← ADHD for Smart Ass Women with Tracy Otsuka
ADHD for Smart Ass Women with Tracy Otsuka
EP 379: ADHD, Medication, and What Actually Works with Maggie Alexander, MS, PMHNP
00:50:53
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Tracy Otsuka
Before we start, a quick note. If you've been listening to this podcast and thinking, I need more than insight, I need support, this is for you. Your ADHD brain is not broken. It just never came with a map. That is why I created you'd ADHD Brain is a okay academy. It's my patented step by step framework to help you build a life. And that finally fits how your brain works.
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Ready to get started?
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Click the link in the show notes to sign up or book a free discovery call with me now. On with the show. Richard Branson, Michael Phelps, Justin Timberlake, James Carville.
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Wait a minute.
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Where are the women? Greta Gerwig, Lisa Ling, Audra McDonald, Simone Biles. That sounds like a list of highly successful titans in a variety of industries. They all have adhd, but you don't hear much about that now, do you? You know what else you don't hear about are the 43% of people with ADHD who are in excellent mental health. Why aren't we talking about them and what they are doing? I'm your host, Tracy Adsuka, and that's exactly what we do here. I'm a lawyer, not a doctor, a lifelong student, and now the author of my new book, ADHD for Smartass Women. I'm also a certified ADHD coach. And the creator of youf ADHD Brain is aok, a patented system that helps ADHD women just like you get unstuck and fall in love with their brilliant brains. Here we embrace our too muchness and we focus on our strengths. My guests and I credit our ADHD for some of our greatest gifts.
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And to those who still think they're
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too much, too impulsive, too scattered, too disorganized, I say no one ever made a difference by being too little.
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Hello, I am your host, Tracy Adsuka. Thank you so much for joining me here for another episode of ADHD for Smartass Women. You know that my purpose is always to show you who you are and then inspire you to be it. In the thousands of ADHD women that I've had the privilege of meeting, I've never met a one that wasn't truly brilliant at something. Not one. So today I am especially delighted to introduce you to Maggie Alexander. Maggie Alexander knows ADHD from both sides. She lives it in her own family, and she treats it every day. As a psychiatric nurse practitioner since 2013, she's worked with hundreds of teens and adults, helping them cut through the noise and actually understand what works for their brains. Her approach is holistic but grounded medication, when appropriate, targeted strategies Micronutrients and evidence based tools that lead to reality lasting change. Before specializing in adhd, Maggie worked as a certified nurse midwife, supporting women and families through some of life's biggest transitions. She holds two master's degrees in nursing and has taught at Oregon Health and Science University. Maggie now lives in Portland, Oregon where she is actively increasing her focus on mentoring other clinicians. She spends her non work time with her family, rides horses and walks in the forest with her dog. Welcome, Maggie. Did I get all of that right?
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Maggie Alexander
Thank you. That feels really good. Thank you so much. Thank you. Yeah.
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Tracy Otsuka
Maggie, I am so excited to have you here today, I really am, because I just know the big hole that we have when it comes to ADHD medication. But before we go there, I know you don't have ADHD yourself, but you're surrounded by it in your family. So I want to know what were you seeing that made that apparent? What did that look like?
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Maggie Alexander
Well, you know the crazy thing, Tracy, is that I didn't see it. And as you can see, I'm not a young woman. Next year I'll be 70. So I just turned 69.
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Tracy Otsuka
You look fabulous.
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Maggie Alexander
Thank you. And in my early to mid-50s, I decided to leave midwifery. Sadly. I loved being a midwife, but I didn't like staying up all night and working in hospitals and some of the politics. So I switched over to becoming a psychiatric nurse practitioner, not knowing at that time that my then 13 and 18 year old sons had ADHD because they could focus on things they were interested in. Right. They were wonderful human beings. They were super smart, super talented. One of them was a dancer, the other one was into computer science. Just terrific children. And I never imagined that they had this thing called ADHD that I thought was a 10 year old boy throwing a rock through a window. That was my stereotype. So. And now that I've thought about it for the last 13 years, my father passed away actually in 2012 before I actually finished my. Got hung up my shingle and I think my dad might have had adhd. And you know, I've had dearly beloved friends and significant others in my life with adhd. So yes, I love all of you with ADHD so dearly. And now I actually understand it, you know, from the inside out. So it's, it's a pleasure.
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Tracy Otsuka
So wait a minute, you did not see it, but you weren't in the ADHD space, right? What led you to that space? How did you get pulled into that work if not for your kids? And I Think your husband has ADHD too, right?
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Maggie Alexander
I had a partner with adhd. Yes. Yes. Yeah, exactly, Tracy. You know, I was going to be that midwife that was going to help other, you know, depressed, anxious, postpartum ladies or pregnant ladies. That's where I got my psychiatric nurse practitioner degree. And fortunately, within the first couple of months of internist, a physician that I'd met at a function, he sent me a guy who I call Matt, not his real name. Matt was 43. He was handsome, he was athletic. He was happily married. He had a good job. He had three kids. And he sat down on my couch and he told me that he was suicidal. And his doctor had sent him to me because he tried Prozac and Zoloft and Celexa, and they just weren't working. And at the point when Matt came to see me, he didn't want to be on the planet anymore. And I'm sitting there not believing in adhd, thinking, my gosh, he's got everything in order. Why is he suicidal? And in the course of our hour and a half together, he told me, when he was a junior in high school, he started messing around, drinking alcohol, smoking pot back in the 90s, right? It wasn't weed then, it was pot. And his dad found out and said, son, you know, we're not having this. Your grades are tanking. He started getting season Ds. He'd been an AB student. We're sending you off to a treatment center, son. And somebody there said, look, we're going to give you a little Adderall to help you get through your senior year of high school. He was a junior in high school at that point. So he got out of the treatment center. His dad said, you know what? We're not sending you back to that public school where they drink and smoke. You're going to a private school. So he got a year of Adderall.
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Tracy Otsuka
Can I ask you a question? Because I know our listeners are thinking, so he got Adderall. He must have been diagnosed with ADHD at the treatment center.
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Maggie Alexander
I guess so, yeah. At that point, I didn't even know to ask, like, you know, how did they decide that? And I'm sitting in my chair in my new office thinking, there's three things that help with mental health. Broccoli, love, and exercise. Right? This is the midwife turned psychiatric nurse practitioner. They're all lovely things, but they don't make a huge difference when you're dealing with adhd, at least not initially. And so he told me a story, and fortunately, Tracy, something clicked in my brain and I just thought, Maggie, maybe it. It wasn't just the private high school, maybe it was the Adderall. And maybe he has that thing you don't believe in, which back then I thought was called ADD because he wasn't hyperactive. There is no such thing as add. Everybody's got the hyperactivity mentally, if not physically. And so I thought, I don't want to give him that dangerous, you know, dependent causing drug, Adderall, right? I want to give him something milder. So I gave him the smallest amount of Concerta long acting Ritalin you can write for. I gave him 18 milligrams of concerta. And I went over suicide precautions and I felt terribly like, oh my gosh, what I do for this poor man. And three days later, Matt called me and he said, oh, my God. And I said, what are you talking about? And he said, maggie, I told you, in an eight hour day, I was doing an hour of work. And we all know this phenomenon. I didn't know it then, but the hyperfocus, you know, he was super smart, he had an IT job and he was getting the basics done. But the reason he was suicidal was because he knew he was capable of so much more, right? So then he said, maggie, and not only that, you know how I was always so tired every day after not working, I'd go home and take a two hour nap. And I said, yeah, I remember you saying that. He said, maggie, not only did I work all day yesterday, but I came home and played with my kids.
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Tracy Otsuka
Oh, this. He was in your book.
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Maggie Alexander
Yes. Yeah.
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Tracy Otsuka
This is the story.
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Maggie Alexander
Yeah. At which point, you know, seriously, I was in tears on the phone. I. The floodlight, you know, a football field. Floodlights went off in my head. And I thought, I gotta learn about this. And so that was the moment, that was the pivotal moment where, you know, I realized, this is real and you gotta learn about it. And it wasn't until months into this process that I started thinking about my boys. And I've helped raise four kids. So there are three, Three young men now, some of them not so young anymore, right, who have adhd. And it just began to dawn on me that it doesn't look like Tigger for everybody. Not everybody's, you know, the guy that. Tiggers bouncing is what tiggers do best. Right. Sometimes we look like Piglet or a little bit of Eeyore or a little bit of Rabbit or. We got that wisdom of owl. You know, it presents in a multitude of Ways.
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Tracy Otsuka
So I'm curious, when you say I didn't believe in it, what did that mean? What does that mean?
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Maggie Alexander
You know, the stereotypes, Tracy, of like adhd, you know, people are making this up. Like, why would we want to give children a Ritalin or an Adderall? They're just. Boys are just being boys. Or, you know, let kids be. We're over drugging kids like that. I was that person 13 years ago.
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Tracy Otsuka
I am really interested in your work around ADHD and medication primarily because I have not had success with it, but also because in my personal experience talking to thousands of ADHD women, I've heard the same stories over and over again. You're usually diagnosed, you're handed a stimulant prescription, and then you're sent on your merry way. And if that doesn't work, which it doesn't for many of us, then they may hand you a non stimulant or two, but there's no precision. And I personally, I felt like a science experiment going through two years of this off and on. I would literally, it got to the point I would literally do the research and then I'd tell my clinician what I thought we should try next. And I know that this story is not unique. However, one time, and this is what kept me going for two years, medication worked for me. Once I was working on a speech. I have no short term memory. I mean, I, I can't memorize anything. Even if someone feeds me a sentence, I won't be able to. I'll just stumble all over myself. I really struggle with memory. And I remember, you know, working for weeks on this speech. I went and got the prescription from the psychiatrist and I filled it Costco. I was sitting in the parking lot. I'm like, oh, I'm just going to try it. I took the Ritalin within 30 minutes I started, and it was about an hour and a half drive back. That hour I went through the speech, I think four or five times, did not miss a beat. That never happened again because it happened one time. I was like, it's in there. There's some key that needs to be turned and there's a lock there. And so I kept trying and trying, but it never worked again. My thought is, was it estrogen? And all the, you know, everything was just where it needed to be for that one particular day. But that was right around perimenopause. After that, I just could never get it back. Or I just, I wanted to ask you that question.
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Maggie Alexander
Oh, my goodness, that's a complicated Question. I hope I can shed some light on it. It's not uncommon that people have this sort of miraculous euphoric experience initially, and then they can't quite get it back. So you're not alone in that. We're digging right into the weeds here, Tracy, early on in our conversation with each other. But, you know, if one were to read one chapter in my book, Shine with adhd, if you only read one chapter, it would be the one on medications, because this is really what will change and has changed in my case, close to 700 people's lives around. The key thing is that you pick the right drug. And as you mentioned Ritalin and I mentioned Adderall, those are the two drugs, right? There's two molecules, methylphenidate, which is Ritalin, and then an amphetamine, a mixed amphetamine, which is Adderall. And there are different versions of these drugs. Of course, there's Concerta. I mentioned long acting Ritalin, there's Vocalin. There's a really cool drug called Jornay. Those are all the methylphenidate, Ritalin drugs. And then we got the Vyvanse, and also something called My Day Is, which is long acting. So they're basically just these two families. So I just say Ritalin and Adderall. So you got to pick the right drug. So in your case, it's quite possible, Tracy, that Ritalin is your friend, is. Is the right drug. The second piece is dosage. And this is what so many people don't understand is it's just like eyeglasses. And I do love that analogy, right? So, like, if. If you were, you know, talking to me and I was squinting, right, and you were like, hey, Maggie, you know, they make these things called eyeglasses. You might want to give them a try. And you happen you were sitting having coffee together or something, and you had a little bag full of eyeglasses, and you gave me a 1.25 reader, and I put them on, and I'd be like, oh, gosh, these do help. You're like, well, try a little stronger. Here's a 1.5. Here's a 1.75, 2.0. Wow, I can read the fine print. Then you give me a 2.25 and I'm like, it's a little blurry now, you know, 2.5. Ugh. Eyeglasses, they're too strong. Stimulants are just like that. They are a little bit more, a little bit more, a little bit more. And then I call it falling off. The mountain too much. So dosage is everything. And in Matt's case, our friend that I told you about, 220 pounds, 6 foot 2. Right. Big guy. I gave him the tiniest amount because Maggie was nervous because I didn't know what I was doing. Gave him the least amount of concerta you could write for 18 milligrams what you would give like an eight year old kid. Right. Well, I hit the nail on the head with Matt. So that's a really important point which has nothing to do with your size, has nothing to do with your sex and has nothing to do with your age. So I have a lot of women that are built like you, Tracy, that are, you know, petite, small, you know, lovely humans on huge amounts of amphetamines like Vyvanse, 70 milligrams twice a day because they metabolize drugs really quickly. Matt is still on 18 milligrams of concerta. That's why we hit the nail on the head because it was the right prescription for him, the right dose. So drug dose and then we'll get into it because I know you have more questions. Duration covering the full 12 hours of the day. You got to wear the glasses all day long. Yeah. So in your case, you know, we can chat more at some point about dosage, but I would be going back to a really low dose and then slowly going up by a little bit. A little bit, A little bit. You don't have to do it over a long period of time, like just every few days you can increase like you take 5mg of Ritalin, break a 10mg in half, then chop that thing into quarters and then take 7.5 and then 10 and at some point you'll have the aha moment and then you'll fall off the mountain. You'll have the side effect. You're like ah, yesterday, Yesterday's dose was the perfect dose.
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Tracy Otsuka
I love what you just said. There's one dose and only one dose that will work. There's not a range, it's not a bell shaped curve.
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Maggie Alexander
Right? Yeah, yeah.
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Tracy Otsuka
One of the things with me and I honestly this is self, you know, I mean I. No one ever told. Well, maybe my doctors have now just because of this struggle. I am a slow metabolizer. I believe in that. I am so sensitive to anything and I'm sure you see this all the time where these stimulant medications, if you have any kind of anxiety, they can really make you so much more anxious. And like I can't Handle coffee, I can barely handle tea. Only certain kinds.
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Maggie Alexander
And I'm just going to repeat what I said about start low because 10% of the population are the mats of the world, right? They need a little bit and they get missed. And later, when I got to know him better, he told me he really didn't like Adderall because it made him anxious.
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Tracy Otsuka
Right.
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Maggie Alexander
It was the wrong drug. It did. It's kind of like, yes, I'm getting my homework done. You know, there's a sort of irritable quality and it makes you hyper focused, but not in a pleasant way. And you mentioned anxiety. You should never have anxiety as a result of your stimulants. If you're having anxiety, the dose is too high or you're on the wrong drug. These drugs, when they work, they are like eyeglasses. They're perfect. There are maybe a little dry mouth, maybe your heart rate goes up a little bit, maybe a tad increase in blood pressure. But other than that there should be no side effects at all. So if someone is experiencing side effects. I just saw a mom of an 11 year old boy who, you know, his psychiatrist had put him on the highest amount of Ritalin you can be on like just enormous amount. And the kid was irritable, he was getting his work done and he hit somebody in school. 11 year old. And then he got labeled as, you know, a bad kid. And I gave him another diagnosis, oppositional defiant disorder. And we did do genetic testing. We'll talk about that in a minute. And turned out Ritalin, which is the drug that we give children first, it's the milder of the two. It was the wrong drug for him. And about 60 to 70% of the population will do better on an amphetamine. So if it's not working, no matter what your age is, you want to switch over to the other medication. And if you started with a milder one, then you go over to amphetamine. But in Matt's case, he was the opposite, Right. He was the guy that was 30% of the population, like Ritalin was perfect for him. In the case of most school kids, most adults. I just came back from the APSAR convention, which is the American Professional Society for ADHD and Related Disorders. And I talked with several psychiatrists there who had ADHD who were taking one extended release stimulant in the morning and we're cranky and we're not functioning well in the afternoon because duration. Right. Their medication had worn off and they themselves did not know that they should boost that with A short acting. And these are our psychiatrists. So you touched on something which is, you know, talking to a clinician. I mean, I'm just going to say we got no training, right? There's no course in nurse practitioner school, there's no course in medical school, there's no textbook. The gentleman who wrote the foreword to my book, beloved Dr. William Dodson, who is one of our heroes nationally, internationally, he is going to publish his textbook. I hope it's going to be this year, but if it's not, it'll be early next year. He's got a publisher. It's going to happen. I'm so excited. But that will be the first textbook in the United States on adhd. So people don't know what they're doing because they aren't trained. 93% of psychiatrists have said I did not have adequate education to treat ADHD
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Tracy Otsuka
well, and then there's the liability, right. Prescribing stimulant medication.
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Maggie Alexander
So there's all of that.
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Tracy Otsuka
Yeah, I can see why this has happened. So you mentioned Dr. William Dodson. He's built a reputation around really dialing in ADHD medication. I would love to know what did you learn from him that completely changed how you approach treatment?
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Maggie Alexander
Oh, gosh. Most of what I've told you today, I have to say is from Bill. You know, the right drug, the right dose, what I refer to as the magic mountain. That's his chart. I have it in the book. Basically, it just looks like little Mount Everest. You go up really fast and you come down really fast. And that's based on a 27 minute long test called the Tova, the test of Variable attention, where he, you know, over many years tested his patients and he found out that there's one dose and one dose only. And you got to figure it out. You can't just give everybody a standard starting dose. So you start out low and you go up. And I'm the one who did the 2.5. I just want to do it really carefully. That was, that was my input. And then the other thing is, which I haven't really emphasized enough is you've got to cover 12 hours. So if kids are coming home cranky or tired or the psychiatrists, one of them had to hire a coach so that she could do her charts in the afternoon because she couldn't focus. Right. You just got to extend it. And sometimes you got to take two extender release or sometimes you got to do what I call as the sandwich, which is a short acting stimulant. First thing in the morning. That gives you that kind of kick in the butt, you know, activates in 20 to 30 minutes. You follow that with a six hour extended release or an eight hour extended release, depending on the molecule. And then sometimes you need a little boost in the evening because you don't want to come off of your meds during the witching hour when you're fixing dinner for the kids. You take another dose at like 4 or 5 in the afternoon. So all of that I learned from Bill.
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Tracy Otsuka
Yeah, so I have consistently read that 20 to 30% of people do not have success with stimulant medication. But in your book you say that it's 85 to 90% of people respond well with medication. So what's the difference there? Is it just we, you know, you try it at the starting dose and it doesn't work right away, then, you know, they just give up on it.
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Maggie Alexander
Well, I think we've touched on some of the reasons, which is they're on the wrong medication. Right. It could be a kid that doesn't do well on Ritalin and that's generally what we start them on. I do have some people who can't take Concerta, but they can take Ritalin. So you gotta just pay attention to the person, whether it's a client or whether it's a family member, and really ask them what their experience is. Because again, if they're having any side effect, it's either the wrong drug or the wrong dose. And you want to address that. You do not want to go up in dose, which is what a lot of people do. Oh, you're not focusing enough. You're being irritable. When you come home, you need more. That is the opposite of what you want to do. You want to go down. So precision in terms of again, picking the right drug and the right dose. That's part of why we have those 20 to 30% not working, because they're not on the right drug and they're not on the right dose. Most of the folks that I come to take care of who have been previously prescribed, they get a, you know, a blanket starting dose. They'll be given 10 milligrams of Adderall or Vyvanse, 30 milligrams. There's no titrating. Even the lovely doctor that I talked to in San Diego in January who was on Adderall, she said, I said, well, how much are you taking? She said, I'm taking extended release 15. I said, how did you figure that out? She said, well, 10 didn't work. Fifteen seemed to be good. Right. I didn't want to take too much. She didn't go up the magic mountain. Right. She got an effect. So Maybe she's wearing 1.5 readers when she really needs 2.0. We don't know.
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Tracy Otsuka
I was told it's been a couple of years now, but by a world renowned expert in adhd, that genetic testing, well, we're just not there yet. I know that you will beg to differ on this. Could you expand on that?
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Maggie Alexander
Yeah. It is commonly thought that genetic testing is really only for people who've been on a multitude of, you know, psychotropic medications. And we're trying to fine tune it. My experience with it is that I ask all of my clients to do it because there's a couple of big hitters. The biggest one is the MTHFR gene, Methylene tetrahydrofolate reductase, finally known as the motherfucker gene.
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Tracy Otsuka
Right, that's better. That I'll remember.
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Maggie Alexander
There you go. And that gene is responsible for converting what's called folic acid into L methylfolate. Why do we care about L methylfolate? It's a precursor to neurotransmitters. Right. So inattention, mood disorders. One of the root causes to those is low dopamine, low norepinephrine, low serotonin. So if you've got a key ingredient, if you think of like magnesium iron, L methylfolate, we need those guys to make our neurotransmitters. And you happen to be one of 75% of my clients who I've tested have a deficiency, including I've got the worst possible one myself. Then we want to supplement. We want to give that person L methylfolate in a, you know, supplement form. And there are some good, good brands out there, good products. So that's the number one reason is you want to uncover that. The other reasons are if you are on an SSRI or you have a history of having been on an ssri, an antidepressant, it will tell you very clearly which of those will work and which of those will not work. Whether you're, you know, a fast metabolizer or a slow metabolizer, you just shouldn't take those medications at all. So those are the two biggest reasons. There's some other benefits as well that tell us about how fast you break down dopamine and a couple of other goodies in there, but it's a really, really valuable tool.
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Tracy Otsuka
I read a really interesting fact statistic in your book that only 25 to 30% of people will have success with antidepressants, which I guess means 65 to 70%.
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Maggie Alexander
Well, right, right, right, Yeah. I mean, it's kind of shocking when you think about going to your doctor, your nurse practitioner for depression, anxiety, and they kind of pull out of their black bag and throw the dart at the target. You know, let's try Prozac first. You got about a one out of four chance that that's going to work. And that does have to do with metabolization. So some people are fast metabolizers. They'll kind of burn through it. One of my kids, when he was a teenager, his doctor, you know, Harvard trained, head of the department, guy gave him Zoloft, which is what we give women and teenagers. And Zoloft is a drug you can keep turning up and up and up. And he went from 25 to 250mg of Zoloft. And, you know, he said, mom, I don't. I like him, but I don't think the drug's working. And at that point, I had just learned about genetic testing, and we tested him, and Prozac was his drug. Zoloft was not his drug. So, you know, a lot of times people will say, you should only take this in the event. This test, in the event of problems with multiple drugs. I would say anyone who's potentially going to be prescribed an antidepressant. Why would you not want to know that ahead of time? You know, we spent a year and a half, thousands of dollars, and it
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Tracy Otsuka
was the wrong drug, right?
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Maggie Alexander
Yeah.
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Tracy Otsuka
And a year and a half of him not feeling optimal. So what's the point? I mean, I speak to so many women who literally have been on an antidepressant for decades, and when I ask them, do you think it's helping? No, but they've been on it for decades, so that's terrible.
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Maggie Alexander
Absolutely. I mean, if you can do genetic testing, it does reveal so much. And I think sometimes, you know, practitioners don't want to do it because they don't know how to do it or they don't know how to interpret the results. And the companies do have, you know, they have consultants and experts that can help you learn how to do it. So if you're a clinician who's thinking about this, some of the companies that are out there will help you walk through, you know, how to. How to interpret the results.
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Tracy Otsuka
Why wouldn't health insurance companies require genetic testing before prescribing any of these Drugs.
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Maggie Alexander
Oh, gosh, you know, this is where we need Dr. Dodson who understands the politics and the madness behind all this. I don't know. I mean, I, I think unfortunately there is a monetary, you know, benefit. Right. For some of the big pharma companies to have people guess and try Zoloft for a year and a half. In my son's case, you know, rather than know which drug is the right drug, that would be something that I would suspect, I guess. But I have found it to be a tremendously effective and useful tool. And as I said, I do use it on just about everybody that I see if, if they can afford it. It's not always covered by insurance, so sometimes you're looking at three or four hundred dollars in order to do the testing.
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Tracy Otsuka
Oh, I think when I checked it was $750. So it's really come down.
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Maggie Alexander
Yeah, if you pay out of pocket and don't have insurance. But generally the company that I use, it's about $400.
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Tracy Otsuka
Let's pause here. Have you spent your whole life being told your way is the wrong way? If you try to use systems designed for a neurotypical brain, of course you'll feel like you're failing. But here's the truth. You were never the problem. You just have a different brain, which means you need different systems. That is exactly why I created the AOK Academy. It's my six step patented framework designed to help you reconnect with your intuition and build systems based on your unique strengths. Let me help you reconnect with your intuition, trust yourself again, and build a life that actually works for you. You've had the answers all along. Help you see them. Look, it's time to stop second guessing and start trusting yourself again. Find the link in the show notes to sign up or book a free discovery call. Now let's get back to it.
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Another area that I have not had luck with. I mean, I get so many of these supplement micronutrient companies who asked to sponsor the podcast and I'm like, I, I'll try it. So I've tried a lot, but I've. Other than omega threes, I really have found no, you know, supplements, micronutrients that actually have made a difference. Just like how sensitive I am to medication, I'm really sensitive to supplements and micronutrients. Again, I get anxious, I feel foggy and bloated. I'm assuming based on what you were writing about, that there are actually supplements and micronutrients that really do make a difference. But is this also the kind of thing where you need to do the genetic testing first to figure out what supplements and micronutrients might help.
- [32:17]
Maggie Alexander
Yeah, that's such a great question. And you actually hit the nail on the head with the omegas, because that is the supplement that there's been extended research on, and they are helpful. But there are others. And if I can give a plug for my mentor and colleague, James Greenblatt. This man has done an amazing job. He started a company called Psychiatry Redefined. This is his book on adhd, Finally Focused by James Greenblatt. I think the subtitle is the Breakthrough Natural Treatment Plan for ADHD that restores attention, minimizes hyperactivity, and helps eliminate drug effects. He just came out with another. He's written about 10 books, but he came out with Finally Hopeful. So for depression and anxiety, we have Finally Hopeful by the same author, James Greenblatt. So he is the reason that I have learned about integrative medicine. I started learning from him back in 2017, and I think his tagline is test, don't guess right. So you want to do lab work or sometimes other kinds of tests some people will do, like hair, mineral analyses, urine testing. But the basics basic labs are written about in the book. They include things like checking your vitamin D, checking your vitamin B12, zinc, copper, magnesium. The minerals make a big difference. They are key ingredients to making those neurotransmitters. For some people, their thyroid might be off. They might be hypothyroid or hyperthyroid. All of this can impact your ability to attend and your mood. So absolutely everybody that I see, I request that they do labs. And when I first started, I didn't learn about this in school. I had no idea how to even order the appropriate labs for ADHD. I learned from Dr. Greenblatt, and it's been maybe 10 of the 13 years that I've been in practice that I have requested that my clients do that. And I run a couple thousand sets of labs. And it's a beautiful thing when you get a setback that are within what we call the optimal range, right? So if you think of, like, you want to hit the target, like, for vitamin D, the LabCorp reference range would be 30 to 100. But if you want to feel better and attend better and your mood's better, you want that vitamin d to be 45 to 60. So you want to get in the middle of the bullseye. So that's really important when you're seeing somebody that they are using reference ranges that are actually what we call optimal reference ranges. Not you got on the target, but you know, your Vitamin D is 31. Okay. It's within the normal range, but it really ought to be more like 45. So test, don't guess. Blood work. Insurance generally covers most of them if you use the right codes. And I generally will put in their ADHD diagnosis and then a code for fatigue and a code for vitamin D deficiency. I live in Oregon and we're all deficient in vitamin D. And generally insurance will cover those. And it's so exciting when they come back because, you know, you kind of have a roadmap for helping people to feel better pretty quickly, two to three months. If you can get those levels up, you'll notice an improvement in terms of sleep, energy, attention, mood. I don't find that just doing that is enough to treat adhd. I just want to, I guess, emphasize that. I think if you can start off with some stimulant medication so the person is able to focus enough to take their supplements. Right. Maggie's holding up her. Her pill case here. Her Monday, whatever, Tuesday, Wednesday, Thursday, pill case for her supplements. It's hard to do that. It's even for me, like, these are sitting on my desk where I see my clients. But the days I'm not seeing my clients, sometimes I don't take these. Right. So when you are on a stimulant that's working, then you have the executive function power, right. To organize yourself well enough to get those supplements and take them on a daily basis. So I find they work better together than separately.
- [36:25]
Tracy Otsuka
If someone is listening, let's say it's someone like me and haven't had success with medication. But we don't live in your state. You're in the Pacific Northwest.
- [36:35]
Where are you?
- [36:36]
Maggie Alexander
I'm in Portland.
- [36:36]
Tracy Otsuka
In Portland, Oregon? Yeah. What a beautiful city. City. They're not in Oregon. Can they work with you? Like, how does that all work?
- [36:45]
Maggie Alexander
I'm just, I guess, opening that door to doing consulting work. And yes, you can reach out to me. My website is. My name Maggie Alexander, NP and I will do consultations across the country. I've done a handful of those. I also praise be. In the next two weeks, we'll have protocols up on my website, so you'll be able to download some simple guidelines. And then I think for 10 bucks or so, there'll be some protocols that you can print off and take to your clinician. And I've done this a lot where I've seen somebody who's out of state or doesn't have the insurance that I take. And I'll write up an assessment, a couple of pages, and they'll take that to their family practitioner or their nurse practitioner, and that person will be like, gee, thanks, you know, now I know what to do. And usually it's just what we talked about, which is, you know, I suggest we start. This person's never been on a stimulant, so let's start with an amphetamine because that's the one that's most likely to work. And let's just start low and go up slowly and then we'll extrapolate from that short acting to an extended release and they can reach back out to me if that doesn't work or they have questions. I'm delighted to talk with clinicians, would love to help educate more clinicians because we're desperate. I was desperate. I didn't know anything when I started. So it's definitely possible to reach out to me as a person who's not in Oregon, I just can't prescribe medication for, for you, but I can help your clinician know what to prescribe.
- [38:10]
Tracy Otsuka
Yeah, well, and I found that they're actually hungry for guidance because they're scared to do anything but what they, you know, the. Just prescribing the stimulant medication, they just don't know what to do. And so in my experience, if there's someone else who's an expert in that particular area, they will take their advice and say, yeah, sure, we'll, we'll, we'll try this.
- [38:34]
Maggie Alexander
Yeah. I mean, the results are so profound, Tracy. It makes me tearful, actually, when I think about the stories that I've had the honor to witness in terms of people, you know, going back to school, getting back together in a relationship that, you know, broke up because they had an impulsive moment or maybe getting out of a bad relationship. People are, I can't put a number on it, but, you know, they go from kind of limping along. In Matt's case, you know, he was suicidal, but of kind of doing okay, but just not feeling that great about their lives to really, really just being productive and happy and integrated human beings. And I have to say, I mean, I love you guys with ADHD so much because you're so bright, you're so intuitive, you're so creative, you're so heartfelt, you're so non judgmental. I mean, you are the advocates. You're the ones that go out there in the world and defend the underdogs and stand up for, you know, those who are being poorly treated or misrepresented. So you're really extraordinary human beings. Just sometimes you have trouble, you know, connecting the dots. Right. You have the great ideas, but then putting it into practice can be more difficult. So to be that person that helps people find those glasses and be able to see and be able to focus all day long. And, I mean, I can't tell you. I Wish I was 20 years younger. I wish I could do this for another 20 years because it's. It's such a pleasure. Yeah.
- [39:58]
Tracy Otsuka
So what do you say to someone who, like, I feel like everything else is working really well for me? I have figured out the right balance as far as sleep and exercise is so important for my brain, but I really struggle with working memory. And what do you think about taking medication when that is, you know, when you've got, oh, I don't know, I need to give a speech, I need to memorize a speech, but not doing it all the time.
- [40:30]
Maggie Alexander
Not doing it all the time, as in using medication here and there. So my experience with stimulants is that, like glasses, you want to take your medication every day. Right. There's no such thing as a drug holiday. There's no such thing as taking it like you would a Red Bull. It's not a boost for a speech. It would be find the right drug in the right dose, the right duration. There may be a factor that we haven't talked about here, Tracy, which is hormones. Menopause. My goodness. Right. 30 years of our life, a third of our lives as women, is going to be spent Right. In a menopausal state. And so when estrogen plummets and drops, cognition suffers.
- [41:11]
Tracy Otsuka
And so for all of us, yes, ADHD or not.
- [41:15]
Maggie Alexander
Exactly. Exactly. So it is vital that we consider that in terms of your question about having to perform, is estrogen contributing? I don't know in your personal situation, if you're using hrt, but there's a lot of new research out there in terms of the efficacy of HRT for women in their 40s, 50s, 6, 60s, even 70s, people starting on HRT long after they've gone through menopause in terms of cognitive benefits. So that would be the first thing I would ask, would be like, are you on hrt? And if not, please go see a gynecologist or an internist and get started on hrt. That will help with working memory, number one. And number two, again, back to stimulants in terms of let's find the right dose and for You, I would say we got to play around with that methylphenidate and see if there's something more we can do. There are different versions of Ritalin. Maybe it wasn't quite the right drug, but there's more to be said about that.
- [42:19]
Tracy Otsuka
Yeah, I have a follow up question there that you just triggered. So I have this just notion that women with ADHD need, when we're talking about hrt, need more estrogen, not less. But nobody will prescribe that. And I remember seeing a study, it was on the section on Attitude magazine for professionals where they have research, and they were talking about how when women are pregnant with adhd, some women actually, their ADHD symptoms, they alleviate.
- [42:59]
Maggie Alexander
It's better, right? Yeah.
- [43:00]
Tracy Otsuka
Oh, my gosh, Maggie. When I was pregnant, I was a pistol. I could not believe how much I got through, how much I was able. I've always had working memory issues. I've always had. Actually, that's not true. I was the lead in all the plays until puberty. And then puberty, I could not memorize anything, not even a chorus of a song I liked. So I remember thinking, what happened to my brain then? Well, now we know it was adhd, but so I always think about, there was so much estrogen and, of course, other hormones coursing through my body when I was pregnant that I had none of the ADHD challenges.
- [43:41]
Maggie Alexander
How was it when you, after you had your baby, Tracy, after you were postpartum, how'd you do that?
- [43:45]
Tracy Otsuka
I didn't have any of the depression or anything, you know, along those lines, so.
- [43:51]
Maggie Alexander
But you're cognitively, in terms of your ADHD symptoms?
- [43:54]
Tracy Otsuka
Oh, I kind of went back to what I was before. And part of it is, you know, you have this new child, you have so many more responsibilities, you're not sleeping as much.
- [44:03]
Maggie Alexander
But yeah, it is such a fascinating subject. I have several transgender clients in my practice. And the trans women who have adhd, when they are on their estrogen and they're increasing it, they have to decrease their stimulant dose. Right. Because they fall off the mountain, it pushes them up over that edge. So they're taking.
- [44:24]
Tracy Otsuka
When the estrogen gets too high, estrogen
- [44:26]
Maggie Alexander
gets too high, they have to decrease their stimulant dose.
- [44:29]
Tracy Otsuka
Oh, yes, that's exactly. Yeah. That makes total sense.
- [44:32]
Maggie Alexander
But for women or women that are premenstrual or sometimes, you know, when you're perimenopausal, if you're cranky and you can't focus and you're having trouble with your memory, you take A little more stimulant. So go up by a quarter or a half maybe dose and see if that helps you for those few days before in the day one and day two of your period. So yes, they're very, very closely related, those two, estrogen and stimulants.
- [44:58]
Tracy Otsuka
But there's barely any research. Right. There's a little mention here and a little mention there and it's just honestly, I think it's criminal because half the pop, more than half the population. Right.
- [45:10]
Maggie Alexander
Hopefully your children and mine will benefit and.
- [45:13]
Tracy Otsuka
Oh, great. Thank you.
- [45:14]
Maggie Alexander
If in my, you know, lifetime I'm going to see a big change in this. But it's coming, it's coming. Yeah.
- [45:21]
Tracy Otsuka
I would love to know from you, what do you think the key to living successfully with ADHD is?
- [45:28]
Maggie Alexander
I think the very first thing, Tracy, is education. And I think listening to experts like yourself is huge. There are others out there. There's a great YouTube channel, How to ADHD with Jessica McCabe. And I have not to toot my own horn, but I think my book is a very positive overview of what ADHD is and you know, how to, how to survive and how to thrive with it, how to shine with it. So the key is education first and foremost. And then I do think you have to start with biology and I don't think broccoli, love and exercise unfortunately are where you need to start. I think you need to find a clinician if you can or, you know, email me or somebody else in the field. Dr. Dodson is, he's available for folks to reach out to and then figure out is it drug A or drug B, is it Ritalin or is it Adderall? Right. Usually it's going to be Adderall. If you don't know, if you've never tried one, no friend gave you one, you have no idea. Then start with Adderall and then get the right dose, get those perfect prescription, please don't hire a coach in the afternoon. This lovely psychiatrist that I talked to right, in California because she didn't have enough medication on board in the afternoon. So take a second dose, take another, the same dose you took in the morning. Be sure that you've got your glasses on all day long. So the key is education and then medication and then if you really want to shine, you know, get your labs done, take the right supplements.
- [46:56]
Tracy Otsuka
Right?
- [46:58]
Maggie Alexander
Yeah. And of course, like, you know, gluten free diet, you know, don't eat so much sugar, try to cut back a little bit on the dairy. There are a lot of good things out there nutritionally, that will help. Exercise, sleep, the basics. But you got to start with the biology. Otherwise it's just so hard, right, to do all those other things. So that's it. Thank you.
- [47:18]
Tracy Otsuka
So, Maggie, where can people find you if they want to know more about you and what you do? And we'll put this in the show Notes.
- [47:26]
Maggie Alexander
Just my website, you know, Maggie alexandernp.com you can email me from there or you can email me directly. It's the same address, Maggie Alexander, npmail.com and I'll be happy to respond. And as I said, hopefully within the next couple of weeks, certainly by the end of this month, there will be protocols and free information downloadable from my website. And the book, you know, grab the book. It's got a lot of good stories in it. Tracy, you've read it. You can, you can verify. But it's, it's a good read.
- [48:01]
Tracy Otsuka
So it's a very good read. And it's just so unusual, all of the information that you put in this book about medication, normally, it's just touched on because I think most of us don't know, you know, we don't have this information. And so that's what I found so helpful about your book. And I don't know if we, I know we held it up, but remember, this is a podcast and not Everybody goes to YouTube, so it's Shine with ADHD by Maggie Alexander. Unlock your potential with skills, medicine and micronutrients.
- [48:35]
Yeah.
- [48:36]
Maggie, thank you so much for spending time with us here today. I just really love this podcast conversation.
- [48:44]
Maggie Alexander
Absolute pleasure. Thank you, Tracy. Thanks so very much.
- [48:47]
Tracy Otsuka
Thank you.
- [48:49]
So that's what I have for you for this week. If you like this episode with Maggie, let us know by leaving a review. Our goal is to change the conversation around adhd, helping as many women as we possibly can learn how their ADHD brains work so that they too may discover their amazing strengths. Thank you so much for listening and I'll see you here next week.
- [49:13]
Maggie Alexander
Foreign,
- [49:17]
Tracy Otsuka
You've been listening to the ADHD for Smartass Women podcast. I'm your host, Tracy Otsuka. Join us at adhd for smart women.com where you can find more information on my new book, ADHD for Smartass Women, and my patented your ADHD brain is a okay system to help you get unsafe, stuck, and fall in love with your brilliant brain. Let's pause here. Have you spent your whole life being told your way is the wrong way? If you try to use systems designed for a neurotypical brain, of course, you'll feel like you're failing. But here's the truth. You were never the problem. You just have a different brain.
- [50:07]
Maggie Alexander
But.
- [50:07]
Tracy Otsuka
Which means you need different systems. That is exactly why I created the AOK Academy. It's my six step patented framework designed to help you reconnect with your intuition and build systems based on your unique strengths. Let me help you reconnect with your intuition, trust yourself again, and build a life that actually works for you. You've had the answers all along. I'll help you see them. Look, it's time to stop second guessing and start trusting yourself again. Find the link in the show notes to sign up or book a free discovery call. Now let's get back to it.