did I do that?” It’s some of those feelings that are related to binge eating, but we’ve noticed that patients who have ADHD and then have this impulsivity or binge eating disorder, Vyvance has tremendously helped.

Lindsay Guentzel (17:46):

You’ve mentioned taking stimulant medications with protein. When you’re actually taking the medicine, having belly full of protein. Why is that so important?

Dr. Raafia Muhammad (17:59):

So it’s important to take the medications with food that is rich in protein, because foods that are rich in protein is what the body uses to make certain neurotransmitters. And at the same time, protein breaks down slowly, so that way you have more sustained energy. You don’t have spikes in your blood sugars.

Lindsay Guentzel (18:18):

It was a pleasure as always Dr. Muhammad. Thank you so much for sharing your time and your expertise with us.

Dr. Raafia Muhammad (18:24):

Thank you for having me.

Lindsay Guentzel (18:32):

Every week we bring Keith Boswell into the conversation and I feel like this week, more than any, is serendipitous. I mean, I don’t quite know the right word. I know there’s probably like some wordsmith listening who’s going to say, no, that’s not the…

Keith Boswell (18:49):

Timing is everything.

Lindsay Guentzel (18:50):

Yeah, right. Whatever analogy we want to use. I’m very intrigued, because the last time we talked, which would’ve been episode 10, which was, “You have your ADHD diagnosis, now what?” You did mention that you had an appointment coming up to speak with someone about medication management. You just take over here, you tell me what happened and where things are now.

Keith Boswell (19:11):

So last Friday I met with a physician. We spent a half hour going over my history, the assessment and the diagnosis. We talked a lot about my life. Honestly, it felt like a mini therapy session in a lot of ways. I was coming into it with a really interesting perspective, everything in my head, all the knowledge I’ve built. And we even got to, “So what do you do for work?” And I’m like, “Oh, I actually work for this company.”

Keith Boswell (19:39):

And so we got to talk about that for a second. So I’m on day six now of medication. And I have to say your dryer sheets analogy immediately came to mind Saturday. Saturday was the first day I took medicine and it was a little bit of an adjustment. I felt compelled, is the best way to describe it. I think I realized this week when I’m stressed, when I’m trying to figure out what to do next, especially when I come out of work and come home, and I’m in that next phase.

Keith Boswell (20:13):

I typically will just sit down. And I don’t sit down because it’s like, “Oh, it’s time to rest.” I’ve been sitting most of the day. It’s more like, I’m literally swimming in my head. And when I sat down this week, I was compelled to stand back up. And it just was a very interesting week. I mean, it wasn’t life-changing, but it was certainly eye-opening. And it certainly created a lot of hope in me for what’s to come. And it was just kind of one of those, “Wow, this is what it feels like to not be swimming in my head so much.”

Lindsay Guentzel (20:52):

I feel like the word compel is such a perfect word to describe it. I’m thinking back, I’m like, “Yes.”

Keith Boswell (21:00):

It felt so weird, too. Because I was like, “I don’t…” and I felt, but it was like, it literally was like, “What are you doing sitting here?” And I’m like, “I don’t know. Like, I mean, let me get up.” You know? And I think the first day I, my wife was laughing, I probably looked like I was playing physical pinball as a human. I was just bouncing around the house. We were getting ready for an event, I was making some stuff to take. But I just was like, I just felt so active and just like, “Wow, I’m just getting all this stuff done.” And I mean, I have noticed side effects this week. I’ve noticed some indigestion and woke up a few times in the middle of the night, but I’m like, this all seems tolerable compared to being so focused during the day. Where before I might have set something down and said, “I’ll come back to that.” I felt like this week I got more of those things done.

Lindsay Guentzel (21:55):

I can very much relate to all of that. I find it interesting, I go back and I think of all of the things that were issues in my life prior to my diagnosis. And then how many of them started to clear up once I was properly medicated and seeing a therapist, and doing other self-care things like acupuncture. But a big one for me, and I can’t wait to dive into this full topic, but you mentioned the indigestion, is, I don’t think we as humans comprehend or maybe want to comprehend, because it would require some changes, how intertwined our gut and our brains are. And how, when we have something in our life like ADHD, everything that’s happening down there is either working with the ADHD or working against it. You know?

Keith Boswell (22:50):

It’s true. I mean, it’s really interesting. I’ve noticed this week, just a difference in my energy levels, depending on what I eat. The physician I met with advised me, she’s like, “Take it easy on coffee this week.” I normally don’t drink a ton of coffee, but I normally have at least a cup of coffee in the morning. And the one day that I actually drank, and it was a small cup of coffee, I drank it after I had taken my medication, I actually felt tired. I kind of felt like, “Oh my God, I need to sit down for a second.”

Keith Boswell (23:20):

And I was like, “What is going on?” And I just, it made me realize, I’m like, “Okay, I’ve, I’ve got a new normal and I’ve got to adjust to it.” And really like, yeah, I mean, I can just tell a difference. I’m like, what I’m feeding my brain and my body, it is going to be critical moving ahead. I don’t know. It just was very eye-opening,

Lindsay Guentzel (23:41):

I cut out gluten. I mean, now it’s been, I mean it’s before the pandemic. It would’ve been like February, November, I think it was November before the pandemic and made such a difference for me. And I look back at a lot of the anxiety and how it played out in my life. And a lot of it came out in digestive issues. I’ll leave it right at that, because it’s not a pretty picture. But it’s interesting, once you start to realize how your body responds to certain things. And I definitely have to watch myself with the caffeine. I’ve been taking medication now regularly since January of 2021, so a year and a half.

Lindsay Guentzel (24:24):

And I can tell the days when I’ve had too much coffee and I start to get kind of the anxious pit in my stomach, what it’s from, but it doesn’t alleviate it. It’s like the doom and gloom is coming and I can’t tell myself, “Well yeah, it’s because you had too many cups of coffee.” I have, most of the time I do a half and half, half regular, half decaf. And everyone says, “Oh, well just find something else to enjoy in the morning.” But like I love coffee, I love the routine of coffee. And so I’m working on finding a balance that works for me because I’m [inaudible 00:25:03].

Keith Boswell (25:03):

Yeah, and that makes a lot of sense. I mean, I, there’s a certain temperature I love coffee at, and I’ve got a mug that seems to hold it well at that. And it’s been nice to just take a sip throughout the day and be like, “Ah.” It’s, but yeah, it…

Keith Boswell (25:18):

I guess the other part, and this would be, I’d love to hear your perspective on this, too. Towards the end of the day, so as you’re tapering off and coming back, the medication is wearing off and you’re changing into the relaxed routine of the evening. I definitely, and I know this is normal, but I’m feeling that, I don’t know how to describe it, but like an agitated come-down. And it’s not like I become physically upset or anything, it’s more like I just feel this nervous tension dissolving. And it’s been great, I’ve been getting out and walking and so trying to be active with it. But, I mean it’s definitely something I’m going to have to build around because it just, I don’t know, it’s kind of just like punchy.

Lindsay Guentzel (26:07):

I would be really interested to look into what you’re taking and…

Keith Boswell (26:11):

Yeah, so it’s Adderall, 10 milligram instant-release, twice a day.

Lindsay Guentzel (26:15):

I wonder if that’s something your body adjusts to, or…

Keith Boswell (26:18):

Yeah, because that’s what I don’t know. And then she had said, if you have any questions to get in touch So it was actually going to put together a list of like, “Hey, here’s what’s going on. Things are going well.”

Lindsay Guentzel (26:29):

And I think that’s the biggest thing for most people. And I think one thing that’s important to remember is that, regardless of what you’re doing in life, whether you’re taking a medication or starting a new workout routine or starting a different way of eating, it takes time for your body to adjust. We’re very much like this society of immediate response. I played the Sims growing up a lot, and the Sims, if you wanted them to work out, you could have them work out all the time.

Lindsay Guentzel (26:57):

Then they would get these amazing bodies and they would have like all of these high self-esteem points. And I sometimes think, I forget that it’s not the Sims. It’s not the simulation of life. I can’t just go to the gym once and I can’t eat healthy one day and that just fixes everything. So I would be really interested to know some of the things that you are feeling and dealing with. If those are things that your body will adjust to or if, not necessarily even adjust to, but if those balance out.

Keith Boswell (27:24):

Yeah, me too. I mean I expect that it will. And she basically said, that’s what I should expect. And it’s probably one of those things, too, because I’m still counting the number of days that I’ve been taking the medicine. Every day kind of feels like a personal experiment where, it’s like, “What is today going to be like?” I mean, quite frankly, it’s just been great because I think it dispelled some of the previous things that I’ve worried about, but it also affirmed why I needed to do it.

Lindsay Guentzel (27:54):

Well, and it’s important to note, you had tried stimulants before.

Keith Boswell (27:57):

I had, and I was thinking about that a lot this week. And based on a therapist’s suggestion that I might have ADHD, which I didn’t believe, but I sought treatment anyways, thinking it might help. And I just remember, I didn’t know enough. I didn’t seek enough. So I ended it. I said, “This is not working.” And so I think going back into it this week, I had the trepidation, I had the nervousness, but I had the research, too. I had talked to a lot of people and even the meeting with the provider, I went into it not assuming I would come out of it with a prescription, because I literally wanted to know what does the doctor think would be the best thing for me?

Lindsay Guentzel (28:37):

Oh my gosh. Well, I so appreciate your candidness and honesty. And I feel like you are on kind of the same journey as me with this podcast, where it’s like we’re learning as we go and it’s…

Keith Boswell (28:48):

Yeah. I’m literally the audience’s Guinea pig in action.

Lindsay Guentzel (28:52):

Yes. I love it. I love it. You’ll have to work out a deal with Cathy over there to get some compensation early. What’s the going rate for sharing your live and in-person medication journey? So one thing I do want to address is, and we said this so many times in the episodes, that what’s working right now is great. And it’s so great when it’s working, but it’s super important to keep in mind that that does change. And a lot of that has to do with ADHD and how it ebbs and flows in our lives and different seasons and what we’re going through.

Lindsay Guentzel (29:26):

And I would just like to point out, I started off in January of 2021 taking Vyvance and it worked great for me. And at the time I was unemployed because of the pandemic, so I was spending a lot of time at home alone during the day. My boyfriend would come home at night and I would have stimulation that way or if I was going out in public in any sort of capacity, I would get that little stimulation. But for the most part, I was very much alone. And so the dose I was on was great. But then in April I started back up at a very busy job. I went back into radio. I started at Minnesota Public Radio in a on-call producer role, but it was like 40 hours a week.

Lindsay Guentzel (30:06):

And the stimulation was so much, it was exhausting in a great way. I was back at work after so many months of staying at home and it was this very news-heavy time in the Twin City. So it was go, go, go, go, go. And I would work in the office from 8:00 to 3:30 or 4:00, and then I could go home and finish work. And it was that drive home where all of that brain fog and exhaustion came back. And so I did go back and have a conversation with my primary care provider, explained what was happening. And they said, “Yeah, I mean, that makes complete and total sense. You’re overstimulated. Now your brain is working too hard during the day. There’s too much going on.”

Lindsay Guentzel (30:49):

And once you know how your brain works, I mean, it made complete and total sense. It’s like, “Yes, of course. Of course I’m exhausted again during the day, because I’ve worn off all of the things that were helping me.” So I did increase my dosage. It did help tremendously. There are days where I feel like it’s a little too much, where I’m not as stimulated, but I love the word you used, compelled, because I feel like that is a perfect describer for how I feel.

Lindsay Guentzel (31:16):

Some days I never thought I would be a morning person, ever. I don’t want anyone to take this away that, oh, I’m relying on medication to be a morning person. That’s not it. But it feels like when I wake up in the morning, I’m excited about what’s ahead because I know the possibilities. Because I know that I’m not going to be foggy or agitated, or less irritable. I won’t say that I’m completely not irritable.

Keith Boswell (31:43):

Pre-medication, I always felt morning was my best time. But I still, between 6:15 and 9:30, I feel like I’m warming up. Ten o’clock is like my prime. Well now, I’m right there from the start. I think in my head, I thought I won’t be able to slow down. You know, I go back to the thing Dr. Schroeder always talks about with the sticky breaks. And it’s like this week it really felt relevant. I was like, “Oh, it’s not that I’m going to be more wound up.” It’s that I just felt like, “Okay, now I can tackle that. I’m not going to sit on it.” And that was just a totally different feeling for me. And it was exciting. It’s not like, “Oh, I got to get up and take my medicine.” It was more like, “Oh, no problem.” That was definitely a change for me. A very positive change.

Lindsay Guentzel (32:37):

Yeah. I don’t know if I shared this, but one of the opportunities I agreed to at my temporary on-call job at public radio, was directing over that 4th of July week, that long holiday week, which was like July 5th through the 8th, which meant a 4:00 AM start time. And I will say the only way I was able to, not only function at that time of day, but actually execute my responsibilities, was because of the routine I’ve been able to develop. Having this diagnosis and being properly medicated and knowing how my body works.

Lindsay Guentzel (33:14):

Got in there on Tuesday, it went great. Got in there on Wednesday, it went great. Got in there on Thursday, and Boris Johnson was resigning and we’re dealing with the time change. And then on Friday, the former prime minister of Japan had been assassinated. And so it was just so interesting to see myself in this role of being able to work competently and know what I was able to do and not get stressed out and execute things. And it really felt like this massive turnaround from the person I was even just three years ago.

Keith Boswell (33:51):

That’s amazing.

Lindsay Guentzel (33:52):

There were a lot of naps. I will say. There were so many naps. But there has to be when you’re working…

Keith Boswell (33:59):

Hey, naps, naps are a wonderful thing.

Lindsay Guentzel (34:03):

Oh man, I would love to hear from people who do shift work and how you set up your schedule, because routine is so crucial for the ADHD brain. And when you are moving around in just so many different spaces and times, I mean would love to hear that. But Bos, I’m so glad that week one has gone. Well, I can’t wait to get updates. I am really excited to hear what you find out when you go back to ask some questions. Thank you so much, as always, for your candidness. And I do think we have a webinar coming up the first week of August. So August 3rd is a Wednesday and we are going to do a webinar on the podcast.

Keith Boswell (34:45):

We are. I’m very excited. We’re going to pull back the curtains, let people get to know you and answer any questions and yeah, it’s going to be great.

Lindsay Guentzel (34:57):

Awesome. Well, I will obviously speak to you before then, but in the meantime, take care of yourself and yeah, I’m very excited for you and very excited to hear how it continues going forward.

Keith Boswell (35:10):

Thanks Lindsay.

Lindsay Guentzel (35:18):

Refocus with is a collaboration between me, Lindsay Guentzel and ADHD Online, a telemedicine healthcare leader, offering affordable and accessible ADHD assessments, medication management, and teletherapy. You can find out more by visiting ADHDonline.com. The show’s music was created by Luis Ingles, a songwriter and composer based out of Perth, Australia, who was diagnosed with ADHD in 2020, at the age of 39. A big thanks to Dr. Raafia Muhammad and Keith Boswell for joining me again this week. Remember to subscribe, rate, and review wherever you’re listening now and join us next week for another episode of Refocused with Lindsay Guentzel.

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