Thank you so much for this video! In your opinion what would be a great course of activation for female 27 undiagnosed but definitely has had add (cognitive function problems, struggle to concentrate when I need to, getting frustrated easily, over stimulated, interrupting) her whole life and now in adulthood it’s coupled with severe anxiety? Would it be worth it to try a stimulant even with the risk it may increase anxiety?
Without doing a thorough evaluation it wouldn't be appropriate for me to make any recommendations. One good thing about stimulants is that people tend to see how they will respond very quickly. Within 1-3 days you would have a good idea of whether the dose of stimulant you try (and starting low would make sense) is helping with ADD symptoms and whether or not it is worsening anxiety.
Hi DR. I currently take fluxotine 20mg for anxiety and recently started Ritalin 20mg 3 times a day. My anxiety is through the roof. But the Ritaline is working really well.
i have autism together with my adhd, so im very anxious especially socially. Guanfacine has helped a lot unlike the stimulants that make me worse. Had an allergic reaction to Wellbutrin and curios to try Strattera after many stims failed. What is your clinical exp doc? Is having commorbid autism an indication that somoene mihjht have a likely higher chance for a negative exp on stimulants? seems to be common reading stories of people with also autims on reddit...
THat's certainly plausible, but very little rigorous research on the topic. Many people do combine guanfacine and Strattera and see benefits from the two together.
I'm glad they help. I saw a lengthier email from you, but it's not appearing here (yet) in the comment section. My response is that intelligence can often mask ADHD - smart people can get by in many situations, particularly elementary and middle school, before it catches up with them.
@@DrJohnKruse in my own life, once I learned to read in grade 1, I read as much as I could on my special interests. I could play chess from the age of 5 and had a broad general knowledge. My grade 1,2 and 3 teachers had stated I had concentration difficulties in class, my parents brushed it off as boredom and under stimulation. I never developed study skills due to being able to get good grades without it. In high school I went from getting A's for physical science to c and e's in grade 10 and math's declined in grade 9 but everything else was ok up until grade 11. I remember hating school everyday from about grade 10 going to long classes that taught me nothing I was interested in and spent my evenings engaged in my interests like writing poetry, reading and drawing. I suspect I may have aspergers as well as adhd but my father was always criticizing me, emotionally neglecting me and I would often vocalize his regret for having children. I really loved my parents up to about puberty. I was left with alot of dissonance because of how I was treated because I was a good kid. I was a prefect in primary school and passed a difficult entrance exam for a private high school but was told it was too expensive even after earning a scholarship. I got a bronze in a regional science expo for building a battery powered vacuum cleaner from household items in grade 9 initially and then enhancing it by adding a more symmetrical fan. I would do chores, cut grass, even created my own little garden in my childhood years to attract spiders while the rest of the yard was not as a live. My father made me hyper aware of myself and my positive illusiory bias's and I became over regulated. They never listened to me and tried to accommodate my limitations. I disliked the social hierarchy of high school and was very sensitive to that and actively chose not to take part in it. With a low self esteem, I was told my cousins are catching up with me, kids at school that were doing well weren't that smart and I could do better. I got mostly distinctions for art in my grade 11th year while failing math's and science pretty much and was told by my parents that they won't pay for me to study graphic design to become a clerk. While my affluent aunt and uncle encouraged my art and didn't know the virulent person my father was because he was so likeable to the outside world. Maybe I would have out grown adhd had I had the right support but I'll never know and have to get on with life.
What would be your first go to treatment for someone who is on a stimulant and doing well but still experiences anxiety & overwhelm. I have a Doctors appt in a week and was going to ask about guanfacine, straterra or buspar but I dont know how much my Doctor would know. Do you have a particular one that stands out as the best option to start with?
My first approach is almost always to consider reducing the stimulant dose. Many times someone obtains all of the benefits that they had at a higher dose, but without any agitation/overwhelm. In my experience guanfacine and buspirone are considerably more likely to help reduce anxiety than strattera. Strattera on top of a stimulant has a reasonable likelihood of increasing anxiety.
Sorry I should have been more clear. The stimulant actually lowers my anxiety a little, but not completley. For someone who has mild anxiety would you recommend adding guanfacine to start? Im just worried that energy and motivation can be a challenge and guanfacine might make that worse. It could also be that the anxiety causes me to avoid painful tasks, and with lowered anxiety I mighr be able to approach the uncomfortable more easily. Thoughts?
@@Ryan-ud9fk your logic makes sense to me. But sometimes our brains don't act logically. In 2024 we still often need to try a medication to see what effect it has on our own neural circuits - and to try to adjust doses according to our response.
Hi Dr, I have tried all the stims but they all make me incredibly anxious, unsociable and restless. I am currently on Ituniv 2mg for 3 weeks but do not notice much. I have CPTSD from a bad childhood and have very bad social anxiety and anxiety in certain settings. Would SSRI be best to help combat this?
Guanfacine (th-cam.com/video/kp9bGbwk3BA/w-d-xo.html) often takes several weeks to work, and some people need doses higher than 2 mg for an optimal response. Even if you have not witnessed any benefit from the guanfacine, it is possible that you may be more able to tolerate stimulants while on the guanfacine. There are certainly some people who have PTSD related anxiety that respond to SSRIs. It is also possible that any ADHD symptoms are actually symptoms of your CPTSD.
It's hard to generalize since there is such a broad range of responses, but most of the research suggests that when ADHD and autism co-occur, traditional ADHD medications, like stimulants, are often useful in addressing the ADHD symptoms. Many people start with a low dose and adjust accordingly. For most people with autism spectrum issues, we don't have good clear choices for medications that help.
What's the difference between anxiety and hyperarousal / hyperactivity? I heard from Dr. William Dodson ADHD patients often confuse the two and that anxiety means to have a 'baseless apprehensive fear' most of the time. I don't have any fear except normal worry of not reaching my goals. But my mind is always thinking of random things, going 100 miles an hour which Dr Dodson says is the physical experience of hyperarousal. My mind can't go quiet for a single moment. I think most people confuse the two conditions, even educators in this field label hyperarousal symptoms as anxiety. If you don't have any fear can you say for sure that what you have is not anxiety?
I would not consider someone who is not experiencing fear, apprehension, or worrying to have an anxiety disorder just because their thoughts are jumping quickly from topic to topic.
I was taking buproprion 75mg (3 yrs) then adderral 15 mg (6months) and had a drug induced mania and tinnitus. I stopped and was prescribed buspirone and felt happier but low energy and hard time with focus so I tried Stratterra and stopped today because I was having severe dry mouth , cracked lips, scallopped tongue and problems swallowing , sore throat and stomach issues, as well a pain in upper right stomach. I also have BPD and feel that buspirone is helping with anger. I feel like the mix of wellbutrin was messing with sympathetic system and just need the adderral with buspirone but Dr. is afraid i may have mania . what do you suggest... I think possible combo Ritlin and buspar because adderal increasesed anger and impulksivity.
You didn't mention what your manic symptoms were. If it was just heightened activity and decreased sleep, it might be safe to retry Adderall at a lower dose. But if there was any element of psychosis, I would stay very far away from any amphetamine again, and check out my video on amphetamine induced psychosis th-cam.com/video/jn76CGJKWQg/w-d-xo.html
Hey doc, I have tried methylphenidate hydrochloride. 5mg, 10, 15mg did almost nothing for me. 20 mg worsened my daydreaming. I was expecting it to calm the voice in my head. Is this enough to know that methylphenidate is not for me? There aren't other forms of methylphenidate where I live. My other options are armodafinil, atomoxetine, clonidine and bupropion. Can you use clonidine acutely and quit abruptly without monitoring blood pressure if your bp is on the lower side? I want to try it but fearing it'll make me lethargic and give me rebound hypertension if I quit? I am not asking for medical advice, just wanted to know your experience with it.
Unless the reaction to the 20 mg methylphenidate was highly unpleasant, some people in that situation might try going higher, in the hopes of getting a positive response. The risk of hypertensive rebound, as far as I have heard, is not strongly dependent on baseline blood pressure. So the risk would be there with clonidine, but all research indicates is much lower with the generally similarly acting guanfacine. And both immediate release and extended release guanfacine have shown efficacy for ADHD.
@@DrJohnKruse Just to be sure, I meant a single 20mg (short release) dose of methylphenidate not a daily dosage. Should I still try going higher? That'd mean a daily dose of 60-90 mg.
@@DrJohnKruse Just to be sure, I meant a single (short release) dose of 20mg methylphenidate, not a daily dose. Should I still try to increase my dosage? That'd mean a total daily dosage of 60-90 mg.
i just sleep all the time now. well, i'm up at night, but i don't beat myself up for making up the time anymore. doesn't mean that my life isn't a smaller pile of s&*t cause i'm well rested, but i do get a bit of 'feeling better.' i'm interested in a non-stimulant stimulant to add to my adhd med. adderall was awesome at first but quickly created more panic and anxiety! bummer! so, i'm assuming i need the non-stimulant...can anyone relate? i'd love some feedback from viewers, thanks!
Female, 5 weeks pregnant, 29 years , ADHD, anxiety and depression Struggling with everything, no motivation mostly, powerless What is the best ttt for her ?
@@DrJohnKruse In general for the first time, do you recommend stimulants or non-stimulants, I saw two doctors one prescribed stimulant and the other, prescribed non-stimulants, and I didn’t purchase any of them because I am so worried
I have a video on guanfacine and ADHD th-cam.com/video/kp9bGbwk3BA/w-d-xo.html where I think on touch on clonidine. It clearly can help, but has substantially higher risk of withdrawal extreme hypertension than does guanfacine.
Caffeine is weird with me at first I'm tired but then when it wears off I cannot get to sleep.
Thank you so much for this video! In your opinion what would be a great course of activation for female 27 undiagnosed but definitely has had add (cognitive function problems, struggle to concentrate when I need to, getting frustrated easily, over stimulated, interrupting) her whole life and now in adulthood it’s coupled with severe anxiety? Would it be worth it to try a stimulant even with the risk it may increase anxiety?
Without doing a thorough evaluation it wouldn't be appropriate for me to make any recommendations. One good thing about stimulants is that people tend to see how they will respond very quickly. Within 1-3 days you would have a good idea of whether the dose of stimulant you try (and starting low would make sense) is helping with ADD symptoms and whether or not it is worsening anxiety.
@@DrJohnKrusethanks for your response😊
Hi DR. I currently take fluxotine 20mg for anxiety and recently started Ritalin 20mg 3 times a day. My anxiety is through the roof. But the Ritaline is working really well.
I hope that you find a combination that works for you.
Taking 5 htp with methylphenidate reduced my anxiety. It also helped with sleep.
i have autism together with my adhd, so im very anxious especially socially. Guanfacine has helped a lot unlike the stimulants that make me worse. Had an allergic reaction to Wellbutrin and curios to try Strattera after many stims failed. What is your clinical exp doc? Is having commorbid autism an indication that somoene mihjht have a likely higher chance for a negative exp on stimulants? seems to be common reading stories of people with also autims on reddit...
THat's certainly plausible, but very little rigorous research on the topic. Many people do combine guanfacine and Strattera and see benefits from the two together.
Positive illusiory bias is a brilliant concept. I learn alot from your videos thanks.
I'm glad they help. I saw a lengthier email from you, but it's not appearing here (yet) in the comment section. My response is that intelligence can often mask ADHD - smart people can get by in many situations, particularly elementary and middle school, before it catches up with them.
@@DrJohnKruse in my own life, once I learned to read in grade 1, I read as much as I could on my special interests. I could play chess from the age of 5 and had a broad general knowledge.
My grade 1,2 and 3 teachers had stated I had concentration difficulties in class, my parents brushed it off as boredom and under stimulation. I never developed study skills due to being able to get good grades without it.
In high school I went from getting A's for physical science to c and e's in grade 10 and math's declined in grade 9 but everything else was ok up until grade 11.
I remember hating school everyday from about grade 10 going to long classes that taught me nothing I was interested in and spent my evenings engaged in my interests like writing poetry, reading and drawing. I suspect I may have aspergers as well as adhd but my father was always criticizing me, emotionally neglecting me and I would often vocalize his regret for having children. I really loved my parents up to about puberty. I was left with alot of dissonance because of how I was treated because I was a good kid. I was a prefect in primary school and passed a difficult entrance exam for a private high school but was told it was too expensive even after earning a scholarship. I got a bronze in a regional science expo for building a battery powered vacuum cleaner from household items in grade 9 initially and then enhancing it by adding a more symmetrical fan. I would do chores, cut grass, even created my own little garden in my childhood years to attract spiders while the rest of the yard was not as a live. My father made me hyper aware of myself and my positive illusiory bias's and I became over regulated. They never listened to me and tried to accommodate my limitations. I disliked the social hierarchy of high school and was very sensitive to that and actively chose not to take part in it. With a low self esteem, I was told my cousins are catching up with me, kids at school that were doing well weren't that smart and I could do better. I got mostly distinctions for art in my grade 11th year while failing math's and science pretty much and was told by my parents that they won't pay for me to study graphic design to become a clerk. While my affluent aunt and uncle encouraged my art and didn't know the virulent person my father was because he was so likeable to the outside world. Maybe I would have out grown adhd had I had the right support but I'll never know and have to get on with life.
What would be your first go to treatment for someone who is on a stimulant and doing well but still experiences anxiety & overwhelm. I have a Doctors appt in a week and was going to ask about guanfacine, straterra or buspar but I dont know how much my Doctor would know. Do you have a particular one that stands out as the best option to start with?
My first approach is almost always to consider reducing the stimulant dose. Many times someone obtains all of the benefits that they had at a higher dose, but without any agitation/overwhelm. In my experience guanfacine and buspirone are considerably more likely to help reduce anxiety than strattera. Strattera on top of a stimulant has a reasonable likelihood of increasing anxiety.
Sorry I should have been more clear. The stimulant actually lowers my anxiety a little, but not completley. For someone who has mild anxiety would you recommend adding guanfacine to start?
Im just worried that energy and motivation can be a challenge and guanfacine might make that worse. It could also be that the anxiety causes me to avoid painful tasks, and with lowered anxiety I mighr be able to approach the uncomfortable more easily. Thoughts?
@@Ryan-ud9fk your logic makes sense to me. But sometimes our brains don't act logically. In 2024 we still often need to try a medication to see what effect it has on our own neural circuits - and to try to adjust doses according to our response.
Hi Dr, I have tried all the stims but they all make me incredibly anxious, unsociable and restless. I am currently on Ituniv 2mg for 3 weeks but do not notice much. I have CPTSD from a bad childhood and have very bad social anxiety and anxiety in certain settings. Would SSRI be best to help combat this?
Guanfacine (th-cam.com/video/kp9bGbwk3BA/w-d-xo.html) often takes several weeks to work, and some people need doses higher than 2 mg for an optimal response. Even if you have not witnessed any benefit from the guanfacine, it is possible that you may be more able to tolerate stimulants while on the guanfacine. There are certainly some people who have PTSD related anxiety that respond to SSRIs. It is also possible that any ADHD symptoms are actually symptoms of your CPTSD.
I have adhd autism which is best to try whst you have found in your practice as can meds maked autism worse
It's hard to generalize since there is such a broad range of responses, but most of the research suggests that when ADHD and autism co-occur, traditional ADHD medications, like stimulants, are often useful in addressing the ADHD symptoms. Many people start with a low dose and adjust accordingly. For most people with autism spectrum issues, we don't have good clear choices for medications that help.
What's the difference between anxiety and hyperarousal / hyperactivity? I heard from Dr. William Dodson ADHD patients often confuse the two and that anxiety means to have a 'baseless apprehensive fear' most of the time.
I don't have any fear except normal worry of not reaching my goals. But my mind is always thinking of random things, going 100 miles an hour which Dr Dodson says is the physical experience of hyperarousal. My mind can't go quiet for a single moment.
I think most people confuse the two conditions, even educators in this field label hyperarousal symptoms as anxiety. If you don't have any fear can you say for sure that what you have is not anxiety?
I would not consider someone who is not experiencing fear, apprehension, or worrying to have an anxiety disorder just because their thoughts are jumping quickly from topic to topic.
I was taking buproprion 75mg (3 yrs) then adderral 15 mg (6months) and had a drug induced mania
and tinnitus. I stopped and was prescribed buspirone and felt happier but low energy and hard time with focus so I tried Stratterra and stopped today because I was having severe dry mouth , cracked lips, scallopped tongue and problems swallowing , sore throat and stomach issues, as well a pain in upper right stomach. I also have BPD and feel that buspirone is helping with anger. I feel like the mix of wellbutrin was messing with sympathetic system and just need the adderral with buspirone but Dr. is afraid i may have mania . what do you suggest... I think possible combo Ritlin and buspar because adderal increasesed anger and impulksivity.
You didn't mention what your manic symptoms were. If it was just heightened activity and decreased sleep, it might be safe to retry Adderall at a lower dose. But if there was any element of psychosis, I would stay very far away from any amphetamine again, and check out my video on amphetamine induced psychosis th-cam.com/video/jn76CGJKWQg/w-d-xo.html
well... why'd my treatment get interrupted?
Not quite sure what you're referring to.
@dr.johnkruse6708 never mind, I just think you're handsome ~
@@mediumslime thank you! I hope the content's useful too!
Hey doc,
I have tried methylphenidate hydrochloride. 5mg, 10, 15mg did almost nothing for me. 20 mg worsened my daydreaming. I was expecting it to calm the voice in my head. Is this enough to know that methylphenidate is not for me? There aren't other forms of methylphenidate where I live. My other options are armodafinil, atomoxetine, clonidine and bupropion.
Can you use clonidine acutely and quit abruptly without monitoring blood pressure if your bp is on the lower side? I want to try it but fearing it'll make me lethargic and give me rebound hypertension if I quit?
I am not asking for medical advice, just wanted to know your experience with it.
Unless the reaction to the 20 mg methylphenidate was highly unpleasant, some people in that situation might try going higher, in the hopes of getting a positive response.
The risk of hypertensive rebound, as far as I have heard, is not strongly dependent on baseline blood pressure. So the risk would be there with clonidine, but all research indicates is much lower with the generally similarly acting guanfacine. And both immediate release and extended release guanfacine have shown efficacy for ADHD.
@@DrJohnKruse Just to be sure, I meant a single 20mg (short release) dose of methylphenidate not a daily dosage. Should I still try going higher? That'd mean a daily dose of 60-90 mg.
@@DrJohnKruse Just to be sure, I meant a single (short release) dose of 20mg methylphenidate, not a daily dose. Should I still try to increase my dosage? That'd mean a total daily dosage of 60-90 mg.
i just sleep all the time now. well, i'm up at night, but i don't beat myself up for making up the time anymore. doesn't mean that my life isn't a smaller pile of s&*t cause i'm well rested, but i do get a bit of 'feeling better.' i'm interested in a non-stimulant stimulant to add to my adhd med. adderall was awesome at first but quickly created more panic and anxiety! bummer! so, i'm assuming i need the non-stimulant...can anyone relate? i'd love some feedback from viewers, thanks!
and, yes, another book, please=quests not tests!
I have videos on this channel about guanfacine, Wellbutrin, Qelbree, and Strattera, and modafinil, which all might be of help.
Female, 5 weeks pregnant, 29 years , ADHD, anxiety and depression
Struggling with everything, no motivation mostly, powerless
What is the best ttt for her ?
I can't make treatment recommendations without a doctor patient relationship, and I'd need a lot more information beyond this general framework.
@@DrJohnKruse In general for the first time, do you recommend stimulants or non-stimulants, I saw two doctors one prescribed stimulant and the other, prescribed non-stimulants, and I didn’t purchase any of them because I am so worried
I went with the non stimulant choice and I started taking Atomoxetine 40 mg , 2 days ago
It causes nausea and makes me feel sleepy
@@AhmedAhmed-z4e6h I hope that you obtain more benefits with a longer time on the atomoxetine.
@@AhmedAhmed-z4e6h Best wishes.
Green tea and Green nutrient smoothie and flaxseed with omega 3
Clonidine 💗👍
I have a video on guanfacine and ADHD th-cam.com/video/kp9bGbwk3BA/w-d-xo.html where I think on touch on clonidine. It clearly can help, but has substantially higher risk of withdrawal extreme hypertension than does guanfacine.