So, hi everyone.

Welcome back to another episode of the ADHD Women's Wellbeing Podcast.

And because it's during this sort of weird, festive period and everyone's doing their own thing, I just wanted to bring you something different and I hope something helpful.

And today I'm bringing what I think is a fantastic resource.

I spent about two hours with an amazing ADHD psychiatrist whose name is Dr.

Asad Rafi.

He is the owner of Sanctum Healthcare here in Manchester and he, he is an ADHD specialist.

And I got to sit down with him and ask him lots of questions.

And what happened was I brought in questions from this community as well, and I thought it's nothing better than having other people's perspectives.

And I always know that when we ask questions, we're helping so many people.

We can always see ourselves in other people's questions and queries.

And we talk in this clip about how we can use our ADHD diagnosis as a way to change our lifestyle, to look at our lifestyle alongside medication.

If we've been diagnosed officially and we're able to have medication and it works, that this is not just the only option, that our lifestyle is so, so important.

And obviously I talk about this so much on the podcast, but everything has to be personalized.

We have to find the ways that suit us, especially with the medication.

We know that it takes quite a long time with the titration and the different types of medication, and it's very similar with what works for us in a wellbeing capacity, what supplements, the way we, you know, find better quality sleep, how we exercise, move our body, the nutrition.

And it's all about finding this self awareness, this space to get curious and to ask questions and to notice how we feel when we are going to bed later or we're not eating, you know, a protein heavy breakfast, all these different things, and really leaning into how we can curate our own personalized treatment strategies.

So in this clip you'll hear that it's a response to a question from a listener who is in her 60s and she has this new recognition of her ADHD and unfortunately feels really overwhelmed by all the options for managing her ADHD brain, her wiring, her understanding.

And this is a very common occurrence that we get this diagnosis.

And it's been, after many, many years, decades of not understanding ourselves and going to different specialists and experts, and we still don't get the answers.

And, you know, further down the line, especially with menopause, you know, perimenopause, it feels like an uphill battle.

So I hope that this question and the answer from Dr.

Raffi will really help you find, I guess, your way, your path with all the self compassion.

I think from this person's perspective, I think what she is maybe alluding to is that because of the awareness of adhd, because of the awareness that there's a lot more conversation about adhd, menopause, hormones, ADHD in women, we never knew it even existed, like, up until a few years ago.

So she's obviously piecing together the many chapters of her life.

And so when you say, has it been pervasive, has it impacted her potential?

And the other, you know, the other sort of like tick boxes, let's kind of say it has.

And she's now been able, you know, at the age of 60, to understand how much has impacted her.

Because I know for sure that so many women who come to me, they're not coming to me and going, oh, I'm just a little bit forgetful, or I'm just, you know, I'm not very organized.

These are women who have been so debilitated and challenged by this undiagnosed ADHD or neurodivergence.

And maybe, yes, like you say, the drop in hormones during perimenopause have amassed it even more, but they have, they are exhausted, they are depleted, they have just like hit breaking point.

So I don't think people are just coming and going, oh, I've had a year of brain fog.

They're coming because it's been decades, but no one's given them answers, no one's helped them, no one's supported them.

They've been passed from pillar to post, they've been put on SSRIs or, you know, antidepressants.

Things haven't worked.

So they're kind of going, oh, my God, I've read this article or I listen to that podcast, that is me.

And many of them aren't able to get a diagnosis yet.

Like, it's so overwhelming.

And when you're in your 60s and your 70s, you're right.

Like things, things are.

Your brain isn't kind of operating as quickly as it is it did, you know, you know, in your 20s and 30s.

So where would people start?

This lady appears to have identified with something that she's read or potentially some form of narrative, which ultimately is that penny drop moment, isn't it?

And you can start to think, well, hang on a minute, that, that sounds like me.

Because everything else I've tried so far hasn't worked.

So I've got to start to question whether it was the right diagnosis that may have been given previously, because whatever I've tried hasn't worked.

And this is the problem.

We don't question some of those diagnoses.

We don't even question the treatments.

We assume that we've been to see a doctor, we've been to see a professional like me.

Okay, let's not blame anyone else.

Let's talk about me.

You've been to see, you know, a professional like me, and dependent on their perception of my credibility, they'll take on board that advice and ultimately say, right, yep, it must be what he said it was.

And they're going through this whole process of trying different types of medications, and ultimately sometimes they're even given the answer.

Maybe you're just resistant to these medications.

Maybe they just don't work.

And, sorry, I can't help you any further.

Off you go.

And therefore, where are you going to go?

You're going to look at sources of immediate, accessible information.

Not all of it's going to be credible.

And if you look at what's online, you know, I look at platforms like LinkedIn, I'm still Facebook generation, unfortunately.

Facebook, you're looking at Instagram.

There's a lot of.

A lot of stuff on there, which is good, it's reasonable.

There's a lot of personal experience, which is then becoming the.

This is how ADHD presents.

You know, your journey is different to my journey, which is different to somebody else's.

That doesn't mean what works for me works for everybody else.

So we shouldn't make that a given either.

So people will need to be given the right message.

They need to understand, you know, from the right experts exactly how, you know, these conditions present.

And where the evidence base is, is if we're looking at supplements online, let's not forget that there is a.

An opportunistic market out there, okay?

You've got vulnerable people who are seeking support and help.

Getting that support and help is going to be limited by accessibility, by cost, by, you know, not knowing where to go.

It's an absolute minefield.

So, yes, there are going to be organizations, there are going to be people out there who are invariably going to be taking advantage.

Some of these supplements are effective.

Just because there isn't an evidence base to it doesn't mean it doesn't work.

But actually, we need to be doing our own due diligence or seeking out clarification from experts as to whether or not those supplements work.

To me, sometimes the supplements, even some of the other interventions that people consider will give you some benefit, but it might only be a marginal benefit.

Looking at marginal percentage gains.

Let's go back to the basics.

Let's get the basics right.

Let's look at how you can manage that ADHD and if that means understanding how things like medication work, you know, understanding how you start to learn about and understand how you operate because you understand what the condition is, correct.

Your sleep, for God's sake.

I'd say 80 to 90% of people with ADHD have sleep related challenges.

And I will have these conversations where they'll say, I get eight hours sleep, I get seven hours sleep, I'm okay, I've not got a sleep issue.

It's not necessarily about the quantity, it's also about the quality of that sleep as well.

It's not restorative.

When we start to do a deep dive into REM sleep and looking at deep sleep, we see it's compromised in individuals with adhd.

That poor sleep then compromises their ability to function on a daily basis.

So you've got this bidirectional relationship and I'm constantly banging this drum of, don't just focus on managing the adhd, fix the sleep.

Let's manage those hormones as well.

Let's look at nutrition and diet, let's look at movement and exercise.

It's got to be a whole systems approach, not just get on it in isolation.

Yeah, okay.

It's really powerful to hear a psychiatrist talk about all these lifestyle changes that are so integral to managing our adhd.

And like you say, like, we know that all of this goes back to brain health.

So if we've got optimum brain health, despite having this disorder, difference, whatever you want to call it, we are, you know, we're supporting our brain.

So like you say, it is going back to those fundamentals of what we can control within our limitations.

And as we grow with awareness and education and understanding, we do our own psycho education, we're then able to go, oh yeah, I'm really noticing that that sleep pattern, you know, the scrolling till midnight every night, waking up, darting out of bed, checking my phone a million times, like all these little things can contribute to the feelings of anxiety, overwhelm, exhaustion.

And it's those little tiny tweaks and changes that can have this incremental impact on actually, I feel better, I can feel better.

And the hormones, I'm so glad that you mentioned that because if we can say, right, well, let's look at sleep, let's just change a little something there, let's introduce Some, maybe some hormones or let's see what hormones you are taking and replace them with something different.

What are you eating in the morning?

Like what breakfast are you having?

How much much sunlight are you getting?

Are you moving your body?

Are you finding time to sort of have a bit of decompression, a bit of meditation, mindfulness, whatever works for you.

And I know I'm not diminishing everything that you do as a psychiatrist, but I like to hear that you can see the impact of looking at it from a lifestyle perspective in combination with potential medication that can also help and bring all together.

Well, let's go back to the initial analogy that we, that we had which was comparing ADHD to diabetes.

Okay.

And let's assume now this is the diabetes podcast.

We would not sit here talking about diabetes from the perspective of eat what you want, don't exercise, don't look at your cardiovascular health, don't look at other elements of your physical health, just take a load of insulin or a load of metformin and everything's going to be okay.

Why is it that we perpetuate that narrative about adhd?

The go to becomes medication and then ultimately what happens?

Let's say you come to me, right, and I say it's adhd, okay, and we're going to start you on medication.

Invariably, this is the pattern that I see, and especially when it comes to high performing individuals, when they start to see an improvement from taking that particular medication because of those years of habitual need to be productive all the time, they start to see that whatever they're doing on a nine to five basis starts to become a lot easier, a lot more efficient.

So what happens where they were struggling to get tasks done within an eight hour period, they're now getting done within four or five hours, which means they take more on, more stress and more load onto that plate, which means ultimately it's then going to compromise their ADHD symptom control.

We know that stress has a significant impact on adhd.

Okay.

And I'll come back to that in a moment.

But invariably then what happens is I've taken more on at work, I'm more productive, I'm doing more at home, and I've joined the gym.

And suddenly this revolution has occurred.

And partly that's because of the nature of the condition.

Invariably, then there's more pressure, there's more stress, we're probably not sleeping as well as we could be further compromised.

So, Dr.

Rafi, medications aren't working as well.

Can I have more medication?

And you kind of go, hang on a minute, let's see what's going on around this whole picture.

And you start to unravel these elements.

How medication should be used is on an individual level, okay?

So do not think that one size fits all.

You need to adjust it according to the individual's lifestyle and requirements.

But use the least amount possible that gives you that maximum effect because you want to mitigate some of those potential side effects.

And every single everything that has an action has a reaction.

So even food has a side effect and a reaction, as does every single medication under the planet.

But this is about educating people to say, do not rely upon medication or as a compensatory mechanism or strategy to overcome sleep deprivation, stress, hormonal imbalance, not eating the right food and not exercising enough.

Because you know who's guilty of that?

Me.

I know that I've done that in the past where, you know, I've taken on, I've become more productive and I can relate to it because my need to be productive all the time is addictive.

And we know that.

It's that dopamine chasing that we engage in because success work for me gives me that immediate gratification and long term gratification.

So that's something that I need to keep a check on.

But do not compensate for it.

Make sure that you're going out and not compromising the things that, you know work for you.

For me, it's exercise.

It's that platform through which I can expend that energy.

If I'm not going to the gym, if I'm not running, if I'm not doing the things that I should be doing, what happens?

I'm just bubbling up inside.

I'm getting stressed.

I struggle with mindfulness, okay.

I will struggle with doing any kind of breath work.

Albeit to be fair, I haven't probably been taught the right way.

So, you know, I can't write it off.

But.

And it takes practice, but look at other things that you might enjoy.

Believe it or not, I love building Lego.

Right?

That helps me.

That's my thing.

I'm not going to.

Well, I'll tell you then.

I love singing.

Yeah.

So if you see me in the car, driving down the street, you'll see me singing and you probably just think he's a bit mad, which I probably am as well.

But these are the things that are going to help find your thing in life and whatever that is, Let it work for you, go with it.

Think about adhd.

A bit like trying to run a marathon.

Not all of Us are equipped to run a marathon, are we?

Right.

Doesn't mean that I'm defective in some way or you're defective in some way.

We're just not built that way.

And ultimately we've got to train for that marathon.

And there might be times when you do a really long run in preparation for that particular race, okay?

And you're doing your 30k runs and your 32k runs.

You're not doing that all the time.

You're doing the short burst.

So you've got, you've got to be able to dial it up, dial it down, and that's the way you've got to look at it.

The problem you've got with those of us who have ADHD is that constant need to be productive, that constant need for internal and external validation by constantly being on top note all the time.

If not even top note, then that incremental constant need for improvement.

Improvement, improvement.

We have got to get to a stage to learn, to become satisfied with things.

That's fundamentally one of the issues, okay, is that we're not easily pleased.

The novelty wears off very quickly.

And actually, you know, we, we overanalyze things.

Our expectations are much greater sometimes than the reality of the things that we do.

The people we meet, the places that we eat, the things that we buy, the place that we go on holiday.

And actually when we don't have expectations of things, we actually have a probably a better experience.

It's so important what Dr.

Raffi has just said about focusing on getting the basics like sleep right when we're thinking about the well being and the holistic habits that are going to have a really positive impact on our adhd.

And this next clip is all about our self esteem alongside ADHD and how growing up without this understanding or this awareness of why our brain feels different, why it's wired the way it is, can have such an impact on our self confidence and our self image, our self belief.

So we also address this potential for misdiagnosis that many of us have gone through with the many different overlapping symptoms of the conditions and this lack of understanding with ADHD that has sort of unfortunately plagued mental health professionals that many of us have gone through decades of being diagnosed with anxiety and depression and OCD and perhaps, you know, disordered eating and addiction.

And yes, it is very upsetting and difficult.

But now I hope through so much more awareness conversations like this on the podcast, that more mental health professionals and doctors are recognizing that ADHD neurodivergence is very often the root of These mental health conditions and then we get to the roots.

We're able to understand, we're able to pick it apart and really help ourselves and feel more empowered.

Have a listen.

There's something that really holds back a lot of us who have ADHD is our confidence in our self esteem.

That narrative in our minds that we're not good enough because we're constantly told, don't do this, stop this.

Believe it or not, there's research out there that tells us that a child by the age of 10 who has ADHD compared to their neurotypical counterparts, faces almost 20,000 critical comments.

Okay, by the age of 10, what impact is that going to have on their self esteem?

So, yeah, do you know what?

We're going to be racked by self doubt.

Okay?

That fear of failure, fear of being found out.

We've got huge imposter syndrome.

Oh, go on, go and set up a private clinic.

You go and set up your podcast.

Go and do whatever you've got to do.

Yeah, but I'm not good enough.

Why me?

Do you know what?

No, there's, there's better people out there than me.

Right?

And then we'll self sabotage it.

Yeah, we'll find a reason not to do it.

And this is where we've got to remember, this is the element of ADHD that's the most debilitating.

It's the bit about ADHD that we all relate to.

It's the element of the condition.

It impacts how we perceive things, how we think, how we feel, how we behave.

It ruins days, it ruins relationships, it ruins absolutely everything, the mood and the emotions.

But here's the key thing that becomes the predominant problem in your life.

Now, if I come to you as a patient, the gp, and that poor GP who has not been given training exposure to this condition, has got 10 minutes in which to talk about.

Right, Assad, what's your predominant problem?

I've got difficulties with managing moods and emotions.

I'm suffering with my self esteem and confidence, getting really irritable.

Doctor.

And you know, I overreact to things.

It's affecting my relationship.

Really sensitive when someone says something to me and even though my wife may say something to me and it's not, she's not trying to be critical.

I always assume the worst, but I'm constantly giving too much to others, trying to people please all the time and it's exhausting and I need structure, discipline, accountability, consistency in my life just to keep things together and if I don't adhere to that, things fall apart.

And I've got to be accountable to others.

I've got to be accountable to myself.

I feel like I'm running a constant checklist.

Without it, my life falls apart.

But then, you know, I'll flip between if someone's having an event or a party, I've not been invited.

Huge amount of fear of missing out and rejection.

But at the same time, you're damned if you do and you're damned if you don't.

Because if you do invite me, I'm sat there thinking, oh, my God, I'm overthinking.

What am I going to do?

What am I going to wear?

Who's going to be there?

Oh, my God, I don't even want it.

I don't want to go.

I'm going to find a reason to mess it all up, okay?

I'm going to be hugely avoidant.

And you know what?

This mask and this veil that I've got to wear on a daily basis because I'm a doctor or I, you know, whatever else I do, I've got to keep up front of my kids, my family.

Whoever it.

Whoever it is, it's.

It's tiring.

And sometimes I question my purpose.

And I just think, what's the point now?

What's that GP going to think?

Yeah.

This is why there's such high rates of misdiagnosis of conditions like depression, bipolar disorder, borderline personality disorder, dare I say it, when there's a flavor of trauma.

Okay.

Or adversity in childhood.

Adversity in childhood.

And trauma is inextricably linked to ADHD as well.

It's one of the etiological elements.

When you're one of those factors that will contribute to ADHD becoming more apparent alongside your genetic risk, the heritability rates that are so high, invariably, there's that bias there.

And even there's, you know, there is the symptom overlap with autistic spectrum conditions.

Well, if you've got a bias towards a certain condition or if that narrative is being presented in a certain way.

Doctors only as good as, A, their knowledge and B, what their patient's telling them.

And this is not me giving you an excuse for doctors, you know, misdiagnosing or not being accurate, it's giving you that explanation.

This is what we see.

Yeah.

Place the blame on us, the psychiatrists.

We don't understand this condition well enough.

Thank you so much for listening to today's episode.

I do hope you found it helpful and, I guess, validating to know that you're not on your own that your experience isn't yours alone.

And there are many, many people that have gone through what you've gone through in different capacities.

And the most important thing is that we come together and we communicate and we ask for help and we learn.

We learn and we create awareness and we advocate for ourselves.

There will be another Ask the Psych episode out next week, and there will be the Toolkit episodes as well released.

So please listen out for those.

Take care, and I will see you all very soon.