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Dr. Kruse and Huberman discuss the common practice of taking drug holidays from ADHD medications, particularly among children. Kruse points out that while the intention is to reduce addiction risk and tolerance, the primary evidence supporting this practice is related to mitigating growth suppression in children. He questions the benefits of drug holidays for addiction or tolerance, noting the lack of rigorous research in these areas.
Dr. Kruse shares a concerning observation about amphetamine-induced psychosis, a rare but severe side effect of ADHD medication. He points out that it's often overlooked and can lead to long-term psychotic states in some individuals. He also discusses how certain populations, like HIV-positive individuals and those with a history of stimulant abuse, may be at higher risk, emphasizing the importance of awareness and careful monitoring.
Dr. Kruse shares his perspective on the use of high THC cannabis and stimulant medications for ADHD. He expresses concern about the potential for increased risk of psychosis, especially in individuals with a family history or previous experience of psychotic episodes. He also highlights the lack of regulation in the cannabis industry and the potential for variability in THC content, which could further exacerbate the risks.
Dr. Kruse challenges the traditional view of career paths for individuals with ADHD, suggesting that instead of striving for a single, long-term job, they may thrive in multiple shorter-term careers due to their interest-driven nature. He also notes that society is becoming more accepting of varied career trajectories.
Dr. Kruse explains how ADHD can manifest as difficulty with time management and forgetting meals, even in successful individuals. He highlights that emotional regulation problems, affecting a significant percentage of people with ADHD, are often missed in official diagnostic checklists, making this a valuable insight for understanding the complexities of ADHD.
Dr. Kruse emphasizes that regular sleep timing is as important as sleep duration for quality sleep. He notes that people with ADHD have a propensity for being night owls due to genetic factors and procrastination, but consistency is key. He suggests stimulant medications can paradoxically help synchronize circadian clocks, offering a practical tool for improving sleep.
The speakers discuss the relationship between ADHD and addiction. They clarify that adults with ADHD face almost double the risk of substance addiction compared to the general population. Interestingly, stimulant medications, when prescribed to children with ADHD, can normalize and even reduce their risk of developing addiction problems later in life.
Dr. Kruse shares his knowledge about fish oil for ADHD, discussing the conflicting research findings and the importance of considering both EPA and DHA. He recommends targeting about 1000 milligrams of EPA per day and suggests that getting a combination of EPA and DHA is likely better for overall health, as the brain is high in DHA.
Dr. Kruse explains Guanfacine and Clonidine, alpha 2 agonists that were originally anti-hypertensive medications. He clarifies how Guanfacine's mechanism for strengthening synaptic connections differs from stimulants, offering a nuanced understanding of ADHD medications.
Dr. Kruse and Huberman discuss Modafinil, its history, and its effects on wakefulness and cognitive function. Kruse explains its original use for narcolepsy and shift work disorder. The discussion covers the distinction between Modafinil and its longer-lasting version, Armodafinil, and their potential benefits for ADHD, highlighting a study suggesting Modafinil primarily boosts cognitive functions rather than just motivation.
Dr. Kruse explains the advantages and disadvantages of immediate-release vs. extended-release ADHD medications. Immediate release offers flexibility and a noticeable effect, but can lead to a crash as it wears off. Extended-release provides a smoother experience but may be harder to feel. He highlights Vyvanse, designed to be abuse-resistant, has a smooth and even effect due to its unique mechanism.
Dr. Kruse explains how ADHD is diagnosed, the criteria, and the symptoms, highlighting that these symptoms are common behaviors that are displayed to an excessive degree, causing dysfunction and distress across multiple areas of life. This provides a foundational understanding of ADHD for anyone seeking clarity on the condition.
Dr. Kruse explains that the ADHD brain relies more on external structure, and the pandemic created a 'perfect storm' by decreasing structure and increasing cognitive demands. He notes the surprising lack of initial predictions about ADHD increases during COVID, highlighting the strong genetic component and the defensiveness of the ADHD community in acknowledging the nurture component.
Dr. Kruse discusses time perception in people with ADHD, noting lab tests show inconsistent time estimation. He also touches on real-world implications, like chronic lateness, and the importance of understanding individual perceptions of time. He mentions research suggesting ADHD may be linked to circadian rhythm disruption and how bright light therapy might improve ADHD symptoms.
Dr. Kruse discusses how social media and constant interruptions can train the brain to overreact to distractions, making it harder to sustain attention, which can make people more ADHD-like. However, it's not all bad; people may become more adept at certain tasks like detecting visual items and multitasking, although performance on individual tasks may still suffer.
Dr. Kruse clarifies that ADHD is not a deficit of attention but a deficit of control over attention. He explains the three realms of attention control—directing, sustaining, and shifting—and notes that people with ADHD have less volitional control in all three. He also discusses hyperfocus as a superpower related to flow state.
Dr. Kruse shares insights on the cardiovascular risks associated with stimulant medications for ADHD, referencing a study that looked at data up to 14 years out. He highlights that while there is a slight increase in risk over time, the absolute rate is still very low for most people. He also emphasizes the importance of thorough history taking and family history to identify individuals with rare genetic conditions who may be more vulnerable.
Dr. Kruse shares insights on the use of nicotine, caffeine, and L-theanine for managing ADHD symptoms. He explains that nicotine can improve executive functions and reduce anxiety, while caffeine, though widely used, is a less effective stimulant compared to prescription medications. He also discusses the potential benefits of combining caffeine and L-theanine, as well as the importance of being aware of the varying dosages in over-the-counter products.
Dr. Kruse shares key strategies for improving sleep, particularly for those with ADHD. He highlights the importance of eliminating stimulants, exercising earlier in the day, and, most crucially, keeping phones out of the bedroom. He also suggests leveraging support from partners or family for reminders and recommends cyclic sighing to engage the parasympathetic nervous system, making it easier to fall and stay asleep.
Dr. Kruse challenges the conventional understanding of how ADHD medications work. He argues that the speed of dopamine reuptake blockage by drugs like Wellbutrin suggests they should have immediate effects, contrary to the common belief that they work slowly. He uses a patient anecdote to support his point.
Dr. Kruse reveals that individuals with ADHD have a significantly shorter life expectancy (around 10 years less) due to accidents and suicide. He emphasizes that ADHD isn't just about trivial issues but has serious repercussions on education, social relationships, and earning potential.
Dr. Kruse shares valuable insights on cognitive behavioral therapy (CBT) techniques specifically designed for people with ADHD. He explains the core components of these approaches, including scheduling, task lists, and prioritization strategies. He emphasizes the importance of having a consolidated task list and using a simple triaging system to prioritize tasks based on urgency and importance.
Dr. Kruse advises that scheduling should prioritize the four basics: sleep, eating, exercise, and relaxation. He emphasizes the critical role of sleep for everyone, especially those with ADHD, and highlights the importance of regular meal schedules.