Chapter 1: What is discussed at the start of this section?
Welcome, welcome, welcome to Armchair Expert, Experts on Expert. I'm Dan Shepard and I'm joined by Monica Maus. Hi. Today we have Sasha Hamdani on. A long time coming. We've been talking about ADHD ad nauseum. I think we've even maybe lost listeners over it. But we finally have brought in an expert to either correct, confirm, who knows? Just explore this topic that we are obsessed with.
That's the fun thing about this show. We get to talk about something that we know very little about and then get real answers.
It is awesome. Sasha is an MD. She's a board-certified psychiatrist specializing in ADHD, RSD, and emotional regulation. Her books include Self Care for People with ADHD and an upcoming book that comes out in October. Look forward to when people start serving pumpkin spice lattes and dressing in Halloween costumes. PSL. Too Sensitive, Rejection, Resilience, and the Science of Feeling Deeply.
Boy, I love this. This is a great episode.
Yeah.
Please enjoy Sasha Hamdani. This episode of Armchair Expert is presented by Apple TV, the new U.S. home of Formula One. Starting March 7th, you can watch complete all-access live coverage of every Grand Prix, including practice, qualifying, and sprints all in one place. Watch every race live only on Apple TV.
He's an armchair expert.
I'm nervous to be too optimistic, but we had a microbiome expert on who has a probiotic that actually is real.
Okay.
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Chapter 2: What are Sasha Hamdani's qualifications and background?
Did it fix my leaky gut in Miss Oliver?
That fast? Maybe. I mean, it's also, like, maybe that with that exclusionary diet?
Yes.
Because I've been gluten-free for five years because of this.
You have psoriatic arthritis? Yeah. You do. Don't you think it's the sexiest autoimmune?
Oh, it's so good. Like, I'm walking around, I'm like, I can feel like it's cold outside. My husband's like, oh, no.
How long have you had it? Or been diagnosed with it?
So I was diagnosed with psoriasis in fifth grade. Oh, wow. Early. Long time. But it didn't affect my joints until I got out of medical school. And I was like, what is this? Why am I elderly? I did my residency in Phoenix and it was warm and nice and I didn't really notice things. And then I moved back to Kansas City where it was cold. I was like, something is wrong with me. It was horrific.
And then I was like, okay, well, let me just up Pilates or up something else that's going to help me.
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Chapter 3: How did Sasha's classroom insurrection lead to her ADHD diagnosis?
What? Maybe it's after your time.
You've been gone for a while. I've been gone for a while. I've been gone for like 18 years. I've moved out. So it's changed a lot. But my mom still lives there. So we're... And I was able to like come to the podcast and then... We had a sleepover last night. That's what I was hoping. I was hoping you got to go to Santa Barbara. And there's a huge ice storm in Kansas City.
My flight has already been canceled. Oh, no. So I'm like, okay, I guess I'll have to go be in Montecito for a couple of days.
Oh, my God. Well, go to Godmother's. It's very, very cute.
Wait, how do I not? Where is it? It's on a really cute street.
There's only that one main street.
Maybe a main street. A parallel to the train tracks.
There's State Street. State Street, right?
It's not there. It's on Lily Avenue. Lily.
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Chapter 4: What challenges does Sasha face with emotional regulation and ADHD?
Yeah. They're not really... Engaged. Yes. And humanity or no concept of work or motivation. So like some people in my high school currently right now, they have the same jobs that they had in high school, but they're just working until their parent dies and then they can move upstairs.
Yeah. Yeah.
I'm delighted that we have the same observation because I got there and I started meeting. I remember I met this girl at a coffee shop and she was shooting math and she was also very interesting and pretty. And I went to her house and it was this very nice house in Montecito and there were other children of rich kids that were just completely neglected.
There's like this whole cadre of rich neglected kids there that I thought was so freaky and weird.
It's weird.
I'm so curious how old you are.
I'm 39.
I can cut it out. Okay, 39.
We're very close in age.
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Chapter 5: What insights does Sasha provide about self-diagnosis and ADHD?
Yeah, you don't know. What their dysfunction is. I don't know. So I've tried to peel that back and figure out and look at why is this bothering me so much? But using self-diagnosis as a tool to get steps to get a formal diagnosis or get more access to knowledge about things and research about things so you can learn about your internal environment.
I think that there is a huge space for lived experience and talking about that.
Yeah, your fear is someone will be like, I am ADHD. I have time blindness. Don't ever expect me to be on time.
Yeah, and that happens. And it's like, guys, I don't want to be on time either.
But I think it should be more like, I have ADHD. Yeah, I think I relate to this time blindness thing. What are the three best tools? Yes. Because I know I do have to be on time places.
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Chapter 6: How do stimulants affect individuals with ADHD?
We all have stuff and we have to figure out how to live in this world. You know, we're not islands.
That's why I'm going to just quickly say neurotypical is bullshit as well. It's the same reason that ESM is fucked up because it has some premise of normal, which simply doesn't exist. We eat people who don't have something going on.
There's zero people.
We're all variable.
And I think the neurodivergent terminology, it was like a psychological term that came out in the 90s. And it was really this umbrella term to talk about autism and ADHD and all of these other things. And the neurotypical was just kind of like a byproduct. What's the opposite of this? Yeah, DSM has problems.
Yeah, yeah, yeah. How do stimulants work? Why is that an effective medication?
This is a weird area of medicine because it's not this cut and dried mechanism. So basically where a majority of that deficit happens is that frontal lobe. So directly underneath your forehead, that's where all that executive function judgment processing happens.
So what a stimulant does from just like a very rudimentary perspective, if your brain has a million different things going on a million different times because of that underlying dopamine and norepinephrine dysregulation, so everything is just floating by at an incredible space, you can take a stimulant, a Ritalin derivative, something in that family,
And it actually works a little bit counterintuitively because it slows things down. And really, it's not that it's slowing things down. It just speeds everything up to match what's going on with your brain.
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Chapter 7: What are the differences between stimulant and non-stimulant treatments for ADHD?
It like synchronizes it almost. Yeah, it is very counterintuitive. I very much feel like I would benefit, but I also know I can't be on that.
Oh my God, there's so many better things.
Than being on a stimulant.
So here's the deal. If you're treating ADHD, you could do it behaviorally or you could do it medicinally, right? And with medicine for ADHD, there are stimulants and there are non-stimulants. And so the stimulants are what everyone thinks of. And they're our gold standard right now because they work well, they work reliably.
And you could tell pretty quickly, is this going to work or is this not going to work? Those are things like Adderall derivatives, Ritalin derivatives. Those are all part of that class. But for a lot of people with ADHD, stimulants, even the long acting ones, they'll give you like a six to eight hour coverage. But ADHD exists outside of that six to eight hours.
So then it's like, what are we doing for the rest of that? So non-stimulants, a lot of them give you a 24 hour coverage. For the great majority, they either fall under the category of an antidepressant or a blood pressure medication or some other class. And you are getting additional benefits. So for those people who have ADHD, who are also anxious.
Here's a medication that's going to help with ADHD. Well, it is a blood pressure medication. So there's long acting formulations of blood pressure medications that can help with anxiety and ADHD. Or you're doing an antidepressant, which is going to help with depression and anxiety and ADHD. Or you can do something long acting that people take for shift work disorder. So it really depends.
on what you need and what you're looking for and what else is happening at the same time. But for a lot of people, when they're coming to the doctor, they're assuming, if I have ADHD, I need to be on a stimulant. I need to be on Vyvanse. I need to be on Adderall. I need to be on Ritalin. And 90% of the time, that's not the direction we're starting at.
Because I always tell people, we need to build skills. So we need to work on that. If that's not possible because your ADHD is dysregulating everything, we need to give a medication that's going to give 24-hour coverage as much as possible so that you have a chance to kind of see and build. There's some people who just that diagnosis immediately lifts them.
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Chapter 8: How does Sasha's new book address emotional experiences related to ADHD?
It's for an ADHD brain to read this book.
Just little page-long blips. I can tell you my favorite one in that book, and it's do a headstand. That's not the one that's going to work the best or anything. It's just the weirdest one. But there is something about that change. One, you're doing something weird. How I figured this out is when I was in medical school, I was studying for organic chemistry. It was just so boring to me.
I was like, I can't do this anymore. would be like, just do something to change your position or just do something to distract yourself a little bit. And it was that inversion of a headstand. That's hilarious. Not necessarily the most impactful, but that's one if you're bored and in the middle of stuff. Another one I think that is important.
So the book is broken up into separate areas and it breaks it down in terms of emotional self-care, physical self-care, professional self-care, all of those other things. I think if I were to pick from those, because some of that book is also things like giving yourself permission to grieve if you haven't gotten a diagnosis, because a lot of these people are coming to a diagnosis late in life.
I'm done with the career portion of my life. I'm done with the child-rearing portion. I missed on so much, and now I'm having to grieve this diagnosis.
I bet there's a feeling of, oh, man, I could have blank, which is heartbreaking.
It's hard, but you know what I tell patients who are in that position is that this whole time you have been building skills. You have been building structures. You have had this brain this whole time. And so now it's what you do with it. And it's what you make of it with this new opportunity. And so you wouldn't have built those skills that you needed if things were different, potentially.
Another very, very important one is just making time for physical activity. I feel like such a hypocrite because I... Hate exercise. I think it sucks. It's so boring and it's so hard for me to motivate myself, but it truly does make my brain work better.
Let's talk about the forthcoming book. Yeah. That will be out. That's called... Too Sensitive. Too Sensitive. Rejection, Resilience, and the Science of Feeling Deeply.
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