[0:35] Ian: Hello and welcome back to the Smart ADHD podcast. Today we're tackling one of the most talked about and often misunderstood topics in the ADHD world, and that's medication. I'm really excited to welcome back Phil Anderton onto the show. And Phil is the founder of ADHD. com. ADHD 360, a true advocate for improving ADHD treatment and support.
[0:56] With his background as a senior police officer in the UK, he saw firsthand how untreated ADHD can lead to challenges in people's lives. And now he's leading the change in providing proper diagnosis and treatment to thousands of people. So maybe you've wondered if ADHD medication is right for you, or you've heard conflicting opinions about it.
[1:18] In this episode, we're breaking down the biggest myths and getting to the reality of how medication can or sometimes doesn't work for different people. Let's get on with it right now.
[1:29] Hello, I'm Ian Anderson Gray, and this is the smart ADHD podcast.
[1:44] Now if you're a smart, creative entrepreneur or business owner navigating your life with ADHD, This is the podcast for you. Now, I'm no ADHD expert, but I'm eager to share my story on what I've learned by talking with experts, as well as digging into the personal ADHD stories of successful creatives and entrepreneurs.
[2:06] I was diagnosed at age 46, and it answered so many questions in my life. But of course, that was in many ways, only the start of my journey. So let's learn together. Smart stories, smart strategies, smart ADHD.
[2:34] Hello, Phil, welcome back to smart ADHD. We last episode we were talking about assessment and the process. And at the end of that process, there are lots of choices open to us because ADHD is a is treatable. It is treatable with through medication, there's coaching, there's lots and lots of different ways.
[2:57] looking at this, but medication is one that I don't know. It's a thorny issue. I speak to a lot of people who are either they think they have ADHD or they have been assessed and they do have ADHD, but they're Reluctant about the whole medication thing and I have to say I have been in that camp as well I'm on this journey now where I wanted to look at it and what I would say more holistic way, but now I realize actually medication is something I want to pursue now.
[3:27] Why medication how does it actually help? What's go what's going on here?
[3:32] Phil: The first thing is we should acknowledge that medication isn't for everyone and it is a choice about how you want to manage and treat your ADHD. And although we are going to talk extensively about medicine today, I don't, I wouldn't want anyone to think that's the only thing you can do.
[3:46] To help you with your knowledge that you've got ADHD and to improve the quality of your life. There are other things and indeed medication alone won't get you to where you could lead your best life. You need a combination of therapies and a, and ADHD meds, but the focus on this is ADHD meds.
[4:03] And you asked me the question there quite subtly, why medication? And the answer is 'cause that's what works. Medication works and we should not be frightened of it. We should not be fearful. We should actually embrace the fact that I, if we take the paracetamol for a headache, why would we not take a medication to help us overcome the deficits of A DHD?
[4:20] It's that simple in its argument. So the answer is, especially when combined with scaffolding and other therapeutical interventions, ADHD medicines work. And that's the answer that starts off the conversation really.
[4:35] Ian: Yeah. And so how does it work? What's going on? Because people listening may or may not know there are, I'm not an expert on this, but as far as I know, there are two types. There's stimulant medication and there's non stimulant medication. That seems strange to a lot of people, I think, because you're, ADHD, your mind is already buzzing around you've got, lacking that focus often.
[4:58] How does giving stimulant medication actually help you focus and what's the difference between stimulants and non stimulant medication here?
[5:05] Phil: So we teach this at our academy. Every month we run an academy for clinicians, and there's a whole afternoon there, minimum, if not a whole day. In five minutes, I can't justify the whole science piece. But it's all down to the pathways in the parts of the brain that we're talking about. The prefrontal cortex, which is the forehead for want of a description.
[5:27] The pathways in there are are our nerve box, our control room for everything that happens. There's a great clinician, Tom Brown, Professor Tom Brown, who works out of California now, used to be at Yale University, an extremely learned man who we're privileged to have as a friend and colleague. And he describes the brain as an orchestra.
[5:46] And imagine that you've got the world's best timpani, the world's best strings, the world's best brass and they've all, so you've got the best players, you've got the best instruments, and everything's ready. But the conductor, which is the part of the brain that we're talking about with ADHD, is tone deaf and can't understand anything.
[6:04] Doesn't matter how good the instrumentals are and how good the whole piece is. If we conduct it wrong, we're going to have a cacophony of sound as opposed to a beautiful piece of music. So what's going on in the ADHD brain is the conductor isn't working properly. So you could be really bright, really artistic, really clever, mathematical, you could be great with language, but if your conductor, the prefrontal cortex, isn't working properly, you're not going to be availing yourself of anything, you're going to have that cacophony.
[6:29] Now, to get it working, what we've got to do is recognise. That the chemical dopamine that runs in on synaptic processes and helps the synapse work properly is not at the optimal level. So we have a dopamine production or absorption or use of deficit and we need to stimulate that production of dopamine and the use of dopamine to the right levels to be truly effective.
[6:55] That's what the medicine does. Now the counterintuitive part of that argument, Ian, is that if the part of the process that we're stimulating is the one that says, you need a filter here, you need to slow down here, Ian, it's time to yank the handbrake, you're just about to say something that's inappropriate.
[7:12] And the dopamine is not allowing that filter to work properly. We have to stimulate that dopamine production so you can yank the handbrake properly. And that's where it becomes counterintuitive. How can stimulating a blabbermouth slow them down? And it's because it gives you the inability to automatically have the handbrake in the filter.
[7:32] The stimulant medication is doing just that. It's making sure that we're getting the best dopamine levels, using them appropriately, properly. So we can actually function in a way that is more acceptable, easier to live, easier to run, easier to be. And that's why we would have stimulant medication to stimulate someone that might be hyperactive.
[7:51] Counterintuitive I accept, but that's where it works and that's what it does. And then the second part of your question is, why would you have non stimulants? The non stimulant medicines, they came about in the last 15 years really. Okay. where some people can't tolerate stimulant medication. So what are the alternatives?
[8:11] And there are two main alternatives in the UK. And they attempt to do what we're trying to achieve in a different way. They're harder to use, they're not as instantly efficacious as a stimulant medication, but they really do have a place. And it's the clinic's, the clinician's responsibility to work out the best solution for patients.
[8:33] And, to rabbit and ramble on even more about it. The art of the assessment is often the part that is focused on with an ADHD treatment plan. But I would argue that it's the art of the pharmacology which is where we make the bigger difference and we need the greater skill set. The assessment has to be done appropriately and we talked about that in the last podcast.
[8:52] But the medication needs a pharmacology level of expertise. There are so many different medications to choose from. Which ones you start with, which ones you switch to if that's not working. What's going to be the optimal dose? How do you plan the optimal dose? How do you work with the patient to make sure the side effects are tolerable?
[9:07] So on and so on. That's the complexity. And that's Where I think specialist knowledge really comes to the fore.
[9:14] Ian: that makes sense because we're all different. We're going to have a different experience with different medication. I love those analogies. I've never heard it described that way. That is so helpful. And also as a, as a professional musician the, the, the orchestra with The uh, conductor who's turned down went down well with me.
[9:32] So I want to ask you some, like a series of questions that a lot of people are have asked when it comes to medication or these are concerns that people have had, some of them are concerns that I've had. Some of them are ones that other people have had as well, but they're common questions.
[9:46] And maybe one of the big ones is we've already covered stimulants, but some people will say Aren't these like amphetamines? These are drugs that in most countries in the world are banned. Surely that's not a good idea to to take those. And obviously, we know that the answer, you've already kind of answered that, but If somebody came to a clinic and asked, had those concerns, what would you say to them about that?
[10:10] Phil: Some great questions there straight away, Ian. And they are the pertinent questions. And it's good to get into the detail. The meeting I had before we recorded our first podcast together was with a a young lady, 40 year old young lady who was struggling with her ADHD and through impulse and opportunity took cocaine.
[10:29] And she found that the cocaine was actually slowing her down, giving her that handbrake and allowing the orchestra to play melodic tunes. Because the cocaine was altering the dopamine in her prefrontal cortex and doing the job that medicine would do. Straight away we can see a parallel between unlawful substances and what we're trying to achieve.
[10:51] So yes, amphetamine is an unlawful and very dangerous drug. And when taken on the streets at varying strengths, various doses, we are in the territory of unlawful behavior, but very dangerous behavior. Now if you take amphetamine and turn that into a medicine, and you produce that to high medical standards, and put the controls in place, it is a controlled drug.
[11:15] And you tweak the compound so that it becomes more accessible and safer for the patient to use than snorting it up your nose or popping a pill off the street. You start to see the benefits of what that chemical can do, but with safety controls around it. If I give you an example long lasting, longer acting, prolonged release amphetamine is an incredibly safe medicine.
[11:41] It's made safe by the pharmaceutical industry. If you go to Camden Lock and buy 20 worth of amphetamine, you don't get any of that control around it. I would much rather see a patient taking an amphetamine based medicine that has been produced to be safe and administered safely than them refusing medicine and relying on alcohol, snorting stuff up the nose and buying tablets from a dealer at the side of the road.
[12:09] Yes, the core chemical base might appear to be the same, but from that moment on, there's no parallel between the two. And we have to, and we should accept, that for decades, speed has been used appropriately in society, and now it's being used appropriately in medicine, and we shouldn't run away from that debate.
[12:31] Ian: Yeah. That's really helpful. I don't, I think this is a concern that a lot of people have, and I have to admit, it's a problem that I've had, I've always been, the idea of taking, Illegal substances into my body. I've always been like against that idea and think, and then the idea of actually taking them myself the point is that these are controlled, they're tested, they are safe.
[12:51] They've had decades of this testing. And so that's such a helpful thing to remember. I think now the other. thing that I hear some people say, and this is probably an older thing. We're maybe going back 10, 20 years ago, but people of my generation, remember kids who were being diagnosed with ADHD and then given these these medications and then saying that they turn into zombies and they just that's how they remember.
[13:19] ADHD boys in their class, they're just they take the medication, they turn into zombies. Now, I don't know, I don't remember any of that. But that's what some people, that's their concern. What would you say to that?
[13:30] Phil: If we go back to when those stories first started to percolate. The most available medicine then, the one that most people have heard about is Ritalin. That was one of the former medicines. And if we liken to an analogy again, if I may, Ian. We've got an expensive piece of mahogany, the human body, that's the parallel, expensive and rare.
[13:49] We've got to get a brass screw into that piece of mahogany to make an effect. Thank you. If we take a lump hammer to that screw, we're going to bend the screw and burst the wood open. We need the finesse of a decent screwdriver with a craftsman to put it in. The medicine's the screw, the mahogany's the human body.
[14:09] And the Lump Hammer is 20 years ago Ritalin. As a medicine, it was crude, it was blunt, and it wasn't sophisticated. And boy have we moved on. We have massively moved on with medicine. I use the expression, and people always raise their eyebrows and have a giggle at me, but some of these modern medicines are really quite sexy.
[14:28] They're amazing, the things that they do. They are quite incredible. And we're no longer using the blunt hammer for the brass screw in the mahogany, we're now using the finesse of a very well tooled screwdriver as the tool. The modern medicines are well, honed and very accurate to use. So if the patient responds with a dulling down of things that is not acceptable to either that patient, their family and friends and peers.
[14:57] Then we would change either the medication or the dose and fine tune things. You can do that if you're using an appropriate screwdriver on your brass screw. You can't do that if you've smacked it with a lump hammer. And the beauty of pharmacology, it comes back to the science of pharmacology, is you can different doses, different types of medicine, different delivery mechanisms of that medicine even.
[15:19] Some of the medicines that the other group, we've discussed amphetamines earlier, the other group is the methylphenidate group and Ritalin is a methylphenidate medicine. But there's one medicine that gives you 50 percent of your medicine in the morning and 50 percent in the afternoon, just by swallowing a pill the size of a Tic Tac.
[15:36] That's sophistication. There's another one, same size, delivering the same drug, that gives you some instantly, 22 percent first off, 78 percent later on in the day. And you adjust what you need around the patient's requirements and the patient's needs. And that is a completely different scenario. to the lump hammer that we had 22 years ago and the finesse that we need to articulate.
[16:04] With the use of the screwdriver is the clinical expertise and we no longer see that inappropriate dullness, the flattening to a point that is, to use that word that you've used, zombified . We don't get that anymore because we've got appropriate medicines, much more sophisticated medicines, and we've got highly trained clinicians using them.
[16:25] Which puts us in the business of having a really great carpenter with a really great set of screwdrivers to Representing that, how we put that brass screw into the piece, the expensive piece of mahogany. It's a different world to the lump hammer world of 22 years ago.
[16:39] Ian: That's exciting. I hadn't realized how much of a move transition we've had in that world. And I know the answer to this question, but it's a common question that people ask or it's a concern that people have is if I take ADHD medication, isn't that going to change my personality? Isn't it going to take away all the positive things about my ADHD? My life, for example, my divergent thinking, my wacky sense of humor, all those kinds of things.
[17:04] What would you say to that?
[17:05] Phil: If it does, we've done something wrong. What we've got to do is give you the ability to yank your handbrake and focus on the things you want to focus on. If we change your spirit and change who you are, we might not be getting everything right. But there is a consideration in there that we have to think about.
[17:22] You're, you talk about your divergent thinking, your inability to impulsively do things. But we, if we can retain that and make that an appropriate set of decision making and give you control and focus, we're doing the right thing. And what we'd never want to do in a clinical setting is even attempt to change who you are.
[17:42] What we need to do is give you back the freedom to be who you are in the most positive way. A patient I spoke to earlier this morning could never organise getting her son out of the door, to the point where a two and a half year old son would say to her at the front door, Have you got your mobile phone, Mum?
[17:58] Now, that's not a positive place to be as a human being. Now she's in treatment, she's setting out his clothes on a Sunday evening for the whole week. She's still the spirited, loving, caring person she was, but she's more organised, and she's no longer forgetting her phone. Yeah, we could turn you into something that you don't want to be.
[18:15] But that's incorrect, that's not good medicine, that's not a good set of relationship and processes with you, the clinician, and yourself. So what we've got to do is work out what your goals for treatment are and achieve those goals with you.
[18:28] Ian: That makes sense. So we're getting towards the end. I've got a few more questions that I want to ask you. Or these are concerns that people have. One of them is, aren't they addictive? We're going back to the, these are kind of amphetamines. These are addictive drugs. So how would you address that?
[18:43] Phil: So the medication is not addictive, the medication doesn't cause addiction. It can be extremely encouraging to know that when you take your medicine you're going to be able to lead your best life as opposed to when you haven't taken your medicine you can't lead your best life. So that in itself is something that could be translated as addiction, but being encouraged and motivated to be the best person you can be is a very positive place to be.
[19:06] So instead of seeing addiction as a negative, the medicines aren't addictive, but those changes, those positive changes we can make for people is both encouraging and rewarding. So we would hope that when we take our medicine for ADHD, we are encouraged to want it and need it. And that's slightly different emphasis to being addicted.
[19:26] Ian: That makes sense. How about the concern that I don't want to be on, I don't want to rely on medication for the rest of my life.
[19:33] Phil: I sit in front of you today as a 60 year old with hypertension and diabetes, and I have to rely on medication for the rest of my life to function. And I honestly, when I went into taking hypertension medicine for the first time at the age of 40, I didn't tell anyone. I was ashamed that I was no longer a fully functioning human being that could, I could no longer get through life safely without medicine.
[19:55] And I, I didn't want to discuss it with anyone. That's natural. That's who we are. But we have to recognize we can't get through life. Very few people get through life without medicine to help them along the way. The human body is so sophisticated. We need to give it a nudge and a tweak now and again.
[20:09] And I take medicine for my hypertension and I take medicine for my diabetes every day. And I won't be a fully functioning adult if I don't. And we have to draw those parallels. We just have to accept that as we go through life, we need something. It's like putting oil in your car. You need to service yourself.
[20:27] And you need to actually make sure you're going to run properly.
[20:29] Ian: That's a good point. How about the concern that some people say they wear off over time. So you might be great for the first two or three months on medication, but then after that the change or the advantage of taking them isn't as great. Is there any truth in that?
[20:46] Phil: No, none whatsoever. It's hilarious actually because what happens is the patient becomes very used to their new normal. And therefore can't relate back to how it was before, maybe the chaos or the lack of function, lack of focus the inability to retain relationships, friendships, all those things that brought them to the door in the first place.
[21:05] So what we often say to the patient who reflects back is, there's two things we can do. Is we can show them their life before medication, and we've got diagrams and charts of where that was and said, That's where you were. Do you think that's where you are now? No, not really. So has it worn off or have you got used to things?
[21:22] Or alternative, the patient puts you, take a week off your meds and we'll reconvene in a week and within 24 hours they'll come back and say, can I have my meds back please? Because we get used to our new normal. It's a new baseline. And why would the human body want to anchor its back, anchor itself back on all of those struggles and problems we've had when you've now got this new euphoric position of being able to lead your best life?
[21:43] Let's try and forget what we've had before, but in doing that, we can lose sight of the struggles that we had. And sometimes you just need to remind people what it was like before.
[21:52] Ian: That's so true. And then the final concern I think a lot of people have is the cost, okay, if you're going through the NHS, maybe that's free, but parts of the world private, it can be very expensive.
[22:02] Phil: And I know that how I answer this question, which I've been asked before, which doesn't put it down, it's still a very valid question. How I answer this question could be a flippant. I'm not being flippant, I'm being honest here. If your dog needed medication that was going to cost you 100 a month, would you put the dog down or would you find the money for the medication?
[22:22] And to a person they said we will find the money for the medication. Your child needing that medication is as important as the dog's. Have you not Sky Tele? That's going to cost you the cost of your medicine. Do you buy a Costa coffee or a Starbucks? At 3. 50 for a Starbucks, that's the same cost as your daily cost of your medication if you're buying it privately.
[22:41] If you're fortunate enough to get it on the National Health at 9. per prescription, you're in a very fortunate position. I would say to any human being, why would you not invest 3. 50 a day in yourself to be able to lead your best life? Now he's saying that Ian, the flippancy is, I do know there are people that believe they can't afford or genuinely can't afford that medicine at 3.
[23:06] 50 a day. I get that, I understand that, I'm not being flippant about it. But that's why in England we have the National Health System, that's why we have the NHS. A whole system that's supposed to be free at the point of need and we can re access that for people and help them by working with GPs to actually get them their prescriptions on the NHS, even if they've gone privately for the diagnosis and assessment.
[23:28] So I wouldn't want anybody to be put off by the cost of medication against changing your life.
[23:34] Ian: Great answer. So we've just got less than one minute left, unfortunately. But we, how do we manage those expectations? You've mentioned there's different medications what are we going to expect when we start to take this medication on the first kind of week or so?
[23:48] Phil: The first week or so, you're predominantly going to be on a sub therapeutic dose. So this isn't going to be, unlikely to be the dose that's going to be the game changer for you. But you will be testing to see if you can manage it, and manage the headache, the dry mouth that you'll get at first.
[24:03] And as long as we can, we then proceed from week one into other medicine doses. Or switch the medicine if we're on the wrong type. So it's a period of experimentation that's being led by your experienced and specialist clinician. Go with the flow.
[24:16] Ian: That sounds great. There's so many other questions I wanted to ask you, but we are out of time. I really appreciate all your time and your answering the questions. All of the links will be in the show notes. ADHD360. com is that, or is it co. uk? What's the
[24:29] Phil: ADHD 360. com Yep. Mhm.
[24:33] Ian: to go. Thank you so much, Phil. We are out of time. Thank you so much for plugging us into your ears or watching on the YouTubes. And until next time, I encourage you to be smart with your ADHD. Toodle oo!
[24:43]
