If You Have ADHD, You Are Likely To Be Depressed

today we are going to try to do something very challenging so i'm going to teach y'all a little bit about the relationship between adhd and depression and i have to say this is one of the most difficult lectures that i've had to prepare uh so that i'm going to need y'all to like cut me some slack first of all so i don't know if this is going to be too much or too little we're going to span a lot of different stuff so we're going to talk about genetics we're going to talk about neuroscience we're going to talk about developmental psychology we're going to talk about sort of the manifestation in the present of depression and adhd and like how that looks so basically what i want to do today is share with you guys the narrative of adhd and depression so what are the genetics what happens in your brain what changes in your brain result in cognitive changes or behavioral changes within a person how do those changes within the person affect their development through life and then what does that look like in the present like where do we end up once you have a genetic change a neuroscientific change a developmental consequence and then you're kind of in the present and then the question is going to be like sort of the next question is like now that we understand how we got here and what our current situation is what we can do about it so this is challenging as an educator because like it's going to involve so many different disciplines of science and even like a little not so much on the spirituality but like psychology and therapy and things like that so i don't know if it's going to be too much information i don't know if y'all are going to be able to follow along so the one thing that i need is the ability to redo this lecture in the future if it kind of implodes um one thing that i that i've started to uh you know really appreciate is that the internet is full of like really really smart and engaged people and so one thing that we're trying to do at healthy gamer which we're sort of committed to is like not dumbing things down so it's my firm belief that you know the better you understand the situation even if it's like hard to understand the more equipped you're going to be to actually make a neg positive impact in your life okay so uh and then if we have time we'll we'll touch on a couple of reddit posts so i'm estimating this lecture to take somewhere between 30 and 45 minutes just so you all know um you know where it's gonna be quite dense and so it's possible it'll like end up with an hour especially if we get to questions and things like that so let's start by talking about adhd and depression so the first thing to understand about adhd and depress let me do an outline so we're going to talk about what we understand about genetics okay and this is the other thing that i have to tell you guys at many points throughout this lecture because this is science and i'm presenting it as such y'all may feel like oh my god does this mean i'm screwed i have adhd i have depression does that mean like because of my genetics and the genetics are so bad that we're screwed no you're not screwed just because of anything that we talk about here even though it sounds like the evidence i'm going to present is going to be quite compelling the statistics are going to be quite shocking and at the same time you're not screwed so don't worry about it okay we'll we'll i'll kind of explain why so we're going to start off by looking at genetics then what we're going to do is sort of look at how our genetics manifest as particular changes in our brain what are the different circuits in our brain that deal with adhd and depression how and specifically what are the circuits in our brain that result in an interaction between these two diseases okay once we sort of understand the neuroscience of the brain of someone with adhd and depression what we're going to end up with is understanding a set of cognitive deficits right so what is like the practical consequence sure i'm going to be talking about things like brain volume and different circuits in the brain and stuff like that but practically how does that translate into particular deficits once we understand the deficits then what we're going to do is take a look at development so if we take someone who has these particular manifested deficits how does their life evolve and what kind of circumstances and experiences do they have as a result of those deficits and once we understand development then what we can do is look at the present so now that we understand the developmental arc what does that result in today like what are you dealing with today and what are the consequences of the development okay so like in the present what are your symptoms what does your life look like right so this is like what we're when we're gonna cite research at every step of the way so if we do a cross-sectional analysis if you guys know what that means on people with adhd and depression what do we find so cross-sectional for those that that don't know is like research that basically is about one point in time in the present okay and so if we like take a snapshot of people with adhd and depression what do we discover about their lives in their situations and then the next thing is that once we understand like all of these different things and we understand okay what are the deficits what's going on in the brain what's the developmental impact what are what do you face on like in the here and now trying to put together a road map to address our problems so like once we understand the complexity that is like adhd and depression can all of this information essentially give us some kind of road map forward you all ready for this is this good okay we'll get to we'll get to a lot of what you guys are talking about okay so let's start with genetics what do we know about the genetics of adhd and depression so the first thing is that twin studies so there's a great paper by in 2019 by farron and larson show essentially a 70 concordance with adhd and depression so what that sort of suggests is that there's a very tight link between there's a genetic root that manifests is both adhd and depression so like twin studies are actually quite compelling here that like there's something going on in the genes so if you look at genes that there's a 70 concordance between these these two things and so we'll get to how this is related and and you know how you manifest as both but it does appear that there's essentially like a very very tight genetic link in terms of adhd and depression now for those of you that are kind of so this is the first point of hopelessness okay they're gonna be several points of hopelessness and i'm gonna try to address each of them in turn so if i were to say that there's a high genetic correlation between adhd and depression what a lot of people will conclude is that if i've got the bad genes if i you know if i got unlucky in the genetic lottery basically i'm screwed for life but the truth of the matter is as a clinician that's absolutely not the case so this is what i want y'all to understand about like the relationship between genetics and how it manifests in an individual so i think about genetics as a vulnerability or a potential and generally speaking what we understand from psychiatrists and this is clinical medicine okay so this isn't like genetic studies this is like looking at real human beings is that genetics plus environment equals illness so essentially what's going on is genetics is sort of like your vulnerability or the probability of something going on and then when you combine that with particular experiences if that formula isn't doesn't go well you end up with illness okay so for example some people may be genetically predisposed to trauma so they have like a 50 you know risk of trauma and then depending on what kind of experience they have let's say they grow up you know in in central africa where there's like a lot of you know genocide and other bad things then that'll result in something like ptsd and so there may be people with like 25 risk or 75 risk and so depending on like you know what the other traumatic experience is let's say this is like you're in the holocaust so then you end up with ptsd and let's say even this person is like you know had a mom who never gave them like like no bedtime stories and this can result in ptsd so you guys see like basically genetic genetics doesn't determine is not like it's not a destiny it's a vulnerability that combined with a particular experience can result in the manifestation of an illness okay so like the other way that i kind of think about this just to use a quick analogy is i kind of think about like the the genetic vulnerability as like a seed okay so like genetics is like a seed and then depending on what kind of soil you plant the seed in and this is where the experience is like the soil depending on what kind of soil you plant the seed and it can result in a plant or not a plant right so if like if my soil is like concrete and i take this seed and i try to plant it in concrete it's never gonna grow so like a concrete soil is sort of like what i think of as like let's say a monk right because they're so control of their mind they're in so such strong control of their mind that like even genetic vulnerabilities can be kind of like overcome compared to if i take you know even a seed that's not very robust and not very healthy and i plant it in super fertile soil like growing up in an environment where you have parents that are like abusive and emotionally neglectful even the you know the the weakest seed when grown in the most fertile soil will manifest in a plant and so then people are saying well okay like i know what the next you know point of hopelessness is oh i have a genetic vulnerability i have a family history of like whatever and i grew up in an unhealthy environment does that mean that i'm basically screwed and the answer is still no because remember that through experiences you can actually change the soil right so this continues to be malleable so even if you have genetic vulnerabilities to particular things by changing your environment by changing your relationships you can still escape the destiny that negative genetics will offer you does that make sense chat we understand that so going back to adhd so there does seem to be in depression there does seem to be a strong genetic concordance between adhd and depression if you drew the short end of this the stick or if you drew the short straw sorry doesn't mean you're screwed okay a couple of other things to note about the genetics and sort of correlation between between adhd and depression so this is quite alarming so adhd increases your risk of depression by five-fold okay so it's like an increased risk it's crazy by fivefold so you're five if you take a group of uh you should take a hundred kids and 50 of them have adhd and 50 of them have no adhd the likelihood of depression is five times higher in the adhd crowd compared to the non-adhd crowd even more alarming is there's a five times five hundred percent basically increase in suicidal ideation for people who have adhd there's also a 3x risk of completed suicide this is staggering okay so people who have adhd are three three times the increased risk of of actually committing suicide okay so there's like a lot of stuff going on here which may relate back to genetics we'll talk about this stuff a little bit more later right so for example we know that suicidality usually completed suicide is not like a long and planned thing so if you there have been studies done where basically people take we examine people who attempted suicide and for some reason or another we were able to save their life and then we asked them when did you make the decision to complete to try to kill yourself and movies and media will portray suicide as like a long and thought out kind of thing right we'll sort of think like i'm going to put my affairs in order i'm gonna write a bunch of notes and i'm gonna do all this stuff and i'm gonna order the favorite thing for like i'm gonna order presents for the next five christmases for my kids because i won't be around to order them right so people like there's this idea that we put our affairs in order but somewhere between 60 and 80 of people the decision to try to kill yourself happens within five minutes of the attempt so it's a very impulsive decision and so if we look at adhd adhd we know increases your impulsivity we'll get to that in a second and so we can see how if you have a brain that is more likely to be vulnerable to impulsive decisions you will actually increase your risk of suicide does that make sense so we'll kind of go into this more so this is kind of a quick result of um you know looking at sort of genetics and the what are what are sort of the epidemiologic factors what are the risk factors and what can we sort of expect about the connection between adhd and depression from a statistical level the other interesting thing about this is that treatment of adhd reduces depression symptoms by 20 so it appears that treating adhd actually has a therapeutic impact on depression so once again what we're seeing here through the twin studies through this stuff and through this stuff is that these are not two separate diseases that both some people are afflicted right this is the main point that i'm trying to make this is what you need to understand is that we may classify adhd and depression as completely separate illnesses but when i work with people as a clinician and when we look at sort of the science and the statistics around it what it seems is that there's a common process that manifests as both adhd and depression so it's not like really two separate diseases it's like there's some sort of common root that manifests in it with these two constructs that are sort of societally made okay so now let's look at okay so let's say that i have you know these genetic changes okay so i've got a set of particular alleles that make me predisposed to depression and adhd so let's try to understand what's going on in the brain of people who are who have this genetic vulnerability so we're going to talk about a couple of different circuits of the brain okay so this is like my terrible drawing of a brain so here's a brain okay so over here we have the amygdala okay so this is kind of interesting so the amygdala is responsible for the experience of negative emotions it's also our survival center of the brain so this is where we experience things like fear and and sort of anxiety and things like that okay we also have uh like the insula which is kind of around here which is also relates to negative emotions so a lot of our emotional circuitry is kind of in this central part of the brain okay there are a couple other other sort of things that i want to talk about this is the nucleus accumbens so this is a major part of reward circuitry so the nucleus accumbens is a dopaminergic area of the brain uh brain which means that it's like infla like it sort of governs behavior and reward it's probably actually a little bit close more to the right which i guess i can fix later and then there are going to be a couple of other parts of the brain that we're going to talk about one is the orbitofrontal cortex or ofc so this involves the regulation of emotion okay so like what i mean by this is i don't know if you guys have had this experience but like sometimes we get emotional and we can logically try to talk ourselves out of it right we can sort of like use logic or control circuits of the brain these are our emotional impulses over here okay so these over here are emotional impulses and this is where our control comes from if that sort of makes sense okay and this is where if we look at this if we look at this thing over here this is where we sort of get the nucleus accumbens will govern a lot of our behavior so we'll kind of get to that in a second okay the other thing um the other part of the brain that we're going to kind of talk about is the dorsolateral pfc okay and this also has to do the motion regulation or emotional control i would say as opposed to regulation we'll talk a little bit about how those are different okay and then the other thing that's kind of important is that like there are connections between these these parts of the brain and those are important too so like we're going to talk about the anterior cingulate cortex okay so this mediates talk between our emotions and let me uh our i don't know control functions okay you guys with the neuroscience so like basically there's this thing called the acc which is here which basically is the circuit that allows these two guys to talk to these folks over here so this is sort of a basic we'll kind of talk about you know what what the changes are in a second so this is what we see in people who have adhd the first thing is that the volume we have the volume of amygdala and insula is smaller than controls okay so what this means is like these parts of our brain are actually smaller there's like a decreased volume so they have small emotional circuits okay now this is kind of interesting because some people may hypothesize they may say well if our like emotional parts of our brain are like smaller doesn't that mean we experience less emotion and it turns out that the opposite is true that if you look at um that how can i say this that uh volume of amygdala is inversely correlated with depression so the smaller your amygdala is the more likely you are to experience depression for people who have large emotional circuits just based on raw brain volume they are actually less likely to experience depression okay now the next thing that's important to understand is so this is so you guys get this you all got that so what that basically means is that like small amygdala and insula which is what we see in adhd results in a greater vulnerability to the experience of depression the second thing that's really really interesting is that the nucleus accumbens of people with adhd is different and the main thing that's different about the nucleus accumbens is that our emotional circuitry has a large positive effect on our nucleus accumbens so what does that mean so this means that people with adhd the influence of their emotions on their behavior is stronger than the influence of emotions on behavior in a normal brain okay so what that means is that people with adhd their behaviors are vulnerable to motion okay do y'all does that make sense so so generally speaking our nucleus accumbens like gets all kinds of different like projections right so what will happen is like there will be an influence from our emotions there will be an influence from our frontal lobes there may be even like influences from like you know let's say our linguistic cortex not sorry not linguistic lingual gustatory that's the word i'm looking for so this is our ability to taste for example like that can have influences on like reward and behavior right so we get all kinds of like stuff that goes into the nucleus accumbens and basically like our brain has this constant calculation of like should i do this behavior is this rewarding or not rewarding and so like you can have things like taste right like your cortices are like oh i shouldn't eat that because i'm trying to lose weight and then like your amygdala is like i've had a bad day you know i just went through a breakup screw it we're just gonna eat a tub of ice cream so that's like literally like the experience of a human being can be mapped onto the nucleus accumbens in the way that these different parts of the brain sort of interact with them so when we look at the brain of someone with adhd the amygdala and insula are going to have stronger impacts on the nucleus accumbens which may also so if we kind of look at like what is the you know what is the result of that what this means if we take like amygdala and then plus nucleus accumbens in the brain of adhd what we get is impulsive behavior and emotional behavior you guys see that like how the more i'm i'm controlled by actually let me put it this way the more i'm controlled by my my emotions the more impulsive i'm gonna seem my behaviors will be more impulsive do you all get that so we can kind of see that the that the phenotype or the manifestation of adhd of impulsivity jesus may come from this neuroscientific interaction so now we're going to get to this in a second but we can see how the symptoms of adhd are the experience of someone with adhd their impulsivity which is not like a neuroscientific thing there's no like impulsivity circuit of the brain i mean there may be a circuit but impulsivity can't be mapped to a neuroscientific structure what we can map to a neuroscientific structure is the integration of all these different things to the nucleus accumbens and based on the way that those circuits integrate into the nucleus accumbens we can have impulsive behavior or we can have non-impulsive behavior another example of that is that when we have a very strong frontal control of our nucleus accumbens we will result in less impulsive behavior okay so now we can see that like you know we can sort of start to see where impulsivity and especially emotional decision making kind of with people with adhd come from okay the next thing that we're going to talk about is in adhd unfortunately there appears to be a weak connection over here okay there's a weak connection over here and so like this the anterior cingulate cortex and people with adhd is weak and so what that means is that the ability for our cortical brain which is like emotional control regulation of emotion and most importantly this circuit that allows the connection between our control circuits and our emotional circuits seems to be weak and so since it's weak our ability to kind of regulate our emotions or put the brakes on emotions seems to be negative and negatively impacted so these are the functions that we call top down control so this is deficient in people who have adhd what top down control means is like you know like you can have impulses within you so i have like an impulse right which i don't really control it's just an impulse and then there's like my brain over here which is kind of suppressing it it's like oh man i really want to eat french fries and then my brain is like no no we're not going to eat french fries we're going to eat a salad so that top down control comes from the frontal lobes and this part appears to be deficient in adhd so this is this can also result in impulsivity you guys see that so now so this is kind of like a quick summary okay so let's let's go over it from the top and then we'll we're sort of setting ourselves up to understand the neuroscience and how this will manifest is symptoms of adhd so the first thing to understand is that um let's pick purple okay so the first thing is that the brain volume of the amygdala and the insulin people with adhd is small what this sort of results in is essentially like our ability to how can i say this so we know that that these regions of the brain being small correlate with worse depression okay so let's just accept that let's not try to understand how that works for a second the second thing is that we have our control circuits of the brain which seem to be less connected to emotions so what that means is our ability to put the brakes on our emotions has gone down so this is also mediated through the acc and lastly we have the nucleus accumbens which essentially determines what we do and what we see in the nucleus accumbens of people with adhd is that it's very sensitive to emotions and less sensitive to top down control y'all with me right so the experience of emotions influences your behavior your ability to put the brakes on that is harder and then this is the key thing about reward circuitry what that means is that like in your brain i know it sounds kind of weird but it's not conscious but you are there is greater reinforcement from emotional decisions i know it sounds kind of bizarre but like what that means if we kind of think about like being like in the the behavioral reinforcement the dopaminergic circuit that actually drives your behavior and creates your motivation all of your motivational hard wiring in your brain all of your motivation in your brain that gets hardwired is going to be more shaped by like emotional decisions so it's kind of really challenging okay so now what we're going to do is get to the deficits so this is what happened so researchers looked did a bunch of studies and essentially what they did is they looked at okay what are the factors in um adhd so if we take a group of people with adhd and depression what are the factors that we can sort of conclude correlate with these two things right so what this essentially do is they take a group of people with adhd and depression they take a group of normal people and they explore okay what is the impact of having adhd and depression so this is essentially what they discovered so the first thing is that there is emotional regulation deficits and i know this may seem common sense at this point or like duh right didn't we just explain that but i want you all to understand these are different kinds of studies right so this is like these are brain scans where they're just scanning people's brain and they don't know anything about the people's symptoms or their experiences of life and these are like looking like asking people questions about okay are you depressed why are you depressed and then they track that down to their individual experience so this is like individual experiences and this is like brain scans right so these are different kinds of data so we're trying to weave them together now hopefully at this point you guys are saying well doug this is obvious and that's the whole point of the lecture is to try to integrate these different kinds of research so we can get a better understanding the second thing is people with adhd and depression are more irritable and irritability is its own biological and neuroscientific thing okay we'll talk about what emotional dysregulation means let me actually see so so actually let's let's define emotional regulation right now so it is the ability to [Music] identify and modify get ready to get wrecked chat um emotional states that promote adaptive and goal directed behavior okay right so this is kind of damning for a lot of us so this is a quick side note so in our coaching program we've had somewhere between five and six thousand people maybe seven thousand now and so we're doing a massive study on our coaching program and what we find in our coaching program is that we see a 20 to 40 percent reduction in depression or anxiety despite the fact that our coaching program is not treatment for depression or anxiety so how is it that coaching can actually improve symptoms that we're not trying to improve at all we're not qualified we're not trained we're not mental health professionals so it turns out that our running hypothesis which we're actually studying right now is that we believe that coaching actually improves eq or emotional quotient it improves our emotional regulation it improves our ability to identify and modify emotional states that promote adaptive and goal-directed behavior that's what coaching is about it's about goal-directed behavior and sort of taking what you are on the inside and sort of like adapting it shaping it so that it it results in like motivation and goal directed behavior so anyway that's what emotional regulation is so the other things that they found was that um people with adhd and depression have discordant relationships so there's discord within the relationships they found peer victimization it's a fancy way of saying bullying and then they found academic hardship okay so when we look at like people with adhd and depression what we essentially find is like people are trying to figure out okay like what are the common elements what is the tie between adhd and depression and these are the five things that they found they found that people with adhd and depression have poor emotional regulation they're highly irritable and what we can actually see is that there are a couple of other things and that we find discordant relationships peer victimization like bullying and like academic hardship so let's try to understand this a little bit better okay so how can adhd and depression result in in these things right so let's try to link our neuroscience to these things and then how can these in turn lead to depression down the road so now there's a really interesting point of of research here okay so this point of research is that adhd i forget exactly leads to like 50 to 70 percent depression but depression leads to 2.7 of adhd so what does this mean this means when you take a young child with adhd when they grow up to be an adult there's like a 50 chance they're gonna have depression but if you take a young child with depression there's a 2.7 percent chance that they're going to have adhd okay so what it actually means is that adhd appears to be a causal factor for adult depression but depression does not appear to be a causal factor for adhd so this is a really really important uh point to understand what this means is that this if everything was purely genetic okay and if everything was just like in the brain then these numbers should be the same but what this suggests is that there's a cogniti i mean sorry a developmental component here that growing up with adhd leads to depression and this is really important for us because this is a point of hope if this was just pure genetics and these numbers were exactly the same forget about the fact that they're like so far apart right like 50 versus three percent that's a huge difference what this means is that there's something here that we can actually intervene on you guys get this okay so now let's try to understand how does adhd early in life result in depression later in life so remember that what we've if we kind of look at adhd we have impulsivity inattention okay um irritability dopamine reward sensitive sensitivity and yeah poor emotional regulation the other thing that we sort of know is that people with adhd their frontal lobes mature more slowly so what that means is like their maturity is going to be less than people of their age so let's kind of just think about this constellation of symptoms and what growing up as this person looks like or feels like okay so the first thing is like let's talk about you know so now what i'm gonna actually do is i didn't do a great job of this so let me actually think about doing it this way okay what we're gonna do we're gonna take these things okay i'm gonna move them over here um no screwed gg okay let's just let's take a look at these three now what we're gonna do is take these okay and we're gonna see we're gonna play a little game chat so these are the things that we know from you know studies contribute to the depression that people with adhd have so now let's play a simple game chat let's see if these match up right so let's say i'm impulsive do you think that will impact how do you think that'll affect my relationships am i more likely to have a discordant relationship if i'm impulsive right absolutely do you think i will mor if my irritability do you think that will negatively impact my relationships absolutely do you think my inability to attend the situations will negatively impact my relationships absolutely so now we begin to see that okay if if depression and adhd is connected through discordant relationships we can see how these three factors will result in discordant relationships right so like i want you guys to put yourselves in the shoes of like a 13 year old with adhd so let's say i'm like hanging out with my friends and then like they're all talking about something and then like my attention wanders i don't participate in the conversation so then like you know i'm just kind of sitting there and then i'm impulsive so i randomly start talking about like zebras and if zebras if there was a cheese named zebra cheese what kind of stripes would it have would it be two kinds of cheeses blended together and then all my friends like look at me like i'm a weirdo because like i'm not able to attend to the conversation plus impulsivity and then what ends up happening so there are studies that show that basically people with adhd get um don't participate in conversations in sort of a healthy way they don't get invited to social things amongst all kinds of other stuff right so we can see that like and let's not let's not forget about irritability like the fact that my brain is more sensitive to being irritable and having a low frustration tolerance makes it hard for me to participate in relationships okay now let's think about bullying so let's see what do you guys think do you think that impulsivity makes me more likely to be bullied like absolutely right and why is that it's because of this so if my social standing in the school is low because of these kinds of things that's going to result in me being bullied so if you talk to people who have adhd what you discover is they got bullied unless you guys know this chat unless they were a class clown so like what people with adhd essentially learn how to do is like the only way i can gain social standing is with my inattentiveness and my impulsivity if i can make other kids laugh i'm not going to be like bullied but otherwise their low social standing their inability to pay attention makes them like get made fun of even more right the fact that they're irritable means like you can get a rise out of a an adhd kid and since i don't have adhd and i've got friends i've got three or four of my friends and i'm gonna like surround the the kid with adhd and i'm gonna bully him he's gonna get pissed and he's gonna throw a punch but the odds are stacked in my favor so he's screwed right because he's not gonna control himself and that's why i'm gonna pick on him if i'm a bully because i know i can get a rise out of him okay now let's think about academic hardship so impulsivity does that lead to academic hardship yes inattention does that lead to academic partnership yes yes yes okay once again the problem here is that oftentimes adhd is under diagnosed in children it is bizarre because because it is the disease that is the most under diagnosed disease and the the most under diagnosed and the most over diagnosed disease in my experience what that means is that a high number of people without adhd get diagnosed with adhd because they want adderall and they're bored at school so they like have trouble with attention and someone gives them pills and it is the most underdiagnosed because a lot of times people will miss diagnoses of adhd and because kids are smart so the smarter you are the more you can set up compensatory mechanisms and no one ever realizes you have adhd and does irritability lead to academic hardship probably but i think this is a slightly less of a thing okay so now let's think about so you guys with me so like we can sort of see it's kind of interesting because we can see that the the factors that studies show us show are correlated and serve as the link between adhd and depression can absolutely be attributed to a developmental process because the child is here and then as the child grows without these being addressed we end up with an adult who grew up with these experiences and so now we can see how adhd in childhood results in adult depression you all see that so this perfectly mirrors what the research tells us which is that if you're going this way there's a 50 chance and if you're going this way if you start with depression you've got a 2.7 chance you all get that okay so it does appear that there's a causal link so the cool thing is that if we can fix these in childhood not just in childhood but even in adulthood what that means is that these things should get better so as we become professionally more successful as we engage in healthier relationships because these problems are not just developmental right because if you're still inattentive and impulsive like it's going to be harder to engage in relationships you may still be a social outcast in this day and age the cool thing is that this is not set in stone so if we fix this even in adulthood our relationships will improve and and we'll see downstream effects so now we get to the present so this is sort of our development right and so now we're up to bullet point five okay and we're going to talk a little bit about what this stuff results in so there are further studies that sort of look at things like emotional regulation and the emotions of people with adhd these are the cross-sectional studies so these studies or this conclusion that i'm drawing is developmental so this is looking at the lifespan of children as they become adults now if we take a group of adults and we just kind of like look at them in this point in time and we try to figure out what is your experience of life in this moment with adhd and depression this is what we discover um that the link between emotion adhd and depression is primarily due to loneliness primarily due to emotional regula relation deficits and shame so this is i'm tacking this on there's not i didn't find a single paper about that i'm sure it's out there but this is just what i've seen so when we're talking about you know what it's like to sit with someone who has adhd and depression these are the three primary experiences which lead to depression in the present okay now let's try to understand where do these come from so loneliness is kind of a no-brainer right we know that discordant relationships and bullying like that's going to lead to loneliness and by the way if we also look at correlations between suicidality you guys remember our 3x risk of suicide very very highly correlated with loneliness if we look at people who actually attempt suicide and commit suicide they're very lonely so now we can even see where the big scale epidemiologic data comes from because these are psychiatric studies so this is looking at the treatment of illness in actual patients like humans okay we can see that loneliness comes from a combination of like discordant relationships bullying and academic hardship because you're not good at school so you don't feel like you're doing a good job similarly bullying and academic hardship will also contribute to shame right so like this is the experience of someone with adhd so we're going to talk about this for a second so if i've got adhd i grow up and what do people tell me oh oh look you're so smart you just need to try harder i don't know why you just can't be more disciplined like i don't know why you are failing so miserably because you are so smart because iq and adhd are not correlated right and so when a child gets told that and like a child understands so the thing that's even more shameful is not even how what the child is told because i've had lots of patients with adhd that have very supportive parents and they're trying to be supportive right when they say oh you have so much potential they're trying to be supportive but what the actual experience is the kid knows they look around and they see everyone else in their class and they can sort of tell they're like i can do math just as well as the kids around me like i understand mathematics i'm a smart kid they look around at all these other people who are just able to sit down and study and like i know that if i get engaged and i pay attention i can learn history i can learn mathematics i should be able to understand this stuff just as quickly as everyone else or in fact that's what they discover is that when they're presented with new information that's interesting they actually potentially even learn faster than their classmates but despite all of these observations that they're just as capable as their classmates they just can't sit down and read a book and so then they feel like idiots they're like there's something fundamentally busted in me and oddly enough the higher their iq is the more shame they're likely to feel that's sort of a clinical observation there's some evidence of that as well there's this thing called the insight trial which sort of showed that the greater insight you have into a particular problem in this case it was a degenerative neurological disease the greater your suicidality is so like it's kind of bizarre and this is what's super sad about working with a lot of my patients with adhd is the smarter they are the more aware that they are that they are of like how screwed they are if that sort of makes sense and if you're like stupid and you kind of don't realize there's a problem it's sort of like ignorance is bliss but bizarrely the most shame is felt by the the students who are actually the smartest and the most aware so when we have loneliness and shame that's going to kind of result in depression and then we're also going to have emotional regulation deficits right and this kind of goes back to our neuroscience our amygdala insula our anterior cingulate cortex and all that kind of stuff so there's some interesting stuff that we can further explore here so you know if we're kind of thinking about you know what our process is for fixing this we're gonna tunnel down just a little bit further and i'm going to kind of dive into emotional regulation because we talk a lot on on stream about loneliness and shame but a lot of people have questions about okay so like if there's an emotional regulation deficit like what does that mean what do i do about it right if if i'm unable to identify and modify my internal emotional states to be become adapt uh to adapt and to direct uh and to engage in goal-directed behavior like what what do i do about that that sounds like devastating right that sounds like my problem in a nutshell is that i can't modify my internal emotional state to like do what i need to do i know what i need to do i just can't bring myself to do it that's another way to put it so further the researchers went tunnel down even further and started to look at emotional regulation and realize that there are three strategies that um people with just in general human beings but especially the people with adhd will employ to regulate their emotions so the first is avoidance so what this means is that that we're going to alter our exposure to internally challenging experiences okay so altering our exposure can be external in a sense or internal i don't like this nomenclature great but it's the best example i have so an example of an you know an avoidance that's external is like i'm afraid that i'm gonna look stupid at the party so i'm not gonna go to the party because i'm afraid i'm gonna look stupid so what they essentially do is they just avoid the situation entirely okay there are also cognitive behavioral avoidance strategies as well okay so you may ask like what does that mean a cognitive behavioral avoidance strategy so this is like where they actually reduce or downplay the internal severity so this is kind of interesting but it's sort of like mentally checking out is what i call it right so this is like when you you like mentally like you kind of avoid something in your mind it's like if i go to a party and i tell myself um you know i don't i i don't even like these people so it's like it's okay if i'm awkward i don't care about these people anyway you mentally sort of avoid in your mind like you use a cognitive avoidance strategy to insulate yourself from some kind of internally challenging experience it's protective in nature right because if i if i devalue the other person in my mind i don't actually have to feel rejected at all do you guys get that so i can avoid going to the party or in my head i can mentally check out from the party when i'm there now this gets a little bit subtle because there are other emotional regulation strategies so the next is suppression so suppression's a little bit different because the emotion is there but i'm gonna squash it down so you may say isn't that avoidance and i'd say no this is sort of fake it till you make it and if we kind of look at like what's the difference between someone who suppresses emotion and someone who's avoidant is like the person who suppresses the emotion is still gonna go to the party right they're just gonna take all their anxiety and they're gonna shove it way down and they're gonna smile they're gonna put on a face and they're gonna pretend to have a good time they're not mentally checked out they're not like afk in their head and being like screw all these guys right what they're actually doing is like there's like an internal struggle but there is also an internal genuineness or authenticity which they're fighting against does this make sense it's very different actually on the inside it is very very different because the the thing the emotion is there we're not avoiding the emotion we're just trying to conquer it and fight it and then the third strategy is reappraisal so this is where like we have cognitive reframes right so this is like where we do some like heavy cognitive work this is like what things like therapy will hopefully help you do where you start to like work on things and you take that negative emotion and then like you do like once you sort of have develop some kind of understanding of for example if i go to the party and i'm anxious i can sort of cognitive reframe and sort of realize oh like everyone else is just as anxious about what they're wearing as i am about what i'm wearing no one is really paying attention to what i'm wearing so i might as well just try to have a good time if some people end up not liking what i'm wearing maybe they'll make fun of me but i'm pretty witty so i can just make fun of them it's like not that big of a deal that's an example of a cognitive reframe it's kind of like processing stuff right working through it etc and what we find in people with adhd is that they so let's say normal human beings let's call normal people blue okay so if we have normal people they'll do like a third a third a third people with adhd will do like nine tenths maybe one tenth zero tenths maybe it's a bit brutal okay and then you have people who are like monks right so monks like in the there's this there's a scale so like after you've got guns gotten someone who's like you know done a lot of internal work or as a monk they'll do like 1 out of 10 avoidance maybe 4 out of 10 suppression and 5 out of 10 reappraisal and at some point you've got you know the i don't know like whatever i mean so so over time like i think you can kind of move in this direction as you do like more emotional work okay and like super high eq will be like nine tens of reappraisal if that makes sense so we can kind of see that all humans will use all of these strategies but there's evidence that people with adhd employ avoidance the most and that avoidance is probably the most damaging right so mentally checking out is a big problem in our community what's less of a problem but is still a problem is like internal struggle or internal conflict and this is sort of like mental piece so these are three different strategies that we can sort of employ for emotional regulation okay so i know it sounds kind of weird but if you're someone who's got adhd what you probably want to do is move from avoidance to suppression first and then eventually move towards reappraisal but it's okay to like feel bad and kind of force yourself through it and that's why people will say like fake it till you make it right it's not mentally checking out it's like acknowledging that you feel bad and then forcing yourself to do something so now we move on to the last step okay so just to kind of cover what we've covered we started with genetics we started with epidemiology what are the statistics around adhd and depression then we talked a little bit about different structures of the brain and how if we look at like i do mri scans or brain scans of people with like adhd and depression what do we discover about their brain and how is it different once we understand understood the neuroscientific deficits we went on to look at you know what does that manifest as what does that look like in someone's life so what are the the vulnerabilities or what are the psychological disadvantages that they have then we sort of looked at how being born or growing up with those disadvantages affects your development and how that sort of results in depression later in life then we looked at in the present you know what what does it look like if you're someone who's had adhd and depression what does it look like in the present to be in your situation and then the last thing that we're going to look at now is a road map okay so now everyone's wondering what do i do about this how do i fix this and the short answer is like there's a lot to do and you know you're not going to get an answer in the next five minutes of how to transform your life but this is what i will say so the first thing that i want you all to appreciate now i'm going to talk purely from a clinical perspective so now i'm going to talk about like as a human being who is a psychiatrist who works with people with adhd and depression here is what i've learned about what works for them the first is that there is a diagnostic um on there's a diagnostic lack of sophistication so what i mean by that is if we kind of look at all of these scales of problems right like we can we can take a look at all of the things we've discussed so is your problem one of like reward circuitry is your problem one of you know orbital frontal control is your problem one where your amygdala is too hyperactive or is your problem more downstream right is your problem something more like um you know emotional regulation sorry and then furthermore we can like tunnel down right is it suppression avoidance or reappraisal which strategy do you use is your problem irritability or is is your problem developmental in nature is the problem that you have a bunch of shame is the problem that you're lonely right is the problem the way that you interact with people so discordant relationships is your problem that you are still bullied either by people at work or things like that is your problem that you lack professional or academic success and this is what i mean by there's a lack of diagnostic sophistication so i can diagnose someone with adhd and depression and i can give them treatment right i can give them medications or do cbt or whatever but in my experience of working with actual human beings if you really want to conquer this it actually starts with this degree of diagnostic sophistication so for you to look at yourself and say like okay which one of these things really fits me because each of these is going to have a different kind of like solution right so let's kind of go through those so like if your problem is reward circuitry like maybe what you need to do is a dopamine detox if your problem is orbital frontal control maybe what you need to do is meditate if your problem is amygdala hyper reactivity maybe what you need to do is alter your diet for a certain neurotransmitter production or be careful about toxic influences or do a grounding meditation because there's meditation specificity all throughout here as well okay maybe your problem is emotional regulation so then this is where like you can do things like you know cbt or other kinds of exercises to like move between these these different areas right so cbt can teach you how to which is cognitive behavioral therapy can teach you how to do reappraisal you know increasing awareness of avoidance so i know it sounds kind of interesting but if you just become aware of your avoidance that can actually move you into engaging in suppression so just awareness is actually sufficient at starting the process of going from avoidance to suppression irritability once again there are dietary changes here so there's evidence that for example altering the diet of people with severe autism to have high iron diets and address nutritional deficiencies um actually reduces the amount of like meltdowns that they have i know it's crazy but people have actually done studies on severe autism and what they've realized is that like so because some of these poor kids like they're just medicated through the roof to keep them like docile and it turns out that there are dietary changes that you can make that will actually alter your irritability there's a bunch of stuff about this in dr k's guide about sort of theories around how altering your diet affects neurotransmitter production right so produces serotonin like gives you precursors that will be produced turned into dopamine serotonin etc things like that if your problem is shame or loneliness so for shame like maybe you need to go to therapy and this kind of therapy may be different it's more processing therapy right if you're lonely this is where like potentially coaching could come in like sure you could go to the therapy route and talk about how you're lonely but maybe by working with a coach you can actually focus on solutions to make friends right like how can i understand like okay where can i go how do i meet people where how do i go outside we had that post recently so a lot of different solutions with loneliness that may not necessarily be sitting in your your therapist's office and like talking about how lonely you are like i know it's crazy as a therapist sometimes i do not think that is the cure to loneliness and now discordant relationships this one is huge because once you are aware right so here's my experience with the majority of people i work with adhd when it comes to this they have no idea what they're doing like they have no idea that the reason their relationships are discordant is because they are inattentive is because they are impulsive that other people have difficulty keeping up with them all they conclude is people don't like me it's hard for me to keep friends i don't get invited to stuff and then that just turns into shame right so like then they start to develop an identity of themselves that i am unlikable people don't want to be my friend it's not anything in their control it's it's just like i am this way and i'm screwed and so it leads to shame and the more ashamed you are and the more you come to realize that people don't want to be your friend you're not even going to engage in relationships and then you don't try to engage in relationships then you end up being lonely so by understanding the nature of your discordant relationships you can even prep people so sometimes i'll even like prep my patients about how to talk to people and say things like hey by the way i've got adhd so like there are all kinds of things that my patients oftentimes do so for example they'll be late to social engagements they'll be um you know they'll sometimes even forget like like they won't keep track of like the fact that we're supposed to meet someone for lunch and so obviously like that person is pissed and so interestingly enough just raising awareness of your you know inattentiveness raising awareness of your disorganization and raising awareness of your impulsivity can actually can actually start to mend your relationships like you can just form healthier relationships once you understand all these things the bullying you know you can teach people how to set good boundaries and the professional academic success there's a lot of stuff here but you know there's dealing with the shame to begin with because that's that's like a burden on you that prevents you from succeeding you know you have a sense of identity as a failure so you can work on that right maybe therapy maybe coaching something like that and then you can also do like actual treatment interventions like maybe you do need like adhd meds maybe you do need cognitive behavioral therapy for adhd right and the point here is that the road map for your progress and for you to put together your life is absolutely there but it starts by sort of having a sophistication of diagnosis what is my actual problem here which of these boxes do i check so you can kind of go down this list right and you can kind of say like okay oh this feels right this feels not right actually like i'm not getting bullied it's not a big deal like oh yeah like my big problems are professional or academic success feeling of shame and then like i'm very very avoided right it's not so much that i'm irritable like i don't get pissed easily i actually do have good friends i've got a good social support structure so i'm not lonely or this and so it's it's very specific in terms of how to navigate it and once again despite the fact that like you know the last thing that i kind of want to share with you all is despite the fact a lot of this stuff is genetic and neuroscientific in nature there's still a lot you can do about it like this is not you know there's a lot of stuff on the intervention side that can be done and generally speaking my my approach is a clinician and this is what you know it's not just as a clinician this is what we also do in coaching is to like help people understand where is your actual problem and awareness of the problem can in my opinion not even doing anything about it just recognizing what the problem is can account for a 50 improvement in whatever you're talking about so just to give you guys like a simple epidemiological example of this so if you look at like obesity in central america so obesity in central america is really really bad and it's probably due to the propagation of like sugary beverages like and people down there like i think that's changing now but you know 20 or 30 years ago like people like some in some parts of central america there was just a lack of education that like drinking you know like sugary juices and sugary sodas like three meals a day is going to contribute to obesity and once people just realize oh hey what i'm putting into my body may affect you know like my health once that awareness is there it actually results in like a positive change in behavior and so if you look at things like socioeconomic status and obesity what you tend to find is that there are parts of the you know parts of the world where they're like there's a very low understanding of like the impact of like what you put into your body and how it affects your health and you can go to places like whole foods and stuff like that where there are all these wellness magazines there's a lot of food that's unhealthy by the way but you can see that even awareness can account for some amount of change and even from video games we kind of know like if you don't know why you're losing a game you can't even begin to improve it if you're just aware of particular mechanics right like being aware of those mechanics will automatically change the way that you play the game and so i think awareness in my opinion is actually worth 50 of the progress and then once you have a specific problem or once you figure out what your specific problem is where your specific vulnerability is you can start to make changes in that particular direction to sort of overcome this issue a couple of things which i i should sort of say if it hasn't become clear i think if this stuff resonates with y'all the first thing you should do if you haven't done it already is seek an actual mental health professional's help so if you're concerned you may have adhd if you're concerned you may have depression go and talk to an actual doctor or like therapist or something so i know a lot of times we'll talk about things like dr k's guide and coaching and all that kind of stuff i really do think the single most important intervention you can do is to actually go see a mental health professional beyond that there are other things that you can do like by all means go watch dr k's guide there's a lot of stuff in there about meditation and these different grounding meditations versus like the meditations that will teach you control by all means check out our youtube video on dopamine detox if you want to talk about this kind of stuff and focus on solutions to make friends and things like that that's something that coaches may be better trained at um you know helping you with professional and academic success that may be something that coaches are can help you with uh you know helping with discordant relationships that can be therapy or coaching but really at the top of the list is if you guys have not seen a mental health professional you should absolutely go do that questions or i guess let me just kind of summarize so just to kind of cap recap today we talked a little bit about adhd and depression and the goal of what i was trying to do today is to stitch together a lot of different disciplines of science to give us a very clear understanding of what adhd and depression like how they interact and what they are so it starts with genetics where we sort of discovered that 70 of adhd and depression appears to be has a 70 concordance in genetics that there are a lot of scary statistics that show that adhd and depression may start at the genetic level so once we understood the genetics we kind of went into certain neuroscience and tried to figure out okay what's happening in the brain of people with adhd and depression how do these two things kind of interact then what we did is looked at deficits right so once we understand what's happening in the brain what does that manifest as within an individual what are the actual deficits that someone with adhd and depression has once we understood what the deficits are we sort of were able to take a developmental perspective so if you take a kid who has these kinds of develop deficits and sort of has adhd as a child how does growing up with those deficits manifest as depression when you're an adult and we kind of explored those things and what what whether the statistics tell us what does the research tell us are they contributing or what are the smoking guns of depression in adulthood for people who have adhd and we discovered that it's discordant relationships bullying academic hardship emotional dysregulation and irritability and then we even looked at sort of a more present focused or clinical focused perspective where we kind of said okay so like once you're here and you're in the here and now you grew up with adhd now you have depression what does that look like in the here and now what are the different strategies that people use in the present to deal with their emotions and then finally once we understood that what is our roadmap for improvement if you fall into this bucket what do you actually end up like what can you do about it and the answer is you can do a lot so you're not doomed by your genetics you're not doomed by your brain there's a ton of stuff that you can do and i've worked very successfully with like tons of patients that have been able to essentially overcome adhd and depression so there's hope out there don't give up and i really hope that today's lecture has empowered you all to better understand this really fascinating aspect of like human neuroscience human psychology and like sort of the experiences of these people in the present questions all right questions okay i'm gonna focus on questions relating to adhd and depression for now uh just how does strengthening the frontal lobe affect stuff okay good question so let's kind of go back so how does strengthening the frontal lobe affect stuff so remember that our motivation behavioral drives and essentially what we do our reward circuitry is the nucleus accumbens now in the nucleus accumbens let's kind of go down here okay so let's look at point number seven how does frontal lobe affect things so in our nucleus accumbens there's like a pro and a con for a behavior okay and essentially what happens is like our emotions may be telling us break up with this person and our frontal lobes may be telling us oh no no don't do that don't give in to the emotion there's like there's a tension between emotions and frontal lobes in the nucleus accumbens and depending on which one wins if the frontal lobe wins then like you'll engage in one behavior and if the emotions win you'll engage in another behavior it even goes a little bit deeper because the reward structure can be related to emotions or frontal lobe and so what that even means is that how can i say this let's say i'm bullying someone the amount of satisfaction i get from bullying someone relates to the emotional impact on our nucleus accumbens versus our frontal lobes which is why we'll see like if you look at people who are lifelong meditators they don't engage in like toxic behavior because it feels less rewarding to them this is how like people who meditate on a regular basis like become better human beings i know it's kind of bizarre because it's not just the influence of like you know what you end up doing it's also the reward that you get from like giving in to your emotions so like giving in to hatred is going to reward it's going to reinforce your behavior in a particular way and it's going to feel really really good if your brain is like framed a particular way when you strengthen strengthen your frontal lobes literally the satisfaction that you get from being a toxic on the internet goes down and so then we see a reduction in that behavior because your reward circuitry has been altered does that make sense um so you mentioned genetics but are you familiar with the science behind epigenetics in regards to this specifically the studies about things like ptsd being passed down to children through epigenetics yeah i'm pretty familiar with that research so let's take the question from the top so there's some evidence okay let's just really go from the top so the first thing is that there's a field called epigenetics which is not the actual genes but the act how genes are turned on or turned off so our genome look we've got a bunch of stuff in there and it's not necessarily the allele or like the the gene like the dna sequence at a particular point but like you can turn genes on and you can turn genes off that's called epigenetics so whether genes are turned on or off actually relates to our experiences so certain kinds of genes will be turned on by certain kinds of experiences so an example of this is when our body gets an infection we will activate transcription we will turn on genes of things like heat shock proteins and other kinds of like genes in our cells that will help us fight infection right so it's like there's a bunch of stuff that like once we get infected our bodies like time to go to war let's start producing like let's turn on our armories and start producing soldiers and like you know cytokines that will help us fight infection so experiences can affect our genetic uh activation and so if we go back to what i was saying earlier about what is the model of genes right so that's where i sort of shared that genetics plus vulnerability is what results in illness and all that kind of stuff is epigenetic so this is also where when we kind of look at that that developmental aspect when we were talking about okay if you have a kid with adhd who grows up with an adhd brain and experiences life as a kid with adhd with bullying and not having friends and like poor academic success that's going to have an epigenetic impact and make you vulnerable to depression so i believe a lot of that stuff is mediated through epigenetics i personally have not looked into the epigenetics of development with adhd as it relates to depression but i sort of feel like i don't need to because there's like i mean hopefully i made a convincing argument of this i think we have enough pieces of the puzzle where we're like pretty sure that that's happening great question though um yeah so can can you explain more how to work on discordant relationships sure so the term discordant relationship means like a relationship that has discord right it's something that's not working properly so if you want to work on discordant relationships as someone with adhd i think the main thing to understand is what are your adhd deficits that could impact the relationship that's the first thing you've got to do so is this relationship not going well because i am disorganized and i like don't show up when i'm supposed to show up is this relationship not going well because i was supposed to pick up pick someone up at the airport and i showed up an hour late because i'm disorganized like that's a very practical example of how disorganization and adhd negatively affects the relationship is this relationship being negatively affected because i'm inattentive so when i do hang out with someone i'm literally not able to attend to like what they're saying so we're going to dinner together and like i'm going to dinner with let's say my partner right so my romantic partner and they've had a bad day and my mind is like wandering all over the place so then that that partner will feel unheard they'll feel like someone's not listening to them they won't feel emotionally supported and it'll create discord in the relationship so the first thing to under to do or maybe it's like irritability or emotional regulation right so maybe the way the reason that my relationship is in discord is because i'm too irritable i've had a bad day and then i like go and meet my friends and since i'm in a foul mood because i'm overly irritable like i snap at them and they feel hurt and then like i feel like kind of i feel like i screwed up right and then the avoidance kicks in because we know that people with adhd engage in avoidance behaviors and so once i create a problem in a relationship since i rely on avoidance i never really fix it right i never talk to them about it i never apologize to them or i overly apologize and never engage in discussion i never asked them hey what was it like to have me being like irritable that day right i never want to hear from them how i'm like actually sometimes not a great friend so i avoid so like that's an example of like looking at not only the the predispositions you have to damage relationships but then also your coping mechanisms can sort of reinforce that damage or interfere with your repair mechanisms because you're so avoidant and that leads to discordant relationships so how do you work on it right so now this is where we kind of look at for example like if you know that what your problems are you can actually have conversations with people about them right you can say hey by the way so like let's say you go to dinner with your partner and and they're like they're talking about things and you can even like while you're tuned in you can say hey i can see that this is something that's really upsetting you and i'm having a lot of trouble focusing on what you're saying and what i really want to do more than anything else is focus on what you're saying um so i'm going to do my best but i apologize if it seems like i'm kind of checked out i'm really trying to pay attention the second thing that you can do is even suggest an alternative and you can say hey like it's really hard for me to like pay attention to you like being in this crowded restaurant is it okay if we table this conversation let's go for a walk after we're done with dinner and like i'd love to hear about it maybe we can go for a walk because oftentimes what people with adhd discover is that having some kind of physical activity helps them pay attention so i've even had i've written notes for students of mine for them to be able to knit during class okay so this is a really interesting thing that if if people with adhd are able to knit they can actually pay better attention mentally so you i'll even have patients who will be like hey let's like i'm going to stop eating this is the extreme i don't think this has ever happened i'm going to stop eating and because this conversation is so important to me i'm going to pull out my knitting because that helps me pay attention it's bizarre right so then you can start to address things you can also signal to other people because remember that if they don't know what's going on internally they're going to interpret your inattentiveness as a lack of caring so you can have a conversation with them where you can help people understand hey it's not that i don't care it's that i really do care and my brain is really not complying right now right so you can sort of address things and then the third thing which i think is really really important to improve discordant relationships is to move away from avoidance if there is some kind of conflict if there is some kind of problem and you feel really ashamed or whatever like you can't bury it right or i guess you can suppress that's that's what i mean by bear i mean so that kind of suppression is actually healthy so burying it and attending to them but avoiding the situation never having a conversation with them never acknowledging things pretending that everything is okay or devaluing things in my mind oh my partner will be fine it's like not that big of a deal like they understand i've got adhd i don't need to talk to him about it all of those kinds of avoidance strategies will cause discord in your relationship so move from those strategies to more suppression where you're like even though it's really going to hurt me to have this conversation because my partner may say may confirm my my deepest fears that i'm actually not a good partner at times i still have to have the conversation i'm gonna squash that feeling down and sit down and actually have the conversation and ideally you can even get to the point of reappraisal where you can work through things on your own and you can say like you know i really care about this relationship and even though it may be hurtful to get confirmation that i didn't do a great job in the long term moving past that is the right move and really what this relationship needs so i have to do it because caring about the relationship and my value for the relationship is greater than my feelings being hurt temporarily that's sort of the ultimate fix so i hope that helps um okay so one person is saying i've tried to get diagnosed for adhd and have been told because i'm depressed and my age it would be inconclusive and am unable to get treatment for what i what what what can i do so i'd say go see a different clinician so let's understand a couple of things so adhd oftentimes people will get tested for adhd so there are neuropsychological tests so you go to a psychologist and they will administer like a test of your attention based on the results of that test they can diagnose you with adhd or not diagnose you with adhd but the truth is that a test cannot diagnose you with adhd all a test can do is give you a probability of what your diagnosis of adhd is if that sort of makes sense because that's how psychological tests are designed a true diagnosis of adhd comes from is often done clinically and a test is used to supplement a clinical diagnosis and so what does that mean a clinical diagnosis that means that you sit down with a trained professional who evaluates you and essentially subjectively decides i know it's kind of objective but it's really one person's opinion because that's how we do psychiatric diagnoses there are no objective tests for psychiatric diagnoses so a trained clinician has to sit down evaluate your symptoms and say yes according to my expertise you have adhd or according to my expertise you do not have adhd so there may be so that's ultimately where the diagnosis of adhd comes from it doesn't technically come from a test you know even the test report will not give you a hundred percent likelihood that you have adhd if you actually read the report it'll probably say and i could be wrong there may be a test out there that because i'm not a neuropsychologist um so you know i could be mistaken there but based on as a psychiatrist when i refer people to neuropsychological testing they'll give me a report back and that report will say like you know we believe that this person has you know has a high likelihood or extremely high likelihood of having adhd here are the neuroscientific deficits that we believe that this person has which which is why we think they have adhd so they go into a lot of detail but they're never going to give you 100 so just talk to a clinician now the main confounding factor is that if you have active depression so if your cognition is being affected by your depression then it it makes it very hard to determine whether your inattention is a is coming from the depression or coming from the adhd if that sort of makes sense because we know that people who are actively depressed have trouble paying attention to things but that has nothing to do with adhd that's because attention is you know a complicated circuit in the brain that can be affected by mood that can be affected by depression so the real way you should make a diagnosis of adhd with someone who's got a diagnosis of depression is ideally to treat the depression have the depression in remission right so then they're not actively depressed anymore and then evaluate their attentive when their depression is theoretically out of the picture and if they still have attentional problems then there's a good likelihood that they've got adhd now as a clinician i've diagnosed people with adhd despite the fact that they're actively depressed and that simply comes from asking questions about what their attention was like before they were depressed right so you can still do that you can still try to do an assessment of like before depression ever manifested what was school like for you did you ever need special testing did you have difficulty with this do you have difficulty with that sometimes i'll talk to their parents and you can still sort of like make a preliminary diagnosis of adhd even in the case of active depression and that's very important clinically so i'd say find a good clinician because a good clinician should be able to suss that out for you and walk you through you know maybe treating your depression so that you can get a good diagnosis but i'm not surprised that one person would say hey we can't give you neuropsychological testing while you're actively depressed because that'll interfere with the test results that sort of makes sense okay just so you all know i know i'm getting a lot of like questions and responses and stuff like i'm still like on the first round of questions okay so like i think i can scroll down quite a bit um someone's saying dr k listening to your voice empowers me good i'm happy to hear that i'd also hope that listening to my words empowers you oh boy adventurer 467 says i'm late oh dude my poor friend if you came in late to this lecture it's gonna be tough dude go back and watch from the beginning um okay why do people have adhd what a good question this is actually really interesting why do people have adhd so it is my belief that adh the reason we so okay why do people have adhd if we want to understand why human beings have things i think the best way uh sorry the best answer for the question why is evolution so i just as a psychiatrist medical professional scientist call me whatever you want to i think if you really want to understand why like you could turn to things like religion or yoga or whatever right and i've studied all that stuff i believe in some of that stuff but in terms of what i'm confident you know sharing with y'all it's basically evolution so if you look at like human beings everything we have things that you know don't exist probably had selection pressures against them and things that do exist have selection pressures for them so for example people may ask the question why do we get depressed and there's a good video about this in dr k's guide depression is the evil is the price we pay for the evolutionary advantage of self-awareness so if we think about human beings at some point we became self-aware and it turns out that from an evolutionary standpoint the capacity for self-reflection gave us such a dominating advantage over every other species in the planet the problem is that when we gain self-awareness we open ourselves up to depression and that has to do with this circuit called the default mode network there's a you know a big thing about that in in dr k's guide i go into all that detail so let's talk about adhd like why would we have adhd if it's a disease right whereas i think you have to and there's a good theory about this which is sort of the hunter versus farmer uh theory which is that when human beings were like you know ten thousand years ago or five thousand years ago human beings had different temperaments so some human beings were very like routine oriented like to wake up at the same time every day like to go to the same place every day and do the same stuff every day so these people became the farmers and there were other human beings that hated being a farmer they wanted variety and they wanted to like go out and explore and they needed to attend to a lot of stimuli so when i'm walking through the jungle my brain needs to be like bouncing all over the place it needs to kind of be adhd it can't just focus on one tree it has to look at this tree and has to look at the ground is there a snake over there is there oh is that like a footprint over there is that is that a broken branch over there and so what there's almost like this adaptive benefit to having a mind that's attention is more loose and not focused and not repetitive and so early on in in human like in societies like we had hunter gatherer societies we had early farming societies and things like that and there was probably a selection pressure for both so the most successful tribe was one that had some farmers some people who were in the routine and some people who were like very dynamic and had attention all over the place so essentially what happened is like that's why we see in society we have both camps right we have the people whose attention is all over the place these are the vatas for lack of a better term and then we also have the kaphas these are the farmers the people who are very routine oriented the reason that adhd is now a disorder is because of a couple of things but the first and biggest reason is because our society has a very very farmer bent so like hunters like don't do well in our society anymore if we think about school for example school is like eight hours a day the same crap all day every day it's not being out in the woods it's not learning with your hands it's not using your hands right it's not being a tradesman anymore or trades woman it's it's all about like schools and books and learning and nine to five and the grind and stuff like that so that benefits the farmers it's a farmer-like society as a result now this thing which used to be an evolutionary advantage when we were hunter-gatherers has now become a disorder because we don't we're not able to function in this society with brains like this so that's my big answer to why is there adhd it's because these brains no longer fit with the society that we have there are also other influences like we know that for example early exposure to technology and especially like short form technology reduces our attention span and makes like it hard for us to like retain attention on one area so it's not just societal influence there can also be like technological influences where there are even studies that have been done on long-form television versus short form television so if you take a kid and you give them long-form tv like you have them watch a movie that's not going to negatively affect their attention span whereas if you have a kid who's watching 30 second clips on youtube for like six hours a day their attention span is going to be like really really short right so they'll still be very dynamic they can juggle a lot of things but their ability to sit through school is not going to be like it's going to be hard it's hard for them to sit down and focus their attention so there do appear to be societal influences that are like more developmental and related to technology too which is why adhd i think is getting worse actually so that's why we have adhd okay oh man what are the comorbidities of other conditions that also match adhd symptoms dude that's a whole lecture in and of itself um but the short answer is that's why we have the process of differential diagnosis so remember that you know adhd is a collection of symptoms like impulsivity for example inattention irritability if we look at the differential diagnosis for those symptoms there's like a ton of stuff right so ptsd is the great chameleon of mental illnesses and can masquerade as pretty much anything bipolar disorder depression can sometimes there's a subtype of depression called depression with anger attacks which is like a bit that depression which we also talk about in dr k's guide so that's where like people who are depressed aren't sad they just get super irritable so even depression can manifest as like irritability and inattention bipolar disorder for sure if you're manic rights or hypomanic you're more irritable you're less attentive you have flight of ideas so bipolar disorder can manifest as substance use is very high on the list of like on the differential right because if i'm like high on adderall or i've had too much coffee i'm going to be speaking very fast my mind is all over the place and i'm going to be irritable so the differential diagnosis is huge if you want to you know a great i mean i guess we could theoretically do whole lectures about differential diagnosis but that's when we're really like talking medical school kind of stuff like that's what i teach clinically like when i've you know a resident who's like a psychiatrist or a medical student who wants to learn about psychiatry like that's the kind of detail that we go into there good question though um seems like defective executive function would be a disadvantage in tribes i would think so so i i think like executive function is like the most op thing in the brain in my opinion so i don't know why we would have a deficit for executive function if we look at it evolutionarily probably the reason that we have deficits in executive function is because of opportunity cost so if you kind of think about it i know this sounds kind of weird but what do you think is like evolutionary evolutionarily advantageous being very like stable and monogamous monogamous and staying in one relationship for your entire life that is like harmonious where you raise two kids and you you know you make sure that you can like support them with resources or being somewhat of an emotional train wreck and having like lots of different children with like lots of different people what's actually like evolutionary advantageous right like falling in love and then having a train wreck of a relationship if that happens like six times over the course of 15 years it's interesting right so like evolutionary advantages are about survival and reproduction by the way i'm not sure that that's the case so i literally do not know because it may be that you know that person's offspring or like less likely to have successful offspring of their own like you never know so so it's interesting but yeah we don't really know why people seem to have executive function deficits but it may be because like if your executive function is too high like you're less likely to have children who knows okay uh um so would you have any recommendation for adhd dears with depression who are currently unable to access medication due to waiting lists any supplementation or specific meditation techniques you'd recommend so i'd go back to the roadmap right so i gave you all like lots of different things to work on as far as supplementation goes i'm not going to recommend any supplements generally speaking we try to steer clear of that here at hg i mean we do do it in dr k's guide because i think there's a lot of backstory before like you understand like you think about taking a supplement so in dr k's guide we go into a lot of detail about the dangers of herbal supplements we also want to do a very thorough like review of the literature and the science before we recommend anything so there are particular things that we'll talk about for depression and anxiety but it needs to have like you know a lot of safety discussions a lot of like exploration of the real efficacy of supplementation so while there are things that i do for my patients and that's basically about that balancing diet is what i would recommend there's a lot of back story to that and a lot of complicated stuff that you need to do before i just say hey do this so i think one of the unfortunately irresponsible things that tends to happen is people will talk a lot about supplements but they won't have in my opinion the boring safe conversations that you really need to before you get into supplementation as far as specific meditation techniques i think i addressed that in the roadmap as well so we we've taught some techniques for restraining attention like the rotating sound awareness meditation um and by the way the the guide now has a meditation index where you can now search based on like if you're looking for grounding techniques and things like that it'll like point them out to you but i think that depending on going back to the roadmap once you figure out what your problem is there are specific meditations for like each of those problems so if your problem is shame for example you may want to do like some kind of anahat chakra or mehta meditation these are heart chakra meditations that are all about cultivating compassion and forgiveness that's going to be different from the meditation that helps you restrain your attention and focus on one point that in turn is going to be different from the kind of meditation that you use to ground yourself when you're emotionally activated and like very irritable right so there are all these different meditation techniques there really isn't great science yet that specific meditation techniques target things at the resolution that i teach because you just have to do a ton of clinical trials we're i think we'll get there we're getting there but clinically i found it to be very effective to teach people specific targeted meditation techniques but those techniques depend on you know the roadmap um so so one person is saying great so adhd is good for nothing now i disagree so i'm pretty sure that if you look at successful streamers and content creators the prevalence of adhd within content creators is higher than the average population i think as our society is becoming more adhd with shorter form content and things like that right so like it's like the adhd brain who did we have um that guy uh who has so he so first of all if you go back through our interviews like we have a bunch of like streamers and content creators who have like we'll say yeah i have adhd um daily dose of the internet so i think i think that's a guy i think if i remember correctly he sort of said like i have really bad adhd and if you kind of think about it what is he doing like he instinctively knows because of his adhd what he finds entertaining so he uses his adhd is almost like a compass to determine like what's getting included in daily dose of the internet and what isn't and it's very successful right so we've also got people are mentioning miss kiff and and xqc and stuff like that so like yeah i mean check out the mischief interview if you all are curious that's an excellent interview about adhd but i do think that it's you know adhd has advantages like once it crosses the threshold of disorder it's the reason we define it as a disorder is like because it's negatively impacts your function so if you've got super bad you know adhd chances are it's just like it's a it's a negative right um but that's why i also prefer to sort of use the ayurvedic system because i am quite adhd but i'm like subclinical so i think avata is a better example of like how to understand the spectrum the bell curve of like attention across human beings is becoming apathetic to your successes whilst obsessing over your failures common with adhd i'm gonna say yes so let's go back to the neuroscience so remember that oh man this is so complicated let me just think about this okay so the question is is becoming apathetic to your successes whilst obsessing over your failures common with adhd and i'm gonna say yes so let's let's lean a little bit on what we've learned today okay and maybe y'all can walk walk through this with me so first thing is obsessing over your failures common with adhd let's unpack that phrase so the first thing is obsessing so one of the hallmarks of adhd is dysregulated attention so a lot of times people assume that adhd means a very small attention span but the truth is if you talk to people with adhd what you find is dysregulated attention and what that means is that sometimes their attention is very very small but the flip is also true where sometimes they get so deeply absorbed in something where like like everything around them ceases to exist so this is a disorder of attention instead of your attention staying kind of in the middle where you can get distracted when you need to get distracted but you can focus when you need to focus what you'll see oftentimes in adhd is a hyper focus to the impairment of their life so i get so caught up in a video game that i lose all track of time i get so obsessive about something that i stop paying attention to everything around me so there is obsession is actually like a very interesting hallmark of adhd and something that leads to the a misdiagnosis because what you'll find is sometimes people will be like you know parents will think about their kids and they're like well my kid sometimes has paying attention but then once he starts playing legos it's clear that legos can hold his attention for three hours at a stretch without any interruption so that must not be adhd because he's sitting there he's playing with the legos at three hours of stretch that can actually be a feature of adhd so it's disordered attention okay the second thing is so that's the obsession so the second thing is obsessing over failures so remember we talked a little bit about how the volume of the amygdala and the insula and people with adhd is smaller the interesting thing is that volume loss correlates with worsening symptoms of depression so it appears that the brains of people with adhd are actually more vulnerable to negative emotions right which is why they're prone to depression so obsessing over your failures is completely consistent with with our understanding of adhd now being apathetic to your successes has two elements one that i've sort of already talked a little bit about and the second one that's kind of new so the first is being apathetic to your successes is likely an avoidance strategy to help emotionally regulate yourself so remember that people with adhd have difficulties with emotional regulation and so their inability to regulate their emotional emotions results in three coping strategies avoidance suppression or reappraisal avoidance is when we kind of mentally check out from the thing we either avoid the situation entirely we literally don't go so we can physically check out of the situation or what we'll do is mentally check out of the situation so we'll even go to the place but we'll devalue something in in my mind so that it doesn't i don't have to be hurt by it right so i kind of go afk in a situation that's absolutely a tactic used to overcome my disordered emotions to begin with it's a coping mechanism so healthier than that is suppression where at least i feel the emotion but i push it down so there's internal conflict versus mentally checking out and then the third and healthiest thing is reappraisal which is when i kind of work through the emotion and i end up like looking at the silver lining or realizing that okay even though i got you know even though my partner dumped me like in the grand scheme of things like there are other people out there i learned a lot from the relationship i'm gonna know better what mistakes not to make next time that's an example of reappraisal so we can see how apathy to success absolutely falls into that avoidance category as a coping strategy against your difficult emotional regulation which we once again know that people with adhd have so that's consistent apathetic with success the last thing that i'll mention which is a little bit different which is a little bit more from the yogic perspective or the eastern perspective is when you're a child with adhd and it's hard for you to succeed because you have certain neuro neurological disadvantages in terms of like attention and things like that one of the things that you have to learn how to do is divorce yourself from success and this is a protective mechanism so i want you to put yourself in the shoes of like a 12 year old who has difficulty studying and so if i have difficulty studying and i'm afraid i'm going to do bad on the test what i have to learn how to do is numb myself right because if i've been if i'm invested in success and i have adhd and then i go and fail the test i get punished right because i wanted to succeed i wanted to succeed i wanted to succeed and so i i try really hard and then i end up failing anyway because i have adhd it's not my fault i spent eight hours in front of a book but my brain wouldn't focus and so that hurts so much so what do i learn how to do i become psychologically calloused i learn how to numb myself i learn how to be apathetic to my success because the cool thing is that if i become apathetic to my success i also in a sense become apathetic to my failure right because if i divorce myself it's like ah i don't care about the test whatever whether i succeed or fail whatever and so it sort of becomes a short-term coping strategy which doesn't really work because as you kind of mentioned you do still obsess over your failures right but that's because your brain is vulnerable to the negative emotion so despite the fact that you're numbing yourself to the success and the failure if you've got a brain that's more vulnerable to the negative emotion what you kind of end up with is i'm numbing both equally but i'm hypersensitive due to my small volume of insulin amygdala to the failure so even though i'm numbing both equally i have an amplification of the negative emotion due to the way that my my limbic system is wired right and so that's sort of like it's it's like actually a perfect example of everything that we understand from neuroscience everything that we understand from development why people with adhd are apathetic to their successes and obsess over their failures and hopefully if you watch that whole lecture you'll be able to follow that you'll be able to arrive at that conclusion as well there are so people are asking about gender differences between male and female adhd so the biggest difference is that men seem to be more vulnerable to adhd than women i don't have the exact statistics but i think some of that also has to do with maturation of the frontal lobe so uh girls tend to have slightly more mature frontal lobes than boys do so at the end when everyone's fully grown it all evens out but generally speaking like sometimes girls will have you know we'll have like be like developmentally one to two years or boys will be like one to two years behind or girls will be like one to two years ahead so that's pretty common a lot of that has to do with frontal lobes and adhd does appear to be more common in men than women um would you argue oh man it's so hard because everything i say you guys that's so i'm like responding to questions from like 10 minutes ago or comments which is hard i have to figure out how to handle that would you argue that adults teenagers these days have a harder time to cope with adhd due to technology because the human brain wasn't prepared for the advancement compared to older generations absolutely so you know if we look at older generations oftentimes like i don't mean to speak poorly of them but like the boomer generation right which it's not all boomers but some of them tend to be very not sympathetic towards the mental health plights of like the digital generation right so the pre-digital generation is like i don't understand why y'all are all so messed up back in my day i had to walk 10 miles through the snow to get to get a glass of milk or whatever right they'll like they'll look at their world and then compare their world to our world and when they look at the when they compare their world to our world what they'll do is they'll look at a lot of the advantages that we have now which they didn't have back then which are fair right so for example like food security i'm pretty sure is better now than it was a hundred years ago you know infant mortality is better now than it was a hundred years ago um you know the likelihood of like dying from cholera is like way better now than it was a hundred years ago um you know we have society has advanced society has become more convenient you used to have to go to a restaurant if you wanted to eat food at a restaurant like from a restaurant right now we have a bunch of people that deliver you can get groceries delivered you can get food delivered you can get all kinds of stuff delivered you can go to school online our life has a bunch of convenience right so there used to be a certain kind of hardship 100 years ago that we don't experience there are objective you know life has gotten by a lot of objective measures like mortality and life expectancy and things like that better than it was a hundred years ago so you know the pre-digital generation looks at us and they say things are so much better and they point to all these things and they say like why are you so mentally unhealthy like why do you have adhd why can't you just study why are you depressed why do you have anxiety i think things that i think the things that they don't look at they take some things for granted because they really don't have any awareness of like what it's like to grow up in these conditions right so they see the change they see some changes which are very external but what the pre-digital generation doesn't understand is like the internal stresses that growing up in this digital world sends us so adhd is a good example of like if we look at content right like first there was youtube and sorry if i'm like historically inaccurate then there was twitch and if we kind of look at the dynamic-ness of content like youtube used to be like you know still like it's a storehouse of content you kind of pick what you watch you're not missing anything because it's to be up there forever and then we that sort of evolves into twitch right and like twitch is like more interactive it's more temporary so you got to kind of be there it's a little bit more adhd and then like that evolves into tick tock which is like the whole point of tick tock is that it's super short right we also have evolutions from text messaging to things like snapchat and i'm still not 100 sure about this but my understanding about about snapchat is that it's it's like you know the whole idea is that the messages are temporary so if you don't check it frequently like it disappears into the ether so if we look at the way that technology is advancing it's selecting for and entraining conditioning a shorter attention span and so that's why it's one of the reasons why i think that adhd is getting worse but technology is also having effects on things like depression and anxiety so when we get bombarded with the worst news from all over the world every single day we begin to see the world as falling apart as we see the world as falling apart we start to feel depressed and hopeless because how can i fix climate change i can't might as well sit at home and do nothing right how can i fix all of this like you know racial hatred i can't might as well sit down and do nothing you know how can i fix all of these like income inequality like i can't fix it i'm powerless so when you like when you get bombarded with this sensory information and you feel powerless and then like the internet gives you this sweet sweet tick tock right it's like don't don't worry man it's okay like don't worry about climate change here watch this tick talk about climate change which will like engage your emotions and make you feel self-righteous and will help you feel better and after you watch that tick tock about climate change why don't you check this one about check out this one about cats because cats are hilarious don't you love cats and so that's what happens right we have like this this world that bombards us with all this depressing information and then it gives us like it creates this problem and then it gives us this solution and we take the solution our brain loves the solution and then we end up trapped in this cycle of like you know being emotionally like pulled around like a like a puppet on on strings and we get like emotionally like existentially depressed and then we get like coping strategies but that's not even a coping strategy it's an addiction really it's like we'll fix that for you oh like you're in withdrawal from heroin like here have some more heroin that's essentially what like is happening in the in on the internet right now is that it's like addicting us to heroin by giving us all this negative emotion and then it's like here i've got the solution for you right here right it's and so like yeah i think that this is a societal thing it's a technological thing in the pre-digital generation i don't think understands that right and so this is even funny we even have a word for it right so like the internet has collectively realized that this is going on so we developed our own language of copium that's like literally like we put we created a word to describe this phenomenon because it's happening and it's so prevalent it's crazy right like even look at the icon like look at this picture of this pepe with his eyes closed who's got he can't even you guys understand he's got a mask on because he can't even bring himself to hold it to his face he is so afk from the world that it needs to be strapped onto him in order for him to get that copium he can't even be bothered to get get up out of his chair and like walk over to the copium machine and like take a hit of copia he just sticks it on he can't even keep his eyes just gotta afk completely you guys get that it's like actually like in the image i mean it's it's a beautiful image like art is like a fantastic way to capture what is happening in society right so you guys think that like i'm good at analyzing society in psychology but like i'm a fraction of what a brilliant artist is capable of because here i am i've been lecturing now for the better part of it's two hours holy and an artist will capture it like this whoever made this captured it in like 300 pixels it's brilliant right they've taken pepe and they've just given pepe different facial expressions and they've encapsulated so much it's also interesting because you know i remember learning in history class that hieroglyphics were a primitive language and that the alphabet is a superior language right because the alphabet allows us to you know construct words and things like that you only need to learn 26 characters and now it's like we've like swung through alphabet and into emojis and so we've come full circle back to hieroglyphics where now like people don't even communicate and once again it was like writing letters used to be inferior to having a phone call and now we've come full circle and we're like back to texting is our primary form of communication and it's like we're coming full circle and they've understood this in in like east asia for a long time right so they have like chinese characters and kanji which are essentially like hieroglyphics and so it's just interesting that a lot of you know a lot of our understanding of like language was like actually kind of eurocentric in terms of its you know a value system that i don't think was actually accurate you

Channel: HealthyGamerGG

Views: 46,980

Rating: 4.9714389 out of 5

Keywords: mental health, drk, dr kanojia, healthygamergg, healthy gamer gg, twitch, psychiatrist

Id: xkXpcs_an80

Length: 117min 3sec (7023 seconds)

Published: Thu Nov 11 2021

Reddit Comments

[u/1eho101pma]

Does anyone else feel that some video titles are click-baity and sometimes titles don't reflect the videos message?

Things like "How being good at games actually leads to suffering", and the big arrow with phychiatrist written on it?