Attention deficit/hyperactivity disorder (ADHD) is one of the most common diagnoses in America. The most effective treatment plans are holistic in nature. Pills can work, but probably won’t work long-term. Integrative psychiatry seeks to fill in the gaps and suggests that medication be a piece of the puzzle, not a singular solution.
Key Takeaways:
ADHD is a theorized to be from unregulated and/or deficient dopamine and norepinephrine in key areas of the brain that can lead to impulsivity, difficulty focusing or concentrating, hyperactivity, procrastination, and more.
Medications for ADHD can work and can be very helpful - but any and all treatment plans should include behavioral interventions too.
Using a holistic approach that includes therapy, supplementation, and coaching sets an individual up for long term success with ADHD.
What is ADHD?
I bet you’ve heard of ADHD. It may be the “coolest” or most acceptable psychiatric diagnosis to have because it often comes with a coveted prescription for stimulants. From a biological perspective ADHD is thought to be primarily the result of unregulated or deficient dopamine and norepinephrine in the prefrontal cortex. Ok, I’ll back up! The prefrontal cortex is the area of the brain responsible for all our thinking, behavioral regulation, and analytical functioning Dopamine is a chemical found in the brain that plays a role in focus, concentration, decision making, and even mood, and if “unregulated” can lead to impulsivity, distraction, and poor judgment. The presentation of symptoms can include procrastination, hyperactivity, impulsivity, inattentiveness, and even depression. We all know someone from school or work who clearly has ADHD. Allow me to admit, it’s something I’ve struggled with since I was five!
Medications for ADHD
The medications used for ADHD can be very effective, especially stimulants. Most people who take stimulants have a positive response – even those who do not necessarily have a diagnosis of ADHD. (Think college kids using a friend’s Adderall while cramming for a test, or worse, to stay up late for a party). Medications like Adderall, Vyvanse, and Concerta, work by stimulating the release of dopamine available for use in the brain. Nonstimulants like Strattera or Qelbree, also work on dopamine, but a little differently in that they reduce the re-uptake of dopamine (and norepinephrine) instead of stimulating the release. Also, nonstimulants can take weeks to work while stimulants work with the first dose. The result of medications for ADHD is increased focus and concentration, improved judgement, and reduced impulsivity.
Caution with medications for ADHD
There’s no such thing as a safe medication, just a less dangerous one. Stimulants can be quite dangerous, hence why they are scheduled drugs. Their risk of dependence is high. They also tend to lose effectiveness over time. Their side effects include weight loss, loss of appetite, GI upset, headaches, increased blood pressure, anxiety, and even substance abuse. Nonstimulants don’t have quite as many side effects, but also tend to be less tolerated given they are often less effective.
Hold on, you probably think I hate ADHD medications! I do not! I do think they have a place, however they should not be the Hail Mary that too many prescribers have made them out to be. Remember as an integrative provider, I think of medications as a piece of the puzzle, not the one-stop-shop.
The positive side of ADHD
Yes, ADHD can be problematic and troubling, but there is a positive side of ADHD, too. Some of the most creative and transformative people throughout history have undoubtedly suffered (or persevered) through ADHD. Bill Gates, Richard Branson, and Walt Disney all were able to channel their ADHD into doing great things. Individuals with ADHD often have intense passion, take risks where others won’t, and see things from a unique perspective. Learning to harness this unique characteristic should be more about creating space for individuals to flourish, rather than fitting them into a box.
My experience with ADHD
Yes! The developing brain already makes decision making and focusing more challenging. Add in ADHD and kids can really, really struggle. Let me share a little bit about myself. As a child I was, let’s say… a handful! More than a few of my teachers until high school actually cried from how difficult I was. Some might say I was a “bad” kid. I beg to differ! I was easily distracted and quick to finish my assignments, so the trouble came easily. Medication made me feel awful and I all but refused to cooperate taking it – so that was short lived.
I craved stimulation and to be challenged. My first grade teacher recognized this and broke up long assignments for me, gave me extra responsibilities, and channeled my ADHD in a meaningful direction. Now, I certainly still had my issues after first grade – second grade was a firestorm! I now recognize how privileged my experience was in first grade.
My teens were a little better, but still difficult. Impulsivity lead to bad decisions. But by high school I had learned how to “hack” my diagnosis by piling on course work, extracurricular activities, and sports. Again, I realize I was highly privileged to be afforded this outcome. Throughout college, and to this day, I have continued to hack my ADHD.
I found out what worked for me: high variety of tasks, routines founded in exercise and nutrition, and the view that ADHD is a gift to me and is fundamental to who I am. I’ve learned to lean into ADHD instead of work against it. This approach isn’t for everyone, and as a provider I do not pretend that my experience translates to every patient. But through this I understand that each person is highly unique – so their treatment plans should be too!
Integrative psychiatry for ADHD: A holistic approach
Now for the fun stuff! We’ve talked about how integrative psychiatry can be used for depression, but I find ADHD to be even more exciting as an integrative provider. I have mentioned the training wheel analogy but it’s worth mentioning again here. Medication in this instance should be like training wheels – something we use as a support but with the intention of learning to ride the bike without them down the road.
When used appropriately, medication for ADHD should be used as a support in conjunction with other interventions. Psychotherapy and coaching are indispensable tools for the treatment for
ADHD and should not be overlooked. Yes therapy takes time, but without it, individuals tend to struggle even with medication. Coaching to develop concrete routines helps individuals with ADHD “hack” their diagnosis by working with, instead of against, their functioning abilities.
Supplementation and nutrition also show serious promise in helping manage ADHD. What we eat impacts our mental health! In ADHD, individuals should focus on protein rich diets in order to ensure the proper building blocks for key chemicals in the brain. Heavily processed carbs and refined sugars can be the cause all kinds of problems in individuals with ADHD by creating spikes in insulin that further exacerbate focus, concentration, and decision making. Vitamins like magnesium and vitamin d also play a role – so providers should be doing labs to check! High doses of fish oil are thought to help with cognitive functioning and might make sense as part of a treatment plan.
Exercise – an absolutely fundamental part of any treatment plan for ADHD. In fact, a fine-tuned exercise plan can be effective for any mental disorder. Exercise increases key neurotransmitters, including dopamine, which can increase focus, concentration, mood, and cognitive functioning. An added bonus for someone with hyperactive presentation is the use of all that pent up energy through exercise. Other treatments include mindfulness and meditation. Learning to calm the mind and be present can significantly improve one’s ability to stay focused. There’s really no limit to what an integrative and holistic psychiatry treatment plan can include.
Conclusion: Integrative psychiatry for ADHD
ADHD is thought to be the result of unregulated dopamine and norepinephrine, among other things, in the prefrontal cortex that can result in poor executive functioning. Medications can be effective for ADHD, but should be used with caution and not as the only intervention. ADHD is best treated with a well-rounded, holistic approach that includes medication, therapy, and nutrition and exercise planning.
If you have questions about integrative psychiatry, are interested in seeking care, or are interested in learning about how to practice integrative psychiatry, please reach out to me via email at ryan@proactivepsychiatry.com. Feel free to repost this blog, just give me a backlink!