Episode 394: Finding Focus with ADHD & The Surprising Upside of Missing Medication

Hello, friends!   In today’s episode, we tackle two thought-provoking listener questions that may resonate with many of you:   Cymbalta Conundrum: A listener shares their experience with Cymbalta, a medication prescribed for panic disorder. They noticed feeling amazing on days they forgot to take the medication, leading them to wonder if they truly needed it. We explore the concept of conditioned compensatory response, the effects of medication on the body, and the importance of gradual tapering.   ADHD Focus Struggles: Another listener struggles with focus and motivation despite trying various medications and strategies. We discuss the complexities of ADHD, the importance of environmental adjustments, and techniques like mindfulness, Pomodoro intervals, and accountability to improve focus and productivity.   As always, you can send me questions to duffthepsych@gmail.com and find the full show notes for this episode at http://duffthepsych.com/episode394   —

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Question 1:

“Hi!

I was prescribed cymbalta for panic disorder and had noticed I felt amazing on the days I forgot a dose. I told my doctor and we decided to taper me off. The first 3 days with no meds felt amazing and the days after I felt like a zombie. Do you think there is any way to explain this?”

Response:

Hello! This is a great question, thank you for asking it.

Cymbalta, also known as Duloxetine, is a medication used to treat depression and anxiety. It’s an SNRI, meaning it increases the activity of both serotonin and norepinephrine, making it different from SSRIs like Prozac or Lexapro. This unique mechanism can make it effective for some people, but it can also have more side effects.

The increase in energy and positive feelings immediately after missing a dose is interesting and can be explained by the concept of conditioned compensatory response. This is a phenomenon where your body learns to associate certain cues with the effects of a substance, in this case, Cymbalta.

Classical conditioning, as discovered by Pavlov, is the process by which your body learns to associate a natural response with a neutral stimulus. In the case of medication, your body takes in the cues around you, such as the location, time of day, and sights and sounds, and associates them with the substance itself.

When you repeatedly take a substance, your body tries to maintain homeostasis by reacting in the opposite way. This can lead to tolerance and, in some cases, overdoses. In your case, when you suddenly stopped taking Cymbalta, your body was still expecting it and made a compensatory response, leading to the feeling of increased energy and positivity.

However, after a few days, you may have started experiencing a rebound effect at the neurotransmitter level, where your body produces less serotonin and norepinephrine, leading to feelings of fatigue and lethargy. This is why gradual tapering of psych meds is usually recommended.

It’s important to consider why you were on the medication in the first place and whether your current feelings are similar to how you felt before starting the medication. If you’ve made strides in your mental health and feel you can manage without medication, that’s great! However, if you find you need medication to function, you can always go back on or explore alternative options.

Remember, it’s a complex situation, and it may take some time for your brain to come back to baseline. Focus on other methods of improving your wellbeing, such as socializing, exercising, and therapy, and don’t hesitate to seek help if you need it.

I hope this explanation helps!

Question 2:

“Hello,

Love the podcast! I have a question. 

I was diagnosed with ADHD as an adult when I went back to school in my late 20’s and my psychiatrist offered me medication, I was so excited to try them and FINALLY be able to focus, school has always been a struggle for me, really everything is a struggle, but I am really struggling now pursuing higher education. 

So, I tried three different medications and they all put me to sleep. I ended up with three associates degrees from my bouncing focuses, early childhood education, social and behavioral science, and psychology. Now I am at a University pursuing social work, it’s supposed to take me two years cause I got my associates but it’ll be four years by the time I finish next spring.. 

I got an extension on my paper because it’s taking me two months to get over being sick and I’m still so tired.. I’ve kept her up to date on my health. I had already done 1.5/4 pages, but it wasn’t done. I sat down three hours ago to finish it and turn it in, I watched videos on my phone and looked at pictures of my nephew as a baby… Even now, I need to work on my paper and I’m emailing you a question. Lol. It is a writing intensive requirement, so the final is a 10 page paper!

In the future, what can I do to help me focus?”

Response:

Thank you for your question and for sharing your story! It’s great that you finally received a diagnosis of ADHD in your late 20s, and I’m sure looking back, you can see how it impacted your life as a child and teenager.

Firstly, let’s acknowledge that you’ve accomplished a lot despite your struggles. Your associate’s degrees and pursuit of higher education are testaments to your hard work and determination.

ADHD doesn’t mean you lack attention; it means you lack control over your attention. You may find yourself paying too much attention to things that aren’t relevant to your goals. This is evident in your example of struggling to finish your paper and getting sidetracked by your phone and other distractions.

To help you stay focused, consider working with a therapist who specializes in ADHD or an executive functioning coach. They can help you develop strategies tailored to your needs. Additionally, pay attention to your environment and identify what gets you off track. Remove or minimize distractions, and use tools like website blockers or phone apps to help you stay on track.

Experiment with different techniques like the Pomodoro technique, which involves working in focused intervals with regular breaks. You may also find that a change of scenery or working in a quiet space helps. Some people with ADHD benefit from background noise or stimulation, so try different options to see what works for you.

Mindfulness practices can also help improve your attentional control. This involves training your brain to stay present and focused. You can try mindfulness exercises, meditation, or physical activities that require your full attention.

Lastly, don’t give up on finding the right medication. Continue working with your doctor to explore different options. Remember, it’s a process, and it may take some trial and error to find what

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