Weekly Q&A: Nitrous Oxide and Mental Health

[00:00:02]Hello, I'm Dr. John Cruz and welcome to today's question and answer hour where I will try to answer questions about the video that came out last week about ADHD more broadly and mental health even more broadly than that. A reminder that the information here is forformational purposes. Um, please take it back to your treatment team. I'm try not trying to make specific recommendations and before I launch into the video summary which was about nitrous oxide um I have launched my substack so for now or short-term going forward the articles that I was publishing weekly on medium will probably in be in both places substack and medium the advantage of the substack is that which is free and open to everybody. Um, people who want to and can afford to subscribe to it, they can subscribe to it, but you can subscribe for free. And I'm not at least anytime in the near future planning to change that. Um, I think Max, if he shows up, hopefully we'll have the link to the substack, but it's Substack. And there it is. Doc Cruz atsubstack.com.

[00:01:24]Thanks, Max.

[00:01:27]So, summarizing the video. So, the video that came out last week was nitrous oxide.

[00:01:35]Sorry, distracted.

[00:01:38]So, nitrous oxide and it's been in the news recently because a California area legislature Keith Kevin Mullen um from just south of San Francisco, actually the west side of San Francisco and San Mateo County has proposed a bill in Congress more severely restricting access to nitrous oxide in any form. Um, but the most widely available form are little canisters. An eight gram size used to be the standard sort of one use dose for making whipped cream, but now they're producing 200 gram canisters. So, 25 times as big in all sorts of ridiculous flavors where it's very clear people are not using them to create bathtubs full of fruit flavored whipped cream. They're selling it as a recreational drug. So, nitrous oxide was discovered in the 1700s by Joseph Priestley, one of the most famous chemists of all time, discover of oxygen. Um, the person who discovered its use is laughing and named it laughing gas was Humphrey Davyy, also a famous chemist. Um, he experimented with it when he was on experiments. He found that it made him giggly and silly and dissociated. So they're already having nitrous oxide parties in Britain in 1799.

[00:03:13]It wasn't until the 1840s that nitrous oxide started being used as an anesthetic and it's still used as an anesthetic today mostly um for dental procedures. Um, but often in combination with other anesthetics, its virtues are that it goes in really quickly and goes out really quickly and also has some anti-anxiety effects separate from its anesthetic effects.

[00:03:43]And in the when it's used now, it's it's not pure nitrous oxide. It's combined with oxygen or room air. Um the the problems with its recreational use is that prolonged use seems to lead to I'm blanking on which vitam vitamin B12 deficiencies which can cause neural damage and that's because nitrous oxide binds to the cobalt and vitamin B12 and inactivates that moyety complex. Um so neurologic damage can ensue from vitamin B12 deficiency and it can be permanent.

[00:04:28]Um the other risk is that again these little canisters are pure nitrous oxide and if all you're inhaling is nitrous oxide you die because there's no oxygen in it. So some of them have been intentional suicides. Um but people have suffocated from using these and the rates are going up and it's been more than 150 Americans each year for the last at least seven eight years have been dying from nitrous oxide abuse.

[00:04:59]At the same time there is growing research showing that nitrous oxide can be a quick effective anti-depressant.

[00:05:07]This was modeled after ketamine became widely popular. And like ketamine, nitrous oxide is both a an MDA blocker and also maybe more or equally importantly is it activates the new opioid receptor. So there's increasing evidence that heart of ketamine's anti-depressant action isn't just from um NMDA blockade but NMD NMDA blockade simultaneously or co-occurring with new opioid activation. Again um nitrous oxide does both of these things. There's several numerous studies showing it can be a quick effective anti-depressant and wears off the effects for depression like ketamine happens within at least measurable within a two-hour time p span and lasts for a day and the effects do seem to wayne after a week if you're not getting reinforcement doses. There are some studies looking at it with reinforcement doses. Um, this does actually seem to be safer than ketamine, less addiction potential, less so far problems with causing bladder issues.

[00:06:28]Um, and in contrast to ketamine where the dissociative experiences of people have them tend to be unpleasant, anxious for at least a quarter 25% of the time they are with nitrous oxide. most people who have a dissociative experience, it's a pleasant, giggly one. Um, so there's sort of question whether an attempt to clamp down on illicit and recreational use of nitrous oxide may derail the development of nitrous oxide for treating depression.

[00:07:07]So that's in terms of treating ADHD.

[00:07:13]I haven't seen any evidence for that.

[00:07:17]And there is some sort of anecdotal research or anecdotal collections of commentary suggesting people with ADHD are more likely to have atypical or unusual responses to nitrous oxide. But some people even without ADHD have unusual responses.

[00:07:37]So I see there's questions. So I'll jump over there. So hello Dylan. So Dylan was curious about my thoughts on using clomine as a monotherapy for OCD comorbid with ADHD. Wouldn't it couldn't it work just as well as something like strata?

[00:07:55]So clomine is one of our older um tricyclic anti-depressants. It's the most strongly serotonin. So it's a it's a serotonin reuptake inhibitor. And clomine itself is more than 400 times more strong as a serotonin reuptake inhibitor than is a norepinephrine reuptake inhibitor. So most of the tricyclic are both serotonin and norepinephrine to different extents.

[00:08:27]However, the active metabolite of clomine has fairly strong norepinephrine action. So on the surface you might again on many references say clomine it's very selective for serotonin and shouldn't basically be touching the norepinephrine receptors. Um but in actuality again that what clomine turns into in your body makes it a potent dual acting serotonin and norepinephrine reuptake inhibitor. So theoretically it could work like stoa again stoer is a fairly specific pure norepinephrine reuptake inhibitor.

[00:09:12]The video I'm preparing for next week or the week after is going to be on raoxitine, another norepinephrine reuptake inhibitor, not approved in the US yet.

[00:09:24]Um, so theoretically it could be an option.

[00:09:29]And then Dylan's follow-up question is how relevant are the cardiac anti cholenergic risks for the general population without any detectable heart irregularities?

[00:09:40]So the downside of the triccyclic again they were good neuroepinephrine and serotonin reuptake inhibitors. They are clearly effective for depression but most people have side effects on them because they have prominent actions on histamine systems on the acetylcholine muscerinic system on sodium channels in the heart. So one particularly sodium channels in the heart um with many of the tricyclics as little as a week or two taking a dose altogether is potentially a lethal overdose and in contrast with most SSRI most people can take 30 60 even 90 days dosage all at once. I'm not recommending this for anyone. And you may be asleep. You may be not very responsive, but fairly low likelihood that it will be lethal.

[00:10:42]So on a daily dose, does that make the cardiac effects particularly worrisome?

[00:10:48]Probably not for most healthy normal people.

[00:10:52]On the other hand, some of the muscerinic and um histaminic um so most people tend to be constipated on constipation, weight gain, um orthostatic hypotension, so low blood pressure when you stand up too quickly are fairly common side effects of omipramine and other tricyclic. even with healthy people. So whether that's mild enough to not affect an individual person, certainly many people can take it without feeling many of those effects. But feeling sedated, constipated, and dizziness when you stand up are all moderately likely to be present. So, so I I mentioned the Substack. So, I I would encourage people to sign up for the Substack even if they Yeah. just because I guess part of it is a game of building numbers and showing that there's people interested.

[00:12:11]Um, so Dennis and I will single out Dennis.

[00:12:18]Dennis was the very first person to sign up for the Substack.

[00:12:26]So Dennis asks, "Is it true that joint hypermobility is over representative represented in people with ADHD?"

[00:12:35]Um, I'm blanking on the name of it. I'm going to say Aaylor's Ellers Danlo. Um, there's a specific connective tissue disorder condition that leads to hypermobility that I am pretty sure I have not looked into the research recently, but I've certainly seen references to it over time that does seem to be over represented in people with ADHD.

[00:13:05]Um, so at least some cases of joint hyper mo or some contributors to joint hypermobility, some common ones do seem to be more common. Um, so I'm reading that. So, so yes, to my knowledge, hypermobility is over represented. Um, and I've certainly seen a few individuals who whose joint hypermobility was to an extent that it did lead to some physical joint problems for them and and had ADHD. So, I've certainly seen it. Um, so one question from Reddit forwarded by Max. Thanks. Um, and the question is, can we talk about Primapex for ADHD?

[00:14:10]So the simple answer is Primopexol is a stimulant. It's a stimulant that was controlled at a lower level of of lower schedule. So um amphetamine products are schedule two under the US classification. I think amalain is schedule three or four. So like ambient or sleep medications so considered less abuse potential. Um but there is data showing it can work and it's um trying to remember if primapexol is silent or not.

[00:14:56]I'm cheating and looking it up as I talk.

[00:15:04]So premopexol is mirrorex.

[00:15:13]So maybe I am so mirrapex primipexol is approved for parkinson's and restless leg. So it's a dopamine promoting agent. Um so I'm thinking more peolene rather than pramipal.

[00:15:29]Pemoline is silert.

[00:15:34]So yes, I I mean I think there is some limited evidence. There's certainly a wealth of basic science rationale that it should be effective and till I look more closely into the literature, I will not say more.

[00:16:01]So Dylan is following up on what are my thoughts on people with dyslexia trying to read. Is it better for them to use audiobooks or should they try to read physically?

[00:16:14]So I am not an expert on dyslexia. So hopefully I will stop talking before I get in over my head. What the little I know is one is that dyslexia is not just one thing or way of the word means trouble reading. Um but there can be a multitude of causes or ways it shows up and differences in what's an effective learning tool for helping them learn. So certainly there are many individuals with dyslexia and there are many or at least several effective ways of breaking down words in different ways that people with dyslexia at least some subsets of people with dyslexia may have more trouble or more challenge dealing with but can learn to access reading that by by specific pathways of training themselves. Um, and my understanding is there are some sets of dyslexia where some of those approaches are less likely to be helpful. So, it may be simpler or more efficient for those people to focus on getting information through auditory sources like audiobooks rather than reading. Um, and I will not make predictions as to whether writing and reading will become obsolete at some point for humans or who knows what the effects of AI are going to be on all of us regarding this.

[00:18:00]So, so Dennis is sharing their experience with clomine.

[00:18:07]Um, and he said the pharmacist was reluctant to fill the prescription due to the cardiac effects you mentioned.

[00:18:21]Yeah. So premopexel again it's approved for both maybe I didn't say Parkinson's disease and um restless leg syndrome. I do have a talk on restless leg syndrome. So whether I specifically mentioned primipexel and that I'm not sure there there is a closer association than you would expect by chance between restless leg syndrome and ADHD. as I sit here shaking my own legs, but mine is not appearing at nighttime.

[00:18:55]And I think it's more anxiety related rather than um restless leg syndrome.

[00:19:07]So Max says they sometimes hear psychiatrists say that methylenadate dosage should be weight dependent. Is that a relic of the past or is there some truth to it?

[00:19:22]So one I only have worked with adults. I mean I in training we have some exposure to children. So cupcake has joined us from the floor.

[00:19:37]So among adults there may be some very extremely loose correlation between methylenadate oral dosages and blood levels connected with weight or size of the person.

[00:19:57]But there's a fairly narrow range of sizes of adults even as many Americans have gotten larger and people worldwide.

[00:20:07]Whereas among kids there's a much broader range of sizes.

[00:20:13]Um so I think a common pediatric approach is in terms of figuring out what is a lower starting dose is to start with a low dose based on that kid's size as much as their age.

[00:20:32]Um, and many of the pediatric studies looking at methylenidate or amphetamines or other stimulant medications are setting dosage in a milligram per kilogram ratio. So I think it probably has more validity.

[00:20:52]Again, it any of these are just thumbnail approximations to starting out and sorting out what doses someone should be on. I think to me it only makes sense particularly among drugs with like like the stimulants where we see the benefits within certainly the day you are taking it usually within minutes to hours that you should adjust dosage based on the benefits you're seeing and based on the side effects. If you are not seeing benefits and not seeing side effects then don't pay attention to what or can don't worry that much about what the dosage is. it makes sense to try a larger dose.

[00:21:36]If you're having side effects, then it makes sense to either pause or pull back to a lower dose.

[00:21:42]Um so again looking at someone's weight or other things are a general rule of thumb or or guide to starting point but it shouldn't be the final point again unless we're in a formal study where they are putting everyone on a certain one milligram per kilogram or something like that.

[00:22:10]So, thanks for the video on restless legs, Max.

[00:22:18]So, Dylan's asking, "Do I think that bperone deserves more attention? You should it be a second line or even first line agent for anxiety disorders? It seems like SSI SSRIs are often given without bperone mentioned." So, I do have a whole video on bpone.

[00:22:36]I've had quite good s so there is some it's sort of considered a third tier agent for ADHD. So there's a little evidence it can help with ADHD.

[00:22:48]Um so BPRON is working on the serotonin 1A subset of receptors. It's not a serotonin re-uptake inhibitor.

[00:22:57]There's some good evidence of combining serotonin re-uptake with 1A action which is what um vibrid does. I'm forgetting begins with a V and I don't want to confuse it with kelbur and other drugs that begin with a V. Um so so it is in the US bsper buperone bupar's approved use and again not to confuse it with propriion which is wellbutin bupropion is primarily a norepinephrine and dopamine reuptake inhibitor is a serotonin 1a agonist.

[00:23:46]Think I got that right. Um, I know it's serotonin 1A and I'm not remembering whether that activates or blocks it. I think it's an agonist. Um, it's approved for anxiety.

[00:24:01]However, it works slowly kind of like an ant SSRI works slowly for depression.

[00:24:08]Berrone works slowly for anxiety. And given that anxiety is a condition that feeds on itself and is affected by expectations, the most commonly used drugs for anxiety in the America and I believe worldwide still are the benzoipines and drugs like Valium, Adavan, Bonopin, Xanax. They work really quickly and that provides a lot of reassurance and positive feedback if you have something that you can take right away and decreases your anxiety. You know it works. Um in fact it it there's a few studies showing it can measurably undermine cognitive behavioral therapy because if you are using a benzoiaspine in the cognitive behavioral therapy you might say yeah yeah yeah all this blah blah blah I'm talking to myself to try to get myself out of anxiety and what really helped was helping the Xanax. The other value is I've often told people that a Xanax or an Adavan in the pocket is as good as one in the mouth. But if you know if I really need to I could go take it then often you don't need to take it. So compared to that, your spirone works slowly and gradually. And most people who get immediate effects who've already tried a benzo say no, I don't want to sit around waiting for weeks to see if this is going to work. And or even if they try it, they're sort of it's not doing anything. It's not doing anything, which further increases potentially anxiety.

[00:25:40]So it can be a hard cell. And I think part of that is why it's not more often used. Um, side effect profiles extremely benign.

[00:25:52]I've had some people who feel slightly cloudy. Again, not sedated, but maybe less sharp. That's uncommon. Usually doesn't cause gastrointestinal side effects. Doesn't cause weight gain.

[00:26:06]Doesn't cause dry mouth or other problems.

[00:26:12]It's commonly prescribed as a twice a day or three times a day drug because it's halflife is not that long. But to drugs that work indirectly don't need there is absolutely no evidence that you need a steadystate level of boperone for it to have an anti-anxiety effect. So again, unlike stimulant, unlike a benzoazipene where its action is directly related to how much is in your blood, if it's not in your blood, it's not working. But the drug that works slowly and indirectly like an SSRI, like bperone, you don't need to maintain steady levels. So bprone I almost always dose once a day in the evening if someone feels and again it's a low likelihood somewhat less sharp or alert then it's happening while they're asleep. It's not affected by it in the morning. They're not feeling groggy. Um and all the evidence so far suggests that once a day is as effective as multiple times a day and is certainly more convenient and easier to remember. So yes, I think it's under represented. So the big amounts of research other than demonstrating it works well for anxiety is that there is good evidence that it does help anti-depressants work better when they're only partially working. And most often it's been looked at with SSRIs.

[00:27:44]Um but it works in combination with other anti-depressants as well.

[00:27:52]So, so Bandy is sharing that restless leg syndrome can be awful and that first generation antihistamines can get restless. um certain people with a whole range of anti-depressants and other psychoactive medications can worsen restless leg syndrome. Um althoughexol and other dopamine promoting agents have been the standard treatment and there's two on the US market specifically approved for restless leg and I'm not remembering what this second one is.

[00:28:40]Um but there's growing concern and I would say growing reason good evidence for this concern that the drugs that are boosting dopamine may actually in the long run contribute to worsening of breathless leg syndrome. So yes, they are treating the symptoms but they may be worsening the underlying pathology and there's a bigger movement to use gabapentin and other drugs for restless leg rather than the dopamine boosting drugs.

[00:29:20]So Dylan asks does bpone have the potential for helping OCD? I came across a PubMed article titled Busperon and obsessivempulsive disorder potential dark horse and it seemed to suggest it can help and I would say that you are more on top of the literature for abuse and OCD than I am. Um yeah to me it's again it's a very low likelihood of any problems resulting from taking it. So the downside of trying it for most individuals, almost any individual I can think of is extremely low and if there's at least even some evidence suggesting it can be helpful that may be useful. So and thanks Max for bringing up the video on berone.

[00:30:16]So hello again clockmaster. Um, mental illness cure. Nice and slow body movements as if being placed under arrest while holding a weapon. That weapon represents severe depression.

[00:30:36]So, I'm not clock master's continuing up.

[00:30:47]So, so Vandy mentions that for them did not work even after months. Um, so that's the other downside of I mean one it doesn't work for everyone. Nothing does. Two is that it can be so slow and gradual that I mean usually I would start at 15 milligrams a day which is usually well tolerated. Does come in smaller doses again taking it at bedtime.

[00:31:14]Um, but if after a month at 15, we're not seeing much, it's do you spend a whole another month going up to 30 and another month to 45. So 45 is FDA maximum recommended dose. I've had some people who felt that 60 worked better, but most of the people I've worked with are in the 15 to 45 range. Um but again so waiting a long time can make it hard to sort out and it won't help everyone. So clockmaster saying thousands of years doctors have tried using logic to cure mental illness when in fact illness stems from body movements. Body movements must be nice and slow. Um, and Max is saying that they excited to see peer-reviewed studies on that.

[00:32:10]And Clock Masters, I've been a patient for 30 years. Doctors have a clue on how to treat mental illness. Doctors are there for a paycheck, an all-time pickup line. I have a degree in psychology.

[00:32:22]Um, not to be disrespectful, but you're either not even listening closely or something's wrong. So, a psychologist is not a medical doctor. A medical doctor is treating mental health problems. A psychiatrist, the training is different. Um, if you're not even listening to the difference between the words, maybe some of it is you're not listening to what else they are saying or instructing. And it's possible that we don't have approaches currently that help you. On the other hand, there is a wealth of information, hundreds of thousands of articles that doctors do have a clue. Do we have it all solved? Do we have it resolved? But we know that many of our treatments, including many of our medications, many of our talking therapies do measurably reduce distress, do measurably improve function, do measurably decrease physical problems that result from having ongoing mental problems, measurably decrease deaths from suicide and other issues. So to say doctors don't have a clue just doesn't bear up. Do we have a perfect understanding? Absolutely not. Um is there more to learn? Absolutely. May we be largely and fundamentally wrong on some of the basics? Yeah, those are all possible. But to say there's nothing there. Um so Vandy Dr. Cruz says desk venaxine XR dose over 50 milligrams helpful.

[00:34:14]Um blanking. So benifaxine is a fexer in the US and when its patent was about to expire they came out with a derivative of it. Um again with dosage the FDA suggestions are recommendations. So, what I tell people, whether it's an anti-depressant or a stimulant medication, if you're not having side effects, if you've seen something helpful or suggestive at the highest recommended dose, um, and there's room for improvement and you're not having adverse effects, then it's usually a reasonable course of action to try more and see what happens.

[00:35:05]And if you have side effects to pull back and if you're not and it's helping, then continue. And don't worry particularly about what the numbers are.

[00:35:17]Again, we know people will have dramatically different blood levels from the same oral dose with probably the biggest single factor being how well your set of liver enzymes are chewing up the drug. But absorption is a factor.

[00:35:34]Body size is a factor. Body proportion of fat to non-fat tissues is a factor.

[00:35:42]Um, and there can be other factors.

[00:35:53]Yep. So I hopefully I said that correctly. So Dylan's pointing out that the he's saying the first line meds for restless leg syndrome are now gabapentonoids and not dopamine agonists. Um and I'm not sure that I've actually seen that from any official neurologic organization. Um to me that makes sense.

[00:36:16]And what I still see is patients coming to me where neurologists have put people on dopamine agonists. Um so whether or not so so I think the field is moving but I think it tends to move slowly and many doctors continue doing what they started out doing.

[00:36:41]Hello again Mr. AKA 1996. um he's reading a systemic review and usually you are more up on the details of neurochemistry than I am um and the anxolytic effects so anxia reducing exalproit which is depicote and others um and 80% of animal studies and 70% of clinical studies so depicote in the US is approved for um bipolar disorder sort of along with lithium. It was the main stay before atypical antiscychotics arrived.

[00:37:24]And depicote I'm not sure if they ever saw it in FDA approval, but certainly it's endorsed by major psychiatric groups. It's also used for explosive intermittent explosive disorder. So temper tantrums in adults. Um so it seems to have whether that's a calming or anti-anxiety effect or an anti- impulsive or emotional disregulation effect that those issues are interlock interlocking.

[00:37:58]Um clockmaster says antiych meds. So, I don't know if you're antiscychotic meds, slow cognitive ability, and motor cognition. Um, they don't all do that, but many do. This means meds slow the body as well. I'm not sure what that even means.

[00:38:32]A patient should be taught to be aware of their body movements. That sounds reasonable.

[00:38:41]So part of the downside of depicote um is that it is one of the medications that it's strongly recommended to get periodic blood testing because it can have um negative impacts on particular liver and blood cells.

[00:39:09]So that makes it sort of more medicalized or more intrusive or more of a hassle both for the patient and the doctor.

[00:39:26]Yep. So Vandy is lamenting there's not enough money for research for mental health illnesses unfortunately and increasingly at least in the US there's not even enough money for cancer research or other health conditions. There's detailed reports of how the current administration's arbitrary and I would say inane budget cuts stopped pediatric cancer trials in midstream. So people had to abandon treatments or the chance of treatment that is potentially life-saving.

[00:40:08]Um, so I'm not sure. I think outside the box. I just see maybe more boxes and bigger boxes. I don't know.

[00:40:24]So Neil Neelian Neil um, recently diagnosed with ADHD at 17. What do I do about the feeling that my parents don't and will never understand me? How this disorder affects me?

[00:40:38]So, this will only help a little bit, but the video I've released or recorded and will probably be ready in a week or two is about coming out to parents and well, coming out as AD, not just to parents, but for parents is a particularly loaded situation.

[00:41:00]Um, so some of the things I would say are that you have most control over what's going on in your body, in your head, your mind, your decisions, your thoughts, what you learn more about. You can encourage, you can suggest, you can influence what goes on with others, but you can't control their minds. So part of this is frustrating.

[00:41:29]And this is frustrating at any age, but particularly in late teenage years. I'm sort of accepting and particularly frustrating in the world right now where many people are firmly affixed to delusional beliefs.

[00:41:47]Some people you won't change. Um but the only end of it is you can you have control over the information you give them. you have control over the tone and circumstances potentially over which you're exchanging information. Um, so couple pointers from my coming out video. I mean, one is probably not discussing these things at the time of a crisis. So, if your ADHD led you to forget to turn in your homework and a parent yelling at you, why didn't you turn in your homework? that's not going to be the most productive time to talk about ADHD because they will hear it primarily as an excuse. Um, but also primarily because they're in an agitated emotional state which is not amendable for learning and you're probably in a defensive, attacked, vulnerable state and not likely to be your most articulate. So, one is just setting aside time to say I'd like to talk about this more with you.

[00:42:50]two, um, and that's it's a starting point of my coming out question is making sure you have ADHD. So, and usually that requires being evaluated by a professional. So, hopefully the alliance of you and the professional, the professional can explain in ways or words that are reinforcing what you say, but are somewhat different. And it often helps to hear the same information in two slightly different ways to reinforce it. It may help if there's any respect for the doctor and the mental health professional that they may unfortunately be more amendable to listening to that person than to listening to you. Um so a couple other things is that one is coming out or talking about it is a process. This is, or as I like to say, this is a quest, not a test. Whether you got all the information across, whether they processed it and accepted it in one setting, isn't the end of the story. As long as you're alive and they're alive, there at least is the potential for having further discussions with you or with them. Other things I recommend are having other resources available.

[00:44:10]Again, if you have the professional who helped evaluate you, that that would be really potentially powerful or helpful, they should be able to articulate what patterns of behavior they saw um in you and why that fits with an ADHD diagnosis.

[00:44:26]But in terms of references, make available short um so easily digestible. So, in just a few minutes, either short written information that's factual about ADHD or short videos. So, I have um on Medium and I think they're connected to videos here on my YouTube channel. I have something like 17 things ADHD isn't and what ADHD is so that someone can listen to it in just a few minutes and process it. I'd say it's also fine to have longer life length books. So Ted Tom Brown's um thinking outside the box explains ADHD in terms of executive functions. That's a good source.

[00:45:19]older books from the 90s and 2000s were driven to distraction or you're not lazy, stupid, or crazy that help explain to someone without the medical or mental health background what ADHD is. So, it's good to have, you know, potential longer books or videos as sort of backup reinforcement for more information when they're ready for it. But don't expect at the onset someone to read a whole book that they want just a minute or two snapshot. And the other really important thing is numerous studies have found that the majority of Tik Tok and other quick video information about ADHD contains inaccuracies or outright wrong information. So, if you leave it up to your parents to go search themselves on the internet for information about ADHD, there's quite a good chance they will come back with information that's just wrong and that may be unhelpful.

[00:46:26]The other thing I get I address and not extensive length, but one there there's two potentially really loaded family situations. Um, one is if you're adopted. Um, so if you're adopted, you are more likely to have ADHD. Part of this is because the pool of people who put up kids for adoption is over represented with those with ADHD. ADHD contributes to having sex at a younger age, to be less prepared for the consequences, to do it more impulsively.

[00:47:00]Um, so if there's a mismatch between you and adoptive parents, that can make it harder to come out. it can make it harder for them to understand.

[00:47:10]On the other hand, the other scenario that's particularly charged is that given there's a strong genetic component to ADHD is it may be that one or more of your parents themselves have ADHD. And although potentially that can be a bonding and connecting episode or or route to connection, there's a couple potential pitfalls. One is their own ADHD may have made made them really be oblivious and missed many of the symptoms of your own ADHD of your ADHD. So if they're not an attentive parent, they may not know that you didn't turn in homework for the whole semester. They may not know that you're showing up late for class. They may not know X, Y, or Z because they're just not paying attention. Number two, even if they are paying attention and particularly if they don't have a diagnosis or label for themselves, but they have ADHD, they may just think, "Oh, well, being on time means you can be anywhere from right on time to a half hour." That, you know, why are people so obsessive and focused on getting down to the last second? So, so they may dismiss or minimize or normalize aarent behavior because their own ADHD. That's again separate from being oblivious to it is is minimalizing or normalizing what really is apparent.

[00:48:41]Read, they may be defensive that andor jealous that I had to deal with these things without the label, without accommodations, without anyone making it easier on me. and here you have all these advantages I didn't have. Um, so there can be a whole host of issues. So hopefully again if you have ADHD and you have a therapist, you can help they can help work through some of these issues with you and suggest specific approaches that may help with your parents. If you don't have that, there are online support groups. I mean, one, there are Chad groups in most US cities where you can talk about fellow people with ADHD who are dealing with some of the same issues. There are forums on Reddit and others and attitude magazines so that you can feel less alone and share strategies and share feelings about what happened when you try to talk about these things. So, remembering you're not alone in dealing with this can be helpful. But I'd say the big take-home message is is this can take time and it's an ongoing journey, not just a one and done.

[00:50:03]So Clockmaster says the overlying belief in psychology is that a doctor must accept the cure will come from a pill rather than a universal coping skill. Um, you're welcome to keep sharing your opinion, but you didn't even seem to have processed what I said a minute or two several minutes ago.

[00:50:29]You can't even keep psychiatry and psychology straight. So, that makes me question the rest of your thinking and conclusions.

[00:50:37]So no, the overlying belief in psychology is not that a doctor pills.

[00:50:43]So many many psychologists are actually fairly vehemently against medication. If you're talking about psychiatry, then there are many psychiatrists who also primarily don't treat people with medications. Many do and increasing numbers do. Um, so, so I am sorry that your experiences have been so negative, but you're making sweeping generalizations that are not supported by reality.

[00:51:18]Um, so Vandy is pointing out that the family still struggles with her in her ADHD.

[00:51:32]So, Clockmaster, you're saying a short and informative answer would be nice.

[00:51:37]And I'm not sure you haven't actually asked a question. So, you ask a question, I will try to respectfully be short and informative. And one of my slogans is if I am not promoting nuance, then I am probably creating some new anst or anxiety. So my approach is often not short because life is usually not full of simple answers.

[00:52:17]Um so Neil the thing is my parents are doctors, PhD pediatricians. They know ADHD but they tell me we just don't see you as ADHD despite diagnosis. They say we see you your personality and how you are.

[00:52:32]So even I mean among pediatricians and even among mental health experts there are still people don't see or understand ADHD and try to frame it as other things.

[00:52:47]Um, I'm trying to, and again, I probably should not be making recommendations in this area anymore specifically than I make medication recommendations, but I would ask them if they are saying that this is you or your personality, please write down a list of what you see as my personality, traits, or characteristics.

[00:53:16]And you don't have to tell them this is the agenda. Um but and then we will look at how much of this personality overlaps with what are ADHD traits. The other thing again particularly depending on when they trained or when they grew up it might be really helpful to for them to look at a book like Tom Brown's emphasis on ADHD. So thinking outside the box is the name of his book. um brownness and the color B R O N B R O W N. Um they may have been trained in the era when ADHD was a list of symptoms of impulsivity, inattentive hyperactivity and may see some of that as not connecting with how they see you. Again, there may be deeper defenses. again, maybe one or the other of them has ADHD and compensated for it with their training and um and and therefore don't want to acknowledge it at that level. Um so yeah, so if I can If there's more specific angles on that, again, the bottom line is you can try to you can control the information you provide them with. You can control the tone of the setting of the conversations. um but whether they're open to learning that you have less control over.

[00:55:13]So, thank you Shadow's brother for saying and thank you Vandy and others for speaking up. Um, clockmaster psychiatry isn't black and white.

[00:55:22]There's way more that we don't know about psychiatry, our bodies and the universe we do know.

[00:55:28]And that the little we do know can be helpful. Do we need to learn more? Absolutely.

[00:55:37]Um so we're getting towards the end of the time. Um what I will say coming up in August, so August 4 will be the hundth question and answer. So I will I think there are ways to give people electronic copies of my new book. So my plan is for people who show up in the chat and and you don't actually have to chat. I don't know how we'll deliver to people who are just here passively watching but and I I don't think I can post the link here. We might need to collect emails or something like that.

[00:56:21]Um we'll work out the logistics. So I think we'll be doing that August 4th.

[00:56:26]It's not even clear whether the book's coming out September or October. Um, so October 11th or not October, August. So August 4th, we'll we'll arrange find some way to do some new book giveaway on and the book is ADHD World about how our whole world is moving into more ADHD like condition including people with ADHD getting more ADHD like because of external factors.

[00:56:58]Um August 11th I will be traveling. I'll be in Spain. I don't know if I'm anywhere in your neighborhood Dennis.

[00:57:06]that will be near Balboa to try to see the solar eclipse with my family. So no meeting on the 11th and on the 18th I will still be traveling but I will as of now I am tentatively scheduling having a question and answer on the 18th. Um we will see how that works.

[00:57:32]So Nelan if I'm pronouncing it wrong sorry um is there any issue with using propranol with anetamine to reduce physical stimulation like sweating or jittering so it's a commonly used approach um the two issues I one is my usual approach if someone is having physical side effects that that's often a sign that it's just too much and you back down and sometimes those symptoms decrease with time or by backing down in the dose and you're still getting most of your benefit. So I guess one potential risk is sort of you might be masking that you're on too high a dose by treating side effects. Um that yeah that seems to be the the biggest potential issue there.

[00:58:42]Yeah. Again, I'm sorry, clockmaster, but I when you say run that coping skill by your patience, I'm not quite sure what you're referring to. Um, so and I hope that you do find the help that you need.

[00:59:02]So again, the Substack is out there. It'll be great if you join and stay healthy, stay happy in a crazy world. And I'll be back next week.

[00:59:16]Any last minute questions?

[00:59:22]One more.

[00:59:40]So, thanks for the subsack list and Okay, I guess that's what I have to say now and I will be back next week if there's any loose ends.