← Rena Malik, MD Podcast
Rena Malik, MD Podcast
Is it ADHD Symptoms or Low Libido?! ft. Dr. Sasha Hamdani
01:27:30
In this episode, Dr. Rena Malik chats with Dr. Sasha Hamdani about the complexities of living with ADHD, focusing on its symptoms, diagnosis, and effect on relationships and sexuality. Dr. Hamdani shares valuable insights and personal experiences, offering advice on managing emotional sensitivity and enhancing communication and intimacy.
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- [00:00]
Dr. Rena Malik
You live with an ADHD brain.
- [00:02]
Dr. Sasha Hamdani
Yes.
- [00:02]
Dr. Rena Malik
So describe what it's like to live in your body.
- [00:06]
Dr. Sasha Hamdani
It's weird. I don't like my adhd. I don't like. If I had the option of having it or not having it, I would choose to not have it. The focus component. Sometimes it's hard to stay engaged with your partner. Like, quite literally, you are running through like, does my body look weird? What should I be doing? How long is this going to last because I have to go and do this other thing and then you get distracted. Or within the actual context of having intercourse, there is also a strong emotional component that comes with that, where you're dealing with, like, you're consistently looking at your partner's body cues, face cues, talking cues, and you're like, is this different? Does my partner still like me? Does it? You know, and so there's a lot of rejection, sensitivity and inward stuff that I've heard from a lot of patients that makes having sex just instead of being a pleasurable experience experience. It becomes this opportunity for them to hyper fixate on anything that could be wrong and imperceptible to everybody else within their relationship.
- [01:08]
Dr. Rena Malik
Do you find yourself having a hard time focusing during sex or maybe being hyper focused on what your body looks like or how your partner's responding? Well, then this episode is for you. Welcome back to the Rena Malik, MD podcast. I'm your host, Dr. Rena Malik, urologist and pelvic surgeon. Today Our guest is Dr. Sasha Hamdani, Board certified psychiatrist, author, entrepreneur, and social media sensation, educating millions about ADHD each and every single day. Today we discussed adhd, Attention Deficit Hyperactivity Disorder, the clinical symptoms and diagnosis as well as treatment. We talked about in particular, how hormones affect ADHD as well as how it affects relationships and sexuality. Specifically, we talked about things like rejection, sensitivity, dysphoria, mirroring, and boredom and how it can affect your relationships. Does infidelity become more common in people with adhd? And what can you do about it? And most importantly, probably every single one of you watching or listening to this right now knows somebody affected by adhd. And the things you learn in this episode are gonna help you be a better friend, better partner, or better parent to them. Let's get to it. Dr. Hamdani, Sasha, thank you so much for being here.
- [02:20]
Dr. Sasha Hamdani
Thank you for having me. I'm so excited.
- [02:22]
Dr. Rena Malik
I'm so excited. We've been like friends on social media for some. I've been like, adoring all of your stuff and I think you are so amazing and brilliant and talented, and it's an honor to have you here.
- [02:35]
Dr. Sasha Hamdani
Thank you. That was so generous. And the feeling is mutual.
- [02:39]
Dr. Rena Malik
So I love your content. And you are not only a psychiatrist who specializes in adhd, so you did a. You did medical school fellowship. I mean, you've trained, you've done research in this area. And then you're also this amazing content creator who creates content and you live with adhd.
- [02:57]
Dr. Sasha Hamdani
Yes.
- [02:58]
Dr. Rena Malik
So tell me, what was your inspiration? Because I think that. And we're going to talk about adhd, but I feel like sometimes being someone who's diagnosed with ADHD comes with a lot of stressors of putting yourself out there and the reaction to when people see you on social media and how that could affect you emotionally. So how did you decide to put yourself out there like that?
- [03:19]
Dr. Sasha Hamdani
Okay, so all of that is true. All of that is true. But ADHD also comes with a variant of impulsivity, and I think it was a little bit of that. I initially started creating content in, like, when Everybody else did 2020. And I had just had my son a couple months before, and I was just really bored. I was in this, like, breastfeeding hole. I had no more TV to watch. And so I started getting onto. I started with TikTok and I started putting out videos initially because I was seeing, you know, reaction videos and things to, you know, you have ADHD when you. And it'll be. The video that made me start to create content was someone who sneezed multiple times in a row, and they're like, this is indicative of adhd. And I was like, wait, do I do that? And then I was like, no, there's no basis in this. And so I started doing reaction videos to that and putting out good clinical information to counteract some of that. And then it just. I don't know, it's like what everybody else has with content, it just gets away from you and then it becomes your life.
- [04:25]
Dr. Rena Malik
Yeah. So tell. Tell the audience who doesn't know about ADHD what is a clinical diagnosis of adhd and maybe talk about some of that misinformation that you saw so people know what's real and what's just a normal variant of behavior.
- [04:38]
Dr. Sasha Hamdani
So ADHD is a neurodevelopmental condition, and it refers to three different subtypes of it. There is inattentive, there's hyperactive, and there's combined type, which is a combination of the two. Before I get into the different types of adhd, I think it's really important to address what is a normal variant of behavior and what is pathological? And I think the biggest distinction is really heightening on adhd. Attention Deficit Hyperactivity Disorder. It is a disorder, and I know that a lot of people find that kind of controversial, but I think disorder indicates that it is a significant enough behavioral change and neurodevelopmental condition that it's impacting almost every facet of your life. In terms of diagnostic criteria for inattentive, that's, you know, your typical space cadet kind of presentation, where people are having difficulty paying attention to the task at hand. They have difficulty initiating tasks, they have difficulty with the organization, they have difficulty for focusing on multiple things at a time. They have difficulty with prolonged attention, like things that require. You're gonna have to study for months for this. With the hyperactive type, you're looking at more of this physical impulsivity and verbal impulsivity, difficulty staying in the seat, fidgeting a lot, interrupting others, intruding in on conversation, being hyperverbal. And obviously, combined type is a combination of the two.
- [06:07]
Dr. Rena Malik
Yeah. So what in terms of, like, these are characteristics that sometimes everyone presents with. Right. Like, sometimes I will be inattentive, sometimes I will be fidgeting. In fact, I'm, you know, generally moving at a. Something. A foot tap or whatever. Yeah. On a regular basis. How do you differentiate that from someone who clinically has adhd?
- [06:25]
Dr. Sasha Hamdani
Yeah, I think you're looking at pervasive behavior. So you're looking at stuff that lasts for a long period of time and typically starts in childhood. So when you look at, you know, it's not normal for a human to be able to focus 24 hours a day, that is not part of the human experience. But when you're looking over a longitudinal period of time, people who are having difficulty, even if they really want to accomplish something, or even if they are trying and utilizing all of the resources and faculties to focus in on that moment, and they're still having difficulty, and it's keeping them from accomplishing certain things in their lives or functioning within the context of a relationship or a partnership or a professional setting, that's causing significant impairment in their life. And that's when you would start to meet criteria for adhd.
- [07:15]
Dr. Rena Malik
What happens to a brain of somebody with adhd? How is that brain different from a normal brain?
- [07:21]
Dr. Sasha Hamdani
You can look at it a couple of different ways, but structurally, the ADHD brain is different. So that frontal lobe in charge of decision making, processing, the very smartest part of your brain. Right. That is actually smaller and develops slower so, you know, you have a lot of these late bloomers with adhd, and a lot of times you're just like, oh, well, they're a little immature for their age. But it's quite literally that frontal lobe is taking longer to develop then the amygdala, that emotional cortex right in the center of your brain that is a little bit larger and a little bit more hyperactive. And so what happens is that when you're processing information, you know, for someone who's neurotypical, a thought comes in, flips around, and the amygdala goes to the frontal lobe. And the frontal lobe is like, this isn't a big deal with adhd. A thought comes in, spins around the amygdala and you just keep spinning and spinning and spinning and spinning and becoming more and more reactive. And you just kind of. And that's part of the difficulty with impulsivity is if you're just getting flooded by all of this emotional response, it's hard for you to behave in a way that sometimes people might perceive as the logical way to do things. So those are two of the big changes. You have a lot of changes in kind of the limbic system, which is how we also process emotions. There are a lot of structural changes with adhd. I think, personally that the DSM is a little bit behind in what we consider kind of diagnostic for adhd, because they don't talk about that emotional part of it. But I think that's very limiting. You know, when you look at the actual data and look at how the brain is structured in comparison from a neurotypical person and a neurodivergent person, there are very distinct differences.
- [09:01]
Dr. Rena Malik
And so I think a lot of people want to know, how do you diagnose it? Is it just they meet these few criteria. Has that evolved? And that's how I learned it when I was in medical school. Has that changed at all?
- [09:11]
Dr. Sasha Hamdani
No. No, it's stupid. It should evolve and it should change. Now, what I'm thinking it should change is not necessarily that you should do imaging, because I think that would be cost prohibitive and that would be something that would further alienate and further isolate people, especially in vulnerable populations, from receiving care. And also I think that, you know, there's a lot of stuff about FMRI images and stuff like that. I think that it's. It's hard with normal variability to be able to assess and distinguish exactly what is this cutoff for normal and what is this cutoff for not so normal? Neurodivergent, maybe I Mean, in a perfect world, we should be looking at all of the things that ADHD kind of touches. So, yes, an emphasis should be placed on focus because that is part of that diagnostic criteria as it stands. But I should also think about all of the impacts that it has with significant hormonal variation and, and how we view emotions, how we view just kind of these secondary diagnostic things like anxiety and depression. Well, are they really a part of ADHD or are they distinct? So I think there needs to be a lot. I think we need to revamp it. I think it's way too narrow in scope.
- [10:23]
Dr. Rena Malik
Yeah, you brought up a good point, which is that ADHD is often concomitant with depression and anxiety, and oftentimes. I was telling you before we started that I haven't seen a lot of ADHD patients in my career, but I've seen plenty with depression and anxiety and I wonder if they were just not appropriately diagnosed because it's so common.
- [10:44]
Dr. Sasha Hamdani
Totally possible. So ADHD runs with anxiety and depression? It absolutely does. But there is a huge population, huge population that is improperly diagnosed with anxiety and depression. And I feel like more often than not it's females that get improperly labeled as anxiety and depression, just because, you know, if you look at the average age of diagnosis for males, it's seven to eight years old, for females it's mid 30s. So it's just an astronomical disparity when it comes to that. And part of it is because as females, you're dealing with misdiagnosis that happens because hormonal changes, people are just like, it's hormones, you're fine, it's not a big deal. Or they misclassify it as a mood disorder, or they. You are going through such significant kind of physiological change with child rearing or pregnancy or things like that, and, you know, it's mommy brain. And so there's so many different excuses when really it's adhd.
- [11:46]
Dr. Rena Malik
So you mentioned that there are changes in symptoms related to hormones.
- [11:49]
Dr. Sasha Hamdani
Yeah.
- [11:50]
Dr. Rena Malik
So what is that like for. So women obviously have more fluctuation hormones. Men tend to release about the same amount of testosterone. While it does change over the course of the day, they're releasing a pretty constant amount of testosterone and that weans over a lifetime. Whereas women tend to have wild fluctuations, particularly around the menopause transition, but even.
- [12:09]
Dr. Sasha Hamdani
Month to month, month to month.
- [12:11]
Dr. Rena Malik
So how does that affect someone who has adhd? What might. If you are either rearing someone who has adhd, you're dating someone who has adhd, or you're friends with someone who has adhd, what might you see?
- [12:21]
Dr. Sasha Hamdani
You definitely know someone that's going through this, I would say so if you really cut it down to the nitty gritty. And obviously it's more complicated than this, but what people need to know is that estrogen and dopamine work together. So when estrogen is low, so in those times right before your period, or the times during perimenopause and menopause, when your estrogen just tanks, your dopamine goes alongside with it, because the estrogen helps kind of promote that dopamine synthesis. It helps prevent the breakdown of dopamine. So now you're getting hit with two things. You're getting like, if we're talking about this premenstrual stage, like right before your period, everyone is like, oh, you're having pms, it's no big deal. Like, you're gonna get through it. Well, yes, but also you might be on ADHD medications now. They're not really working, it feels like, at all. Or you're getting into a spot where, like, your, what is a normal fluctuation now you're just dipping into pretty significant anxiety and depression symptoms that people can sometimes get suicidal over. And it's because it's coupled with this ADHD and this lack of dopamine.
- [13:28]
Dr. Rena Malik
Just to clarify, ADHD symptoms are essentially with a lack of dopamine. So is that, is it sort of a simple way to describe it is like there's a. Not your brain's not producing enough dopamine.
- [13:40]
Dr. Sasha Hamdani
When people talk about the lack of dopamine. Yes, if you wanted to distill it, yes. But like, you're never going to be able to tell exactly, like, how much dopamine is present where. Right. It's a problem that the amount of dopamine you need is not present in the right location at the right time. Okay, that's. That's kind of the issue.
- [13:59]
Dr. Rena Malik
So what are ways that people who are taking care of people or loving people or being a part of their lives who have adhd, how can they respond in a favorable way? How can they be supportive? Right.
- [14:11]
Dr. Sasha Hamdani
Yes.
- [14:11]
Dr. Rena Malik
During these experiences when either their medications aren't working, or if they're not taking medications, they're. They're having worse symptoms or they're really struggling for whatever reason, they may be going through a life change that's cause their symptoms to flare up, how can people be more supportive?
- [14:27]
Dr. Sasha Hamdani
I think honestly acknowledging it, that's huge. That's huge. And like, in relationships, communication is just paramount to Everything else. Right. So I think acknowledging it is a big deal. And number two, I think that when you are dealing with these fluctuations that happen sometimes it's difficult to seek out help during those times because you don't even know what's going on. It's, it's neuronal chaos. It's just so much is happening in your brain. And so this might be the time where you get more help with executive function. Things like this might be the time where like, oh God, this, this next four days are going to be really bad. Okay. This might be where your partner kind of steps in and does more of like the day to day kind of picking up the slack and being more helpful during those times. And I know that inadvertently I, myself and my own relationship have fallen into these patterns. And it, it's like clockwork that I have four days where it's just harder and I am, I am more financially impulsive during those times and I have a shorter fuse and it's harder for me to get things done. And so those are the times where I feel like now both of us are on the same page. And he really picks up the slack and helps with that. And you know, if I am just on the couch and I'm like, I am tapped out, like nothing is happening here. I can't, I can't do any more. You know, this is just a, this is a storm we're gonna have to weather together. And that he picks up a slack.
- [15:56]
Dr. Rena Malik
That's awesome. Yeah, I think that's great. I wonder if. And again, I can't speak for it, but taking care of men a lot of. In my practice, what I find is that men don't communicate as well as women. They aren't given those tools at a young age. Right. Because they're, they're taught to just man up and deal with it. So I can imagine where that would be point in a relationship where it would be a challenge because maybe the partner who's struggling with. And we can talk about triggers, but struggling with whatever trigger is making their symptoms worse, they're not able to vocalize it. And so their partner's like, why are you, why are you spending all this money? Why are you lying on the couch all day? What's wrong with you? And instead of like actually and it could happen in both genders. Right. But anyone who's having difficulty communicating what they're going through and they have a partner who doesn't get it, well, then that would be a point where they would have really big relationship strain.
- [16:44]
Dr. Sasha Hamdani
And it happens consistently, which is why I'm talking about the communication portion of it with such emphasis. Because I know like myself getting into and being in the relationship that I am now, I it. There was such a steep learning curve for me and I, I think one of our early issues was just we didn't know how to talk to each other, we didn't know how to problem solve as a team. And for me, and even still, like sometimes when I am just overstimulated or overwhelmed, the only way I can get out, what I need to get out is if I have write it down. And so we are in the same room emailing each other and that's what helps. And it's just, it's a way to keep my brain organized so I can write down. And sometimes I like, I do multiple drafts of the same thing because I'm like, that's not really what I want to say. But. And then when he reads it, he's, he has the ability to read it without having to like discern my emotional environment around it and have to deal with me responding in the right way. So that's, that's one thing that's helped us.
- [17:47]
Dr. Rena Malik
That's good. That's a really good tip.
- [17:48]
Dr. Sasha Hamdani
Yeah.
- [17:48]
Dr. Rena Malik
There's other things I think in relationships with someone with ADHD that, you know, you sort of worry about. One is that there is this element of boredom being quite common or being because of this lack of dopamine, the right place at the right time, that sometimes you can be, can develop boredom. And I can imagine that would affect obviously if you're in a long term relationship, significantly. But if you're say you're in and out of relationships like, oh, now I'm bored with this partner, I'm gonna move on to the next one.
- [18:14]
Dr. Sasha Hamdani
That's a really common pattern. And I think 80s she brain craves stimulation. And so when you, it doesn't, it doesn't discern what is good stimulation, what is bad stimulation. A lot of times that's when your frontal lobe has to kick on and be like, this is appropriate, this is not. And so sometimes you get into this habit where if your relationship is smooth sailing, like it was sparks and exciting in the beginning and now you've hit this beautiful plateau where there's no drama, you're fine. Your brain interprets that as like, I'm bored, there's a problem. I'm not getting the same kind of feeling I was getting before. And so you get into this panic where it's like, I need to either leave or you inadvertently do things to stimulate the relationship. And that's when you're picking fights and you're going in and doing things to cause to self sabotage to some degree. And that doesn't always happen, but that's. These are some of the unique pitfalls that happen in relationships with ADHD that need to be talked about and need to be explored because everybody thinks it's them. Everybody thinks like, oh my God, this isn't me problem. I'm just not made for relationships I'm not made to have. I'm a burden to another person. And so it's just like once you start talking about it more, you realize how common it is.
- [19:28]
Dr. Rena Malik
That's really helpful because I think a lot of people will. Yeah, exactly. Like you said, think it's them or think that no one's right for them or that they can't find the right person. And really it's just the way their brain is interpreting things.
- [19:40]
Dr. Sasha Hamdani
Yes.
- [19:41]
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- [20:11]
Dr. Rena Malik
And then in terms of triggers, so we talked about hormones, obviously stress is a trigger. I imagine lack of sleep is a trigger. What are other triggers that might cause someone with ADHD to either have more impulsivity or more inattentiveness, more of the symptoms that are causing them issues.
- [20:29]
Dr. Sasha Hamdani
Think about anything that throws off your normal emotional balance. So stress, yes. Sleep, yes. But even things like people are very sensitive to dietary changes. And more research is coming out showing like neuroinflammation causing issues with adhd. So certain foods, certain senses. I recently started cutting out wheat, which I know that not recently, it's been three or four years. And I don't suggest that for everybody, but the reason I cut it out was quite literally because I had such significant brain fog, such significant brain fog that I remember the day that I decided to go quit. I was in my husband's car and I pulled into the garage and I was going to take out the groceries and I was Shutting the garage. And I was opening his trunk and I got like sandwiched and I was just like, so, like in my own world at that time, I was like, I truly don't know what variable to change to get out of this jam. Do I lift the garage door? Do I close his thing? Like, and I sat there and I was like, oh, God, something's happening in me. And I had eaten like a full on loaf of bread before that. And I was like, okay, things have to change. And, and my brain fog has improved. But it's stuff like that, it's, it's really regulating and figuring out hydration is so important. Food is so important, diet is important, Exercise, so important. So all of these things to keep you in balance, which is unfortunate because with adhd, consistency is not always super easy.
- [22:02]
Dr. Rena Malik
Yeah.
- [22:02]
Dr. Sasha Hamdani
And so, yeah, that's such a challenge.
- [22:05]
Dr. Rena Malik
I can't even imagine because I think it's hard enough for a normal person to be consistent with all those things and to say, like, I'm just imagining being an ADHD person listening to this podcast or watching this and being like, oh my God, this is too much for me, and then just shutting down. So are there like tips, small things, small changes that you recommend people start with and focus in on so they can make sort of incremental improvements over time?
- [22:30]
Dr. Sasha Hamdani
Yes. And you're never gonna get it. All right? You're never. That's not, that's crazy. It's just so much, I feel like where I found success and what I tell my patients to do is just track, track, track, track, track, track. Because you're not gonna have holes everywhere and it's not gonna be consistently, you're having hole. You're going to find these pockets where things could do better. So we were talking a little bit before the podcast about Focus Genie. Part of the reason I made that app was, was during COVID I was a new mom. I had no structure. I like, the world was shut down. I had nothing to tether myself to. And so I felt like it was impossible to stay on top of those things. So this has a focus tracker where you can track your sleep, you can track your food intake, you can track your water intake, and you can also track how impulsive were you, how fidgety were you? And you're getting all of that data in a visual format and then you can extrapolate and tie that together. So if you're like, God, my focus was garbage today. Oh, I didn't have a single cup of water today. I didn't have A sip of water, my. Okay, then you can start making like how impactful are these things?
- [23:42]
Dr. Rena Malik
Actually that's really, really useful. So diet, exercise, sleep, nutrition, anything else?
- [23:49]
Dr. Sasha Hamdani
I mean, yeah, tracking those parameters, really important. I, I mean I don't want to get into this thing because not everybody needs medication. But staying consistent on medications, if you do, not just ADHD medications, but things like thyroid medications and things like other controlling other underlying medical health issues. So important if those are out of whack, it makes everything else harder.
- [24:13]
Dr. Rena Malik
Yeah, absolutely. In terms of exercise, is there certain types of exercise, like resistance training versus aerobic, Is there a certain number of minutes they should reach? Is there data on that?
- [24:22]
Dr. Sasha Hamdani
The thing that's great is that now we're seeing this trajectory of how we look at exercise more, more leaving like this is how your body should physically look and moving more into like this is what it's doing for your brain. I think what I tell my own patients is I don't care what you do, just do something. Yeah, just do something that is going to be easily maintainable and that you can kind of sustain and keep up with because that's all going to. The eventual goal is that you are just pushing this oxygenated glucose into your brain. You're just shoving it because your brain takes up 25 of your oxygenated glucose for a day. The stuff you're putting into your body and then you have to just push it up there, you have to get it to the place it needs to go. And so exercise is so good for that. It's also so helpful in maintaining good sleep, which I think derails so many people in terms of what type of exercise is best for adhd. A lot of that also depends on what age you're talking about, what gender you're talking about, what perimenopausal exercise regimen versus a 18 year old's exercise regimen could be totally different. So just finding what is right for your body and finding something to be consistent with.
- [25:34]
Dr. Rena Malik
I find that oftentimes if you go down a rabbit hole of like, you know, what's the best based on this or that, that's just time away from actually doing the thing.
- [25:41]
Dr. Sasha Hamdani
Totally.
- [25:42]
Dr. Rena Malik
You know, like just do the thing.
- [25:43]
Dr. Sasha Hamdani
Just research it to death and you get nowhere.
- [25:45]
Dr. Rena Malik
Yeah, I mean it's empowering certainly, but ultimately it's like, do the thing, get up right now. If you're listening, get up and do some jumping jacks while you listen. Or like do some whatever, you know.
- [25:54]
Dr. Sasha Hamdani
Anything, truly it does not matter. And it does like I can tell you, and I probably shouldn't tell you, but I hate exercise. I. I understand the value in it, but I loathe it. I don't. I've never had that feeling where you have this rush of endorphins and you feel better. Never. I don't know what that is. I've never experienced that. I hate it in high school and I hate it now. But I do it because my brain feels better afterwards and I'm. I function better when I exercise. And so the things that I've been able to stay consistent with is, you know, I got into yoga and that moved into Pilates, and I do a lot of that in studio and at home. And then I've started incorporating weights into that. And that's. That's just kind of what I've been able to be consistent with. The Pilates at home. There's so many YouTube videos, there's so many resources for that that you can do. And the weights, I don't. I don't really know what I'm doing with the weights, but I do it between patients. It's like where I have these moments of time. It's nothing super structured, so it's just finding these little windows of stuff you. You can be consistent with.
- [27:00]
Dr. Rena Malik
Then in terms of diet, you mentioned how glucose in the brain is, like, really, really important. So what about people who are doing, like, very low carb diets or ketogenic diets? Now, I know for certain conditions there's actually value, like in you doing a ketogenic diet, but that's not very many. So does that have any evidence for ADHD in terms of improving or worsening symptoms?
- [27:22]
Dr. Sasha Hamdani
My issue with doing, like, very, very strict ketogenic diets, you're doing things like intermittent fasting, is it truly depends on the person. Right? Like, there's some people that it truly, truly benefits, and it's like their brain lights up and there's some people that are in this state of starvation and they cannot function. And so it. It really, like making a blanket statement about what's best for you. I don't know. I say you should try and stick to what feels best for your body. Because again, with adhd, as we're looking at, like, kind of, how are we going to at least move into this realm of trying to be more consistent if you're doing something and your body feels like shit? Oh, can I say that?
- [28:03]
Dr. Rena Malik
You could say it.
- [28:06]
Dr. Sasha Hamdani
If you. If you are moving in a direction where you feel terrible, you're not going to want to continue it. And then you're going to fall off the wagon and you're going to not even just become inconsistent, but you might replace it with stuff like what's the point? With unhealthy things and that that becomes problematic.
- [28:24]
Dr. Rena Malik
Yeah, yeah. So there's no real like evidence. I wonder if there's like subtypes of ADHD that we haven't yet figured out that maybe like certain people would do really well with certain types of interventions. Behavioral versus some would do better with these other types of behavioral interventions.
- [28:40]
Dr. Sasha Hamdani
Girl, let's figure out the DSM first. One dumb problem at a time. So I, I, the the reason I think that that is actually a really interesting theory. I think there probably is something to be said about how different brains respond differently. I don't know whether like a formal grouping or subtype would exist, but I think if there is a way to incorporate this kind of emotional component, it's so I don't understand why it's not there yet, because it seems so clear to me that there is such a strong correlation, just like from a neurochemical perspective and also from just like this lived experience. I think that that would be the key to figuring out and at least tethering, like, I feel sad when I do this. Okay, let's not do this. And you know, things like that. That's going to give us a lot of good data points.
- [29:34]
Dr. Rena Malik
So let's clarify a little bit. What do you mean by this emotional component? What is that in adhd? And what do people not realize that that's actually a symptom of maybe their ADHD?
- [29:44]
Dr. Sasha Hamdani
So with ADHD, and this isn't totally specific for ADHD, but it's present in almost 100% of people with ADHD. There is a concept called rejection sensitive dysphoria, which, which is an incredibly intense emotional, sometimes physical response to real or perceived rejection or criticism. So it is like, I'll give you an example. If, if a boss calls you and says, I need to talk, all of a sudden you, it's not just like, okay, I, I wonder what, what they want. It is that you have worked yourself into a spiral. You're feeling like physical symptomology, like a, like crushing pain in your ribs. Like, I can tell you I had an experience like that with that exact situation. My boss said, I need to talk to you. I was nine months pregnant at that point. I had worked myself up so much. I was looking at my Apple watch. They were like, you're an svt. I was like, oh my God. So then I was like, I was literally walking out the door to go to the hospital and my boss was like, what are you freaking out? I just wanted to tell you that you have a surprise baby shower. And that's what it was. And I had convinced myself that they were getting rid of me because I was pregnant and that it was. And it was just so significant. But that kind of emotional response is something that, number one, nobody talks about. Number two, I think needs to be encapsulated in diagnostic criteria because it is so significant and so debilitating. So I think this increased and heightened emotional sensitivity and response needs to be in that DSM criteria.
- [31:24]
Dr. Rena Malik
I want to talk about that. But before I want to make sure we don't miss talking about medications because I think that it sort of flows in line with diagnosis and treatment. And we've talked about some concerns, some behavioral changes that can be quite impactful. As you mentioned earlier, not everyone needs medication. But in terms of medication, these are medications that help you focus and help you help reduce your sickness. So talk a little bit about what options there are and maybe some of the, the side effects that people are very, I think, concerned about. A lot of times we've heard about people feeling like, oh, you know, we're dulling people's, you know, we're dulling people's spirit a little bit on these medications.
- [32:03]
Dr. Sasha Hamdani
If you're looking at 80, if we're strictly talking about medication, there are two big classes. There are stimulants and non stimulants. Stimulants are the gold standard. The stuff you've heard about, Adderall, Ritalin, five ants, all of those are stimulants. Non stimulants are things that are obviously not stimulants. So they can be antidepressants, they can be blood pressure medications, they can be other types of medication that we use that don't work in that similar mechanism as a stimulant. So when you're looking at stimulants, they're Adderall and Ritalin derivatives. They're short acting, they're long acting. So you can really kind of find a personalized solution based on what your symptomology is. Here is the issue with stimulants. Stimulants are heralded as the gold standard because they work effectively and they work quickly. You're going to know within that first day or so whether this is a good idea or a bad idea. The problem with them is you can't stimulate a person 24 hours a day. So you need to find a way to bridge that gap and use the medications as a tool because it's not going to be curative. Right. You just need to use it to kind of help. Now with non stimulants, you can get 24 hour coverage, but you're not going to, depending on what you're dealing with, you might, might not feel that kind of level of elevation that you do with a stimulant. So some people don't like that because of that. So those are kind of the two big types of medication in terms of. You hear it all the time like, I don't want to treat my adhd. It's going to take away my sparkle, it's going to dull my personality, it's going to take away my creativity. I've heard that a lot. When you're on the right medication, whether that's a stimulant or a non stimulant, the goal of the medication is to get you to function like you do on a good day. It's not going to, it's not the limitless pill. You're not going to feel like superhuman. You're not going to be able to do all these things that like a normal person wouldn't be able to do. But it's going to remove that level of executive dysfunction that you have where it's hard for you to do the things that you can do on a good day.
- [34:03]
Dr. Rena Malik
So it's not treating you, it's just treating, it's not treating the underlying cause, it's just sort of treating the symptoms in the moment where that medication's on board. So do people take, take it as needed? Are there some people who take it as needed?
- [34:15]
Dr. Sasha Hamdani
Yeah, there are, there are people that, that take it in. I mean, everybody's need is a little bit different, right? I mean, you can look at how symptomology is over. You know, your ADHD doesn't go away, but you might be in certain environments where it's significantly worse. You might be at like this super boring desk job where it is so hard to maintain your focus and it's hard for you to get stuff done. But then as soon as you're at home, you're getting stimulated by all these different things and it's easier for you to get stuff done. It just kind of depends what your environment has in store for you, how you're processing in that moment. And so yes, there's some people that take it in only certain environments. There's some people that take it consistently take it all throughout seven days a week, they're taking it and they're taking it to get as much coverage as possible. So it kind of depends on what, where your level of dysfunction is and how significant it is.
- [35:09]
Dr. Rena Malik
Are people with ADHD more creative?
- [35:12]
Dr. Sasha Hamdani
Of course. Of course. No. What I would say is that there's a couple of things that I would lean towards. Yes. And I think that part of that is that they tend to be a little bit more open to risk. And part of that is that inherent impulsivity. But I think that leads to a lot of creativity. You're not limiting your brain from thinking about certain ideas. You're not limiting your brain from executing certain things. That's why there's a lot of entrepreneurs that are have adhd. It does have some positives with adhd. It's not strictly negative. It's just all about how you manage it.
- [35:47]
Dr. Rena Malik
I actually thought about that. I was like, I wonder if a lot of high functioning executives have adhd. Because when you're, when you're focused on something with adhd, you can be very, very efficient. And I actually, my ex boyfriend had ADHD and he was like all over the place, started medication and he was like unstoppable. Like he could study for hours and he was so focused and he was so on it and he was like a different person. It was crazy. And I was like, oh, if you could do that all the time, I mean, you'd be like, take over the world. Yeah, exactly. Yeah. So, you know, I think it's interesting because you can harness this dysfunction with the proper treatment to excel in some ways.
- [36:32]
Dr. Sasha Hamdani
Yeah. And tools. And utilizing the right tools. And I think it's a matter of number one, this is why pattern recognition is so important. Figuring out where are your deficits, so you figure out the right tool to bridge that gap.
- [36:46]
Dr. Rena Malik
Now there's, at least when I was growing up, there was a lot of misuse of these medications. I don't know if it's still the case probably, but there was a lot of misuse for kids who wanted to get ahead in school taking these medications to be able to focus study longer without being distracted. What is the harm of that? And obviously it's a controlled substance, so it can't be given out just like willy nilly. Willy nilly. But certainly people were able to get it. And so what are the concerns with that?
- [37:11]
Dr. Sasha Hamdani
Well, first of all, no one's getting it right now because everywhere is in shortage. So it's like that's, I mean, it's still kind of a problem. But the concerns if you are taking. We'll talk about stimulants. If you're taking a stimulant medication and you don't meet criteria or need that medication, it's a non specific stimulant. Right. So it's stimulating your brain, but it's also stimulating your heart. It's also stimulating other parts of your body. So you might get exceedingly anxious, you might get cardiac wall dysfunction. You. So there are lots of different areas where you are stimulating that you have no business stimulating. So I, I think that that's something I get very concerned about, especially in that college age population of people that are abusing this medication not just to get ahead, but there was an entire. I had a college student just like openly telling me this the other day and I was like, okay. And he was telling me that he takes Adderall recreationally because he can drink longer at frat parties.
- [38:12]
Dr. Rena Malik
No.
- [38:13]
Dr. Sasha Hamdani
And I was like, weird that you want to tell me that. No, I will not give you Adderall. It's just, it's, it's one of those things that I think it is. So there's not, you know, people don't really talk about the risks of these medication. And there are risks there, there is cardiac risk that happen with that. There immense addiction potential that can happen with this. But for people who have adhd, they're taking Adderall and Adderall and, and just stimulant derivatives. A lot of them. Those are the patients that are like forgetting to refill their medication or they're, it just makes them feel normal and they feel like, okay, this is how I should function on, on an average day. But they're not getting like this excessive high from it. It's not that they're running to chase this feeling. For people that are taking it, that aren't diagnosed with adhd, they can sometimes feel a euphoria with it and they feel like this burst of hyper productivity that also is derailing other things in their body. But that's what's causing the significant deficits.
- [39:19]
Dr. Rena Malik
Yeah, that's a really great way to explain it. Whereas a person who needs it takes it to feel normal. And a person who doesn't need it has this larger potential to get addicted because they're going to feel like, oh, I'm so productive or whatever they're aiming to get from that stimulant. And it's still a stimulant. Absolutely. In terms of relationships. Let's go back to that a little bit. You Know, is there a component of hypersexuality or potentially like the higher risk of cheating or infidelity in partners with adhd?
- [39:48]
Dr. Sasha Hamdani
So I don't know exactly what the data shows on that because I mean, you'd have to get a very honest broker to be, to disclose that. Right. So, but what I can tell you is anecdotally from the, the huge population of patients that I've had and from looking through like my own personal experience dealing with this, I think there is, just like we talked about in the beginning, there is that dopamine seeking behavior, you feel uncomfortable with stability and this smooth sailing that, that is very unsettling for a lot of ADHD brains. And so yes, there is this, this, this feeling like this I want to seek out novelty, I want something new, I want something exciting. And so that can be that you're hopping from one partner to another. It can be that within the context of a relationship that you're dealing with cheating. And again, this isn't an excuse. This is, this is an opportunity to discuss behavior. Because having ADHD is not an excuse to cheat on your significant other. Yeah, it is, it is an opportunity to be like, this is why this happened. This is the I, I need to correct this behavior or I need to leave this relationship. So it's, it's looking at it in a way that you are understanding from a neurobiological perspective and a judgment neutral perspective. I think that's what's really should be talked about more with ADHD in the context of relationships. I think that there's a lot of emphasis placed on like this person is a cheater, they're to blame. And I, I want people to accountability and ownership of, of their behaviors, but I want them to also do that in a way that they're not like piling on a lot of self loathing with that and being like this is how my brain works. This is how I aim to work with my brain. So these behaviors don't continue to happen. Because I don't think anybody who has cheated on a significant other or been cheated on loves that process. Right. That seems very stressful. And so I, I think that there is, is definitely an opportunity to understand there is a propensity and a desire to go towards new novel things because I'm understimulated at this point. How do I correct that without blowing up my whole life?
- [42:08]
Dr. Rena Malik
Yeah, I think that's so important if you are an adult because there is obviously adults who have not been diagnosed with ADHD but have it and either you see your partner or you yourself have characteristics and you're listening like, oh, my God, this is me. Yes. How common is it to get diagnosed as an adult? Is this something that they should seek help for?
- [42:30]
Dr. Sasha Hamdani
So I'm biased, I think yes, because I think honestly, anything that helps you understand your own brain better, go for. Right. You should, if you have the means to do that, you should understand your brain better. Is it common? I mean, a lot. It's getting more common now that this is becoming more part of this cultural dialogue. I think a lot of that depends on all who you see. So, you know, if you are going sometimes if you're going to a primary care doctor or if you're going to a therapist that isn't well versed in ADHD or really anybody, like, even psychiatrists are guilty of this. Also, for people who haven't been well trained in ADHD and are only picking up, you know, that typical childhood presentation, they're not willing to look for things that are outside of the scope of what they know. So just researching your provider, making sure they're well versed in ADHD and all of its facets, I think is important. And the way you do that is simply by looking them up and seeing that they talk about adhd, that they cover adhd, that this is one of their clinical expertise areas.
- [43:34]
Dr. Rena Malik
And then in terms of, like, is there something as a clinician, like, as say, someone is listening and is a clinician that they can maybe read up for themselves or give a patient a quick questionnaire or something that they can do quickly in their office to assess for it. It.
- [43:49]
Dr. Sasha Hamdani
So I don't love that. And there isn't anything. Because I think the, the correct way to diagnose ADHD and to look into that is look at all of it in a comprehensive man. I want to see what is this psychosocial stuff that's going on? What is the underlying medical stuff that's going on? Is this all a thyroid thing? Is this all like something because of adrenal fatigue? Is this, you know, what. What is this actually doing? So. So it's important to get that positive criteria to say, yes, this looks like adhd, but also to rule out all the stuff that it might not be.
- [44:23]
Dr. Rena Malik
So I think just ruling out the other things potentially and then referring to somebody who is an expert, okay. In terms of relationships, again, what I've been told is that people who have adhd, who have sex, tend to struggle sometimes because they're easily distracted or it's hard for them to focus. And of course, it's. You know, I talk about this a lot, but it's really important to be able to focus on the pleasure, enjoy the pleasure and be present in the moment, which regular people have struggle with, but ADHD people will struggle with more. So what do you see in terms of sexuality?
- [44:59]
Dr. Sasha Hamdani
I think it's twofold. I think if you're looking at, like, the focus component, that's one thing, but also there's a strong emotional component that comes with it. With the focus component, sometimes it's hard to stay engaged with your partner. Like, quite literally, you are running through, like, does my body look weird? And what am. What should I be doing? Should I. Like, how long is this gonna last? Because I have to go and do this other thing? And then you start. You get distracted. Within the actual context of having intercourse, there is also a strong emotional component that comes with that, where you're dealing with, like, you're consistently looking at your partner's body cues, face cues, talking cues, and you're like, is this different? Does my partner still like me? Does it? You know? And so there's a lot of rejection sensitivity and inward stuff that I've heard from a lot of patients that makes having sex just instead of being a pleasurable experience, it becomes this opportunity for them to hyper fixate on anything that could be wrong and imperceptible to everybody else within their relationship.
- [46:02]
Dr. Rena Malik
So how do they get through that?
- [46:04]
Dr. Sasha Hamdani
Again, communication, I think, is so important. And I think talking to your partner about, like, I'm. I'm having a hard time staying connected, or. I had a patient who was telling me, you know, she had a really difficult time, and her partner was like, you just don't want to have sex anymore. And so they hadn't had sex in years after recently getting married. And so she was telling me that she was like, I realized that a lot of it was tied into my focus and that I just felt bad that I couldn't connect, and then that I'd get in my head even more about that. Like. Like, God, he knows that I'm not connecting, that I don't want to have sex. And so he's. It's driving him away, then he's gonna leave. What am I gonna do? And then that starts going down. And so they got into this thing where they eased back into it when she felt like she wanted connection but she wasn't quite ready for sex. It would start with holding hands and then, like, move from holding hands, and then they would, like, hold hands in the bedroom. And then they would do. And so it was this gradual kind of reintroduction and. But even, even coming up with those cues that you don't have to verbally communicate, but having those kind of things, like you do it once, you tell your partner, this is what I'm doing. And then that introduces like, okay, we're both on the same page. Let's go forward from here.
- [47:18]
Dr. Rena Malik
Yeah, I can imagine that would be very fatiguing from a partner because I hear a lot of the complaints from patients that, like, my partner's not interested. There's always some excuse, and that can create a lot of like, strain and anxiety and then you can end up in a sexless marriage.
- [47:31]
Dr. Sasha Hamdani
Yes.
- [47:32]
Dr. Rena Malik
So I think you're right. Communication is super important. And. But also, you know, the partner needs to be open and receptive to working with them through that. And I always say, like, what you're describing is almost like being open to responsive desire, like being where you're like, okay, I don't want to have sex right this second. But like, I know that if we are close, maybe we hold hands, maybe we touch each other, maybe we snuggle, that I may get in the mood.
- [47:56]
Dr. Sasha Hamdani
Right.
- [47:57]
Dr. Rena Malik
In terms of like taking medication before sex. So these medications are what we call vasoconstrictors. So they decrease blood flow to certain parts of the body, including the genitals. So that may affect potentially arousal for women because they'll have less clitoral tumescence and erections for men because they're not going to get as much blood flow.
- [48:18]
Dr. Sasha Hamdani
Right.
- [48:18]
Dr. Rena Malik
Do you see a lot of that in your patients?
- [48:21]
Dr. Sasha Hamdani
Yes and no. So it's a double, double edged sword. Because while some of that could happen, sometimes people say that they really feel a tremendous benefit because now they can connect to their partner and they're not distracted by a hundred million different things. So it really depends on what that trade off is. Yeah, so it kind of depends on the person.
- [48:43]
Dr. Rena Malik
Right, right. And I think we can always help with increasing blood flow even through a vasoconstricted vessel, through medications or things like that if needed in those circumstances. In terms of like orgasmic difficulty, I think a lot of it probably stems from this inability to focus and connect, particularly for women, I would say, in terms of like, becoming more present. So dealing with the thoughts about focus and body image issues and rejection sensitivity that they're experiencing. Say they get all that under control. It still requires a degree of focus to reach climax.
- [49:19]
Dr. Sasha Hamdani
Yes.
- [49:19]
Dr. Rena Malik
And so are you seeing a lot of difficulty in orgasm with Women, do they report that to you?
- [49:25]
Dr. Sasha Hamdani
I have heard that quite frequently that it is difficult for them to get into a spot where they are capable of doing that. The thing that confounds this is again, a lot of times I'm hearing that within the context of a safe, stable, healthy relationship. And that's what kind of leads to, if something was new and exciting, I wouldn't have this issue. And that's what kind of leads to this kind of balance of like, like, is it a problem with the relationship? Is it a problem with me? And so it's kind of reframing to them, like this can happen, this can happen. And there you need focus in order to get where you're going on this. So I feel like a lot of this is not only communication between the partners, but if this is something that, honestly, as a practitioner, if I'm lucky enough to be the recipient, that I feel like they trust me enough to have these conversations. This is something that, again, from a non judgmental place, you, you get this opportunity to talk to your patients like this. It could be what's happening. This isn't a reason to jump ship. Let's, let's kind of explore this more. And so I, I think that yes, you do hear about it.
- [50:35]
Dr. Rena Malik
That's so interesting because you bring up this point of like, yeah, now they'll have more stimulation if they have a new relationship. And so they may be able to, that's kind of a positive for them, for their brain. And so they're able to focus more and enjoy sex more. And so it might, you might start thinking like, oh, every time I'm in a long term relationship, you know, I leave and I have better sex. Or maybe you do have some infidelity and you have great sex with that person and that tells and you're like, oh, now I need to leave my partner. When in reality it's just this, this sort of combination of sexual dysfunction, inattention and, and lack of stimulation or boredom that are all causing this problem. That's fascinating.
- [51:14]
Dr. Sasha Hamdani
And you know the fix for that for, for patients that are in long term relationships, I mean, if you understand that this is stemming from a lack of stimulation and mental stimulation and boredom per se, it could be as simple as changing your location. It could be, go to a different room, go to a different town, go like, go, go do something else different. Go introduce something that's like more playful, do something different. And because I think so many people, they just repeat the same thing over and over and over again and expect a Different outcome. It's wildly frustrating. I think that this is just something that. I'm so glad that you are one of the safe places on the Internet where you can talk about this freely.
- [51:58]
Dr. Rena Malik
Yeah, absolutely. I mean I think novelty is so important for. Even for people who are not neuro, who are neurotypical. Because if you think about it, right. Yes, you like vanilla ice cream, you like having it, it's good, it's delicious. But if you have it every day, so bored, right. You want a little variation. And if there's comfort in having some stability and knowing like this is how I orgasm, this is how it's going to happen, it's going to be great. I know what to expect. But if you think about you change one little thing and interestingly, even if you do something new with your partner, that's enough. It doesn't have to always be in the bedroom. It can be even outside of the bedroom where if you try something new, you go and you take a class together, a new type of class, anything that you will now have a little bit more chemistry in the bedroom that day because you tried something new. And so it doesn't have to be like, oh, I'm gonna go buy whips and chains. Like it can be very, very minimal. It can be like holding one hand a different way. It can be going into a different room. Totally. It can be wearing a shirt, not wearing a shirt, like something just very minimally different. But different enough that it offers some slight challenge or some slight variation.
- [53:02]
Dr. Sasha Hamdani
I've told people just flip sides of the bed. Even flip sides of the bed, like go upside down on the bed. So where your feet normally go, start there. Like just something enough that it feels a little bit different.
- [53:17]
Dr. Rena Malik
Yeah. And I will plug like there are some very easy little like wedge pillows that you can use that can change positions that don't have to be like a full on swing that you have to hang somewhere. Like just little things and they look like they're just back support pillow. So no one has to know and you know all those sorts of. But you know, that's sort of a simple, easy thing to do.
- [53:35]
Dr. Sasha Hamdani
And then you can use it for back support.
- [53:36]
Dr. Rena Malik
Absolutely. Dual purpose after you clean it, you know, make sure your kids aren't all over it. The other thing that I've seen on your content is that ADHD people tend to mirror people when they meet. So sometimes they will literally like pick up and do things maybe in a similar way or talk in a similar way. And that's a great way to Actually build rapport. So if you talk, look at people who talk about negotiation or people who talk about building relationships, it's often very positive for the other person to be married. Because they automatically like you, right? They automatically enjoy your personality and enjoy you because they see themselves in you, although they don't realize it. And so that I can imagine, when you meet someone, can be really like. You can immediately love this person or think they're amazing, and then over time they're going to transform into their normal self potentially. And so how does that affect people's relationships, whether they're romantic or not?
- [54:27]
Dr. Sasha Hamdani
So I can tell you, a majority of my 20s, I was just a chameleon. Like I could, depending on who I was around, I was a totally different person. And the thing that gets difficult about that is that you just start to lose touch with who you actually are and what you prioritize and want in a relationship. I see it in males and females, but I think societally, I think it's almost imposed on women a little bit more to, to just like blend into the situation a little bit better in relationships. Like if you are having that, you know, and I think a lot of this stems from that rejection sensitivity. You find parts of yourself intolerable, so you mask them to look like something else. I think that you get into a real issue with this self perpetuating cycle where you've changed parts of yourself. You finally get into this relationship, it's a long lasting relationship, and then you start to show parts of your authentic self and then you're getting this like, ugh. And so then it's like, okay, well then why did I, why did I show this? You don't even like me for who I am. And then it starts to degrade the relationship from within. And so it's really difficult. And I think again, I wish there's a, there's no pill for this, right? There's no, like a part of that just comes from an intrinsic understanding of who you are, what you like, what you expect out of a relationship. And again, because that frontal lobe develops slower, you might not even know that for a while. Like for Women it's like 26, 27, 28, where that actually starts completing that process. So you blasted through your 20s by then.
- [56:02]
Dr. Rena Malik
That's crazy. I mean, I can't even imagine like some of these, like it's a disorder that you technically have your whole life, right? Your brain is just different, right? But it's diagnosed that. So you're dealing with it throughout your entire life. Where you're building friendships, you're building relationships and you are probably struggling like quite a bit in terms of maintaining close connections with people who as friends and then as relationships.
- [56:27]
Dr. Sasha Hamdani
Yeah.
- [56:28]
Dr. Rena Malik
I saw something where you said that kids with ADHD by the age of 12 have had significantly more rejections and negative comments from parents, teachers and siblings than the average person I know.
- [56:41]
Dr. Sasha Hamdani
And it's so sad. And I think, I mean that's just an estimation. But then when I went back and actually thought about like my own life, even things like I was getting like looks and imperceptible kind of like non verbal cues, like people were telling me to sit down or to calm down, I mean just consistently. And then my sister whose brain works like an actual computer, I don't want to get it like none of that. And was heralded as like just this. You're doing everything right, everything's great. And so like you're seeing that juxtaposition of you and your sibling and that becomes really difficult too. And she's great.
- [57:21]
Dr. Rena Malik
Well, you obviously had amazing parents. I've heard your story of how they supported you through getting the diagnosis and then ultimately finding out you had the diagnosis. And that's like so, so brilliant and wonderful. And I think it must be even harder for people who don't have supportive parents or who think like, you know, or don't even get them treated because they think that their kid is just lazy or not focused, not capable. And so that's where I worry. So as a parent, what can you tell parents? Obviously people listening here care about like being healthy and being better. So what are some signs that maybe they should get their child evaluated and are there things that they can do while they're waiting as there is difficulty for some people getting someone who's an expert in ADHD to like see them?
- [58:10]
Dr. Sasha Hamdani
Yeah.
- [58:10]
Dr. Rena Malik
What can they do to help support their child? Maybe prevent them from struggling so much in the short term before they can get fully evaluated.
- [58:17]
Dr. Sasha Hamdani
I think that if you're just like what we talked about with the criteria in the beginning. If your kid is struggling with inattentiveness in school, like difficulty staying organized in school, and again, a lot of that is developmental. Right. You're not going to expect a seven year old to function like an adult. That's just insane. The teachers are the ones who see it all. They see it all and they're not going to be able to be like your kid has ADHD because that's a medical diagnosis. They're not going to be able to tell you, but they'll be able to kind of tell you like these are the areas we are worrying about. And so, so oftentimes, you know, I have a lot of patients with children with ADHD where both parents aren't on the same page. One of them wants to medicate, one of them doesn't, or one of them believes that there is something physiologically wrong. The other one is like, no, this isn't a thing. I was exactly like this. And when I was little, some of that time I'm like, you know, this is the thing that's similar in both of this is you want the best for your kid. And so you don't have to call, don't call it, it anything. You don't have to call it adhd, just address what's happening right now. No matter whether it's ADHD or not adhd, your kid isn't doing great at school. So what can you do in the classroom, at home to make it easier? So like in the classroom, are there modifications that you can do? Like maybe they need more one on one time with the teacher. Maybe they need to sit closer in, in the classroom so they get less distracted than in the back. Maybe they need to get their vision checked, maybe they need to get their hearing checked. You know, things like that. What can you do? Because I think sometimes, sometimes even parents are getting caught up on just like the label of it and the stigma of it and that, that comes with education, that comes with time, that comes with, you know, if they're willing to hear it. Because sometimes they're just, you're not going to get to that spot. But the goal is to take care of your kid. And so how are you going to do that?
- [60:02]
Dr. Rena Malik
Yeah, I think the other thing is oftentimes there is, I mean school is structured, it's a modern construct. Right? It's, it's because when we went to war, they needed something to do with the kids from nine to five while people were working in the factories. Right. They needed something to do with them during that time. And so it's a modern construct and it's also not designed with kids in mind. Right. It's not designed where kids are not supposed to sit for eight hours a day. They're supposed to be moving and they have energy and they're supposed to expend that energy. And so I think some of that with my children will be like, okay, we need to get up and move our bodies really quickly and during breaks between class, get up and move your body or things like that. Just to help them sort of, of get through the challenges of just like sitting all day, especially boys. Like, I have two sons and I find that like they, like girls will sit in color really well and like they'll. But my son's like, no, they can't sit still for eight hours. It's impossible. And I don't think that that's necessarily atypical. But I think as you're describing, like, if they're really struggling and they like cannot focus on the task at hand, and even though they're like, mommy, I'm really trying hard, right? Like say that's your child, like, you know, you have to believe them, like they really are trying hard and like to help them through that. And I think those tips that you gave are really helpful. And then also, I mean, the same things would apply, like checking out things in their diet that may help improve them, checking maybe exercise for them if they're not getting enough during the day, making sure they're getting enough sleep, which is really challenging because if you have a kid who won't sleep, I mean, I've been there, but you know, those things can also be helpful.
- [61:37]
Dr. Sasha Hamdani
Yeah.
- [61:38]
Dr. Rena Malik
You live with an ADHD brain.
- [61:39]
Dr. Sasha Hamdani
Yes.
- [61:40]
Dr. Rena Malik
So describe what it's like to live in your body.
- [61:45]
Dr. Sasha Hamdani
It's weird. It's weird. I mean, I. Here's the deal. I've spent a lot of time reflecting, trying to figure out like, like, if I had to describe that, what does it feel like? And I think it is. I don't like my adhd. I don't. I like, if I had the option of having it or not having it, I would choose to not have it. But there are things that come with it that I think have made me more successful than what I feel like if I didn't have it. Because it's made me more able to take risks without worrying about things. It's made me more creative in certain aspects. So I would say that a lot of the big successes that I've had are because of my adhd. And so I wouldn't have gotten that opportunity. So I feel very conflicted about it because, because I think on the day to day basis there are a lot of very annoying things about it that make it difficult. And then on the flip side, there's some incredible positives that have come out of those perceived deficits. So it just kind of depends on the environment of how I'm looking at the exact same problem.
- [62:51]
Dr. Rena Malik
It feels like, it seems to me as an outsider, like there could be some really high highs and then some really low lows. And it's sort of like trying to balance those on a day to day basis, which if you are good at harnessing the challenges and doing all the things that can help set you up for success, can help those highs be really high.
- [63:08]
Dr. Sasha Hamdani
Yeah. And I think that that is, that's probably true of a lot of things. Right. Learning how to harness and balance your strengths and deficits I think is skill sets that everybody should learn. But I think it's especially important for people with ADHD just because without doing that, you can derail so easily. So, so easily.
- [63:30]
Dr. Rena Malik
Tell me about a time where you had this derailment or failure that really sort of like.
- [63:38]
Dr. Sasha Hamdani
Like, how much time do you have? Okay, well, I'll tell you what, kind of brought this when I, when. So I did pretty well in high school. I got into this combined that six year program in Kansas City. And so we started medical school classes like right off the bat. And one of our classes was neurology. And I studied, I studied just my ass off. I like, I was like working so much harder than I felt, like what my peers were working and I had gotten it down. I'd got like, I, I knew every structure in that brain. I go, I do the test. I get done before everybody else. I'm like, I have nailed it. I'm amazing. I drop it off. And then they, I don't know if you had this in your med school, but they had like, they would like post the grades with like numbers so you'd have to like look up your number. And so I'm going to the board and I'm like, God, oh my, my God. This person got a 32. That poor loser. And then I looked down, I'm like, oh, that was me. I got a 32. And I was like, I don't even understand how this happened. So I went to the professor and I was like, what the hell is this? And they were like, I don't know. You just got a 32. And I was like, can I see? There's no way you incorrectly did this. I. They brought out the test. I didn't flip it over. Oh no, I didn't flip it over. That's horrible. And so I was like, I will do this verbally. Like, you can give me the test. I'll do it for any. They're like, you're either going to learn from this or you're not. And so I wasn't allowed to redo it. I had to like climb out of this hole. I Got, like, more and more. I got depressed after that because I was like, like, if I get a hundred percent on every single test going forward, I'm still gonna get probably a C in the class, and there's no way I'm gonna get 100 on the test going forward. Like, I like, how am I gonna get through med school? I'm already. And people think I'm a moron because I'm 32 on a test. And so I just. That. That got me into this significant hole. And so, like, I wasn't motivated to study. I wasn't motivated to eat well. I wasn't. I definitely wasn't motivated to exercise. And it got so bad that my dad was like, just come home, man. Like, you are going to be kicked out anyways and just come home. So I came home, and I was supposed to be studying for a big test. And he's like, let's just learn about adhd. Let's learn about how your brain works. Let's figure out how to problem solve. And so, I mean, he just guided me through this whole process. Like, we really focused on this. And then the last three or four days, there was another test coming up, and I studied for it, and I studied so hard, and I was like, I feel like I'm studying for my brain. I understand this. I'm learning in a slightly different way. I went and I did the test. I got 100% on that test. I was called into the office, and my instructors accused me of cheating. What? And I was like, please, give me a break. So unfair. And so. And like, my dad at that point was like, I will show you the. The study. Like, she was making whiteboard projects of this. I will take pictures of. And he was my biggest advocate. Like, I. I will write a letter to the thing. I will show them pictures. You can have a tour of our house. She could do the test again right now. And I had to take the test again. No, I got 100 again.
- [66:43]
Dr. Rena Malik
They made you take.
- [66:44]
Dr. Sasha Hamdani
I took the test again. So, I mean, I. Like, this is like, instead of actually.
- [66:50]
Dr. Rena Malik
Applauding you, they doubted you. That is so horrible.
- [66:53]
Dr. Sasha Hamdani
So. But this is like this story of, like, once you get that label, like, if you're lucky enough to climb out of it. And, like, my dad was the one who pulled me out of that depressive hole. Like, you can do it. You've done this before. But then as soon as I go back to that environment, they've already pegged you. And so then you just fall apart again. This is what I'm talking about by derailing. You have. There's so many opportunities for. To just get squashed by it.
- [67:19]
Dr. Rena Malik
That's crazy. Tell us about your app, Focus Genie, because I think it's so wonderful that you did this, that you put this together for people with adhd, because I don't think there's anything like it. And I think that as you mentioned, tracking and having a way to do that can be transformative.
- [67:37]
Dr. Sasha Hamdani
Yeah. So I originally, again, it came about when I couldn't manage any of those stressors right after I had my son during COVID and I had this idea, and it wasn't even my idea. Like, it was. People on social media was like, please do this. And I was like, I don't know how to do that. That sounds really hard. And so my sister got involved and she is like, her brain is so brilliant and analytical and focused. She's so focused. So we work together and basically we created this comprehensive ADHD management app where you start with like just basic understanding. And they have. It's almost like an Instagram swipe through, just like two minute swipe throughs where it talks about relationships, it talks about finances, it talks about home, it talks about understanding the neurobiology. And so you start with this basic understanding and then from there you can track your own behavior. It's all gamified. So you can just like, as you're doing these things, you're earning points and you're like, okay, let's keep going. You. There's a to do list that is, you know, you can break it down based on kind of like what kind of task it is. So at the end of the day, at the end of the week, at the end of the month, you could be like, whoa, I'm awesome at doing all my work tasks, but I do nothing at home. So you can break it down based on that. There's a journaling and mindfulness section, there is a timer, so you can actually break down tasks. And within that, you can either listen to music or you can have. You can actually. There's a study buddy and one of them is me, so you can study with me. But one of the most exciting things is I love, I truly, truly love everything about the app because it's crowdsourced by the people, the community on social media, asking for what they wanted. But what was unfortunate is that I released it September 13th of 2023, and my dad was diagnosed with cancer that day. And so I just let it go. I didn't do anything. And he passed in April of this year, so six months later, and I just didn't give it attention. And so now I'm kind of, like, building it back up and getting back into it, and I'm just like, oh, my God, this is. This is such an incredible opportunity. And so in January, we're rolling out. Because my grief was so significant during this time, I wasn't able to truly, Rena. I wasn't able to do anything. I wasn't able to start tasks. I wasn't able to, like, you would ask me, like, go to. You need to make dinner, Which, I mean, no one's ever asked me that because I can't cook. But, like, if that was the thing, I wouldn't be able to break down the test, like, go to the grocery store. Go pick up the. So this is. We've integrated an AI model in here that you can type in what you want into the app, like, I need to clean my room. It'll break down the tasks for you, and then you can upload them into your to do list, and you can get them done that way. So, like, I feel like it's so good for when people get stuck in this analysis paralysis where they can't. They can't progress from that point. It'll give you a starting point, and that's what I'm most excited about.
- [70:42]
Dr. Rena Malik
It's like an ode to your dad.
- [70:44]
Dr. Sasha Hamdani
I know. And he was so excited. He was, like, following numbers, and he's like, ooh, you guys are. What happened here? I was like, sorry, I've been focused on other things, but it just. I see him in this creative product, so it makes me so proud.
- [70:58]
Dr. Rena Malik
That's awesome. That's so awesome. I'm so sorry about your loss.
- [71:00]
Dr. Sasha Hamdani
Thank you.
- [71:02]
Dr. Rena Malik
You talk about music, and there's certain sounds and music that can be really beneficial for the brain. So is that incorporated in the app or, like, how do you. How do people find those sounds for them?
- [71:13]
Dr. Sasha Hamdani
Oh, my God. First of all, that should be an entire different podcast thing, because it's such a cool, cool area of study. And there. I. I didn't know this, but there's, like, sound therapists that, like, this is what they focus on. Like, what kind of sounds impact mood, impact productivity. So we actually looked into this app, and we got. I think it's four separate sounds. There's brown noise. There's ambient noise, there's lo fi, There's. There's, like, different types of music, and you can play around with them and figure out what. What suits your brain best. But the certain music, which. And you can ask anybody with ears.
- [71:48]
Dr. Rena Malik
Like if they have anybody.
- [71:50]
Dr. Sasha Hamdani
Yes. Who have felt like, you know, music has impacted my ability to focus on things. For each person, it's a little bit different. You might have someone who's like, you know, I need this 852Hz music to kind of calm me down. And it's that exact frequency or that I really need and it kind of cools, cools my spinning. There are other people that are like, I need something very high tempo because it's almost stimulating to my brain that allows me to calm down. It just kind of depends. And so this gives you options that you can pick from and you can break down your tests with that music and figure out what works best.
- [72:25]
Dr. Rena Malik
Yeah, I actually do that too. I listen to lo fi when I, when I do work, it just helps me focus. And so that's like when I need to do deep work, like, I just need like something to keep me focused and that tends to work, which is sort of exciting.
- [72:37]
Dr. Sasha Hamdani
It's so exciting.
- [72:38]
Dr. Rena Malik
That's so fun. I mean, I think there's, there's so much to unpack. Are there, you know, there's, there's things like the Pomodoro method where people like work for. I forget what it is, like 90 minutes or 60 minutes and they take a 5 minute break or 10 minute break and they go back at it. Are those things useful for people with adhd?
- [72:54]
Dr. Sasha Hamdani
I think so. The timer that we have here, I think is a variation of that, except you can, you can break it down how you want. You can do, you know, because I think doing large chunks is kind of inaccessible for a lot of people. I break mine down into like a five minute working period, a two minute break, a five minute working period. So just breaking that down. But honestly, even if you didn't want to use the app at all, there's a three day free download, so you can see what you like in that and then if you want, go other places and grab what you want from it because it's, it's there to educate and to teach you kind of how your brain works, what you like about it. Pomodoro method is great things, things that just help you track. I think that's one of the most important things because learning your patterns. For a long time I was just doing it on my notes app and I felt like that was helpful. Just a little disorganized in terms of like, it was hard to keep track of exactly what I was tracking. But if you're more organized than I am. That. That's a great method. Just learning from your own brain. That's awesome.
- [73:54]
Dr. Rena Malik
Awesome. So what are you working on besides the app right now that you're excited about?
- [73:58]
Dr. Sasha Hamdani
I mean, you interrupted me in the car today.
- [74:02]
Dr. Rena Malik
Yeah. So guys, just so you all hear, what happened is Dr. Hamdani was like in her car. She's like, I'm here. So I come outside and there's three cars down the street that all have their car on. And I was like, which car are you? Because I don't want to start going up to strangers cars and being like, hi. But yes, go ahead. I interrupted you in the car.
- [74:20]
Dr. Sasha Hamdani
No, I mean, I was, was talking because I have recently been working on my second book.
- [74:28]
Dr. Rena Malik
So exciting.
- [74:29]
Dr. Sasha Hamdani
Yes. And, and it is about the ADHD brain and emotional sensitivity. So I think it's just going to be such an interesting viewpoint because there's nothing out there yet. But I think it's so significant because so many people with ADHD fall into these, these like everyday scenarios where they just get completely steamrolled by them. And so things like, how do you deal with like in a professional setting, like a, a boss wanting to talk to you? How do you deal with like in a friendship setting? Rejection within a peer group. How do you deal in a relationship setting if you feel like you've initiated intimacy and your partner doesn't want that? Like, how do you deal with that rejection? And how do you reframe it in a way that's not going to just blow up your life and instead you can work from, and communicate and work through. Yeah.
- [75:22]
Dr. Rena Malik
That's so exciting.
- [75:23]
Dr. Sasha Hamdani
I know.
- [75:24]
Dr. Rena Malik
I'm also working on my first book. So it's a, it's a whole process.
- [75:28]
Dr. Sasha Hamdani
So much.
- [75:29]
Dr. Rena Malik
It's so much work.
- [75:29]
Dr. Sasha Hamdani
It's so much.
- [75:30]
Dr. Rena Malik
But it's so worth it. I mean, like, I think as, as you do it, it becomes like this, this thing where you're like, oh, finally people are gonna see it and have it and available to them in this like, little package that they can look at anytime, you know.
- [75:42]
Dr. Sasha Hamdani
Oh, it's so. I can't wait to read your book.
- [75:46]
Dr. Rena Malik
Awesome. And then so we end our podcast with questions that we ask everybody. They can be about adhd, they can be about your life, they can be about something totally non related. Sure. What's something you know now that you wish you knew earlier in life?
- [75:57]
Dr. Sasha Hamdani
I wish I knew that people change. I wish I had. You know, because when you're younger you think about like these relationships that you're in and these friendships that you're in and the work environment that you're in, and you think that's going to be the same way for the rest of your life. And so you base decisions and your emotional. You just expend so much emotional energy, and you don't think about, like, five years down the line, is this going to matter to me? Or five years online, is this going to matter to them? And so I just wish that I had a better understanding of that because making, like, having that in my brain has made me a much happier fully frontal lobe developed adult.
- [76:34]
Dr. Rena Malik
Yeah. I think what you probably mean is that you change, right? That, like, your relationship to those people will change. They may or may not change in terms of their personality, but, like, you're gonna.
- [76:45]
Dr. Sasha Hamdani
You evolve. Yeah. Yeah, right, I change.
- [76:47]
Dr. Rena Malik
Yeah. Because, I mean, people may change or may not like you, but that's not. It's your relationship to them that changes.
- [76:53]
Dr. Sasha Hamdani
Yeah, I change.
- [76:55]
Dr. Rena Malik
Yeah. What matters changes. Mm. Yeah, I like that. What's something you have to do every day? Day?
- [77:01]
Dr. Sasha Hamdani
I have to call my mom every day. I have to call my mom every day. And I think that part of that, I hope is. Is a behavior that is going to be replicated to my own children.
- [77:13]
Dr. Rena Malik
Yes.
- [77:14]
Dr. Sasha Hamdani
But I think that it is such a. It's so grounding for the both of us. I think that's really important.
- [77:20]
Dr. Rena Malik
Any plans to move back to California?
- [77:22]
Dr. Sasha Hamdani
Did you talk to my mom before this? Was this planted?
- [77:24]
Dr. Rena Malik
No.
- [77:27]
Dr. Sasha Hamdani
I don't know, but I think she should move. Yeah, I. I think about it all the time. It's just living in Kansas City. So easy. Yeah, it's so easy. It's. I mean, the people are so nice. You can. I mean, it. Everything is drivable. There's no traffic. Cost of living is low.
- [77:47]
Dr. Rena Malik
It's true.
- [77:48]
Dr. Sasha Hamdani
I mean, it's just. And you know, I'm here twice a month, so it just feels like it's, you know, maybe.
- [77:55]
Dr. Rena Malik
You never know.
- [77:56]
Dr. Sasha Hamdani
Maybe.
- [77:56]
Dr. Rena Malik
Yeah.
- [77:57]
Dr. Sasha Hamdani
Yeah.
- [77:58]
Dr. Rena Malik
What's a health hack or life hack you would share with some people?
- [78:02]
Dr. Sasha Hamdani
A good health hack would be not downplaying the importance of hydration. And I wish I wasn't this person, but I think water tastes boring. Like it just. Like there's no motivation for me to drink it. It's too cold. It kind of hurts my teeth. I don't like it gives nothing. So I don't. I don't generally enjoy that process, but I think keeping a visual cue. So I keep a water bottle on my nightstand. I keep A water bottle at my desk and that, like, it's there. I have to drink it. And then, like, flavoring it in some capacity. It's really increased my water intake. I think. Better. I feel better. I'm. I'm less emotionally reactive and I'm less wrinkly.
- [78:40]
Dr. Rena Malik
So, yeah, that's great. I also struggle with hydration if I don't have my water bottle with me. But also, like, I. You know, I think, like, when you're a surgeon, particularly, like, you're in the operating room for hours or even in clinic, especially when I do wear masks. Like, you know, you just, like, didn't drink enough. And so there's, like, needs to be a conscious effort to drink it up.
- [79:02]
Dr. Sasha Hamdani
Constant. And I think about it all the time. Like, ooh, didn't drink any water. But again, that app is the thing that showed me I was like, I did not drink a single thing of water today. That's not a normal human adult behavior. Like, I got it. Gotta step it up. So I think. I think that is something that I have really, really, really tried to dial down and make more consistent.
- [79:22]
Dr. Rena Malik
It's so funny as a urologist, there's, like, us who don't drink enough. Then there's people who literally are drinking, like, four Stanley cups a day. And I'm like, you're going a lot because you're drinking four Stanley cups a day. But that's a whole other story.
- [79:35]
Dr. Sasha Hamdani
Who are those people?
- [79:37]
Dr. Rena Malik
They're not us.
- [79:37]
Dr. Sasha Hamdani
Yeah.
- [79:40]
Dr. Rena Malik
If you couldn't be a psychiatrist, an entrepreneur, a TikTok and Instagram celebrity, what would you be?
- [79:47]
Dr. Sasha Hamdani
I would want to work in documentary film, and maybe it's boring in my brain. That seems really interesting. I feel like I would want to be able to visually tell a story. I think that's really compelling and that's. I just find that so awesome.
- [80:05]
Dr. Rena Malik
I thought you would have said, like, make music of some kind.
- [80:09]
Dr. Sasha Hamdani
You'd be. I'm so not musically inclined. I played clarinet for two months when I was in third grade, and I was running down the hallway with the clarinet, and I got to read through my lip, and that's my last time. I've probably held a musical instrument.
- [80:23]
Dr. Rena Malik
But you like. Because I remember hearing a story where, like, you did, like, when you had this whole issue in med school, you just went to, like, a bunch of.
- [80:30]
Dr. Sasha Hamdani
Concerts all day, every day.
- [80:32]
Dr. Rena Malik
And so I was like, oh, man.
- [80:33]
Dr. Sasha Hamdani
She loves music, and I do. And, like, said, I. I still feel music is so healing. Like, after my dad passed, my sister and I was like, you know what? I just want to see Noah Khan, and he's not playing. So we went to Tennessee and to Nashville and we just, like, went to this huge festival in the middle of a hurricane. It was just not greatly planned. But, I mean, it was. I feel like it is. If I was 10% more musical, I would have changed my answer.
- [81:02]
Dr. Rena Malik
You could still enjoy musical.
- [81:03]
Dr. Sasha Hamdani
I can and I do.
- [81:04]
Dr. Rena Malik
Yes. Well, thank you so much for being here. It's an honor to have you and it's awesome.
- [81:10]
Dr. Sasha Hamdani
Thank you for having me.
- [81:11]
Dr. Rena Malik
Thank you guys so much for joining me on today's episode of The Rena Malik, M.D. podcast. If you guys like this episode, do me a favor. Share it on social media and let me know what part of it you liked the best. Also, check out Apple or Spotify. Leave me a rating or review to help other people find this podcast as well. And as always, I'm going to take care of yourself because you're worth it.
- [81:30]
Samantha Christine
It. Hey, guys, I'm Samantha Christine, host of the Empower Podcast right here on the Pursuit Network. If you're into wellness that fits into real life with honest convos, workout tips that actually make sense, nutrition hacks that support your lifestyle, and a lot of encouragement to become your strongest self, you'll feel right at home on my show. Whether you're a busy mom in a season of rebuilding or just trying to stay consistent with the all or nothing mindset, the Empower Podcast is for you. New episodes drop every Wednesday wherever you listen to podcasts, so come hang out. I'd love to have you.