Stimulants and Non-Stimulants, Common Side Effects, and Squashing Rumors: An Introduction to ADHD Medication with Dr. Carolyn Lentzsch-Parcells #145
Can I get addicted to ADHD medication?
Is Adderall the same as meth?
With questions like these circling within communities and around the internet, it's no wonder so many ADHDers are confused, and sometimes terrified to take ADHD medication -- or to tell their family and friends they're on it.
It's "Medication May" on the Motherhood in ADHD podcast, and the goal of this episode series is to break stigma, bust myths and equip you with as much knowledge as possible about ADHD medication.
So you can feel confident in making the choice that's right for you.
On this episode, we continue our conversation with Board-Certified Pediatrician and ADHD specialist Dr. Carolyn Parcells. She gives us an overview of ADHD medication, answers commonly-asked questions, and busts several pervasive myths.
You'll hear about:
- The basics of ADHD medication -- the different types and how they work in the brain
- The differences between stimulant and non-stimulant ADHD medication
- ADHD medication and kids -- the types of medication for different age groups, risks, and benefits
- The complete low-down on ADHD medication and risk of addiction
Answers to questions like:
- Why is my medication less effective before and during my period?
- Can I double my dose if it's not working?
- Are there certain people who should avoid stimulants?
- Should I take a break from my medication so I don't develop a tolerance?
- And more!
Thank you, Dr. Parcells for your sharing your wealth of knowledge as an ADHD specialist!
To learn more about Dr. Parcells, visit her website at: www.GTW-health.com
To connect with Dr. Parcells, email her at: dr.carolyn.parcells@gmail.com
Learn more about the International Conference on ADHD here: chadd.org
This material is not intended as medical advice. Please consult your doctor or a trained medical professional to find the treatment plan that best fits your personal situation.
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Dr. Carolyn Llentzsch-Parcells 00:00
They basically showed that the kids who are diagnosed with ADHD and treated younger had a very low rate of drug use and abuse. The kids who are diagnosed with ADHD but not treated had the same increased rate of drug use and abuse as the kids who weren't diagnosed.
Patricia Sung 00:19
Are you overwhelmed by motherhood and barely keeping your head above water? Are you confused and frustrated by how all the other moms make it look so easy. You can't figure out how to manage the chaos in your mind, your home or your family? I get your mama, parenting with ADHD is hard. Here is your permission slip to let go of the Pinterest worthy visions of organization and structure fit for everyone else. Let's do life like our brains do life creatively, lovingly, and with all our might. When we embrace who we are and how our brains work, we can figure out how to live our lives successfully, and in turn, lead our families well, at the end of the day, we just want to be good moms. but spoiler alert, you are already a great mom. ADHD does not mean you're doomed to be a hot mess mama, you can rewrite your story from shame spiral success story. And I'll be right here beside you to cheer you on. Welcome to motherhood in ADHD.
Patricia Sung 01:25
Hey there successful mama. It's your friend Patricia Sung? Well, it is medicine may and probably a little bit of June. In this month, I'm dedicating the episodes of the podcast to sharing quality information, debunking myths and helping you figure out what you want to do about taking ADHD medication. Now in three years, I have avoided this topic because I was scared. As soon as you start talking about medicine, all the haters show up and start trolling. So I want to be clear, this material is not intended to be medical advice. This series, the entire goal is not to tell you what to do, or you should do this, you should do that. I can't decide that for you. I don't know your medical history or your values or your coexisting medical conditions. And even if I did, not a doctor, I'm a girl with a lot of personal experience who does a mountain of research. And I want you to do the same. Investigate research, don't take my word for it. Find a trained medical professional who has experience with ADHD to help you consult with your doctor and find the treatment plan that makes the best sense to fit your situation. Because you are the only one who can decide what's best for you. When we have ADHD, we have spent a lot of time in our lives being told that our perception of reality is wrong. And that leads to a lot of self doubt and lack of trust in our own decisions that I want to change that my goal is to arm you with as much information and knowledge and confidence that I can. I want you to decide to take or not take medicine because you are fully comfortable and competent in your decision. So many people with ADHD are not getting the best treatment out there because of lack of information, misleading information, or quite frankly, straight up BS on the internet. And by word of mouth. On top of that there is so much shame and embarrassment about having ADHD and treating ADHD and that includes taking medicine for your mental health.
Patricia Sung 03:31
So when you show up at your doctor's office to ask about what your medicine options are, I want you to know what kinds of questions to ask. When you're talking to a provider that maybe doesn't know as much as you had hoped that you can recognize that lack of experience or knowledge and know that you would be better served to seek out a second opinion. I want you to feel empowered when you talk to your doctor to set up your treatment plan. So with that being said, let's dive into today's episode about ADHD medication. Last week we met Dr. Carolyn Llentzsch-Parcells, I highly recommend you go back and listen to the first part of the episode before you listen to this one because it is good stuff mama, let me formally introduce her. Dr. Parcells is a board certified pediatrician and she works with girls to women and also young men, specifically working with them with their ADHD. She also works with learning issues mental and behavioral health. She's owned her own practice for the last five years and is really involved in Chad, which if you're not familiar is that children and adults with attention deficit hyperactivity disorder. It's a really great nonprofit helping families navigate what to do when you're dealing with ADHD. Dr. Parcells is a mom with ADHD who is a doctor who specializes in ADHD and is also a parent parenting ADHD. So obviously don't have to tell you that she's got a little bit of experience under her belt in these two epic SOS, we are talking about her diagnosis story along with the shame and the doubt and the fear that we have in taking ADHD medication and getting treatment for ADHD and getting treatment for our mental health.
Patricia Sung 05:14
We're digging into the types of medication, how they work, how do we choose the right one for us wading through the muck and mire of the concerns we've got about addiction and side effects and hormones and all the layers that go into choosing and finding the right treatment for you. Okay, so let's dig in to some facts here. Again, like I'm going to ask for the shortest possible for ADHD brains. Understanding the different types of medicine like stem in versus yes stimulant, how do they work in like the simplest version possible, hopefully that the mom could then understand and also be able to explain to her kid is what I'm hoping for.
Dr. Carolyn Llentzsch-Parcells 05:54
Okay, so let's start with the stimulants because the stimulant medications are still the gold standard first line medications for ADHD can. And first of all, just to kind of set the stage here as far as like what we recommend, like the American Academy of Pediatrics recommends for ages six and up medication is recommended as first line treatment for ADHD. In addition to classroom accommodations, for the younger kids, we recommend something called Parent behavioral training. And for the older kids that coaching, although I think parent training is also really helpful there to the only age group that we don't recommend medication as first line is ages four to six. And the reason for that is because those kiddos have a little bit higher risk for having side effects with those medications. So in that age group, it's the parent training and classroom interventions first, but that does not mean that if that is not sufficient, we cannot use stimulant medication. But in that situation, we very clearly recommend what's called methylphenidate. And I'm going to circle back around to that in a minute to explain what that is. Okay. So that's just kind of to set that stage. So with the stimulant medications.
Patricia Sung 06:59
I'm sorry, I'm going to interrupt because one of the myths I got when I was asking questions from listeners, yeah, is that medicine is only for children. No.
Dr. Carolyn Llentzsch-Parcells 07:08
I wish the insurance companies would understand that. Oh, please. Medicine is not just for kids. Get one of the main ways I fixed us getting to school on time, is changing my medicine. Yes, thank you very much. So the stimulant medications are first line medications for ADHD stimulant medications. In general, the way they work or the way we understand that they work is by increasing available dopamine in the brain. Dopamine is one of our neurotransmitters are one of the chemicals that our brain cells make that allows the brain cells to communicate with each other, right? So basically helps our brains work as well as possible. We still don't completely understand what's going on with dopamine in the brain with ADHD.
Patricia Sung 07:51
we can stick a camera in your brain to find out what's happening because you'd be generally frowned upon. If they used to do that back in the day. They used to stick things in people's brains. It didn't go out, do you got anyone. So that's what we don't know. 100%. We're exactly educated guesses here.
Dr. Carolyn Llentzsch-Parcells 08:05
But we do know from the resource that we have. We do know that dopamine in particular, as well as norepinephrine seem to play a pretty important roles in ADHD. And these medications help increase the available dopamine in our brains with the idea that that then helps our brains to function better. So within the stimulant medications, the way I explained it is there's two families, there's the methylphenidate and there's the amphetamines. The methylphenidate are things that you might recognize like Ritalin, Concerta, de Tirana, jornais focalin is a little bit different than I'll explain that in a second. And then there's some newer ones too, in that class, they're always coming out with new stuff. Right. So the methylphenidate medications increase dopamine in the brain by blocking it doesn't make the brain makes more dopamine, it keeps the dopamine from getting broken down and taken out of the system as quickly. So it allows the dopamine that you do have to be used more and more efficiently, kind of the way I like to explain it. And what's really interesting about the methylphenidate medications is that it's all the same molecule, every single one of those other than focalin and I'll explain that in a second is all the same molecule. The only difference is how it's delivered. And the way it's delivered can make a huge difference in both how effective it is but also the side effects that somebody experiences. So even though Concerta which tends to last about 10 to 12 hours, and most people is the same molecule as say metadata CD, which lasts about six to eight hours. And most people it's the same molecule, but somebody might have more side effects with the conservative than they do with the metadata or it might be more effective as the conservative than it is with the metadata.
Dr. Carolyn Llentzsch-Parcells 09:46
So I point that out because I think a lot of times folks have a negative experience with one medication or feel like one medication doesn't work and then they give up on stimulants altogether or even the stimulants within that class and encourage you not to do that. The focalin is a little bit different because that's what we call Dex methylphenidate. And basically what that means is that when you have these medications and a mixture together, even though it's technically the same molecule, they're mirror images of each other, you have kind of the right handed molecule and the left handed molecule, and the dex is the right handed molecule, the duck's methylphenidate, so they took the other one out and just left the dex methylphenidate. And for some people that is more effective or has less side effects for some people has more side effects or is less effective. So it's just one other option. The other thing is is that in both the amphetamines and the methylphenidate, I mentioned kind of like on average, how long some of these medicines last. But for all of these medicines across the board, people can be either fast metabolizers, slow metabolizers or average metabolizers. And that has nothing to do with how you metabolize or processed food. It's specifically how your liver processes this specific type of medication. And so when we talk about how long these medicines last, we're talking about in an average metabolizer. If you were a slow metabolizer, it could last much longer. So like for example, I'm actually a slow metabolizer Concerta kept me up at night because it lasted too long for me, if you are a fast metabolizer, you're going to process the medicine quicker than most. So in that situation, a medicine that's supposed to last 10 to 12 hours might only last six hours for you or even less. So that's one of the things that can get really kind of nuanced, if you shall when we're trying to figure out the right medication, right dosing for folks. Okay, so that's the methylphenidate, the amphetamines, those increase available dopamine in the brain by encouraging the neurons to release more dopamine. So it's a different mechanism of action is what we call it. So that's why for some people, one class will work better than the other because the ultimate goal is the same.
Dr. Carolyn Llentzsch-Parcells 11:48
They function a little bit differently. Right. And the amphetamine class is much like the methylphenidate class, you have medications like Adderall, Vyvanse, a vecchio at Zen s. Again, there's some newer ones, but Adderall and Vyvanse are kind of the two that most people are aware of those medications also vary largely by the delivery system and how and when they're delivered, they vary and how long they last much like the methylphenidate and you can also have fast metabolizers and slow metabolizers with that class as you can the methylphenidate class. One of the differences though, is there is more variation in mention that kind of Dex molecule, the right handed molecule versus the left handed molecule, there's a little bit more variation that you can see in that class. So for example, Vyvanse is all Dex amphetamine, Adderall is about 75% Dex amphetamine and vecchio is about 50%, Dex amphetamine. So there's a little bit more variation there. But again, you have formulations that last a variety of hours. And actually, in each class, you also have what we call long acting medications, as well as immediate release, or short acting medications that are only about three to four hours for a lot of people. So that's kind of how I explain the amphetamines. The other thing I will mention about these is from a dosage standpoint, this is something that again, I think people don't quite understand, because it is different than a lot of other medicines. dosing is not based on your age, your size, the severity of your ADHD, it is all about how you and your body and your brain respond to these medicines. So regardless of age, including adults, we always start at the lowest or one of the lowest dosages, and we titrate or work our way up until we reach the most effective dose with the least or most tolerable side effects. And that's how we do it. I've got little tiny things that are on doses that you're like really, okay, cool, but you're tolerating it well. And then I've got big six foot two dudes on tiny little whip doses. And I'm going really well you need Okay, cool, if it works. So I do think that's one of things that is kind of interesting and different about the dosing that that a lot of times folks don't understand. The other thing I want to point out about the difference between the two medication classes, because I think this is really important as well.
Dr. Dr. Carolyn Llentzsch-Parcells 14:01
Oftentimes what you'll see, as far as which class we pick, first, I mentioned the methylphenidate are recommended for the youngest kids, it's actually not just the four to six year olds that that's recommended for for the most part, we recommend methylphenidate first for pretty much any of our school aged kids. And I'll be perfectly honest, in my personal experience doing this with younger kids, teenagers, young adults, unless there is a significant family history that makes me go oh, I mean class is the class that works for your family. Got it. Let's start there. I typically start with a methylphenidate because all of these medicines have the potential for the same set of side effects. But I find at least in my population, that there's a slightly lower risk for those side effects with the methylphenidate than with the amphetamines do carry a slightly higher risk of decreased appetite, weight loss, irritability, anxiety and agitation and the younger the kiddo the more likely we are to see that with that said, does that mean that I don't have nine year old holds on amphetamines that are rocking it out and did not tolerate a methylphenidate. Yeah, absolutely I do. Do I have kids with anxiety, you know, weight gain challenges that are rockin it out on Vyvanse? Yeah, I do. So all of this is to say you've got to figure out what works best for you or for your kid. But that's just kind of the basic structure of how we try to figure out where to start at least. And the good news is we have a bunch of options. The bad news is you have a bunch of options.
Dr. Carolyn Llentzsch-Parcells 15:26
Right. And so it can be that's the other thing I always tell my patients is look, we might hit the nail on the head right out of the gate. And that would be awesome. But know that it can take time to find the right medicine, it can take time trying different medicines at different doses, we may have to add another medicine, it's not always an easy process, it was not an easy process. For me, it's still not an easy process for me, but it is worth it for a lot of folks, if we stick with it and can find the right thing. So that's how I describe the stimulants. Then there's the non stimulants, the non stimulants, we don't have as many choices, there's the main non stimulants that we really have been using. And using more and more, the more we learn about them are the what we call alpha adrenergic agonists is a really fancy word for old school blood pressure medicines. But what they do, actually kind of jokingly slash not so jokingly refer to these as the literal chill pill. Because what they do is they decrease the output of the sympathetic nervous system is a fancy way of saying they tamp down our fight or flight response. Not in a bad way, like not to the point where like, you're not gonna like, you know, no one, you're in danger here. Right? Right. But they literally kind of just POM that overexcited sympathetic nervous system. It's interesting.
Dr. Carolyn Llentzsch-Parcells 16:41
So if you look at the data will say that we don't totally understand how they work in ADHD, which is true except for the fact that given what I just explained, right, here's what they do for folks with ADHD, or potentially, I should say, potentially do for folks with ADHD, not as great for the attention and focus not that they can't help some, but that's not their main efficacy. They help with impulsivity, irritability, agitation, emotional regulation, rejection sensitivity, sleep, seems like it makes sense to me. That's all I'm gonna say about that. And they're not anti anxiety medication. But I do find that for my patients who have ADHD and anxiety, sometimes it can be helpful, and it can be helpful in managing that anxiety or decreasing the intensity of the anxiety. So intuitive is the trade name. guanfacine is the generic of the main one that we use. The other one in that class is called clonidine, and then trade name is Cat Bay for the longer acting version, those two medicines also have short acting versions or immediate release versions, I should call them. And those we typically use will will sometimes use at night for sleep, because they cause a little bit more fatigue and dizziness are kind of the two main things we watch for with those. And with the immediate release versions that can be seen a little bit more. But that can come in handy if we're needing to help with sleep.
Dr. Carolyn Llentzsch-Parcells 17:53
The way I like to describe it is that it helps with the ADHD brain spin that we have at night, it kind of turns down the volume. It doesn't make the voices go quiet. But it turns down the volume and it makes them take their turns is how I like to describe that. So that's kind of one of the primary groups of non stimulant medications that we've really started to use again, more and more, and we're starting to use it more in adults. We used to use it primarily in kids again, because it was like the hyperactivity and impulsivity piece of things that we see more in kids than we do in adults. But we're starting to realize that there are adults that could really benefit from this as well. So we are starting to use it a little bit more. The other non stimulants out there. You know, Strattera is one that a lot of people have heard of, or atomoxetine is the generic A, to be perfectly honest, that one is one that we're not really using as much, because it's just both Data Wise. And clinically, we just don't see it to be as beneficial. And it actually carries a pretty significant side effects profile in and of itself. Now, of course, it's not to say that there aren't people for whom it works for and certainly if you're on it, and it's working, you know, if it ain't broke, don't fix it, right. It's just not one that we're using as a first line very much anymore.
Dr. Carolyn Llentzsch-Parcells 19:00
There is a new one out there called Calibri. And I can't even pronounce the generic, so I'm not going to. But that one's still pretty new out there. It has not yet been approved. For adults. They're hoping to get that approval in the next kind of month or so here. And both that and Strattera are what we call SNRIs, selective norepinephrine reuptake inhibitors. So those kind of address more of the norepinephrine side of things than the dopamine. And that one, I'll be honest, I can't speak to a whole whole lot. I mean, I've seen the data on it. And the company's data suggests that they think it's going to be effective for attention and focus, as well as hyperactivity and impulsivity and those kinds of symptoms. I haven't used it a whole lot, so it's hard for me to really pass judgment on it. I have seen a lot of issues with the side effects personally. And then there are several other things kind of down the line but Wellbutrin is one of the other ones I typically mentioned because it's an antidepressant that also kind of primarily affects dopamine. Among other neurotransmitters, again, it's not as effective necessarily as the stimulants, but it can be helpful for the ADHD symptoms. And it can be particularly helpful for somebody who also has depression along with their ADHD.
Patricia Sung 20:15
Okay, I have like 700 questions. I'm like, where do I start? So one of the myths I got in this process was there is only one ADHD medication that they could prescribe. And clearly by your list earlier, that is not true. So we've debunked that one. And a lot of moms asked, like, how do I know which one to pick? And thank you, you explain that so well of like, where to start. And we're, like, understanding the pros and cons do like they're all different. And again, one of the myths that I keep hearing is like, you should take this test, and it's going to tell you what medicine you should take.
Dr. Carolyn Llentzsch-Parcells 20:47
Yeah, that would be great. Love to have that that would make my job so much easier. Like, yes, please. Sadly, my magic eight ball is in the shop along with my wand. But I think what most people are referring to, though, is the pharmacogenetic testing that's out there. And it's not it's it's interesting, because like so many other things in medicine, you'll hear people that will tell you that it's complete bunk. And you'll hear people who completely swear by it, as with most things, I kind of take more of a middle of the road approach, it is not an end all be all, it is not a perfect system, it is not a magic bullet. What that testing basically does is it looks at various genetic markers that we're aware of that look at various receptors, enzymes, etc, that may affect the way that your body responds to or processes certain medications to determine if there is an increased risk, not a guarantee an increased risk for something causing side effects or not being as effective. And it can be helpful, in particular with the antidepressants in at least narrowing down in the sense that like, Okay, if certain medicines have enough markers to suggest that they are higher risk for causing side effects or being less effective, it might make sense to start with one of the other ones. And because the antidepressants take four to six weeks to take full effect at each dose and each medication. Sometimes that can be helpful in decreasing the amount of time it takes to find the right thing for you.
Dr. Carolyn Llentzsch-Parcells 22:20
Now, I do do this testing somewhat some in my clinic, but I always tell my patients, that it's not magic. And that, you know, sometimes we get these reports back. And it totally confirms what we already knew. Sometimes we get these reports back, and it has helpful information. Sometimes we get these reports back and the medicines that didn't work or cause side effects are in the like, okay zone, and the ones that are working are in the non okay zone, you know, because they can't, at least not yet. They can't take every single factor into account with the ADHD medications, I find that testing to be less helpful. Not that it can't be, especially if somebody has tried multiple medications, multiple doses of medications, and they're struggling to find the right thing, then yeah, it might be worthwhile. But a lot of the information that testing can give me because these medications work so quickly, and we can change them and titrate them so quickly. A lot of that information I'm going to get after just trialing a couple of meds pretty quickly, you know what I mean? So like, is the value really there for you? Right? And so that kind of cost benefit ratio, if you will. And I don't just mean cost in the financial sense, I mean, in the time and resources and stress and all the senses. So yes, there is some testing out there. But it's honestly, I think over the years it, hopefully it will get better. And we will be able to use it more. It's just not quite there yet. It'd be awesome if it was.
Patricia Sung 23:47
Is there anyone who should not take stimulants besides the age range that you've already mentioned.
Dr. Carolyn Llentzsch-Parcells 23:53
That's a great question. If anybody has an allergic reaction, like a significant severe allergic reaction, then that might preclude them from taking a stimulant, or at least a particular class of stimulant. The main thing that people kind of talk about, though, is heart conditions. And that by the way, though, that doesn't mean that people with heart conditions can't take stimulants. Okay. But certainly if there's a family history of abnormal heart rhythms of early cardiac events in young people, things like that, then at the very least, we want to do an EKG or a cardiology evaluation before we start medication to make sure we know what the risk factors are, and make sure that if we do decide to start a stimulant that we're doing so in a safe way, but with that said, throughout my career, I have had several kids with known arrhythmias or known congenital heart anomalies. By the way kids with congenital heart anomalies have a higher risk and rate of ADHD and learning disabilities. I have had those kids on stimulants, and they've done just fine. We watch them. We watch them close. And we tell them what to watch for and all of those things, but it doesn't necessarily preclude them, there are going to be some of those folks where we decide that, again, that cost benefit ratio, right, the risk is great enough that it's not worth the potential benefit. And so that's just something that you've got to kind of talk with your doctor about and team with. And those are also kids that I keep very close contact with their cardiologist and you know, we work as a team if we have to make adjustments and those kinds of things.
Patricia Sung 25:24
Mama, are you looking for some extra support? Could you use a few more like minded mamas in your circle? Here is your official invitation to join our Facebook group, the motherhood and ADHD community? Here, you can ask questions, share advice, but most importantly, know that you're not alone. Click on the link in the show notes or search on Facebook for motherhood in ADHD community. So come join our little corner of the internet with other mamas who know how your brain works and won't look at you crazy when you share what's floating around inside there. Instead, they'll say I get it. I've been there. And I know how that is. So come on. What are you waiting for? See in there. Again, that's the motherhood in ADHD community on Facebook. One of the questions I got was, if we don't feel like our doses high enough, can we take two extended release tabs at the same time? Is that a solution?
Dr. Carolyn Llentzsch-Parcells 26:19
Not without talking to your doctor first? Talking to your prescribing provider, it depends on the medication and the dosage you're already at. If you're taking 70 milligrams of Vyvanse do I want you to take 270 milligrams five answer's no, no I do not that is well above the recommended and studied dosing. So no, you don't ever want to double up your medication without speaking to your physician or your prescribing provider first. There are certain circumstances though like for example, if I start someone on Concerta, the dosing is 1827 3654 72 milligrams, I start somebody on 18 milligrams, that's not enough for them. I moved them up to 27 milligrams, that's still not enough form. Okay, great. Those eight teens, you have take two of those. Let's try the 36. But again, that's under my supervision and with my instruction in the right circumstance, 72 milligrams of Concerta is a recognized reasonable dosage. They don't make a 72 milligram. So we give them 230 Six's. So if your dosage is not enough, the real key there is talk to your provider, right and see what the options are.
Patricia Sung 27:26
Okay, next myth? Do we need to take a medication break? Like on weekends? Or for kids over like a summer holiday? Is that a thing we need to do? I do some background. And I think a lot of times when people are weighing that it's because they have a fear of being addicted to their medicine or growing tolerance. And so like I want to address both Do you need a break? And then also the root of why people are concerned about that?
Dr. Carolyn Llentzsch-Parcells 27:53
I think that's an excellent question. And it's one I get asked a lot. So do you need to take a break? That, again, is an individual question. And it's actually something that we have been discussing in the professional ADHD world, if you will, especially as of late, the kind of gold standard had advice has been? No, you want to take your medicine every single day because ADHD affects our lives every single day. It's not just about school, it's not just about work. It's about all the things right. So we typically do recommend taking medication every day. With that said, there are people, not everybody, but some people will find that their medication becomes less effective over time, or they build kind of quote unquote, tolerance is the word that people use. And for those people, it does appear that sometimes taking scheduled breaks from their medicine may help with that. The tricky part is is we're not totally sure exactly how long that should be is that one day a week on the weekend, every weekend is that the whole weekend, every weekend is that one week, every few months, that for example over a break. It may vary by person. And it's something that actually is kind of a topic of discussion these days. So there's that scenario.
Dr. Carolyn Llentzsch-Parcells 29:06
There's also the scenario of you know, I frequently have people ask me if they can take a break from their medicine, right? Or if they can take a break over the summer, they can take a break over the holidays, when they asked me that question. Instead of answering it I asked another question, which is why? Why do you want to take a break from your medicine? Because there's usually some sort of reason. Certainly, sometimes it can be the things that you mentioned that they're afraid that they're going to build tolerance, or they're afraid they're going to be addicted to their medicine. And I'm going to come back around to that one in just a minute. But a lot of times, especially with my teenagers, and it's really funny, I've already asked them if they're having any side effects, and they told me no. And then they say, Well, I don't like to take it on the weekends or holidays and I go okay, well, why not? Well, because I don't like the way it makes me feel. Ah, okay, let's discuss that more. Let's dig into that a little bit more. Right. Tell me what it is that doesn't feel good. And sometimes they'll tell me headaches or decreased appetite or they just don't feel like them. elves or they don't feel as social or what have you. And so then we really dig into Okay, well, is the issue really that we need to take a break from our medicine? Or is it the issue that we need to change your medicine? Or we need to change your dose? And sometimes the answer is we need to change the medicine or the dose?
Dr. Carolyn Llentzsch-Parcells 30:14
Sometimes the answer is no, really, we've tried a lot of things. And this is what works best for them. And they really do like the way their medicine works for them when they need it. But they would like a break from it. Okay, well, then, you know, let's listen to that, let's discuss what the options are there. And again, it also depends, I feel like on how ADHD affects that person, you know, we're all different in the set of symptoms that we have, we're different in how those symptoms affect us, and which symptoms give us the most difficulty if I have a patient who really struggles with emotional dysregulation, and that emotional dysregulation affects their family relationships, and friendships and ability to get things done on the weekend. And those kinds of things. Yeah, that's not somebody I'm gonna recommend take some break from their medicine, right? If I have a teenager who's learning to drive, please do not take a break from your medicine. Yeah, we used to really have this kind of hard line of like, No, you should take your medicine every day all the time, bla bla, bla, bla bla.
Dr. Carolyn Llentzsch-Parcells 31:12
And I still lean towards that for most people. But I do think it's definitely again, like everything else is kind of individual. The other thing you have to take into consideration with it is the dosage of the medication and how you respond to that I have folks who are on relatively speaking higher doses of stimulant who can start them and stop them, no problem, they can be off for a week, they can be off for a month, they can restart it and have a problem, no side effects. A lot of people though, if they're on a mid range to higher dosage, if they stopped for too long, and then try to go right back to that dosage without stair stepping back up. I don't feel very good. Again, it's a very kind of personal and specific thing. Now the other thing you mentioned, though, that I do not want to forget to address because it is so important is you mentioned the question of addiction. This is such such such such a major myth. And it's such a huge barrier to care. For so many reasons. I want to be very, very, very clear on this one.
Dr. Carolyn Llentzsch-Parcells 32:06
The long term data is very clear when these medications are used in the appropriate dosages that we use to treat ADHD and are monitored by a prescribing healthcare professional. Okay, they have an incredibly low risk, I'm not going to say none, but a very low risk of addiction dependence and abuse, okay? The dosages we use don't cause addiction. For the most part, it's more of an issue when people abuse the medication, okay, that we can then go down that road. The other really, really, really important thing that the data has shown us is that people for whom their ADHD is optimally managed, including the use of medication have a significantly decreased risk of drug use drug abuse and drug dependence. Oftentimes, when we go undiagnosed, or we go untreated, or we go sub optimally treated, we are much more likely to seek out illicit substances or to abuse alcohol or other drugs because one we're self medicating to, we've got that whole impulsivity thing that we're dealing with. And we vary dopamine seeking people to dopamine. And so we seek the things that give us the dopamine, even if it's not the healthiest way of obtaining the dopamine.
Dr. Carolyn Llentzsch-Parcells 33:27
And I tell you what, I see it in my clinic all the time, if I don't get my hands on them before they get their hands on weed, or THC in some other shape or form. Because goodness knows people get creative these days, it can be really difficult. So I think that CERN and that misconception is one of the things that prevents people from getting optimal treatments. But then in addition to that, that's also one of the misconceptions that leads to shame and judgment from others, even other people in the medical profession, you know, whether it's physicians, or pas, or nurse practitioners or pharmacists, or nurses or whoever, you know, a lot of us know that look, we go walk in to pick up our scripts, or we walk in to ask for our meds or we start with a new physician or a new provider. And I wish I wish I didn't I didn't have to say that. But I do. I do. And it's definitely one of the things that a lot of us in the field are working very hard to change, and to shift the mentality. And like I said, That's not to say that these medications can't be abused, they can. And it's not to say that they can't be diverted, which is the term that we use for the medication going to people for whom they were not prescribed to be misused, they absolutely can be misused, and we do have to recognize that we do have to acknowledge that and we do have to educate people, but that doesn't mean that the people who need them shouldn't be able to get them and use them appropriately.
Patricia Sung 34:47
Yeah, it's the me I get so I mean literally like legit angry, frustrated about us knowing that the people who are using this medicine to help them have to jump through so many hoops Got to get it. And yet all those hoops, all the red tape and all that is not directed at the people who need to use it for their care or want to use it for their care. And the way that it's meant to write all those hoops are for the people who are making poor decisions. And unfortunately, we take the brunt of that. And it's sad.
Dr. Carolyn Llentzsch-Parcells 35:20
It's also one of the things that I think because they are controlled substances. And because there is this concern out there, which like I said, some of it is it is an issue we have to acknowledge. But there's also some misconceptions around it, that it's also one of the things that is making it difficult to find a provider, right, it's difficult to find a provider who can and will prescribe these medications, in part because of the challenges and restrictions placed on us, but also because of the concern for liability. And sometimes, like I said, misconception around the medication, there's physicians out there who don't want to do it, because they're just not comfortable because they don't know enough about it. There's also physicians out there who would want to provide this care, but don't feel like they're being given the time or the support for the backing to do it and do it well. And if they can't do it, well, they're not going to do it. I can't fault him for that. You know.
Patricia Sung 36:14
I was gunna say the system is broken, and we got a lot of fixing to do. Yes. So on that same topic, I want to hit this myth is that Adderall is the same as meth.
Dr. Carolyn Llentzsch-Parcells 36:27
Hold on, I need to get my bullhorn on my soapbox. No, no. And datamine is not that Methylphenidate is not meth. I know it is confusing, because one has meth and one has amphetamine, neither one of them was meth. It drives me nuts. And actually, it is kind of funny. I've got a couple of my really wonderful patients who have great dry senses of humor who know how much this bothers me. And so they'll literally write on their paperwork, they'll joke about it. They'll be like, I got my mess the other day. And then they'll just see me live. Did they do it just to like, watch me in an
Patricia Sung 37:03
I'm sending you an email to order my meth.
Dr. Carolyn Llentzsch-Parcells 37:04
right. cracked me up to date. But no, it's a teenager's? No, it's it is not math. None of them are math. And again, when used properly, these are not drugs of abuse or intoxication, or addiction. Again, they can be misused, so can a lot of things. So can a lot of medications, right? But again, when we use them properly, and we diagnose people properly, and we get them the help that they need. The long term data is so so clear. So clear, I actually saw the app start is the annual meeting for ADHD professionals in it at one of the meetings I saw the most amazing graphic, I wish I could duplicate it. But they basically showed that the kids who are diagnosed with ADHD and treated younger had a very low rate of drug use and abuse. The kids who are diagnosed with ADHD but not treated, had the same increased rate of drug use and abuse as the kids who weren't diagnosed until later. Which I thought was fascinating. Because as much as I value diagnosis and education and other techniques, which I do I do. And I'm not saying that medication is always the number one choice for everybody. Right? It's not, but I found that very, very poignant, very poignant.
Patricia Sung 38:27
So let me just make sure I understand the two groups, it was kids who weren't diagnosed at all. And then the kids who were diagnosed but didn't take medicine or just weren't being treated.
Dr. Carolyn Llentzsch-Parcells 38:36
It was kids who were not diagnosed until later in life, like late late adolescence, early adulthood, kids who are diagnosed but not treated with medication, and kids who are diagnosed and treated with medication. Wow. Yeah. Wow, that was, that was impressive. And again, goosebumps not saying that medication is the right choice for everyone. Right, but it really did. Yeah, it hit home.
Patricia Sung 38:59
And I think, you know, I'm aiming this episode as as a mom making the decision for yourself. But obviously, we are more likely to have kids who have ADHD. And when we start to make right decisions for our children, that data tells me what I need to do to take care of my kid. Right. Exactly, exactly. And whatever. So and So neighbors telling me about whatever she heard from her grandma's friend salutely.
Dr. Carolyn Llentzsch-Parcells 39:21
Absolutely. And I think to your point, too, it's our kids that we worry about making these decisions even more. So for, right it's one thing to make the decision for ourselves, and to deal with whatever consequences or benefits may come for ourselves. It's a whole nother thing to make these decisions for our kids. So yeah, I agree that data was pretty crazy. Pretty impressive.
Patricia Sung 39:40
Okay, so as we wrap up, the last one I'm going to ask you is a bit of a doozy when we forget about our hormones and our cycles. A lot of times like so many moms and the same for me it's like we just don't feel like our medicine is working as well like that week before cycle or interesting Michael, and I know there's not a lot of research that is out there. Is there anything that you have seen in your practice? I know obviously, like little kids know, cycles, but like in your older teens, have you seen anything that's like helpful to deal with fluctuations in our cycle.
Dr. Carolyn Llentzsch-Parcells 40:15
The good news is we finally are doing research on women and ag. And we do know that our cycles affected, right, because estrogen and dopamine are directly affect each other. So yeah, for a lot of us, our ADHD is worse the week before our periods. And for some of us, we also have the mood issues, or the anxiety issues or irritability. And it just depends on the person, how much of an issue that is, and how challenging that is. And again, this is a big area of conversation these days amongst those of us in the field, because like you said, there hasn't been a lot of data, we're starting to get some data in an ideal world for some of us. And we do figure out how to do this for some people, it would be to increase your dose during that week. But trying to figure out how we do that with insurance and coverage. And and and, and, and and can be tricky. Sometimes it depends on what you're on. And how we're if we're able to do that. Sometimes it's adding a booster dose, like some short acting ones. But then for some people, and again, this is more clinical experience in it is research based, per se. But just like I've seen some of my patients do better when they have PMDD, premenstrual dysphoric disorder when we start birth control for some of my patients that can help because it helps even out and you don't have as much fluctuation. So for some of my patients, that can be really helpful as well. But yeah, no, that is a thing. That is a real thing. And the good news is recognizing it as a thing now. Yeah. And it's actually women and ADHD, and women and ADHD throughout the lifespan has been a big topic of discussion in the field. And at these conferences, which is good.
Patricia Sung 41:49
I cannot wait to see, you know, come 20 years from now, when we really have some good data on this. I know flushes out because I know right? It will be fascinating and things will hopefully be a little easier than weirdos. Maybe they will I don't know, but fingers crossed. So I think the answer is basically you need to talk to your provider and see, do you have any of those options? Because yeah, when you get in unfortunately, with the controlled substances, there's just so much red tape to it can be tricky. Yeah, at least knowing you're not crazy. Exactly. And if any, if anyone is struggling with PMDD, we have an episode about that. So I'll link that in the show notes to have we had a PMDD specialist on to talk about that. It was fascinating. Okay, I could ask you 357 more questions, but I'm going to wrap up. And we're going to do our lightning round questions. Okay. So you don't have to explain anything, just fill in the blank. And we'll move on.
Patricia Sung 42:45
Number one. The best thing that I've read or listened to recently is
Dr. Carolyn Llentzsch-Parcells 42:49
because there's several going through my head but it's probably going to be Elaine Taylor classes, The Essential Guide to raising complex kids.
Patricia Sung 42:56
Okay, number two, my most boring about me fact is,
Dr. Carolyn Llentzsch-Parcells 43:00
I know there's a lot of them.
Patricia Sung 43:03
I love this question because it stumps people with ADHD who normally are like so creative.
Dr. Dr. Carolyn Llentzsch-Parcells 43:09
Like, it's exactly like the stuff that comes to mind is not the warrant, I guess that I My favorite food is french fries.
Patricia Sung 43:17
Okay, number three, I'm having a rough day. My go to quote, poem, book activity, whatever is
Dr. Carolyn Llentzsch-Parcells 43:25
it varies, is what I'm realizing, as we're sitting here. And I would love to say something fabulous, like yoga, or meditation. Probably anything that makes me laugh.
Patricia Sung 43:38
Okay, number four, don't tell anyone. I
Dr. Carolyn Llentzsch-Parcells 43:43
Oh, goodness. Honey, those, just None that I'm going to say on your podcast. Now, I've already said it that we really don't clean my car very often. Really don't.
Patricia Sung 43:56
Number five, if I had a magic fairy wand for one spell, I would
Dr. Carolyn Llentzsch-Parcells 44:01
organize and clean up my entire house.
Patricia Sung 44:05
And number six, my best piece of advice for mamas with ADHD is
Dr. Carolyn Llentzsch-Parcells 44:10
remember that when it's all said and done, it's all about love. That's it, period, paragraph, end of story. Just love them. Love them, love yourself. The rest will take care of itself.
Patricia Sung 44:21
So if the mamas want to connect with you, how do they find you?
Dr. Carolyn Llentzsch-Parcells 44:26
Yes. So you can go to our clinic website. It's www dot g t w dash health.com. And, yeah, and that has our website as well as like ways to contact us and things like that. And if I can't kind of give a plug for the conference, of course. Fabulous. So you'll kind of heard me mentioned conferences here and there. The International Conference on ADHD which happens every year in November is happening this November 17 18th and 19th you In my hometown of Dallas, Texas, very excited, and we are finally back in person right now at least, you know, everything wheeling, and we'll be doing in person and probably a hybrid setup. But we will finally be back together again, which we're very, very excited about. And it is an amazing conference, it's the only conference I have been to that is for medical professionals, mental health professionals, teachers, coaches, parents, adults with ADHD, pretty much anyone and everyone who has worked with knows or love someone with ADHD, which last time I checked should pretty much be all of us. And there is for those of you who need them, we there are CEUs for mental health providers, as well as for teachers and CMEs. For medical providers. The best way I can describe it as it the first time I went, it was like three of the most soul affirming days, because literally skipped down the hallway and swing dance with my buddy in the hall, while still being seen as a respectable professional. It's pretty fabulous three days of using the term neurotypical as an insult. Yeah, it's great. It's good to know if you can join us. Needless to say, we would love for you to and if you can join us virtually, there's always a lot of really great information, as well as really just great connecting with others who are part of this fabulous Federalist community. And probably the easiest way to get information on the conference is going to be through the Chad website. So that's chadd.org. And all the information for the conference is right there on their website.
Patricia Sung 46:30
Awesome. Well, thank you so much. I like I can, like breathe a big sigh of relief, knowing that the mom who's listening right now is well armed with quality information to understand how medication works, and what makes sense for them. And like where to start and knowing that obviously, we wish there was the magic fairy wand that would tell us which medicine that would be great for us and how to use it and all the variables but that comfort to know that it is a trial and error process. And we have to go through that process to find it. Yeah. But that's expected and it's not unusual or correct, you know, out of the norm to have to sort through and figure out what makes sense for you. But yet, the data proves that if this is an option for you, long term, side effects aside and all that like this is a quality decision that you're making for your overall well being in so many ways, not just the surface of you know, can I cross a few things off on my to do list today, so Right, so thank you. I really appreciate you being here today. And hopefully we'll get to chat again soon.
Dr. Carolyn Llentzsch-Parcells 47:39
I would love to
Patricia Sung 47:40
Okay, thank you. I really appreciate it
Dr. Carolyn Llentzsch-Parcells 47:42
You're welcome.
Patricia Sung 47:46
Hey, there, Mama. I've got something fun for you. Who doesn't love a quiz? I want to know which mama animal are you because you're not your average Mama Bear. You have a magical ADHD brain that puts a sprinkle of brilliance on everything you do. Sure, you may have forgotten that laundry in the washer for the third time. But what are your strengths? What makes your ADHD parenting style unique to you? How do you use that sparkle to bless your family? So which mama animal are you? Find out by taking the quiz? What's your ADHD mama parenting style because you're not your average Mama Bear? Head on over to Patricia sung.com forward slash quiz and find out and then when you do I want you to post your results on social media so we can see that your hashtag, not your average Mama Bear along with the hashtag. I'm a mama and I'm feeling the animal that you get. Again, that's Patricia sung.com forward slash quiz. And I can't wait to see what you get. So tag me at Motherhood in ADHD. For more resources, classes and community head over to my website motherhoodinadhd.com