Dr. John Kruse your explanation about ADHD and Social Anxiety is the FIRST time since getting my diagnosis of ADHD at age 51 yrs old that I could see where this fits. I questioned my diagnosis because it felt like my whole life it was anxiety distracting me but that in of itself is causing the inattention. I thought it was simply anxiety. However, I can see now that’s theirs really not that much reason to try to differentiate. I am trying Adderall right now and noticed it does seem to tamp down whatever is going through my head and for a few hours I can be doing something and stop walking in rooms constantly and don’t know why etc. I went from 10mg 3x a day to 15mg because I just wanted those thoughts to stop. Noticed anxiety symptoms considerably worse so backed back down. That with a small dose of anxiety medication is most helpful. I am going and doing the “thing” as I call which I contribute to the Adderall and the anxiety med is just there to counteracts some effects of the Adderall.
In my (female) personal experience of ADHD and social anxiety, I find that I spend a lot of time replaying conversations. I seldom have social anxiety in anticipation of a social event unless I know it will be difficult. Instead my anxiety occurs after the event, when I replay my conversations in my head ad nauseum. I think I am often checking if I said the right thing, double checking that I didn't make any social "mistakes", checking how I may have come across in the moment etc. I catch myself thinking about this and decide I don't want or need to be thinking about it and replaying the conversation. I know mentally everything I did was fine and if not that's ok too. I may manage to switch my attention to something else. Then a short time later the replaying comes back into my head and it's a few minutes before I even realize I am thinking about it. I try to stop again. This repeats. It is very distressing. I only recently put together that this may be an issue of attentional regulation and thought switching rather than pure social anxiety. Could that be a factor in what is going on?
@John Kruse I have begun Intuniv XR (Guanfacine) a couple months ago, and I am finding it does help with being able to control and set aside these types of thoughts.
Awesome video. I was recently watching a podcast from Michael Singer, author of two great bestsellers, distinguish between the mind/emotions and the “You” who recognizes the former. When your consciousness is focused inward on what Eckart Tolle would refer to as “pain bodies”, past negative experiences which one stored internally instead of letting it pass through, future similar experiences can trigger the same response. Attentionally, one is inwardly focused in these cases which leads to less than optimal social experiences.
Hi, do you have the references for stats i.e. 30-40% of people with ADHD have SA. Also is there any literature about the 3 similar symptoms (social difficulties, inattentiveness and failure to complete tasks). Many thanks.
@John Kruse I am now 1mth on nebivolol, and my focus and productivity/motivation improved significantly. I regret starting on diuretics many years ago as now there is rebounding effect when I stop. Diuretics are one of the worst meds out there. Seems impossible to get off them and I still have to take 12.5mg HCT. Now I am just wondering what would the effect be if I combine Nebivolol 10mg, Irbesartan, and Guanfacine 1mg, whether I could skip diuretics altogether with such combo
@John Kruse Strange that you did not mention guanfacine 1 to 4mg that many patient praise. The problem with AD is they kill libido although some say bupropion is an exception in that regard. I have a feeling that bupropion/guanfacine/buspirone would be a winning combination for many patients. And if SAD is too strong I would add nebivolol as well. If bupropion is not well tolerated, I would replace it with buspirone 15mg and melatonine 3mg combination that was reported to have AD effects. Guanfacine 1mg Buspirone 15mg Melatonine 3mg Nebivolol 5mg
@John Kruse I believe the most efficient med for SAD is olanzapine, but it is prescribed off-label for obvious reasons: strong benefits but high price to pay down the road (difficult to say what is worse long-term, olanzapine or clonazepam). Hence I believe the key is to go with cocktails, each component acting through a different mechanism e.g. similar to BP meds where rather than increase the dosage of one class another one or two classes are added to the first to fight the cause. More and more pdocs prescribe things like hydroxizin 60mg for night terror anxiety suffered from veterans, yet another dangerous med, but probably less dangerous than benzos. Or mixture of meds that include propranolol (probably for cost reasons, nebivolol is much better, or next in line bisprolol and carvedilol both 3rd generation beta-blocker). So having guanfacine acting directly on the CNS, while at the same time having 5mg Nebivolol beautifully calming the heart thus brain as well, even reversing LVH (I am 100% certain Nebivolol should be used for some SAD, all by itself) among other benefits, together with hippocampus neuro-genesis of the combination Buspiron/Melatonine, my hypothesis is this cocktail would help in many SAD cases with the least amount of side effects possible.
Dr. John Kruse your explanation about ADHD and Social Anxiety is the FIRST time since getting my diagnosis of ADHD at age 51 yrs old that I could see where this fits. I questioned my diagnosis because it felt like my whole life it was anxiety distracting me but that in of itself is causing the inattention. I thought it was simply anxiety. However, I can see now that’s theirs really not that much reason to try to differentiate. I am trying Adderall right now and noticed it does seem to tamp down whatever is going through my head and for a few hours I can be doing something and stop walking in rooms constantly and don’t know why etc. I went from 10mg 3x a day to 15mg because I just wanted those thoughts to stop. Noticed anxiety symptoms considerably worse so backed back down. That with a small dose of anxiety medication is most helpful. I am going and doing the “thing” as I call which I contribute to the Adderall and the anxiety med is just there to counteracts some effects of the Adderall.
I'm glad that my explanation made sense for you.
In my (female) personal experience of ADHD and social anxiety, I find that I spend a lot of time replaying conversations. I seldom have social anxiety in anticipation of a social event unless I know it will be difficult. Instead my anxiety occurs after the event, when I replay my conversations in my head ad nauseum. I think I am often checking if I said the right thing, double checking that I didn't make any social "mistakes", checking how I may have come across in the moment etc.
I catch myself thinking about this and decide I don't want or need to be thinking about it and replaying the conversation. I know mentally everything I did was fine and if not that's ok too. I may manage to switch my attention to something else. Then a short time later the replaying comes back into my head and it's a few minutes before I even realize I am thinking about it. I try to stop again. This repeats. It is very distressing.
I only recently put together that this may be an issue of attentional regulation and thought switching rather than pure social anxiety. Could that be a factor in what is going on?
@John Kruse I have begun Intuniv XR (Guanfacine) a couple months ago, and I am finding it does help with being able to control and set aside these types of thoughts.
Awesome video. I was recently watching a podcast from Michael Singer, author of two great bestsellers, distinguish between the mind/emotions and the “You” who recognizes the former. When your consciousness is focused inward on what Eckart Tolle would refer to as “pain bodies”, past negative experiences which one stored internally instead of letting it pass through, future similar experiences can trigger the same response. Attentionally, one is inwardly focused in these cases which leads to less than optimal social experiences.
great video!
Hi, do you have the references for stats i.e. 30-40% of people with ADHD have SA. Also is there any literature about the 3 similar symptoms (social difficulties, inattentiveness and failure to complete tasks). Many thanks.
BPD impulsive type also exhibits impulsivity.
@John Kruse I am now 1mth on nebivolol, and my focus and productivity/motivation improved significantly. I regret starting on diuretics many years ago as now there is rebounding effect when I stop. Diuretics are one of the worst meds out there. Seems impossible to get off them and I still have to take 12.5mg HCT. Now I am just wondering what would the effect be if I combine Nebivolol 10mg, Irbesartan, and Guanfacine 1mg, whether I could skip diuretics altogether with such combo
Can social anxiety become better when taking adhd meds ?
@John Kruse Strange that you did not mention guanfacine 1 to 4mg that many patient praise. The problem with AD is they kill libido although some say bupropion is an exception in that regard. I have a feeling that bupropion/guanfacine/buspirone would be a winning combination for many patients. And if SAD is too strong I would add nebivolol as well. If bupropion is not well tolerated, I would replace it with buspirone 15mg and melatonine 3mg combination that was reported to have AD effects.
Guanfacine 1mg
Buspirone 15mg
Melatonine 3mg
Nebivolol 5mg
@John Kruse I believe the most efficient med for SAD is olanzapine, but it is prescribed off-label for obvious reasons: strong benefits but high price to pay down the road (difficult to say what is worse long-term, olanzapine or clonazepam). Hence I believe the key is to go with cocktails, each component acting through a different mechanism e.g. similar to BP meds where rather than increase the dosage of one class another one or two classes are added to the first to fight the cause. More and more pdocs prescribe things like hydroxizin 60mg for night terror anxiety suffered from veterans, yet another dangerous med, but probably less dangerous than benzos. Or mixture of meds that include propranolol (probably for cost reasons, nebivolol is much better, or next in line bisprolol and carvedilol both 3rd generation beta-blocker). So having guanfacine acting directly on the CNS, while at the same time having 5mg Nebivolol beautifully calming the heart thus brain as well, even reversing LVH (I am 100% certain Nebivolol should be used for some SAD, all by itself) among other benefits, together with hippocampus neuro-genesis of the combination Buspiron/Melatonine, my hypothesis is this cocktail would help in many SAD cases with the least amount of side effects possible.