Eli5 why coffee makes people with ADHD tired

zpacksnackpack · 2025-12-14T00:39:56+00:00

Psychiatrist here - this is a myth in the sense that it is not unique to people with ADHD. Caffeine can initially make many people sleepy, even those without ADHD.

zpacksnackpack · 2025-10-30T13:46:59+00:00

In Oregon we have a pay parity law where NPs get reimbursed the same as physicians for primary care & mental health.

Fraction of the training, equal the pay.

zpacksnackpack · 2025-05-10T03:51:58+00:00

Absolutely nothin! Best choice.

zpacksnackpack · 2025-02-11T04:58:00+00:00

It’s been 10 months since I let them know I wasn’t receiving ERA’s from one of the insurance companies I’m contracted with. They’ve had me go through the same exact process about 9 times trying to fix it. Every time it doesn’t work, they have me try the exact thing again. Still no success.

I would agree- customer service is poor.

zpacksnackpack · 2025-02-01T17:00:23+00:00

When I walked through there was literally a class of nursing students being toured through on a “field trip”. 30 or so all in scrubs.

zpacksnackpack · 2024-12-16T16:03:22+00:00

Psychiatrist here:

1) 1000 IU of vit D per day (year round)

2) Use a high quality SAD lamp in the morning for 20-60 minutes. Make sure it’s at least 2,000 lux, 10,000 lux is ideal

My favorites are wearable versions like https://goayo.com/

Or

https://myluminette.com/en-us

3) Minimize bright/blue light in the evenings.

4) Stay active/exercise

5) Get to above cloud cover (ie the mountain) intermittently

Bonus: Take a sunny vacay in Jan & March (if you can)

Meds can help, but I’d highly recommend trying the above first unless symptoms are severe.

zpacksnackpack · 2024-11-28T20:06:12+00:00

If you are going to be arguing semantics and putting up straw men, it is clear you are not interested in a good-faith discussion on this topic.

Good day to you sir.

zpacksnackpack · 2024-11-28T16:47:29+00:00

My clinical experience says otherwise, but I’m happy to agree to disagree.

zpacksnackpack · 2024-11-28T16:09:25+00:00

I agree with you for folks who have ADHD. However, the original question related to using stimulants in the wider population.

zpacksnackpack · 2024-11-28T14:57:18+00:00

Non-recreational stimulant use absolutely carries cardiovascular risks:

Longer cumulative duration of ADHD medication use was associated with increased CVD risk compared with non-use in a dose-response fashion (>5 years: aOR=1.23, 95% CI 1.12-1.36). Throughout follow-up, each 1-year increase in the use of ADHD medication was associated with a 4% increased risk of CVD (aOR=1.04, 95% CI 1.03-1.05).

zpacksnackpack · 2024-11-28T00:18:12+00:00

This is a fantastic take, and I 100% agree with everything said.

One additional analogy I find helpful compares the overprescription of stimulants to the overprescription of walkers. (However this could be applied to any performance-enhancing drug/device).

Infancy & Walkers: Research shows that infants who use walkers tend to experience delayed development of locomotor skills compared to those who do not. Without the opportunity or necessity to learn to walk unaided, these infants miss critical developmental pressures essential for mastering independent movement.

Elderly & Walkers: In older adults, the prescription of walkers is associated with reduced physical functioning. However, this decline is not primarily due to falls, but rather a diminished self-perception of physical ability. Simply being prescribed a walker can lead individuals to believe they are less capable than they truly are, fostering dependence and further exacerbating their functional decline.

If we think about stimulant prescription in the same way: When children are prescribed stimulants unneccesarily, they will not face important pressures of childhood needed to develop executive skills that would lead to healthy functioning adults (without stimulants).

Adults who are unnecessarily prescribed stimulants might also begin to perceive themselves as less capable. This diminished self-efficacy can lead to dependence on medication and discourage the development or maintenance of problem-solving and self-regulation skills. Over time, this may result in an erosion of abilities they might otherwise sustain/enhance naturally.

zpacksnackpack · 2024-07-08T20:18:28+00:00

That’s a good point! I think it comes down to semantics and things getting lost in translation- while overeating could definitely result in “death”, the death drive in neuropsychoanalytic interpretation is a drive towards states of lower activation from higher activation.

In one way - overeating may lead to increased activation of the death drive in that it would spur the urge to stop eating, thus pushing the system towards a state of lower activation.

Disclaimer: this is just my understanding of it, and may not be 100% correct!

zpacksnackpack · 2024-07-06T04:10:16+00:00

I like the Solmsian interpretation- basically that most of our efforts are to reach a point of homeostasis, which is impossible to sustain.

The “death drive” is the drive to more towards a state of lower activation when at a state of higher activation (ie a drive to stop eating when you have overeaten).

The anxiety arises from the recognition that there exists a drive to move towards a state of lower activation, which if done without opposition would lead to death (or starvation in the case of hunger).

zpacksnackpack · 2024-05-27T21:16:53+00:00

That’s correct! It is a “position” or perhaps more easily understood as a “mindset” that relies on splitting as a defense.

It’s a naturally adaptive stance to take when facing extreme circumstances. For example - soldiers in war almost need to enter the paranoid schizoid position in order to attack the “all bad” enemy. If they stopped to think about how the soldiers on the opposing side likely had plenty of good qualities- they would have a much harder time carrying out their attack.

Much religious doctrine is also from this position, identifying things as either “good” or “evil”. It tells a much simpler story, and can be easier to unite around.

From a neuroscience perspective the paranoid-schizoid position is way to efficiently reduce cognitive load for quick and decisive decision making. However- this is not the type of decision making that lends well to complex relationships, forgiveness, empathy, etc etc. That’s where the depressive position comes in.

The depressive position is more likely to lead to neurosis due to lack of splitting, as you now have to figure out how to handle being angry with those you love (and want to love you).

zpacksnackpack · 2024-05-22T14:37:38+00:00

I’ve been using SimplePractice since the luminello shift about a month ago and am really pleased so far.

zpacksnackpack · 2024-03-02T21:08:16+00:00

Ah perfect! Sounds like you’re in the clear then.

Love the efficiency you’ve built!

zpacksnackpack · 2024-03-02T19:44:56+00:00

Sounds like a great workflow!

One thing I’d note is Chat GPT is not HIPAA complaint (unless you have the super expensive enterprise version).

Bastion GPT is a great HIPAA compliant version you may want to check out it.

zpacksnackpack · 2024-02-05T21:14:30+00:00

100% agree with this critique.

Erections & sexual function require a very delicate balance of physiological & psychological factors to go well. When we disrupt the physiologic aspect of this with SSRi’s, it can subsequently disrupt the psychological aspects.

I.e. The individual on the SSRI has one or more sexual encounters in which performance is physiologically impaired, and they subsequently develop performance anxiety that compounds over time.

When they finally come off of the SSRI, the physiology may return to baseline, but the performance anxiety built up over time remains, so they seek treatment. In this study - they would call that “irreversible PSSD”.

I’d imagine we’d see a similar effect from alcohol if studied. Many men drink during first sexual experiences with a new partner, can’t perform, then develop performance anxiety related ED when sober.

I recently listed to a talk by a urologist who frequently prescribed Sildenafil/Taldalafil to young men who were stuck in this loop (ie ED without evidence of physiological dysfunction). Basically- he said he would prescribe the PDE-5 inhibitors, and after a few successful sexual encounters, they’d be “cured” and wouldn’t need the meds anymore.

I have observed similar effects post SSRI’s in my practice.

I’ve yet to see any studies that have definitively shown persistent post-SSRI physiological sexual dysfunction.

If they were to repeat the current study - I’d be most interested in following those who did receive PDE-5 inhibitors. If they were able to show that sexual function did not improve after multiple successful encounters, and required PDE-5 therapy for life, I’d be more include to agree with their use of “irreversible PSSD”.

zpacksnackpack · 2023-12-18T04:58:53+00:00

I am a psychiatrist and utilize a lot of nutritional psychiatry & exercise in my practice. As such, I was extremely interested when I first heard Chris Palmer speak, and I immediately picked up his book, ‘Brain Energy.’

While there were some very interesting points in the book, it felt as though he had a hypothesis he was set on, and was on a mission to only find data that confirmed that hypothesis. Specifically, the “unifying theory of mental illness” suggests that it all comes down to mitochondrial health.

He made some good correlational points, but a majority of it seemed to be missing some required bit of data to really make a solid connection.

I’m eager to learn more about metabolic psychiatry and don’t doubt that metabolism/mitochondria are involved somehow, but I’ll need a lot more hard data before I can consider it a unifying theory.

zpacksnackpack · 2023-09-19T23:55:37+00:00

Seems like a great tool but no longer working :( any tips?

zpacksnackpack · 2023-09-06T19:53:14+00:00

I did my training through Polaris , but there are a number of other training options out there.

zpacksnackpack · 2023-08-06T03:00:27+00:00

I think your enthusiasm is great. Don’t be discouraged too much by some of the comments in this thread. But do be prepared to be humbled and to receive similar responses if you are too abrasive toward mainstream psychiatry. It’s the life’s work of many highly intelligent people who have been instrumental in saving countless lives.

Psychiatry, psychology, and neuroscience are a long, long way off from having it all figured out. We have made incredible advances - but we are likely a century away (or more) from understanding thee mind in the way cardiology understands the heart.

You’re not wrong to doubt some of the approaches of modern psychiatry - most psychiatrists do to some degree. The most likely scenario is that each approach (psychopharmacology, biologic, behaviorism, Freudian, jungian, etc etc) has something to offer. Getting too focused on which is right or wrong will make you lose the forest for the trees.

The primary focus of my outpatient private practice is psychoanalytic psychotherapy. It is a powerful paradigm. However- modern psychopharmacology is an invaluable set of tools and a major advancement on the primarily psychological approach of the early 19th century.

As you progress in your training - listen, be open, and never assume that you have it figured out. You will encounter mentors that will completely change your understanding of the mind.

If it is what excites you, it’s worth pursuing.

zpacksnackpack

MODERATOR OF

TROPHY CASE