The problem lies in the measurement of the changes that are much more subtle than  medical trials are able to detect. Clinical studies utilize scales that measure changes in subjective mood and vegetative symptoms.  In these studies, antidepressants show more efficacy in severe forms of depression.  The worst part is that a majority of patients show partially resolved symptoms.

If we stop looking at these conditions as distinct disorders and deconstruct them into subtle changes in the individual’s attitude and relationship to the world, we will see much more robust easing of distress of the ravages of depression and anxiety.  Thus, my clinical experience is that antidepressants are much more effective in subtle or sub clinical forms of depression!  Perhaps some who are lingering in years of psychotherapy or self-blame should take a fresh look and consult their Physician Psychiatrist!  Antidepressant therapy would not negate all the psychological, spiritual, or existential work done, but rather complement and facilitate it.

“When did you start using, and why?” I asked.

“Oh, about a year ago.  I just wanted to reduce my pain,” was his response.

“Where is the pain?”

“It’s the pain of life, Doctor.  I am always uncomfortable.”

“How did you get into IV drugs and heroin type of drugs?”

“Oh, I tried different things but none of them took the pain away like these pain drugs.”

“Did you see a doctor for your life pains?”

“Yes I did, and tried a few antidepressants, but none of them worked like what I found on my own.”

“What were the consequences of your use?

“Well, I dropped out of life, and got involved in the criminal world to support my habit.  I stopped most of my relationships, was fired from multiple jobs, and dropped out of community college.  I have many criminal charges for theft, assault, possession and other stuff.”

I felt a sense of overwhelming sadness sweep over me as this young man’s story was repeated with minor variations in four other patients that afternoon.  I had pulled a back muscle the night before and was feeling pain and discomfort of my own.

The rate of depression and addiction to opiates is at all time high, especially with our younger population.  No one has really pinpointed the cause. The availability of opiates has been particularly deadly as it blocks, numbs and kills the pain like no other chemical. This also leads to severe addiction, deadening of the soul, and a total alteration of what is to be human when not monitored by a skillful prescribing physician.

Could it be that we have become intolerant of experiencing and being with pain? Could it be that our cultural bias of ‘happiness at any cost’ and shunning of pain be it psychic or physical has conveyed the wrong message to our newer generations? Could it be that the diminishment of inner spirituality and the bankruptcy of the houses of religious dogma have left our youth frustrated and in search of escape routes from this reality as we know it?  Could it be the materialist philosophies now so in vogue have ignored, denied, and shunned the concept of an immaterial soul in all of us that can develop resilience and grow stronger in face of pain of life and being?

These are not merely academic questions as they are the critical dilemmas at this point of our collective history.  All our attempts to prevent and treat addictions, although well intended and necessary, will fall short if we don’t address the uniquely human condition of pain first.

One hundred years ago, in a series of talks in Paris, a spiritual teacher who had faced the bitter pain of persecution in his own life told us:

“If your days on earth are numbered, you know that everlasting life awaits you.  If material anxiety envelops you in a dark cloud, spiritual radiance lightens your path. Verily, those whose minds are illumined by the Spirit of the Most High have supreme consolation.”

~ Abdu’l-Baha,  Paris Talks

How does this relate to ADHD?  I believe that the ADHD mind structure craves desire at all times, leading to frustration, impulsivity and proneness to compulsive or addictive behaviors.  Cultivating awareness of this tendency and satisfying it with bliss and passion for healthy aspects of life is the key to a fulfilling life.  If this at first sounds esoteric and hard to grasp, sit with it quietly for a while; your inner wisdom will guide you to an experiential understanding in due time.  It takes patience, gentility and openness to cultivate these inner insights.

Since our current psychiatric categories attempt to remain atheoretical, many physicians avoid application of these terms as much as possible.  The fact remains that we are still running into medical conditions such as tics and neurological symptoms in a group of high school girls that have no physical explanation thus far as the symptoms do not fit a recognized pattern.  Many journalists seem to be afraid of talking to psychiatrists;  so far I have only seen neurologists intervewed publicly on the matter.  There is still a stigma attached to calling something psychiatric, even more than a century after the ground-breaking discoveries of Freud.  Meanwhile,  the debates rages on as every other possible cause to the unexplained symtoms is explored.

These coping mechanisms become so entrenched by adulthood that the underlying ADHD process is not apparent at first.  Concurrent management becomes necessary.  I am always amused when an ADHD-tailored therapy leads to resolution of anxiety and depression.  The patient is baffled as to how a stimulant therapy could lead to a sense of calm and euthymia.  There are many variants and gradations to the process and individualized clinical care must remain the rule as there are many other confounding factors.

Since health and healing in the broad sense are ultimately subjective and frequently defy our current scientific knowledge, many physicians become frustrated in clinical settings due to the individual variability of human biopsychosocial-spiritual needs.  The limits of  dry and objective scientific inquiry into human suffering, and the visceral experience of disease is glaringly apparent in day to day clinical practice. The void is filled at times by resorting to a pool of knowledge from other traditions and philosophical approaches.  More emphasis on nutrition, life style, self-empowerment, meditation, mindfulness, spiritual attitudes, message, and biofeedback amongst others can assist the process of healing.  The trouble comes when pseudoscientific language and practices creep into these efforts and attempt to justify medical neglect.  Your doctor has probably witnessed a few of these incidences in the past and is wary of any thing new.  Take a few minutes to express your position and concerns and invite her to dispassionately examine other methods of healing that you are exploring.

At the biological level, it appears that the nerotransmitters of reward and attention are more diffusely activated in some people, resulting in a partial shift of attention when a new stimulus calls in. The inner experience is multilayered attention leading to exhaustion, a sense of being overwhelmed, and ultimately nonattention.  At this point, the system shifts into assigning importance to what needs to be immediately attended to by revving up the emotional brain.  This part of the brain is reserved for such tasks, but comes with its own baggage of rapid mood shifts and anger displays, at least in my view.  Clinically,  this chain of events has been confirmed over and over.

With treatment, many describe a quieting of the conversations on their head, but this phenomenon resembles psychosis in no other way. Here is yet another way that we mislabel a complex presentation as Attention Deficit!  Attention Shift disorder might be more appropriate term for this variant.

~ Shoghi Effendi, The Promised Day is Come (from the preface)

You are not hyperactive so you never suspected the problem could be related to attention/impulsivity parameters, yet you are distractible, impulsive, moody, have a constant background of running commentaries in your head. You are always thinking about the next thing and all those “stay in the now” self help books are just nice concepts which have no relation to your daily routines. You think mediation is a great idea but have rarely felt present enough to experience it.

Above is a very simplistic caricature of the many people I see who struggle with binge eating and weight issues and suffer from an underlying ADHD syndrome spectrum.  Although I cannot deny other conditions such as mood, anxiety or a frank eating disorder, I believe that ADHD symptoms are mostly ignored in adults.  We focus too much on attentional deficits in the ADDers and not enough on other behavioral problems.

The solution lies in first acknowledging the core problem: Poor self image and lack of trust in one’s abilities to monitor impulses must first be addressed and normalized.  I  then like to move into simple exercises to increase the awareness of food choices and an acknowledgement of the powerlessness of impulse management.  Most of the ADHD medication treatments also help alleviate the problem.  Some have developed a bad reputation as drugs of abuse for weight reduction, but the truth is that treating ADHD itself is the underlying mechanism that brings binge eating behavior under control.  Stop beating yourself up!  Let’s try another angle at solving the problem.