Perspectives on adult ADHD

A patient came to me because of severe anxiety and despair about the work piling up around him. The anxiety was real. So was something else underneath it.

My routine practice is to begin every stimulant trial with a low-dose immediate-release preparation. The reason is straightforward: it gives both of us information. What patients report when they make the transition to extended-release often tells me as much about the diagnosis as the initial response did.

When a clinician's theoretical framework becomes more important than the patient in front of them, the framework has become a problem. The history of psychiatry offers no clearer illustration of this than the case of Rafael Osheroff.

In couples where one partner has ADHD, the same complaints surface again and again: he doesn't listen, she never follows through, he forgot — again. These are not failures of love. They are the predictable consequences of a brain wired differently.

City stimulation or quiet countryside — how does where you live shape the ADHD mind? A psychiatrist reflects on Chicago and Saugatuck.

There are no controlled trials demonstrating that psychedelic therapies treat ADHD. What follows is not a clinical recommendation — it is an attempt to think carefully about where two rapidly evolving fields might, someday, intersect.

Some of the most capable people I see are also the most depleted. They have spent years compensating for ADHD that was never identified — and the cost of that compensation is real.