Congratulations for making it to our final chapter. After the previous six chapters, you may be feeling rather full of ideas, so we will keep this seventh course light. We hope you have learned a lot about ADHD and that you will benefit from some of the new approaches we have described. Hopefully, some of you will be taking this knowledge to your health care providers before ordering new supplements, while others will be rummaging through your cabinets, armed with magnifying glasses, reading all the food labels. You may be inspired to talk to your local grocer about offering more organic food options or writing to the head of some major food chain that needs to clean up its ingredients. You might join a yoga class or simply order a CD and slow your breathing down to five breaths per minute. Before you take this knowledge and run, we’d like to highlight some of the main points and tie up a few loose ends.
If you only remember one lesson from this book, we hope it will be this: Be a seeker. By that we mean continue to seek new information and more effective treatments for yourself and for those who are dear to you. You may need to try many different treatments, one after another. You may have to consult with different specialists. To be a successful seeker requires a lot of patience and determination. As a person with ADHD, you may tend to get easily frustrated and make snap decisions rather than wise decisions. Be sure to fully evaluate the effects of whatever treatment you are trying before moving on to the next. Sometimes a slightly higher dose or an additional few weeks can make all the difference. The same is true for doctors and consultants. If you decide to work with professionals, give them time to do their job. The following case illustrates how an impatient parent can disrupt a child’s care.
Allison phoned to make an appointment for her 17-year-old son Daren, who was suffering from ADHD and severe sleeplessness. He tossed and turned every night, never sleeping soundly. During the day he was drowsy, but he couldn’t sleep. Allison, who also had ADHD, loved her son, advocated for his needs, and kept up with the latest treatments, but she tended to jump from one thing to another too quickly. For example, she wanted me (Dr. Gerbarg) to evaluate Daren to prescribe medication to help him sleep. Allison came into the office with Daren and began telling me about the many treatments they had tried. Meanwhile Daren sat on the sofa looking exhausted and agitated at the same time. One leg kept jiggling up and down while his hands fidgeted. Allison said she wanted me to prescribe medication to put Daren to sleep at night. During the discussion, I explained that a simple breathing practice might work better than medication to help Daren relax and put himself to sleep. Since he had not responded well to other medications, it would be better to let him try something new rather than just giving him heavier sedation. They both agreed to give it a try. I noticed that Allison was tense, tended to interrupt the conversation, and unintentionally agitated her son. I asked her to sit in the waiting room so that I could teach Daren how to use coherent breathing to get himself to sleep.
As soon as she left the room, Daren asked to lie down on the sofa while I taught him coherent breathing with resistance breathing. As he shifted into breathing at five breaths per minute with his eyes closed, his entire body relaxed and became absolutely still. Within a few minutes, he fell asleep. When Allison returned to the room, I explained to her how well he had done and gave them both instructions for continuing the practice. At the end of the session, Allison asked, “What about the medication?” I replied that we needed to use the time that day for coherent breathing and that we could discuss medication and other treatments during the next visit. We made an appointment and said good-bye. One week later, Allison left a message on my voicemail saying she was disappointed that I had not given Daren any medication, and she cancelled his appointment. They never returned, but I still remember Daren sleeping so peacefully on the sofa. Perhaps, he remembers, too. Maybe someday he will return to the breathing practice.
You are unique and your brain is one of a kind. What works well for someone else may not work for you. Conversely, you may discover a special benefit that others will not get from a particular combination of treatments. So, it makes sense to combine the treatments that work best for you. Each successful treatment should bring you to a higher level of functioning, so just keep building on those successes.
In Chapter 1 we introduced you to Andy, the boy who kept visiting the ER with broken bones. Now, after reading this book, you have learned enough about complementary treatments to understand the steps Andy took over many years to solve his problems and create the life he always wanted. The curious child, always looking for new things, new adventures, grew into an explorer of new treatments.
We saved the details of Andy’s story for the last chapter because they illustrate how one person found solutions to some of the more subtle symptoms of ADHD. There is no single complete description of all the things that people with ADHD experience. Andy is particularly talented at describing some of the less obvious aspects of his mental world. You may be experiencing thoughts or problems that have not been included in the ever-expanding diagnostic lists of ADHD symptoms. Listed or unlisted, some of these problems might respond to treatment.
Recall that Andy started using stimulant medications to help him focus and study in medical school. He wanted to find another way to manage his ADHD because he didn’t like feeling speeded up by the medication. Andy was struggling with the following lifelong problems:
1. Poor attention, difficulty reading, slow processing, and difficulty absorbing information.
2. Memory problems. For example, Andy would dial a phone number—but by the time the person on the other end of the line picked up the phone and said hello, Andy would have forgotten whom he was calling.
3. Difficulty paying attention to the world around him and consequently failing to notice things.
4. Low energy, low mood, feeling worst in the evening.
5. Feeling insecure, worrying about imagined slights. For example, if someone didn’t say hello or return a phone call, it really got under his skin, leading to ruminations (going over and over the same worries in his mind) and inability to stop the negative thoughts (“Why doesn’t he like me anymore? What did I do to drive him away? What’s wrong with me?”)
About 10 years ago, I (Dr. Brown) started treating Andy with the herb, Rhodiola rosea, increasing his dose to 450 mg per day. Andy reported improvements in energy, alertness, attention, his sense of being in the present and engaged in the world, and a new feeling of well-being. Adding 2000 mg a day of omega-3 fatty acids (EPA + DHA) did not seem to affect his ADHD, but he continued to take them to improve his cardiovascular health and cholesterol levels. Using three capsules each morning of Clear Mind (Ameriden International)—an herbal blend containing Rhodiola rosea, Rhododendron caucasicum (Georgian snow rose; another energy-enhancing herb); Brown, Gerbarg, & Muskin, 2009), and Ribes nigrum (blackcurrant; believed to increase absorption of the other herbs)—further boosted his energy, mental clarity, and alertness. Instead of losing track of whatever he was trying to do, Andy was able to maintain his attention until he finished. Insecurities and negative thoughts did not vanish completely, but they faded into the background and didn’t bother him as much. When he forgets to take Clear Mind for even a few days, his mood is off and he becomes less happy and more irritable.
Seven years ago, Andy found that using the LISS cranial electrotherapy stimulator consistently helped him sleep (see Chapter 6). Now he recommends it to many of his patients.
Five years ago, Andy learned a set of breathing techniques, called Sudarshan Kriya, that included resistance breathing (Ujjayi), rapid forceful breathing (Bhastrika), cyclical breathing (Kriya), yoga postures, and some meditation. At that time, Sudarshan Kriya opened his emotional awareness, leading to greater happiness. Although he no longer practices Sudarshan Kriya, he still uses resistance breathing to rapidly relieve anxiety and calm down. He sometimes uses rapid breathing practices to improve mood and mental focus.
Two years ago Andy added 100 mg a day phosphatidyl serine to his regimen. Phosphatidyl serine is a naturally occurring phosphorous-containing lipid in cell membranes and fat. Studies of phosphatidyl serine supplementation for memory and cognitive function have shown modest positive results in people over the age of 40 (Brown, Gerbarg, & Muskin, 2009). Nevertheless, the effect of the additional supplement was quite noticeable—improvements in attention, processing speed, memory, and absorption of information. Andy was able to dial a phone number and remember whom he was calling when the person answered the phone. He felt less “spacey” and more present. His wife especially appreciated his increased ability to pay attention to what other people were saying.
We have to admire Andy’s determination. Even with all of these improvements, he continued seeking. Although his mood was considerably better, Andy was aware that his sense of well-being depended on vigorous physical exercise every day. On some days, for example, when he had to go early to the operating room and missed his morning workout, his mood dropped. About 6 months ago, he started taking Vivix (Shaklee Corporation), a concentrated form of resveratrol (a plant-derived compound that may have anti-oxidant, anti-cancer, anti-inflammatory, and blood sugar lowering properties) containing antioxidants. Resveratrol stabilized Andy’s sense of well-being, even on days when he couldn’t work out.
Before starting complementary treatments, Andy managed to do good work and to be a good husband, father, and friend, but it often required a tremendous effort to overcome his ADHD problems. By gradually building up layers of complementary treatments, it became easier and easier for Andy to improve his relationships and enhance his work productivity. By helping his brain to work better, complementary treatments enhanced his abilities to listen, notice, think, absorb, remember, plan, respond, and feel good about himself and his life.
At first glance, the complexity of Andy’s treatments may seem daunting—so many pills, so many treatments. Yet, consider this: Andy overcame most of the ADHD problems that had plagued him his entire life; he got off of stimulant medication, and he became the person he had always wanted to be. For him it was well worth the time and effort. Now Andy enjoys a wonderful life, in many ways better than the lives of most people who don’t have ADHD. Perhaps it is because he is a true seeker. We predict that he will find more innovative ways to fine-tune his splendid ADHD brain.
Thriving in modern society requires a lot of mental work. People with ADHD are at a disadvantage in having to overcome symptoms that impair their abilities to work, play, and engage in fulfilling relationships. However, many people with ADHD have the potential to succeed in all areas of their lives by reducing or eliminating symptoms related to the disorder. While medications and standard behavioral therapies have helped many people improve, more can be achieved by integrating standard treatments with complementary approaches that target neurological mechanisms that are critical to optimal brain functioning. Health care providers are encouraged to learn more about these non-drug options in order to offer their patients the widest possible range of treatments. Consumers can play a major role by asking health care professionals to help them try these new methods and by advocating for more research and development of complementary treatments.