The ADHD Doctor: How to Focus, Stop Procrastinating, Manage Your Emotions, & Feel in Control

Dr. Sasha Hamdani (00:25:09):

When you're looking at females, they typically fall into this pattern of more the inattentive presentation. So these are the daydreamers. They're forgetful. They have difficulty organizing things. They have difficulty with routines and motivation to get tasks done. And so these are the people that in general can be a pleasure to have in class. They're getting passed along and they're doing well. But internally, they're working so hard, so hard. And you know what? That doesn't get better. You get through your elementary school years, you get to puberty. Then all of a sudden you get smoked by hormones. And now hormones immediately change things. Now instead of physicians, and again, not the fault of physicians. This a fault of criteria. But now instead of physicians looking at this child and saying, "Whoa, we missed something. You're having all these mood swings and school is hard for you and friendships are hard for you and all of that." They're saying, "You're a teenager.

 

(00:26:19):

These are hormones. Get used to it. This is what you hear as a 13-year-old girl." And then they have to get through it. So you just kind of just bear it and then you get into college and your demands get harder. You start getting into more serious relationships. And then maybe you get into a situation where you're trying to start your own family. Okay, now you're getting hit with another wave of hormones. And actually during pregnancy, estrogen levels are a little bit higher. Dopamine levels are a little bit higher, so you might do okay. But then postpartum comes and rocks your world. And so you get this drop in estrogen, drop in dopamine, so you can't regulate the way you used to. And so now you go to a doctor again, you're like, "Things are bad." And they're like, "It's hormones. Let's put you on an antidepressant because you're depressed.

 

(00:27:10):

This is postpartum depression." And so it gets missed again. Then you get through all of that and you get through your reproductive years and now you're in perimenopause and things are chaotic because your estrogen drops again. And you're like, "Something is wrong. Something is wrong." And now it's, "Well, you're hormonal. Give it 10 years. We'll see you later." Brain

 

Mel Robbins (00:27:34):

Fog.

 

Dr. Sasha Hamdani (00:27:35):

Yeah. There

 

Mel Robbins (00:27:35):

You go. This happens during perimenopause. In fact, you've described my whole life.

 

Dr. Sasha Hamdani (00:27:42):

I know.

 

Mel Robbins (00:27:42):

I had postpartum depression, crashed. I started having severe brain fog and other symptoms during perimenopause. So you get hormones, which help, but didn't help the brain fog. And again, it was just diagnosed with anxiety, living with anxiety, struggling, struggling, struggling, pushing through postpartum depression. Oh my God, the sobbing is you're breastfeeding. I don't feel like myself. And then perimenopause, then the creams, and then all of a sudden ADHD diagnosis. And it's like, wait, what? And it felt as soon as I was not only diagnosed, but found the medication that worked for me, it's like all of a sudden after 47 years, I felt like I was in my body.

 

Dr. Sasha Hamdani (00:28:31):

Yeah. And that gets missed. It get missed over and over and over again because our criteria doesn't catch that.

Dr. Sasha Hamdani (00:28:46):

Yes.

 

Mel Robbins (00:28:46):

Why?

 

Dr. Sasha Hamdani (00:28:48):

A lot of times when you look at ADHD, there can be anxiety and depression that is a separate thing that travels along with it. That can happen. But for a lot of people, because again, circling back to that emotional regulation part of ADHD that everyone seems to miss, and that is so critically important to getting a comprehensive picture of ADHD. Number one, if you've gone through your whole life and you've thought that there's something wrong with you and you're less than and you're broken, that's going to make you anxious. If you can't do the things that you know perfectly well that you are capable of, that's going to make you anxious. And you know what? It's probably going to make you pretty depressed too. If you're going through these huge moments of this energy dysregulation where you are getting tons done and then it's like you've hit your max and then you - And then you

 

Mel Robbins (00:29:43):

Crash.

 

Dr. Sasha Hamdani (00:29:44):

You have this huge crash and then you feel like, okay, I have literally nothing left in my tank. That looks like depression. But these are all emotional dysregulation issues that are happening. And so that's why you see that with ADHD.

 

Mel Robbins (00:29:58):

I'm Is there a connection between undiagnosed ADHD and eating disorders?

 

Dr. Sasha Hamdani (00:30:05):

Yes, there is. But I think that again, that stems from dysregulation and it stems from a lot of ADHD, you're not able to be mindful about certain things. So sometimes it's not actually. When people think about eating disorders, they think about on one extreme that you're not eating enough and on the other extreme you're eating too much. For the extreme where you're not eating enough, a lot of times with ADHD, sometimes it can be like you don't really have hunger cues. And this is outside of the medication. It's just your body isn't communicating, telling you you're hungry. And I know personally, if I get invested in a task that I'm truly interested in, I can go eight hours and I'm not eating, I'm not drinking, I'm not getting up. On the flip side, with binge eating disorder and things like that, there can be a time where you're trying to stimulate your own dopamine.

 

(00:31:01):

You're trying to get things going without even knowing that's what you're doing. And you're grabbing for things and you're eating and you don't even know. And you can look down and you're like, okay, that was a whole sleep of Girl Scout cookies. So you can be on either end. So yes, there are linkages with disordered eating on both ends.

 

Mel Robbins (00:31:20):

And what's interesting is, again, this kind of distinction that you're seeing, Dr. Hamdani, of the external presentation versus the internal turmoil.

 

Dr. Sasha Hamdani (00:31:30):

How I describe it is it's like the outside of your house is on fire versus the inside of your house is on fire. It just feels like both are on fire. Both are literally in flames. The way we look at it now is we only care if we can see the flames. Flames are going on inside the house.

Dr. Sasha Hamdani (00:32:00):

Yeah.

 

Mel Robbins (00:32:01):

Because the person who cares about them sees these patterns and has sent this episode in a text saying, "Hey, I'd love for you to listen to this because this sounds a little bit like what you might be dealing with." What do you want the person who's hit play and is starting to really process what you're saying for the first time?

 

Dr. Sasha Hamdani (00:32:24):

I think if you are listening to this episode, I don't want this episode to push you one way or the other. This is not meant to convince you that you have ADHD. This is not meant to push you in one direction. It's meant to ask you questions about your own internal environment so that you can start digging deeper and figuring out, is there something here or is there something that needs to be addressed? And what I want to reiterate about all of this is that I think good, compassionate care and diagnosis stems from a very non-judgmental and shame-free place. And so just being able to look at this episode and whatever other research you do in a very compassionate and self-compassionate way, I think you'll be able to receive information and actually start to put together patterns about your own behavior a little bit better.

 

(00:33:19):

And that might be ADHD, it might not be.

 

Mel Robbins (00:33:21):

What do you think the biggest misconception is about ADHD that keeps people, especially women, from getting help?

 

Dr. Sasha Hamdani (00:33:29):

That you have to treat it with medication. I don't think you have to. There are some people that are on medication and it is life-changing for them. And so I'm never going to. And even when I was talking about antidepressants before, same thing, that can be life-changing for some people. So I'm never going to go back on that because medication is a tool and can be wonderful. But also being able to actually commit time and figure out therapeutic tools that might work, it is also so critically important. And some people don't need medication. They get through with doing cognitive restructuring and work through therapy that can be extremely beneficial.

 

Mel Robbins (00:34:13):

I so appreciate your answer. What I find reassuring about what you're saying is there are other ways you can support yourself. And we're going to get into that very specifically about what to do and how to get a diagnosis and what are the things that you can do and what are the medications. I remember when I got my diagnosis, it was both an extraordinary relief and I had a lot of grief and anger.

 

Dr. Sasha Hamdani (00:34:41):

Yeah.

 

Mel Robbins (00:34:42):

Is that common to feel a sense of grief when you finally understand what's been there the whole time?

 

Dr. Sasha Hamdani (00:34:52):

Yes. When I evaluate people, I actually tell them about that. I don't know what this evaluation is going to show or if it's ADHD, if it's not ADHD. But depending on what we go through, this is just a deeper exploration of what's going on in your body. And you might feel like this is an answer. This is what I've been looking for. And it might feel like I wasted so much time and I'm grieving that loss of time and potential and all of that stuff. And to them I say, that is normal. You are allowed to feel those things. That's perfectly normal. And there should be space for that because that is a very valid expression of what's happening. But I also tell them that in that time, it wasn't wasted because you were doing the hard work. You were building routines, you were building structures, you were building workarounds that eventually as you have the right tools and scaffolding, those are going to come in handy for you.

 

(00:35:54):

Those are going to make this process a little bit easier because I've also seen on the flip side of things, when people are started on medication and they don't have that scaffolding in place, and then when they're off medication, it's like they're floundering again. So I think this multifactorial approach of doing lifestyle and behavioral modification with medication, if that's appropriate, can be extremely helpful.

 

Mel Robbins (00:36:19):

It was life-changing for me. I'd love to talk about the connection between being high achieving and how that, especially in women, can hide ADHD, especially from ourselves.

 

Dr. Sasha Hamdani (00:36:34):

Yes.

Mel Robbins (00:36:40):

Not in the context of ADHD.

 

Dr. Sasha Hamdani (00:36:43):

So masking is when you have, it can be conscious or unconscious camouflaging of your symptoms. And this is something that women do exceptionally well because I think from a young age, we're sensitized to do this because we don't want to be in trouble. We don't want to stick out of a crowd. We don't want to bring a lot of attention to us. I'll give you an example with me. I was a combined type presentation, so I was very hyperactive. I couldn't stay in my seat, a big fidgeter, but I learned I can't get up all the time in class. I'm getting in trouble constantly. So I would squish my thighs down on the seat or I'd grab the bottom of my chair and try to suction cup myself to the chair because I'm like, "I need to physically restrain myself from getting out." Now from a productivity and a masking perspective, you also see things like perfectionism.

 

(00:37:40):

I don't want to get in trouble. You see things like overcompensating. I'm going to stay at work extra long and I'm going to over-prepare and I'm going to get things ready because I don't want to get in trouble. I know I'm going to miss something, so I'm going to prevent that from happening. You see things within relationships and knowing that there's that emotional regulation. You see a lot of women just kind of accepting stuff that they might not think is appropriate for any of their peers, but they're like, "I was probably in the wrong. I was a little bit too emotional. I chased them away." And so in order to protect that emotional sensitivity, they don't want to get into conflict. They don't want to fight. They don't want to do things like that. So I mean, there's lots of different ways that are directly impacting and harmful to someone who is continuing this mask for a long time.

 

(00:38:39):

Eventually that mask gets too heavy to hold.

Dr. Sasha Hamdani (00:38:43):

No. Everyone asked me that. I am so jealous of the people who say that it is. I'm jealous of the people who say that it is. And the reason for that is I feel like there are some things that ADHD has brought me that I wouldn't have otherwise. Being on social media, going to the White House, getting book deals, that is because of my ADHD. That's because of that hyper focus. That's because I was interested in something and it bled into this area. But there's also things on a day-to-day scale that I feel so limited by. And I feel like the analogy that I give is it's like a superpower that I have very little agency over. Because it's like you can fly now and that's your superpower, but you can't choose when or where. So you're just going to blast off into space at any given time.

 

(00:39:36):

Oh my God. So I feel like I love the concept of a positive reframe. And I think there is some beautiful, beautiful, beautiful, beautiful things about ADHD. I really do. But I think there's also some things that are really difficult to deal with. And I think when people continuously focus on that superpower trope, for me, it diminishes a struggle. And so I feel like the best way to approach ADHD is just realistically. They're good. Just like anything else, there's good stuff, there's bad stuff, and it's how you deal with it. I

 

Mel Robbins (00:40:15):

Appreciate you saying that because I always thought that it sounded like toxic positivity by somebody who doesn't have ADHD. And when you also consider Dr. Hamdani, what you are teaching us, which is for decades, medical professionals, society, the DSM has not included the full scope of ADHD, especially the emotional dysregulation. There is no superpower to feeling constantly overwhelmed in your life. And yes, there are some small benefits. And I love the analogy that you said it's like having a superpower you can't be in control of. I would love to be able to throw fire from my palms, but I don't want it going off at the wrong time. And there's a lot of anxiety that comes with going through life thinking you can't trust yourself. You can't trust yourself to follow through. You can't trust yourself to be on time. You can't trust yourself to remember.

 

(00:41:22):

You can't trust yourself to not screw this up yet again. And so I really appreciate you saying that.

Dr. Sasha Hamdani (00:41:42):

Yes. So we've talked a lot about the emotional regulation side of things.

 

Mel Robbins (00:41:47):

Yes.

 

Dr. Sasha Hamdani (00:41:48):

There is a neurological phenomenon that you see in almost a hundred percent of people with ADHD, they experience some component of rejection-sensitive dysphoria.

 

Mel Robbins (00:41:56):

Rejection sensitive dysphoria. What does that even mean? That's a big thing.

 

Dr. Sasha Hamdani (00:42:00):

It's a big thing. It's a mouthful. Rejection sensitive dysphoria is this incredibly robust emotional response, sometimes physical, but mostly emotional response to real or perceived rejection or criticism or this fear of disappointing someone. It is this internal emotional response, flooding of neurochemicals that happens.

 

Mel Robbins (00:42:27):

How do you define this, what this is?

 

Dr. Sasha Hamdani (00:42:30):

It is a neurological phenomenon when you look at emotional sensitivity. And you have -

 

Mel Robbins (00:42:36):

What you have if you are somebody struggling with ADHD.

 

Dr. Sasha Hamdani (00:42:40):

I'm saying just part of the human condition, right? Emotional sensitivity in general. If you're saying this is kind of normal emotional sensitivity, you have emotions down, emotions up, situationally appropriate, you're right in the middle. You have lack of emotional sensitivity where people really aren't responding in the way that they should be. They don't feel big highs, they don't feel big lows, maybe not situationally appropriate. Then you have people that are highly emotionally sensitive, and they are the people who feel things quickly and deeply and for a long time. And I would put rejection sensitive dysphoria as the ending point of that as most emotionally sensitive because when they feel something, even if it's not actually happening, if they perceive that there is a risk that I'm disappointing you or that there's some rejection or the person doesn't like me, their world caves in. They start turning inwards and it becomes this flooding of neurochemicals and alarm chemicals that are happening that literally paralyze other areas of the brain.

 

Mel Robbins (00:43:45):

Wow. Holy cow. You have a brand new bestselling book, Too Sensitive. I love the title. Thank you. Why is this rejection sensitive dysphoria important to dedicate an entire book to this?

 

Dr. Sasha Hamdani (00:44:04):

Because no one talks about it. So we don't have the tools and the language to treat it appropriately.

 

Mel Robbins (00:44:11):

Can you show us what this may look like in day-to-day life?

 

Dr. Sasha Hamdani (00:44:15):

Yes, I can. I can show you with text messages from you.

 

Mel Robbins (00:44:20):

Oh God.

 

Dr. Sasha Hamdani (00:44:22):

Okay.

 

Mel Robbins (00:44:23):

So the team has screenshot my phone. Okay, go ahead. Or actually screenshot their phone and something that I've said.

 

Dr. Sasha Hamdani (00:44:29):

Okay. So if we're looking at just this screenshot with you responding to something that I'm saying, and all it says is no worries. For me, what is happening in my brain is, is she mad at me? Is she unhappy with me? Does she want me on the podcast still? I am spinning because in my brain I've attached a level of uncertainty because I'm afraid that there is rejection and criticism underlying this. And that to me is a direct reflection of my own self-worth. So I am going to spin on this. I'm going to ask other people about it. I'm going to show my phone to other people and be like, What do you think about this message? And I am going to waste a tremendous amount of emotional energy on this. Now, the things that I could do with this is that I could chew on it for hours and hours, which is what I love doing.

 

(00:45:26):

And that's what I usually do. Alternatively, I could do things like I could overcompensate. I could send you a text message back and be like, okay, I'm just making sure that we're cool. Or, okay, I want to reiterate our plans. And you're like, I am busy. So there's a lot of emotional handholding I would need in that moment. I might do things like I get that text message, I've already decided that you're mad at me. I'm done now. And that has been my trajectory in my 20s with relationships. I would read into neutral interactions. I would read them as threatening in some capacity, and I would be like, I don't need this. I'm studying. I don't need this. And I would end the relationship because you're not going to push me away. I'm going to leave first. You see different patterns. And it is truly when you take a neurologically emotionally sensitive person, which is something you see a lot of in ADHD, and you put them in these everyday kind of situations, because of that emotional dysregulation, they have a hard time filtering that information because that emotional part of their brain is popping off before that logical part.

 

(00:46:42):

So they are just running with this flooding of emotional chemicals. And if you think about that, this is the stuff that keeps me up. This is the stuff I worry about. This is the stuff I reality test with people and they get so annoyed because I'm constantly going and asking them, is this normal? Is this not? There's so much, I don't want to say life loss, but that's what it feels like. I'm just spending so much time doing that.

 

Mel Robbins (00:47:07):

I have spent a lifetime doing this, and yet at the same time, I'm just doing the best I can to manage all the inbound anyway. If you relate and you read messages like this, what do you do?

 

Dr. Sasha Hamdani (00:47:23):

Yeah. And for the record, it's not just messages. It can be things like for me, I'm so sensitive to tone, to shifts in tone. I'm sensitive to body language. I'm sensitive to I can pick up an energy in a room before I go in. Same. So this is one of those things about being emotionally sensitive and then simultaneously being emotionally dysregulated is that those things hit hard. Yes. So recognizing it is huge. That's a big, big, big thing that I think is really important. The other thing that we see is important are things that work in the moment to reduce activation. Some easy ones are things like movement. And it doesn't have to be like do heavy cardio or lift weights. Do some sort of movement that's going to increase that oxygenated glucose to get to that frontal lobe. Okay. So

 

Mel Robbins (00:48:17):

I see the text message and I'm like.

 

Dr. Sasha Hamdani (00:48:20):

Yes.

 

Mel Robbins (00:48:21):

I do squats?

 

Dr. Sasha Hamdani (00:48:22):

You can. You can. Because think about what you're doing. Once you understand neurologically what's happening, you're dealing with this overactive amygdala and this underperforming frontal lobe.

 

Mel Robbins (00:48:32):

Oh, I see. Oh my God, I just got it. So in that moment, the input from just a simple text message is like.

 

Dr. Sasha Hamdani (00:48:40):

Yes.

 

Mel Robbins (00:48:41):

And that floods your brain.

 

Dr. Sasha Hamdani (00:48:43):

Yes.

 

Mel Robbins (00:48:43):

And your thinker, your prefrontal cortex is like, "I don't know what to do. I can't come online. Something's going on." And so neurologically, even though a text message seems stupid and inconsequential, neurologically, your brain is screwed.

 

Dr. Sasha Hamdani (00:49:05):

You are responding to a threat like you have seen a murder. When you are actually assessing threat, whether it's a social threat, whether it's a physical threat, your brain doesn't know the difference in that moment. Your body's responding in the same way. So you're having this flooding of neurochemicals. And so what you need to do now is understanding, okay, my emotional center is overwhelmed. My frontal lobe is not working as well as it should. And then you look at that situation and whether it's like, okay, I can utilize movement and that's going to get some oxygenated glucose to my frontal lobe where it's supposed to be. And hopefully we can get that thinking back on board. The other thing you could do, delay the reaction. And this is something that it took me so long. I understand neurologically, I am flooded right now. I know that in 10 to 15 minutes, I'm going to feel different.

 

(00:49:54):

And so in 10 to 15 minutes, I will reassess this. And I will even do things like I'll set an alarm. I'll set an alarm, 10 to 15 minutes, I'll come back. And gosh, darn it, I do feel different. But I think what's important is that with this book, Too Sensitive, I don't want to make you less sensitive. I want to help you be more in control. I

 

Mel Robbins (00:50:20):

Love that. I don't want to make you less sensitive. I want to help you be more in control. That is the perfect statement for us to then talk about how you feel more in control. Because I'm sure as you've been listening or watching, and you're really taking in everything that Dr. Hamdani is teaching you and me today, you are thinking of 13 people in your life, or you are thinking, wow, this sounds like me.

Dr. Sasha Hamdani (00:51:08):

Yeah. Let's go through this because I think a visual will help. So I'm going to pull up a visual. Great. So if you think you have ADHD, let's start with the first step. So first step, track your symptoms. It is so important to, number one, know your baseline. Number two, it's also needed to understand how your treatment is progressing. And whether that's therapy or whether that's medication, are those holes being fixed?

 

Mel Robbins (00:51:38):

Yes. So what symptoms am I tracking?

 

Dr. Sasha Hamdani (00:51:41):

Okay. So if you do these things, you get a gold star from me. I want you to track initiation of tasks, distractability during the task. Are you getting pulled out of the task? Completion of tasks. So I would lump that all into one, but I think it's important to make those distinctions. Where is a problem? Is it starting? Is it staying in the task? Is it actually getting it done? That's important. Number two, I think that is vitally important is sleep. Sleep. Track what you're doing with sleep. I want to know how long you slept. I want to know if your sleep was fragmented. Are you waking up in the middle of the night? Is it hard to fall asleep? So give me as much data as you can. This can be notes on your phone.This doesn't need to be something super formal. Okay. And the third thing that I want you to track that I think is really important is mood.

 

(00:52:30):

I actually don't give a lot of guidance on this because it's almost an interesting diagnostic fact to see how you track mood. However you want to track your mood, just give me some sort of mood data point. Okay. Because I want to see, number one, how that pattern progresses over time. And then especially for women, if you cross-correlate that with your hormonal cycle, want to see that too. Got it. Because if there's a strong hormonal component, we need to look at that as well.

 

Mel Robbins (00:52:55):

Got it. So if I were to do this for a couple weeks, you'd get some good data because then you could go, and has it been like this in the past?

 

Dr. Sasha Hamdani (00:53:02):

Ideally. Ideally, I don't want a couple weeks. I want enough for two hormonal cycles. Oh, so you want two

 

Mel Robbins (00:53:09):

Months? I want

 

Dr. Sasha Hamdani (00:53:09):

Two months.

 

Mel Robbins (00:53:10):

Okay, great. You can have two months. It's going to take me that long to get an appointment with you anyway. Okay, track your symptoms for two months and we're doing kind of productivity, initiation, distractability, completion, sleep patterns, and mood.

 

Dr. Sasha Hamdani (00:53:23):

Yes.

 

Mel Robbins (00:53:23):

Boom.

 

Dr. Sasha Hamdani (00:53:24):

Boom. Okay. Step two, talk with a qualified professional about an ADHD. What

 

Mel Robbins (00:53:31):

Is a qualified professional?

 

Dr. Sasha Hamdani (00:53:32):

I know. Who do

 

Mel Robbins (00:53:33):

I go to?

 

Dr. Sasha Hamdani (00:53:33):

I know. So here's the deal. There are, especially now, there are lots of different roads to get to where you need to get to, right? Okay. Let's start from my favorite. I'm biased because I'm a psychiatrist. I feel like going to a psychiatrist sometimes gives you the best evaluation. And the only reason I'm saying that is because you have the benefit of going to a medical physician so they understand medical background. You have the benefit of going to a psychiatrist. So they've done the psychiatry residency where they've done the therapy side of things and they've done the medication side of things. So it can be if that person is appropriate for an ADHD medication after this evaluation and has ADHD, this could be a one-stop shop kind of thing.

 

Mel Robbins (00:54:22):

But there is a desert and deficit of access. Access is a problem. Access in many communities, many countries for many people. And sometimes we're like, do I go to my primary care? Do I go to a pediatrician? Do I go to a nurse practitioner?

 

Dr. Sasha Hamdani (00:54:39):

Absolutely. We're only as good as what our system allows because access to care is a huge issue. And there's so many barriers to care, whether that's there's literally not enough psychiatrists, whether that's a cost issue, whether that's they aren't taking your insurance. There's so many different things or that they're saturated. They can't see patients. You could go to your primary care doctor or your pediatrician. And that's a beautiful place to start. That's a beautiful place to start. Generally, there's a lower barrier to access with that. A lot of times they'll do an assessment that involves getting information from collateral resources. So talking to, for kids, they'll talk to parents, they'll talk to teachers, they'll get scales to look at ADHD behaviors. So depending on what is available to you, that's another road. Then you could do the therapist road, there's many different layers. You could do a neuropsychologist who could do neuropsych testing where you do a comprehensive evaluation of everything that's going on.

 

(00:55:46):

Is this ADHD? Is this depression? Is this anxiety? Is this bipolar? So they will do a full, it's super long.

 

Mel Robbins (00:55:54):

And expensive.

 

Dr. Sasha Hamdani (00:55:54):

And expensive.

 

Mel Robbins (00:55:55):

That's what I did. That's what we did with two of our kids.

 

Dr. Sasha Hamdani (00:55:58):

And

 

Mel Robbins (00:55:59):

It was expensive. I would not have been able to do it had all of this started happening and I was aware of what was happening even just a couple years before that.

 

Dr. Sasha Hamdani (00:56:08):

So here's the deal. There are other resources. So besides the therapist route, besides the neuropsychologist route, there are other layers of therapists that could potentially do the evaluation. Some of them with nurse practitioners, not a therapist, a nurse practitioner is something different. Some of them can prescribe, some of them cannot. With therapists, generally, they cannot prescribe. But again, we're not talking about prescription.

 

Mel Robbins (00:56:36):

Well, we just got to get the actual actual assessment done first so you know what you're dealing with. And I do find that this is a big roadblock.

 

Dr. Sasha Hamdani (00:56:45):

Here's what I will tell you about any provider that you see. To save you time, to save you heartache. One of the most important things that I tell anybody who's starting this process is look up the provider ahead of time. Look at their reviews, look at what they treat, look at all these things because it's unbelievable how strongly some people feel about ADHD. Some people are completely unwilling to even address it. And so it gets to be really difficult when you're going into an evaluation and it's hard to even get that evaluation from them. And so I think that the people who really enjoy treating ADHD, looking at ADHD, evaluating ADHD, they put it pretty prominently on their information. So I think that's important. You can look at reviews, you can get word of mouth. And honestly, you deserve that. You deserve a good assessment that is personalized for you.

 

Mel Robbins (00:57:45):

Right. You're worth that.

 

Dr. Sasha Hamdani (00:57:47):

Yeah.

 

Mel Robbins (00:57:48):

Step three.

 

Dr. Sasha Hamdani (00:57:48):

Step three, discuss options.

 

Mel Robbins (00:57:52):

And there's lots of options on that board. Medication, therapy, coaching tools, systems. Let's talk about the options.

 

Dr. Sasha Hamdani (00:57:59):

Yeah. A lot of people, they immediately think, "If I have ADHD, I'm going to be put on Adderall and that's what's going to happen." No. So let's go through some of the different options. Number one, if you're looking at ADHD management, there is medication and there's non-medication. So let's start with the medication side of things. Medication broken up into two big classes. There are stimulants and they're non-stimulants. Stimulants, the stuff you've heard about, Adderall, Ritalin, Vyvanse, those are all in that stimulant class of medications. They work in two different ways. One is to help with alertness and to fight off those sleepiness cues. And two is to point towards reward. There was a beautiful Washington University study that was done on this just like Christmas of 2025, so it's relatively recent. Stimulants, the issue with them, number one, they're controlled substances, so that gets a little weird.

 

(00:58:59):

But number two, you can't stimulate a person 24 hours a day. It's like you got to eat, you got to sleep, you got to do normal human functioning things. So even the long-acting stimulants, really, you're getting about six to eight hours of coverage, if that. Usually it's four to six hours. Short-acting, two to four hours. So you're getting these tall peaks of coverage where it's, okay, I feel like I am completely regulated at this point, but it crashes down pretty quickly. But you move next into the non-stimulant class of medication. So stimulants are one side. Non-stimulants. Non-stimulants, those are generally agents that work on a couple of different things. There's some that are antidepressants, so they help with anxiety and depression at the same time. There's some that are blood pressure medications. They're all these different types of medications that have multiple usages. And the thing that I generally like about non Non-stimulants is that a lot of times it's 24-hour acting, which people don't know about because a lot of times they're like, "Oh, if I have ADHD, I'm going to have to be started on this medication, which I'm going to hate." Non-stimulants, you're not going to have this two hours of coverage, you're going to get a 24-hour -

 

Mel Robbins (01:00:18):

What

 

Dr. Sasha Hamdani (01:00:18):

Are

 

Mel Robbins (01:00:18):

The names of non-stimulants?

 

Dr. Sasha Hamdani (01:00:20):

So guanfacine is one. Stratera is one. One you might have heard of is Wellbutrin, that's a non-stimulant for ADHD. So there's lots of different agents that you could potentially think about adding that give you full coverage, that possibly cover more than just the attention component, that don't crash you down in two hours and instead just kind of raise that baseline. So they're beautiful agents. It really depends on what you need.

 

Mel Robbins (01:00:51):

If the person who's listening is thinking, "I am really resistant to the medication because I'm concerned about the side effects." If they were a patient in your practice, what do you say to a patient in your practice when somebody raises that concern?

 

Dr. Sasha Hamdani (01:01:09):

Then don't do medication. So if I explain exactly how those medications work and what the intended effect and what the side effects are and how to get on them, also how to get off of them, if I'm giving you all that information, you're like, "No, thank you. I don't want that." That is a perfectly reasonable choice. We go based on what you feel ready for. It's not my job to push medication on you. It's not my job to get you there sooner. Do the tools. The tools are going to help you anyway.

Dr. Sasha Hamdani (01:01:52):

It can sometimes be really nebulous and hard to figure out exactly where to start, what lever to pull. That's when I think a therapist can come in very, very, very handy because they are able to take that data from your patterns, synthesize it, figure out where the holes are, and then figure out how to optimize and approach that. And I'll tell you from my own experience, I really started to drill down and work on the therapy side of things. And what are the skills? What are the tools? How can I explore my own behavior so I can figure out what to fix? And that I think was life-changing.

 

Mel Robbins (01:02:28):

What is the fourth step if

 

Dr. Sasha Hamdani (01:02:30):

You think

 

Mel Robbins (01:02:30):

You have ADHD?

 

Dr. Sasha Hamdani (01:02:32):

Okay. Step four. Use trusted resources while you wait. I think this is important because I think a lot of getting assessed, it can take a while. It can take a long time. And if it happens, right? I mean, there's some people that don't have access to it. And so I feel like in that interim, learning and exploring your own internal environment, and also relying on resources that you know are reputable, that are going to help you, that aren't just some random person on the internet that's talking, you want to get information from things like journal articles or news. And again, some news. So newspapers that cite journal articles. Well,

 

Mel Robbins (01:03:22):

I actually, this is one of the things I appreciate about you, that you put a lot of content online.

 

Dr. Sasha Hamdani (01:03:26):

Yeah.

 

Mel Robbins (01:03:27):

And so if you're having trouble gaining access and you are in the waiting game, following somebody like you,

 

(01:03:40):

A medical doctor who's talking about this, who lives with this, that's a way for you to learn more and to understand that this is not a deficiency in you. This is something you are just going to learn more about. And there are tools that you can use while you're waiting. And you can learn more and become smarter about this while you're figuring it out. And that's the whole point. And that's why I actually wanted you here because you do put out a lot of content.

Dr. Sasha Hamdani (01:04:22):

If I had 10 minutes left of my life, I would want to know if I had ADHD. Why? Because I want to understand my brain. I don't think it's ever too late to understand your brain. I just want to know for me going through that ADHD experience, I know firsthand how it feels to have that guilt and that shame compounded at every single thing. And for me to analyze every turn I've made and to think about it and where did I go wrong and what was happening and how could I have done it better? To know that I did do my best. This was a neurological phenomenon that was underlying all of this, that was making it difficult. You still did a great job. You got through this. You built on this. I want other people to feel that.

 

Mel Robbins (01:05:16):

I do too.

 

Dr. Sasha Hamdani (01:05:17):

Yeah.

 

Mel Robbins (01:05:18):

Dr. Hamdani, what are your parting words?

 

Dr. Sasha Hamdani (01:05:22):

It's never too late to understand your brain.

 

Mel Robbins (01:05:29):

I am so grateful that you're here.

 

Dr. Sasha Hamdani (01:05:32):

Thank you for having me.

 

Mel Robbins (01:05:33):

I cannot believe how much I learned today that I did not know. I feel more confident. I feel like I understand myself so much better. This episode is an extraordinary gift that you just gave us because we got to sit down in a private session one-on-one with a psychiatrist as renowned and as passionate and committed as you are. And I appreciate the accessible and realistic way that you talked about what to do next and what to do while you wait and while you figure this out. And so just from the bottom of my heart and from people all around the world that you will never meet, whose lives will be forever changed because of what you shared with us today, thank you.

 

Dr. Sasha Hamdani (01:06:28):

Thank you for having me.

 

Mel Robbins (01:06:31):

And thank you. Thank you for making the time to learn about ADHD. I hope you share this with people that you care about. This is a conversation that is for all of us, and these tools that we discussed today are things you can start to implement in your life or the lives of people that you love immediately. And in case no one else tells you, I wanted to be sure to tell you as your friend, that I love you and I believe in you, and I believe in your ability to create a better life. I cannot wait to see your comments. I can't wait to see this shared around the world. So thank you, thank you, thank you. I'm going to welcome you in to the very next episode, the moment you hit play. I'll see you there. Thank you for watching all the way to the end here on YouTube.

 

(01:07:13):

And if you're asking yourself, "Okay, what should I watch next?" You're going to love this video and I'll welcome you in the moment you hit play.