Dr. Tracy Marks (3:47)

I'm happy you have me here.

Tamsen (3:49)

Yeah, I think this is great. I have so many questions. First of all, personal questions, but I'm gonna make them, make sure that they apply to everybody. Okay. I found you on YouTube, which I'm sure a lot of people tell you. Scrolling one night and talking about so many different topics. In particular, ADHD was the big one for me at the time. I will just tell you my own personal story. I had gone to a doctor, a therapist, and I said, you know, I think you might have adhd, but you need to go and take a. Like a, you know, actually do a form and go through all of the process. And I totally like it. Skipped my mind to do it, and I never wound up doing it. So I'm like, that must be something going on with my life. But that's my own. My own personal, like, what has happened to me? I am 55 years old. ADHD was never something we talked about in my generation or that I remember. There is so much talk out there right now and a lot of new information. About ADHD in adult women. So what do we need to know? Let's start there.

Dr. Tracy Marks (4:46)

Wow. So I get a lot of questions and comments. A lot of the comments, though, have to do with people being thankful that they feel heard and seen and that, wow, this sounds like me. I didn't realize. No one's ever talked with me about this. I knew something wasn't clicking. And probably once they get that realization that maybe there's a possibility I might have ADHD or where do I go next? But I tell you, I mean, this is a real common thing. What you mentioned about, like, not really hearing much about this earlier on. I mean, I trained. I'm older than you, but I trained 25 years ago. And at that time, the thinking was. Or what we learned was that ADHD was a neurodevelopmental disorder that starts in childhood. We still believe that, but you grow out of it.

Tamsen (5:39)

You grow out of it.

Dr. Tracy Marks (5:40)

You grow out of it. And that only a small percentage of people may be left with some. Some leftover symptoms in adulthood. But predominantly it's a childhood issue. A problem with that is. And so that's changed over time. We realize that's not really what happens. It's a lifelong issue. But you have a whole generation of doctors who still believe that, and if they're not in psychiatry or psychology, they have no reason to stay up to date. So then there's still this idea that it's not real.

Tamsen (6:12)

Right, right. It reminds me a little bit of the menopause conversation we were having before we turn the cameras on, where, you know, there's a lot of doctors that are still not educated about the changes and what we've learned in terms of guidelines and data when it comes to menopause, perimenopause, and treatment. I guess the conversation about ADHD came on my radar because there were so many women talking about brain fog and so many women saying, wow, I've hit this time in my life where I have no focus, no concentration, no ability to walk into a room and remember what I was doing. Or I'm on my computer and I'm doing 100 different things all at the same time. And I think that's where it came on my radar first to start having that conversation about it and then dig into it a little bit and see, are women finding out or are people finding out later in life that is something that they've been dealing with and they didn't know, or is it something that can develop later in life?

Dr. Tracy Marks (7:05)

Yeah, that's a great question. So it's really multifactorial. ADHD isn't something we still believe it starts in childhood. It's a long, a lifelong issue and it just doesn't start in adulthood. But what can happen is you may have enough compensatory things that you do or some, what we call like subthreshold symptoms that don't get to the point where it causes a lot of problems for you. Because pretty much all of the diagnoses in our manual have a list of symptoms. But then also it's included if you have these symptoms, it causes significant dysfunction. So it's not just the presence of some symptoms that it causes significant dysfunction. So you may have some issues or some focus, disorganization, those types of things that are going on in say, grade school. But because you're a hard worker and you persist, you can just keep going and you don't, you just push through it.

Tamsen (8:06)

That's kind of like your norm anyway, right? Like that's what you've known. That's the only thing you've known.

Dr. Tracy Marks (8:09)

That's right. I mean, we're not in everyone's head, so we don't know that this is what everyone's doing. And I've even seen this in my practice where I'll see people at different inflection points. So there may be someone I see in college who was never say on medication or got a diagnosis in grade school, but now that they're in college and the load is heavier now, they just, they can't compensate anymore or professional school or a new job with a lot of demands. So similarly, as we get older and we have more responsibilities and things, if there's any kind of vulnerability with regards to ADHD in your brain, it just gets uncovered now because the load is too great for you to just handle it.

Tamsen (8:55)

Wow. I also wonder, I guess with digital and the way we never turn off and we were joking that, you know, we don't go far from our phones, but that's really the truth. Do you think that that has brought more things to the surface because we just can't manage it all or we're trying to manage it all. Cause we think we can.

Dr. Tracy Marks (9:11)

Absolutely. So the whole cognitive overload that you can get from too much input, that's a. It's not. I mean, it makes sense, just common sense wise. So you're just, you know, you're too stimulated. But like from a, from a brain standpoint, one of the functions that's affected with ADHD is working memory. Your ability to take in information, manipulate it in real time, make decisions, et cetera. So if you're always kind of being loaded down with content that you're reading, responding to, even if that's entertaining, it still work for your brain.

Tamsen (9:50)

Oh, even entertaining us. I didn't realize that.

Dr. Tracy Marks (9:52)

Even though it's entertaining. Yeah.

Tamsen (9:53)

I mean, I do feel like I'm on input all the time and I don't know where to export anything some days. So. All right, so let's go back to tools we can use if that's going on, and then also deciphering the difference because I feel like we've got to do a little bit of both here. I think if there's a woman that's listening right now that is in midlife and saying, like, I have adhd and I think I hear that a lot these days. I feel a lot of people labeling themselves with that. Do you hear that more and more because we're talking about it?

Dr. Tracy Marks (10:24)

Absolutely.

Tamsen (10:25)

So what do you want to warn people of? Because I think that's important.

Dr. Tracy Marks (10:28)

Yeah. So it really is a double edged sword. On the one, I love the fact that we have so much that we have more access now to information and learning. Love that. But on the one hand, you can get a dilution of what ADHD really is because people will just associate it with, I can't focus, so my ADHD is kicked in. I can't focus. And it's so much more than difficulty focusing. And like I said, with too much stimulation, you can have trouble focusing. With anxiety you can have trouble focusing. Like there's lots of things that can impact your focus. So yeah, I do think there are people labeling or self diagnosing saying they have ADHD because they watch someone on TikTok say, I can't do this. Well, I can't do that either, so I must have ADHD.

Tamsen (11:14)

They need to go to your YouTube because you make it digestible and you have millions of people that you are helping there every single day. That's right. I give you real information. Seriously.

Dr. Tracy Marks (11:22)

Thank you. I love it. On the other hand, though, there are many people who have missed the boat when it comes to being recognized as having adhd, getting a diagnosis and doing something about it. And then there are those people who may have had some milder form of it that then gets uncovered when they have a heavier load in life, like, you know, being older and taking care of aging parents, like all of those things. And so I'm happy that people now are better able to recognize that, oh, maybe this is actually What I have. So I do think there are a lot of people who've just not been diagnosed who actually do need the help. Because when I keep saying that ADHD is so much more than focus, I mean, one of the things that I think we've kind of, that we've missed with ADHD and even the way that we diagnose it, we focus on behavioral things like impulse control, inattentiveness, hyperactivity. But ADHD also negatively affects our executive function, which is of a part of the brain called the prefrontal cortex. I won't get too deep here with that, but those functions really kind of, in my opinion, are at the heart of difficulty with adhd. So with executive functions, that includes things like being able to, we call it set shift, or being cognitively flexible, being able to switch tasks, working memory, being able to hold things in your mind, kind of like your RAM on your computer, planning, even emotion regulation, that's a part of executive function. So with someone with adhd, they can have difficulty managing their emotions. So it really is more comprehensive than just focus and attention or even hyperactivity for that matter.

Tamsen (13:22)

Right. And I think that most of us know it, lay people know it as focus and attention, and that's what we're thinking. I can jump from thing to, I mean, that's what I think. I can jump from thing to thing to thing, and I'm not focused. Is it adhd? And I've heard myself ask that question. But so how do you. If somebody's going, okay, I have some of those symptoms you're talking about, I have some of the other symptoms that you're talking about with executive function. Right. How do you know at this point in your life if you're somebody that's an adult, your 20s, 30s, 40s, is it, it's not too late to be diagnosed.

Dr. Tracy Marks (13:51)

Correct, it's not too late to be diagnosed. And that's the, that's the next step

Tamsen (13:54)

and to be able to do something

Dr. Tracy Marks (13:55)

about it and be able to do something about it, because the brain is still changeable all through your life.

Tamsen (14:01)

I love that you say that. We're going there. Okay.

Dr. Tracy Marks (14:05)

Don't worry. So, yeah. So I would say instead of only relying on AI or social media to get evaluated, there are some measures that, we call them measures, but some questionnaires that you could find online that are free. One of them is the I gotta get this right. ASRs, it's adult ADHD self report symptoms.

Tamsen (14:31)

Okay. We're put that in the notes, then we'll look for it. Yep.

Dr. Tracy Marks (14:33)

And what it's for or what it can help you with is not to self diagnose, but to take it and then take that to a doctor or clinician so that you're loaded with information already seeing the doctor, that's less work for them to do. And they can spend more time getting deeper into looking at your past history. Because it's not just the symptoms you're experiencing right now, but it's what's the pattern throughout your life. Because again, this isn't something that only shows up in adulthood. It could worsen in adulthood. But most people, if they really think about it, will think, well, you know, actually I did have some struggles. I just never said anything or just dealt with it.

Tamsen (15:16)

And so you've got to look at all that. You've got to have a doctor look at all that. But I think the good news is you can go online, get a form like that, at least get that conversation started. So you're looking at some of the other things you're talking about.

Dr. Tracy Marks (15:26)

Correct.

Tamsen (15:27)

What are some of those symptoms that would be, would be part of that, that somebody should be listening for right now or noticing about themselves?

Dr. Tracy Marks (15:34)

It would be things like difficulty initiating tasks or being motivated to do things. And not just like, gosh, I really don't feel like sweeping the floor. But it's almost like your mind can just go blank when it comes to I have this thing to do and there's just this huge barrier, almost feel frozen. You just cannot go there and do it. So anyway, difficulty getting motivated to do things, you may have difficulty sustaining finishing things to the end. So you've got a lot of leftover projects and things that go on.

Tamsen (16:11)

I scared you're on my to do list, Dr. Marks. I'm scared that you've been on my to do list.

Dr. Tracy Marks (16:17)

Needing to create to do lists. I mean to do lists are great, but needing to create too many tasks that you've got to write down because if you don't, you won't do them at all because it just kind of slips out of your mind.

Tamsen (16:31)

I feel like that's menopause though too. I don't feel like in between it's all the same. I feel like it's all the same thing. I'm sorry.

Dr. Tracy Marks (16:38)

Keep going. Also. So one of the another, this is an executive function called inhibition. Having difficulty holding back on an automatic response. So an automatic response, say in a conversation with someone would be to just as soon as you say something that triggers something in my mind for me to just blurt it out and say it, okay, but that's not socially acceptable. So my brain inhibits doing that and I listen, finish listening to you and give you my full attention and then have a response. But the person with ADHD has trouble with that and so they may another sign may be trouble holding back and interrupting people a lot.

Tamsen (17:24)

I like hearing some of those because of the fact that I do think that they overlap with a lot of things and I do think that it's something that a lot of people are talking about now so they feel confused. But if they want to fill out that form, I guess first and then figure out if they go to a therapist, is that what they would do with that?

Dr. Tracy Marks (17:40)

They could go to a therapist. As far as actually getting a diagnosis, it just kind of depends on the training of the therapist. But generally you think of either physician or psychologist. There may be some therapists who would then be able to help the person see, yeah, I really do think this is adhd. But then still refer them for treatment. Hey, want a cookie?

Tamsen (18:07)

Oh, I know you just ate, so you're craving something a little sweet.

Dr. Tracy Marks (18:11)

Besides, one cookie isn't gonna kill you.

Tamsen (18:14)

How about half? Just a bite.

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Tamsen (18:29)

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Tamsen (18:36)

Oh gosh, I love this time of year. There is something about this time of year where I just want to move, I want to walk, I want to get outside, I want to just get in motion. Long walks, workouts, being outside again, it makes me rethink the basics I'm wearing every day. I've been getting back into my lifting workouts and BOMBA sports socks have been such a game changer. They're cushioned where you need them. They stay in place. And I'm not distracted, like adjusting everything all the time. I can just focus on moving. And you know, I love my morning walks. And you know what happens when I put my boots back in the closet? Then I'm all about comfortable footwear. BOMBAS has warm weather footwear and it's back in rotation. It's lightweight, supportive and perfect for travel days or for just running out the door. Especially when it comes to their sandals. Even their basic stuff has surprised me overall. The tees, the underwear, they're soft, they're breathable, and and they just feel like an upgrade from what I was wearing before. This is also a part that really matters to me. For every item you purchase, an essential clothing item is donated to someone facing housing insecurity. One purchased, one donated. With over 150 million donations and counting, that is pretty amazing to me. Head over to bombas.comtamsen and use code TAMSEN for 20% off your first purchase. That's B O M B A S.comtamsa code TAMSEN at checkout. Is there a difference between girls and boys at a young age with adhd? Because I remember I had a cousin years ago, and they called it add. Attention Deficit add. Is that different?

Dr. Tracy Marks (20:13)

No, it's just kind of slang.

Tamsen (20:14)

Oh, it is. It's just not a lot. You're not. That's not the word they use anymore.

Dr. Tracy Marks (20:18)

Not really. So the official terminology is adhd.

Tamsen (20:22)

Okay.

Dr. Tracy Marks (20:23)

But people will just kind of shorten it with ADD if you don't have the hyperactivity portion. But technically, it's still adhd. Inattentive type.

Tamsen (20:32)

Got it. And he was put on medication, but I never remember. I always remember it being like the boys because he was hyper, and I never remember their conversation about girls. Is that normal?

Dr. Tracy Marks (20:45)

That is normal, yeah. What's normal?

Tamsen (20:48)

I don't know.

Dr. Tracy Marks (20:49)

Yeah, it's. It's common. Let's say that in the sense that even in developing the diagnosis or even like the people who created the criteria studied boys. I mean, that's kind of what the data was based on. Hyperactive boys. So that's the picture that's kind of locked in our minds of the boy bouncing off the walls and disrupting class. And so that would really be more the hyperactive subtype or type of adhd. But if someone is purely inattentive, they don't have the hyperactivity, the impulsivity, things like that, the blurting, interrupting, they can be quietly disorganized in their mind and cover for it because they just work harder and they don't get the attention of the disruptive child. So girls can potentially look less disruptive, but still have the trouble with manipulating things in their working memory and keeping up with things. Tasks drop. They can get overwhelmed with trying to keep up with things to do. And then as we get older and become the people with families who they expect you to be the one taking care of things, then it becomes even more burdensome. They can mask symptoms in the sense that they still overperform, maybe sleep, go, you know, go to bed really late because they're doing Stuff while the family is still sleeping and they're up doing all this stuff and finishing things, and no one knows but them that they're struggling, what that's taking.

Tamsen (22:28)

I know because I know people say it's a superpower, but I think it's also that it's somebody that's really working hard through all of it. Correct?

Dr. Tracy Marks (22:34)

Yeah. They're just there. They're doing what they think they need to do. And in their minds, and that's the beauty of online information. In their minds, they could have just been thinking, this is just what it is. I've got a lot of stuff to do. And everyone like this, but everyone's not necessarily like that or it's not as much of a struggle for them.

Tamsen (22:56)

I think it's just so important how digestible all of your responses are to everything, because I think things can get very overwhelming out there in the content space and confusing. And then we have people that are trying to figure it all out or just give up. And you allow people to have real answers with your answer. So thank you for that. You have said over and over again, the brain is changeable, which is very exciting. Can you explain that a little bit better?

Dr. Tracy Marks (23:21)

Yes. So just like when I trained in early 2000, I finished in early 2000. We did not really think of ADHD as being lasting until adulthood. We also didn't think that the brain changed. It was, you got what you got and it's fixed and you do what you do with it. Nol well, I mean, it's just in the concept of neuroplasticity, with your brain changing with experience. It did exist, but it just wasn't adapted or adopted well in the scientific community. So probably, I would say Maybe early to mid 2000s is when it really started taking hold, that the brain really does change rewires based on your behaviors and the things that you do, which is a wonderful thing because it means that bad habits that form can be unformed and new habits can be built on top of that, allowing us to do things differently and not just kind of get being stuck in a rut. That doesn't change.

Tamsen (24:29)

How do you do that? Can you teach us? Can we do that today? Yes, I would love it. Hearing it is one thing, right? Knowing that you see it in yourself. How can people go about. How can they walk away today with some tools that say, like, hey, you know what? I have some habits that I don't like. I hit my alarm 15 times in the morning and can't get out of bed. I Put off, I procrastinate things. I try to take on too many things all at the same time. And then the big one I think I hear these days is I don't have a memory like I used to have, so I'm not even gonna bother. And I think that that's kind of this, you know, it bums me out that people feel like that because they feel like they're not trying. So you're giving us hope for that. How do you start changing habits first?

Dr. Tracy Marks (25:11)

Yeah. So I would say that I kind of look at this two pronged. One is increasing brain health in general because the healthier your brain then it's primed and ready to take on and remember these things you want to do differently. And then there's the habit. So as far as brain health goes, probably the most evidence based activity that you can do that improves neuroplasticity, that is the formation or neurogenesis, the formation of new nerve connections is cardiovascular exercise. Cardiovascular exercise increases brain derived neurotropic factor, which is like fertilizer for the brain, which helps prune damaged or dysfunctional nerve connections and reform new ones or grow even new ones in certain parts of the brain. And then things like preserving or paying attention to or being intentional about your sleep. Often you hear the sleep. I can sleep when I'm dead.

Tamsen (26:18)

Yes. Okay. Well that was the generation I grew up with though. That was what it was. If you went on four hours of sleep and worked hard the other 20 hours, you were a hero.

Dr. Tracy Marks (26:28)

Yeah. People use it as a badge of honor and it's a horrible thing for your brain. I think it is too prioritizing.

Tamsen (26:34)

But I didn't think that before.

Dr. Tracy Marks (26:36)

I know because culturally.

Progressive Insurance Announcer (26:38)

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Dr. Tracy Marks (26:39)

So prioritizing sleep, trying to get seven to nine hours for an adult, what does that mean, to prioritize sleep? That means you are planning for it. You have a bedtime. I can't tell you how many people I ask when I see them as patients, what's your sleep? What time is bedtime? And I get the. It depends. It should not depend. You should have a bedtime and prepare for it. So an hour before whatever that time needs to be, you start doing a wind down. That's what I mean by prioritizing sleep. And then try as far as like diet and what you eat, reducing processed foods and all of that stuff. So that's brain health issues.

Tamsen (27:20)

And blueberries, walnuts, the omega. All those are really make a difference.

Dr. Tracy Marks (27:25)

Yes, the anti inflammatory foods. So yeah. So all of that stuff then on the Habit side, you know, I think you could start with identifying things that you would want to change. Cause it can feel overwhelming to just say, to approach it as, I need to be a new person, I need to stop this. Then you're not gonna do it. Cause it's just. There's gonna be a block there. So start with one thing. That one thing could be your sleep, but we'll move past that. Let's say it is getting your day started earlier or coming up. Here's a different one. Another thing that's brain friendly is reducing decision, not having decision fatigue, essentially reducing the number of decisions that you need to make in a day. And I think that's something that we easily overlook is seeing is all that significant. Yeah, but you know, you think of your brain as a battery. You wake up in the morning, it starts at 100% charged. If you've got ADHD, it might start at 70% charged. And then all the things that you do during the day, just drain the battery. So if you've got to figure out what you're going to eat, what you're going to wear, what. But, but, but like those are all things that you could unload from your brain and stop draining the battery. By having some things that are set in place that you just do it

Tamsen (28:57)

just like hit me when I feel organized and I know exactly what I'm wearing, exactly what I'm eating, exactly what the day looks like, everything is not cluttered. I feel so much better. Is that what we're talking about?

Dr. Tracy Marks (29:07)

That's what we're talking about.

Tamsen (29:10)

Okay, good. Why is that so difficult though? Because I feel like, you know, you kind of like set and repeat, you know, and it does make you feel better. But I go off track on that and I can't do it all the time. I feel like I'm not supposed to. It's not supposed to be that organized. For some reason, you know, I agree.

Dr. Tracy Marks (29:29)

And you know. Cause it does take planning. So that's another step to it. And it's easy to feel like, it's easy to deprioritize it. You know, I have that trouble with meal planning. I know all of this stuff, but yet I can still be like, what are we gonna eat today? And want to do the whole, like going to the grocery store and figuring out all the meals. But so that is a habit that you could start of taking one thing, not planning out your whole life, but taking one thing where you're always kind of thinking about, what do I need to do with this? A decision that you've got to make and trying to turn it into just a habit that becomes autopilot for you. So you plan it out so that you don't have to make those decisions.

Tamsen (30:14)

And I guess that would be the same thing with when you're getting up in the morning, going to sleep at night. You've eliminated two decisions if you've decided to put those on your list.

Dr. Tracy Marks (30:21)

Absolutely. So another part of that with waking up at the same time all the time or going to bed at the same time is habits or structure and predictability is neuroprotective. Our brains like knowing what's coming. So having routines, I mean, we see this in toddlers. They get off their routine, they get fussy and melt down. Well, just because we grow up to be adults doesn't mean we don't feel the same way. We just don't express it that way because we know we can't just scream when we're upset.

Tamsen (30:56)

Some of us, some of us are still doing that.

Dr. Tracy Marks (31:00)

So having structure and routine is very soothing for the brain and it helps it be more productive in other areas.

Tamsen (31:10)

I have noticed one thing I get very hyper fixated on. If I have a, I don't know, something for breakfast or something for lunch, then I want to do it every single day until I'm so sick of it for three weeks. Is that because I want routine? Is that because. What is that?

Dr. Tracy Marks (31:27)

Yeah, so could be a couple of things. It could be that you've got a routine that you've got. So that just feels good to just do that same thing. You don't have to choose what you're going to do tomorrow. It could also be that you're fixated on something that you like. You know, the brain likes novelty. It likes, it gets stimulated from things that excite you. So if it is something that you really like or that gives you a lot of pleasure, then it could continue. You can arouse or activate your brain for a while until it starts to get boring.

Tamsen (32:02)

And then now mine's a sandwich. So I don't know. But I have noticed that. But I've noticed like I order, like one day I want it and then I want it for the next. Then I never want to see it again. So I don't know. That's been a habit over and over that I've noticed and I don't know where it came from. But that's, it's some. Maybe that's what it is. I don't want to make any more decisions that could Easily be that I think I do want to go back over into talking about the brains being changeable for a minute. Because I do. I think that that's not discussed quite enough. And I do feel like we feel at 55 years old or whatever age somebody is listening to this right now. I've learned everything I can learn. I've memorize as much as I can learn. If you're talking about some of the other habits to incorporate in a day, what would that be? Would that be getting back to writing, not having AI do it all the time? Would it be reading instead of watching television? Are there some things that we should exchange on that list that would be helpful to help our brain continue to grow?

Dr. Tracy Marks (32:55)

Yeah. So those are some good ones you've already named as far as doing activities that require thinking and problem solving and things like that. So unfortunately, as wonderful as AI is and making us more efficient and whatnot, it can make us dumb. I mean, it can make you rely too heavily on another intelligent source that you don't need to read yourself and just being told things. So all the things that we learn earlier in life of reading makes you smarter, smarter. Continuing to read, continuing to, you know, to do things where you're making decisions. But also I would say the thing we probably don't talk about a lot is the social connection. And it doesn't mean that you have to have a lot of friends, but just continuing to have connection with someone or something could be an animal. But we know that the social connection piece is very important when it comes to brain health and neuroplasticity and enhanc how we think.

Tamsen (34:07)

Why is that? Why is that so important?

Dr. Tracy Marks (34:10)

You know, I think that from a chemical standpoint, you know, from a mechanism standpoint, forming connections activates other chemicals like oxytocin and whatnot that also have positive effects on the brain. That would be kind of my scientific answer. But also then the bonding that happens, that is just kind of a feel good mechanism. We know that isolation is damaging. So this is the opposite of that. Certainly saw that and we saw that for sure in real life with COVID or during COVID period. So yeah, I think that's kind of a missing piece that's not always factored in is the social connection. And again, it doesn't have to mean that you have a lot of friends that you're always going out with. It's just connecting with, with someone or something.

Tamsen (35:10)

I think I've noticed it as I've gotten older. I think I don't know the word community was thrown around a lot, but I think I didn't really understand what that meant. That it didn't mean that you needed 50 people in the community. It could be two, but you knew that was the person to rely on. And I've noticed it as I've gotten older how important that is in a given day.

Dr. Tracy Marks (35:29)

That's right. I mean knowing that someone, that there's someone there who cares about what you think, I mean, and that you matter, like that's really, that's huge.

Tamsen (35:41)

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Dr. Tracy Marks (38:10)

I recommend both. So the thing with the form is to be able to quantify or at least just kind of see on paper, what are some of the symptoms that you have that correlate with adhd and then take that information and then see a doctor or clinician for a proper evaluation. Because then that, with that form, first of all, it helps you kind of get a better sense of. Is this my imagination? Oh, wait, I actually do have 20 out of 30 on here. And then you can take that information. And now it's just a richer experience that you could have with the person evaluating you.

Tamsen (38:51)

I feel like nowadays I hear women, especially coming into perimenopause, confused about what's going on, feeling like there's no focus, feeling like they can't remember things, feeling like they're struggling in some way, feeling like they were managing perfectly before, but not anymore. Are you seeing that more and more? Or do you think you're seeing it more and more because it's a conversation we're having online?

Dr. Tracy Marks (39:15)

So I think we're seeing it more because there's just more conversation around it. But I also think that we are seeing more of it. Or maybe the prevalence has increased, and that's not supported by any study I've done, but the prevalence has increased because of the more demands on our lives these days. You know, extended families with, working with, you know, parents like all of these things. So. And we take on more. I think we're taking on more now than, you know, like my parents did. They went to work, they came home, watched TV and went to work the next day. But now there's. There's this, that, this, that, this, that, and there's all this stuff. There's one thing, though, I do want to include that I didn't mention before. When it comes to perimenopause and menopause and adhd and women having this drop off around that time is estrogen is actually a big brain chemical that also is involved in reproductive health. And that actually is. Was a mindset shift for me in recent times of not realizing how important estradiol is. The form has on our Brain estrogen is like a dopamine amplifier, and so it helps kind of keep things in line for us, helps us have better executive function and all of that. So. So for women who are vulnerable to ADHD and again, may have had some subthreshold symptoms and just kind of managing through life, when that estrogen drops off now their buffer's gone for that reason as well. Estrogen also enhances neuroplasticity, too. So estrogen is big for the brain. It is.

Tamsen (41:25)

And I know that we've had Dr. Lisa Moscone on the show in the past talking about our brain and the menopause brain, obviously. And I think that talking about it was that something that you had ever paid attention to was estrogen, Because I don't know that anybody had. I mean, this has been a very recent conversation. So when women. And I hear it all the time, like, why didn't anyone tell us? I'm so frustrated. Why didn't I know this? It's not our fault. Like, this was not a conversation that was being had. And I don't even know if all the data was there, quite frankly.

Dr. Tracy Marks (41:56)

I agree with you. And I'm getting ready to go to one of our psychiatry national conference, and I'm curious as to how much I will see about this, because I don't feel like this is being talked about that much of just how much estrogen affects the brain and the loss of it affects the brain.

Tamsen (42:13)

Well, we have estrogen receptor. We have receptors in the brain. And I've seen enough of those. I'm not a doctor, but I've seen enough of those graphics to know when something is missing. So if you have a woman that is coming to you that's in perimenopause or menopause and says, like, look, I think I have adhd. I can't focus. I can't. I don't know what's going on. I can't remember things. I'm feeling off. If they're already on hormone therapy and they're already having that estrogen, you know, coming back into their system, are they also able to go on to a medication for adhd?

Dr. Tracy Marks (42:48)

Absolutely, they can. So, yeah. So there's the hormonal piece of restoring that. Even though we HRT or hormone replacement therapy is not an established treatment for adhd, I just have to say that disqualifier. Yes.

Tamsen (43:00)

Say that again, actually, because I think that people. Because I will say this, I do know that I had severe brain fog. And I do know that when I went on Estrogen, it helped me regain my confidence and I felt like I had less brain fog. But that is not what it is for.

Dr. Tracy Marks (43:14)

That's right. It is not a treatment for adhd. Okay. But given how impactful it is, given all the work that it does in the brain, it stands to reason that replacing it will enhance your function if you get it replaced. Okay. So that's, you know, that's kind of, that's basically just restoring your biology, getting hrt. Then there's the treatment though, for what's still left over. And so the main treatments or medication treatments are stimulants, Stimulants and non stimulants. So the stimulants, the main two categories are methylphenidate, Ritalin is a brand name, and the amphetamine based drugs, Adderall, Vyvanse and whatnot. Now those can be good or bad. There are some people who can take stimulants and it's like the lights turn on and everything's wonderful for them. However, it doesn't always cleanly work like that. They have lots of side effects and people can lose their appetite, which, if you're overweight, you might be happy with that, but that's still not great. But it can disrupt your sleep. Some people can get crashes with their emotions after the medication wears off. So, you know, so they're not always easy to take, but they can be a very good solution. And one good thing about them is they work for a certain period of time. It's not like antidepressants where you need to take them for weeks consistently every single day to see what the effect is gonna be. With stimulants or like pain pills, you take them, they work for three to five hours, or if you take a long acting, it's longer than that. And then when it wears off, it's out of your system or it's done. Okay, so you, for some, you know, I have some patients who, they know that afternoon meetings are really where they slip. They're good in the morning, so they don't wanna be on something all day long. So they'll take a short acting stimulant just in the afternoons or just on Tuesdays and Wednesdays when they have these meetings. So stimulants are able to kind of laser focus in on these times. Then there's the non stimulants. These would be things like the brand name Strattera is just one example that you would take every single day. This medication increases norepinephrine, so it works by a Different mechanism and for some people, and it's argued that they may improve executive function a little bit better than the stimulants. But it is something you gotta take every day. Again, every medication can have side effects. There really aren't good. There are some non. There's some others that like clonidine and things like that. But in my experience they haven't been quite as good, robust in their effectiveness.

Tamsen (46:06)

If somebody says, Dr. Marks, I don't want to take any kind of prescription medication, are there other things that I can do, other tools, other habits that I can build to help me during this time? If I have been diagnosed with adhd, sure.

Dr. Tracy Marks (46:18)

So there is like ADHD coaching, ADHD or executive function training. There's lots of that. There's a proliferation of that now that we are talking about these things more. And that would involve things like, this isn't an exhaustive explanation of it, but things like teaching you or coaching you how to shrink tasks. If you struggle with motivation, you don't wait until you're motivated because it's not going to happen. Or you just can't command motivation on demand. But to start with the smallest step and then once you get going, it's like engaging the clutch. Once you get going, then you can build motivation through that. If you don't, you give yourself a time limit. You're gonna do this one piece of the task. So if I wanna organize my office, I'm just gonna start with clearing the desk. That sounds very basic and like, well, what does that matter? I've got all of this over here to clear too. No, you start with, I'm just gonna clear this desk. I'm going to do it for five minutes. And after five minutes, if I just can't take this anymore, then stop. But you might find that after five minutes you're like, oh, wait, I can go do that shelf too.

Tamsen (47:35)

So you give yourself something to succeed at or achieve before you're overwhelmed, right?

Dr. Tracy Marks (47:41)

Yeah. Something manageable because the succeeding then builds more. It's reinforcing that I can do this actually. And I don't have to wait for all of this, this motivation, okay, now I'm ready kind of thing.

Tamsen (47:55)

The planets have aligned perfectly for me to clear this desk. I know sometimes I feel like I'm waiting for the planets to align. Women during this time are also looking at. I'm kind of done with this career. I kind of want to move into something else or I want to stay in my career but do something a little bit different and maybe more purposeful. Are you having a lot of them come to you saying, I want to do that, so I'm going to do two things at the same time and try to balance everything, and then they're just exhausted by the end of it. Because I do know that there are a lot of women that are looking to that next chapter, and they want that chapter to be wonderful, but sometimes it's hard to get there.

Dr. Tracy Marks (48:29)

Yeah. And so you don't know how to get there. And because they're probably just used to doing, doing, doing and overachieving, they just start this new thing, not recognizing that, wait, you don't want to increase the load, and you're gonna have distracted attention from trying to do two things at one time. And then. And then you can fail and then just feel like, I'm not capable of this. So really, it'. Sand. This is where kind of the ADHD coaching can come in, of someone helping them see how to chunk out things or how to do it in a way that reduces their cognitive load and, like, let go of this a little bit and transition into that so that they can, you know, make that switch over better.

Tamsen (49:16)

And also remembering that their brain is changeable so they can do something else. Because I think it's so important, especially during this time, to have that hope that your brain is still evolving in another way.

Dr. Tracy Marks (49:27)

Correct. Correct. You know, if you've been. It can feel like a mountain that you've got to move.

Tamsen (49:34)

I think we all know that go

Dr. Tracy Marks (49:35)

from here to there, but, yeah, you can, number one. So just kind of knowing that up front, but then, okay, how do I actually believe that in my heart and do it? It's the tiny steps that are doable, and just going one step at a

Tamsen (49:52)

time, you make everybody feel really good. I'm sure after they're done talking to you, I hope so. They can do the true. Dr. Marks, if there's one thing you want to leave people with who are listening, whether or not they've been diagnosed with ADHD or they know somebody that's dealing with the symptoms or they're dealing with something that they're not sure what it is, what would you like to leave them with?

Dr. Tracy Marks (50:13)

I guess I'd like to. It's so hard for me to just do one thing, but you could do two or three.

Tamsen (50:19)

You can do whatever you want.

Dr. Tracy Marks (50:22)

I think it starts with going from awareness to actually taking action. It's one thing to listen to this podcast and see a bunch of things online and say, hey, you know what? This might. This sounds like Me and then have nothing happen from there and just kind of keep struggling through life and having nothing really change. So I would say if you suspect that you have adhd, go get evaluated, not just for having a label, but for accuracy to know, is this really what the problem is? Because as I mentioned before, there's other reasons that you could be struggling. It could simply be perimenopause or menopause. And restoring that balance just helps you keep going forward. And you don't really have ADHD per se, but it looks similar. It could be other hormonal issues like thyroid. Thyroid can slow you down with your thinking and create the brain fog. And it's very common for women to have an underactive thyroid over time. Depression, I mean, so it's about getting clear on what is it that you should be focusing on to improve. And one more thing I wanted to add to the, you know, what can people do to help their adhd? Another thing is body doubling. And it's kind of random. I'm just bringing this up.

Tamsen (51:52)

That's okay. I'll take it. I'd like to have a body double. A lot of days.

Dr. Tracy Marks (51:56)

Body doubling. I know, right? Body doubling is where you. You do work in the presence of someone else. You could even do it remotely, like getting on FaceTime or something and having someone who's, you know, it doesn't have to be like sitting at your desk work. It could be cleaning. It could be organizing and having someone else on the other side doing something similar or even just doing anything. They could be doing some kind of work and you're organizing your room. It helps keep the brain motivated. So when you struggle with the motivation thing, so it kind of wakes the brain up and says, oh, okay, there's somebody else doing this. Let me do it too.

Tamsen (52:35)

Even if you're on the phone with them or something just to hear a voice, or is it better to see them?

Dr. Tracy Marks (52:39)

It's better to see than on the phone. And the reason I slot this into what I was saying about getting evaluated is if, say, your brain fog or your disorganization dropping tasks is more related to, say, thyroid dysfunction, then body doubling isn't necessarily gonna help you or apply to you.

Tamsen (53:01)

Oh, interesting.

Dr. Tracy Marks (53:01)

You still might like it. But so getting specific about what the problem is can help you know, what needs to change.

Tamsen (53:08)

Where can people find you? I know where I find you on YouTube all the time. But where can people find you?

Dr. Tracy Marks (53:12)

Sure. Yeah. So my handle on YouTube is Dr. Tracy Marks. And that's Dr. And then Tracy is T. R a C E Y Marks M A R K S. My website is markspychiatry.com wonderful.

Tamsen (53:27)

And your incredible book. We'll talk about that at the beginning, of course. But thank you so much.

Dr. Tracy Marks (53:32)

Thank you.

Tamsen (53:32)

Yeah. It's really great to have you.

Dr. Tracy Marks (53:34)

Yeah, this was fun.

Tamsen (53:36)

Today's podcast is sponsored by Midi Health. So many of you know this, but I was dismissed over and over again when I was struggling with perimenopause symptoms. I didn't even know I was in perimenopause. It is so important you're getting care from someone that specializes in women in midlife and that they're willing to have the hormone therapy conversation with you. I get questions from you every single day about where to go for support and I'm always suggesting MIDI Health. It's covered by insurance and you don't even have to leave your house. Ready to feel your best and write your second act script, visit joinmitty.comtamsen today to book your personalized insurance covered virtual visit. That's joinmitty.com Tamsen Midi the care women

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Dr. Tracy Marks (54:49)

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