Dear Dr. Nadeau,
I have suffered with most symptoms of ADD my entire life, but wasn’t diagnosed with anything until college. In college, a thorough assessment was made and I was diagnosed with symptoms of ADD relating to anxiety (or vice versa, as in, one was causing the other). I was medicated for the anxiety for almost two years and that made the problem quite manageable.

However; I have stopped taking the medication because of potential side effects and because I would prefer to cope with the problem in other ways (I don’t want to be dependent on a medication).

In most areas of my life I have kept things manageable (in organization and money areas, for example) but in other major areas (like completing important projects) I am still having major difficulties. The anxiety is also a significant problem; for example, when I wake up in the morning, I am anxious from the moment I open my eyes right up until I’m walking out the door. Every morning I feel like I’m dreading something awful and inevitable, though every day is usually just like the one before.

Do you know of anywhere I could get a list of tips on how to cope with these sorts of problems without medication?

Any help you have to offer would be greatly appreciated.
J.M.

Dear J.M.,
Medication and self-management strategies shouldn’t be seen in opposition to each other, but as two approaches that support each other and help you feel and function at your best. I am always sorry to hear people express their attitudes toward medication as being “dependent” upon it. Dependency is a word that best describes an inappropriate, non growth-promoting pattern — such as continuing dependency upon parents after you’re an adult, or addiction to a habit or substance that overshadows all other important areas of your life. Taking non-addicting, appropriate, helpful medication shouldn’t be seen as a “dependency”, but rather an appropriate approach, one among many, to help regulate the neurotransmitters in your brain that allow you to feel well and function efficiently.

I am certainly not a “medication first, last, and always” proponent — far from it. There are many things that you should do, in addition to taking medication, to promote well-being. And medication is not always called for throughout your life. Depression, anxiety, and ADHD are very much affected by self-care and environmental factors. You may be able to arrange your life, by making ADD-friendly life decisions, so that your stress levels are much lower and there is little or no need for medication. You can improve your emotional and cognitive functioning through:

• daily exercise
• good daily nutrition
• adequate daily sleep
• nutritional supplements
• stress management
• relaxation techniques
• neuro-cognitive psychotherapy

The last item — “neuro-cognitive psychotherapy” — is a term I’ve coined to describe a type of cognitive therapy that also takes specific ADHD needs into account; providing the education, structure, and support needed by adults with ADHD to function at their best.

John Ratey’s “A User’s Guide to the Brain,” and Daniel Amen’s “Change Your Brain, Change Your Life,” both talk about the importance of sleep, diet, exercise, and non-medical nutritional supplements to improve emotional and cognitive functioning.

It sounds as if psychotherapy could be very helpful to you at this point in your life, to gain a better understanding of what’s driving the daily anxiety that you experience. This is something that needs to be dealt with now — very directly. We’re only just beginning to understand the very destructive forces that are put into play in women who struggle with chronic anxiety. Chronic exposure to stress hormones, we now know, can trigger many psychiatric and physical problems down the road. Stress hormones lower your immune system, leaving you vulnerable to many illnesses. Fibromyalgia, very common in women with ADHD, seems to be directly related to chronic stress.

I hope that you can learn more about medication as an appropriate PART of a comprehensive approach to managing your anxiety and your ADHD patterns. You sound like a very responsible and determined person who has already been able to accomplish a great deal to manage these challenges in your life. But don’t try to go it alone, and don’t try to “tough it out” — you and your body will only pay for it later when the aftermath of chronic stress begins to take its toll. With awareness, education about anxiety and ADHD, determination, and some guidance from a good ADHD expert, you’ll be able to lower your chronic anxiety and create a manageable, satisfying lifestyle. -Kathleen Nadeau, Ph.D.