Managing ADHD and Emotional Challenges: Beyond Medication Solutions

ADHD/ADD and Emotional Regulation

Hello, Doctor: I have had symptoms similar to ADHD since childhood.
I was taken to National Taiwan University for an evaluation during kindergarten or early elementary school, but I was not given a detailed diagnosis and the doctor attributed it to parental issues (although it may have been difficult to confirm at that young age).
Throughout my education, I was often questioned about having ADHD, but my family felt it wasn't severe enough.
Additionally, I had a peer who was diagnosed with ADHD and has been on medication for control.
My family would say things like, "Will taking medication really help? If you have it, so what?" or "Even if you have it, what support for ADHD have we not provided besides medication?" It wasn't until I turned 30, when the pandemic affected my work and led to feelings of low mood and depression, that I decided to seek medical help after reading about adult ADHD.
I found a specialized clinic for adult ADHD and, after undergoing psychological assessment, I was confirmed to have ADHD symptoms.
I started taking Atomoxetine but experienced occasional panic attacks as a side effect (at a dosage of 5mg), which would occur about 2-3 hours after taking the medication and last for about an hour (sometimes intermittent).
Given that emotional issues were more prominent, I switched to Venlafaxine 150mg.
After starting Venlafaxine, I experienced fewer side effects, but due to anxiety symptoms arising from work and life situations, I began taking Xanax.
However, due to stronger side effects, I switched to half of a 0.25mg dose of Buspirone (I discussed with my doctor that I am more sensitive to medications and have previously experienced significant side effects when resuming the same medication at the same dosage after stopping).
The side effects are milder, but occasionally I feel that the efficacy of the medication isn't as strong, and I cannot adjust to a higher dosage.
Therefore, I would like to explore cognitive behavioral therapy (CBT) in addition to medication, hoping it can help maintain my mood and focus training.
I have a general understanding of different schools of thought and theories, and I have tried to apply similar patterns in practice, but I often find myself stuck.
Various thoughts flood my mind, and my indecision leads to further emotional lows.
I try to break the cycle, but often my emotional responses overwhelm my rational thinking before I can catch up.
I would like to ask what other methods, besides medication, can help improve sudden feelings of wanting to disappear and facilitate clearer changes or decisions? Thank you.

C, 30~39 year old female. Ask Date: 2023/02/13

Dr. Li Jite reply Psychiatry

Dear Sir/Madam,
From your letter, it is evident that you are experiencing discomfort and distress due to concerns about ADHD and anxiety.

1.
Facing an uncertain future, anxiety disorders are common in modern society.
This is a chronic condition that requires long-term treatment for recovery.

2.
Anxiety disorders are chronic illnesses that have periods of exacerbation, remission, recovery, and relapse.
More than half of patients may experience a recurrence of symptoms even after they have improved.
Due to individual differences in physiology, it may take time to identify the most suitable medication, so please be patient and cooperate with your physician.

3.
In terms of pharmacological treatment, each primary medication requires 4 to 6 weeks to assess its effectiveness.
If you experience any discomfort, it is advisable to note the duration and frequency of these symptoms.

4.
In addition to medication and psychotherapy, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, anesthesia-free, highly safe treatment option that does not require hospitalization and can improve anxiety and depressive symptoms.
As for adult ADD, it remains a topic of ongoing discussion; some symptoms may be related to the original condition, while others could be side effects of medication.

Our clinic is open for consultations from Monday to Friday, both in the morning and afternoon.
We recommend that you consider visiting the clinic for a personal assessment of your symptoms, allowing for a collaborative discussion to determine the best course of action for you.

Wishing you good mental and physical health.

Reply Date: 2023/02/13

More Info

Managing ADHD and emotional challenges, especially in adulthood, can be a complex journey that often requires a multifaceted approach. While medication can be an effective part of treatment, it is essential to explore additional strategies that can help improve emotional regulation, focus, and overall well-being. Here are several non-medication approaches that may be beneficial for you:
1. Cognitive Behavioral Therapy (CBT): CBT is a structured, goal-oriented form of psychotherapy that has been shown to be effective for individuals with ADHD and co-occurring emotional issues such as anxiety and depression. It focuses on identifying and changing negative thought patterns and behaviors. By working with a trained therapist, you can learn coping strategies to manage impulsivity, improve focus, and develop better emotional regulation skills.

2. Mindfulness and Meditation: Mindfulness practices can help you become more aware of your thoughts and feelings without judgment. Techniques such as meditation, deep breathing exercises, and yoga can reduce anxiety and improve concentration. Regular mindfulness practice can help you create a mental space that allows you to respond to stressors more calmly and thoughtfully, rather than reacting impulsively.

3. Behavioral Interventions: Establishing a structured routine can significantly benefit individuals with ADHD. Creating a daily schedule that includes specific times for work, relaxation, and self-care can help improve focus and reduce feelings of being overwhelmed. Additionally, breaking tasks into smaller, manageable steps can make it easier to stay on track and feel accomplished.

4. Physical Activity: Regular exercise has been shown to have a positive impact on mood and cognitive function. Engaging in physical activities that you enjoy can help reduce anxiety and improve focus. Even short bursts of activity, such as a brisk walk or stretching, can help clear your mind and boost your energy levels.

5. Nutrition and Sleep Hygiene: A balanced diet rich in whole foods, including fruits, vegetables, lean proteins, and whole grains, can support brain health and emotional well-being. Additionally, prioritizing good sleep hygiene—such as maintaining a consistent sleep schedule, creating a relaxing bedtime routine, and minimizing screen time before bed—can improve your overall mood and cognitive function.

6. Support Groups: Connecting with others who understand your experiences can provide emotional support and practical advice. Consider joining a support group for adults with ADHD or mental health challenges. Sharing your experiences and learning from others can help you feel less isolated and more empowered.

7. Skill Development: Working on specific skills, such as time management, organization, and emotional regulation, can be beneficial. There are many resources available, including books, workshops, and online courses, that focus on developing these skills in a practical and supportive way.

8. Professional Guidance: Regular check-ins with a mental health professional can help you navigate your feelings and experiences. They can provide tailored strategies and support as you work through your challenges. If you find that certain medications are not working well for you, discussing alternative options or adjustments with your healthcare provider is crucial.

9. Journaling: Keeping a journal can be a helpful tool for processing your thoughts and emotions. Writing about your experiences can provide clarity and help you identify patterns in your feelings and behaviors. This practice can also serve as a way to track your progress and celebrate small victories.

10. Gradual Exposure to Challenges: If you find yourself feeling overwhelmed by tasks or decisions, try gradually exposing yourself to these challenges in a controlled manner. Start with small, manageable tasks and gradually increase their complexity as you build confidence.

In conclusion, managing ADHD and emotional challenges requires a holistic approach that combines medication, therapy, lifestyle changes, and support. By exploring these non-medication strategies, you can develop a personalized plan that addresses your unique needs and helps you achieve a greater sense of balance and well-being. Remember, it's essential to work closely with your healthcare provider to ensure that any new strategies align with your overall treatment plan.

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