If you’ve ever been interested in learning about Transmagnetic Stimulation (TMS), genetic screening, and being diagnosed with ADHD – then you are in the right place! This week, Dr. Sasha Hamdani joins me to talk about all of those topics and more. 

Like several of the past guests in the series on healing, I found Dr. Hamdani on TikTok. Y’all, Mental Health is a big topic over there! Dr. Hamdani is a Board Certified psychiatrist and ADHD specialist. In addition to her private practice, she has a robust social media following across multiple platforms where she provides accessible and accurate information about ADHD. I am excited to introduce you to her and the work she does in the area of mental health and healing.

You’ll hear:

  • Dr. Hamdani and I both share our ADHD diagnosis stories and then discuss whether or not someone can someone have symptoms of ADHD but not have ADHD. (9:18)
  • Transmagnetic Stimulation (TMS): what it is, who it can help, and how it helps. (16:44)
  • How you can prepare for your first meeting with a mental health medical professional. (34:21)
  • The benefits of genetic screening, what kind of data you can get from the testing, and who should use it. (39:42)
  • How the stigma of having ADHD is different for women. (49:28)

Resources mentioned in this episode:

Registration is open for The Daring Way Retreat in September 2022!
Dr. Hamdani on Instagram  ThePsychDoctorMD
Dr. Hamdani on TikTok ThePsychDoctorMD 
Dr. Hamdani’s website


Dr. Sasha Hamdani is a Board Certified psychiatrist and ADHD specialist. In addition to her private practice, she has a robust social media following across multiple platforms where she provides accessible and accurate information about ADHD.

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Dr. Hamandi 00:00
A lot of people expect, just throw me a pill man and make this better. And it's like, that's not how this works. Like with trauma, especially, there's so much work that you as the patient have to go through in order to unravel that complicated trauma and rebuild that those healthy neural pathways. And that medication isn't going to get to. You need to do that work in therapy. So the fact that you're working with a therapist, who's suggesting these alternative pathways for you is great.

Andrea 00:29
You're listening to Make Some Noise Podcast episode number 430 with guest Dr. Sasha Hamandi.

Welcome to Make Some Noise Podcast your guide for strategies, tools and insights to empower yourself. I'm your host, Andrea Owen, global speaker, entrepreneur life coach since 2007, an author of three books that have been translated into 18 languages and are available in 22 countries. Each week, I'll bring you a guest or a lesson that will help you maximize unshakable confidence, master resilience and make some noise in your life. You ready? Let's go.

Hi, everyone, welcome to another episode of the podcast. I'm so glad you're here. You know what, if you're feeling like it, you can send me a DM or shoot us an email and let us know how you're liking this new theme framework that I'm doing here on the podcast. We're still on the first theme. I know you don't have that much experience, neither do I. But I hope that you're liking the experts that we're having on and just what we're talking about. We are going to switch over into relationships in about a month. I have a lot of experts on around the topic of therapy and different modalities and today's expert is no different.

But I first wanted to tell you a little bit more about The Daring Way retreat that I have coming up. I have two of them actually. As to answer your question like what do we actually do? Like what are you going to walk away with? And I want to first read to you the explanation that either Brené wrote, Brené Brown wrote or somebody in the senior faculty who's like in marketing. Okay, so here's what here's how they explain when I say they, I mean Brené Browns team, the senior faculty at I don't know what the name of her company is, whatever it is BrenéBrown.com. Okay, here it is. And I'm going to read it in my super professional voice. Excuse me, all right. ‘During the process, facilitators explore topics such as vulnerability, courage, shame and worthiness. Participants are invited to examine the thoughts, emotions and behaviors that are holding them back and identify the new choices and practices that will move them toward more authentic and wholehearted living. The primary focus is on developing shame, resilience skills, and developing daily practices that transformed the way we live, love, parent, and lead.’ Scene.

Okay, that is all great, that is all great, but how I describe it is, yes to all of that. And The Daring Way helps you not feel like shit. So when they say participants are invited to examine the thoughts, emotions and behaviors that are holding them back, that's the stuff that all of that is the stuff that I wrote about in How To Stop Feeling Like Shit. That's how that book, that's where that book was born. The people pleasing the perfectionism, the, you know, feeling like you have to identify someone who's strong, the self-sabotage, the isolating and hiding out, the numbing out, raises hand. Those are the kind of behaviors emotions, thoughts that a lot of us sort of default into. And what The Daring Way helps you do is to, as they say, move, move them toward more authentic and wholehearted living. So what we do in order for you to first of all know what that is, and then help you practice actually doing it in your real life is we identify your values. Like, what kind of identity do you want to have? If we're if we're kind of looking towards, you know, James Clear’ who wrote Atomic Habits, his language around, you know, identity based habits, like what kind of person do you want to be? It's the same thing as values. What's important about the way you live your life? So we identify that. And then from there, we also talk about these obstacles that get in your way when shit happens in real life. Cuz it's going to. Like the thought patterns that we immediately default to or you know, do you get passive aggressive do you get quiet? Do you get sarcastic? Do you lash out? Depends on the person depends on the situation. So this is we go through all of that. And then it's also really about normalizing terrible behavior. Maybe that's not a great way of putting it. But, you know, we all do things and think ways that we're not proud of. And so this program also normalizes all of that. And it's not an excuse to keep doing it, but if you come from a place of compassion for yourself, many times compassion for others, it helps you kind of exhale, and go, okay, I'm not broken, I'm not a total dick, I am just a human, who's behaving because sometimes I've trauma responses, sometimes because of shame, sometimes it's whatever it is that we don't like to talk about. And then we find new ways of behaving.

And also, this whole modality and retreat is about holding space for your stories, if you want to. If you want to share them around some things that have hurt you, and that have caused you to behave this way. Because when we put it all out there in the open in a space that is a container, to be able to carry that, you know, as, as the facilitator is me, yours truly, who is trained, and have a lot of experience doing just that. Again, it just allows you to kind of exhale and be seen and heard by other like-minded women and be seen and heard by me, and normalize it, and allows you to keep taking steps forward and learning new skills. That's what this is. It's learning new skills, to be able to cope with life because sometimes life is hard. And it hurts. And we don't know what to do with things that are handed to us that are really incredibly hard to carry and deal with. So that is one way of explaining what The Daring Way is, if you go to the retreat pages there's several video testimonials of women who have attended my retreats before talking about what they learned what their favorite part was. It’s in Ashville, North Carolina. There is a recovery-based one, that one's in September. And that's at AndreaOwen.com/recovery-retreat and then the other one, that's a non-recovery retreat. You can be in recovery and go to that one too, by the way. That one's at AndreaOwen.com/retreat. Those two links are in the show notes. And they're also going to be in my social media bio, as well as on the website. You can find it.

Okay, today's guest I'm excited to introduce you to Dr. Sasha Hamandi. I found her on TikTok, as one does. And it for those of you like it's not like Craigslist. This not like a Craigslist doctor. TikTok is a social media channel. Mental health is huge on TikTok, by the way. So I came across at Dr. Sasha and she talks a lot about ADHD which we will get into. But this whole episode is not about that. I asked her about TMS because my psychiatrist recommended that I have it. I have not done it though. And we talk about genetic screening, which is something that I've always been interested in and kind of like I had some, I had some misconceptions, if you will, about what someone can get out of genetic screening for psychiatric conditions and mental health and some other topics around mental health. I really think you're gonna get a lot out of it. I absolutely love this conversation.

So let me tell you a little bit about her. Dr. Sasha Hamandi is a board-certified psychiatrist and ADHD specialist. In addition to her private practice, she has a robust social media following across multiple platforms where she provides accessible and accurate information about ADHD. So without further ado, here is Dr. Sasha.

Thank you for taking time out of your day with two toddlers to come and talk to us. I know. I know how that can be. You know, I'm the most interested in as we dive into this, you know, mental health slash self-care conversation. How did you get into this particular topic? Like did you go to medical school and we're like, I'm gonna help people with ADHD or did just happen on accident.

Dr. Hamandi 09:18
So I have ADHD, like if that's not totally blatantly obvious, and I was diagnosed in fourth grade, so pretty early diagnosis, but my parents were really worried about the stigma. And so didn't tell me I was diagnosed. So I went to the doctor, started medication and actually school became really enjoyable and interesting for me and I did well throughout school. I did so well that I got into this combined undergrad and med school. So I got into med school out of high school started there, but that was the first time I was ever away from home and just sobbed. I was terrible. Like my whole world collapsed. And you know, my parents were like, oh, are you taking your vitamin? And I'm like, no. It was my vitamin.

Andrea 10:08
You were in college. So you didn't know. So when you're in college…

Dr. Hamandi 10:11
No, I had no idea. So then they were like, okay, well, heads up, it's actually not a vitamin, it is medication, you have ADHD. So that was just like, a lot to process all at once. And so then, you know, going through medical school, like I really, like I just kind of went the opposite way. And I like fought the diagnosis, like, there's no way I have this. Absolutely not. Like this is for hyper a little boys. Like, no, this isn't me. And then as I went through, and like struggled with finding the right medication, finding the right modifications, by the time I limped through medical school, like by the end of it, I was like, okay, like, I have accumulated enough experience that I think this is probably field I need to go into. And then I wanted to psychiatry, and that's kind of how that started.

Andrea 11:00
So it's fairly early on. I have so many questions, first of all, so you didn't go and like get your bachelor's degree in like biology or like, like a lot of people in chemistry, or in medical school do?

Dr. Hamandi 11:08
I was all at the same time, which was like, great, too, because it was fast, but also terrifying, because like, if you failed out, like in the first like, if you made it through, it was a six year program, if you made it through five years, you wouldn't have any degree. So it's like, okay, what am I doing? That's horrible.

Andrea 11:27
Stakes are high. Stakes are high. And I would, I would think that that's a lot of pressure to with your peers.

Dr. Hamandi 11:35
It was it was. It was…it's hard. And you know, I don't um, I don't know if ADHD is something that you struggle with or what your personal story is with that or if that's something that's like, if you know, other people who have been impacted by that, but like someone who's experiencing ADHD, like and who was used to being like the smart kid in high school, that's like, that is what I built my identity around. I got like, plopped into the situation. I'm like, okay, I guess I'm dumb now.

Andrea 12:10
I've never met anybody who wasn't told about their about their pretty significant, like, mental health challenge. No, I wasn't diagnosed until earlier this year. And it’s just now that I'm starting to put the pieces together and look back on, especially my school life. So both of my children were diagnosed. My son was diagnosed when he was five, that was a nine years ago. And then, which didn't surprise me, he's inattentive. And then my daughter started showing some symptoms and we actually thought that she might have a learning disability, because I did not suspect ADHD because her symptoms were different than my son's. So of course, like, I only had that like frame of reference. So I was like, that must look like him. And it doesn't, so it must be something else. So we went through the whole process with a psychologist who specializes in learning disabilities and attention, difficulties. So, and it came back like clears day like textbook ADHD, inattentive. And when I was my husband, I was sitting in her office, and she's describing how it shows up in girls and I almost kind of stopped listening a because the obvious and be because I saw my own life. And I was like, wait a minute, wait a minute, stop, stop, stop, stop for a second. You mean to tell me this is what it looks like.

And then all of a sudden, I'm remembering how much I struggled. Probably starting in middle school, I always had to have tutors, I always felt stupid. Then in college, I got put on Effexor because I had severe anxiety disorder and was like having full blown panic attacks, and somehow graduated with honors from college. And then just recently, the psychologist told me that a lot of times they prescribe Effexor because for some it can help with ADHD symptoms. And I was like, oh my god, is that what happened? And then I got off it when I got pregnant in 2007 I got off the Effexor. And I, you know, to have tumbled back and anyway, all that to say, I think my life would have been different had I been on medication.

Dr. Hamandi 14:13
Yeah, and I hear that a lot. I do hear that a lot. You know, with ADHD, especially in women that get diagnosed kind of later because I mean, that's so common, right at like, as a population we are trained to think about ADHD is this diagnosis is like a hyper little dude. Like, that's what we're thinking about. And so, generationally, there's like this huge amount of women who got skipped because they weren't disruptive in class, they weren’t inattentive, and they you know, it didn't impact anybody but themselves. And then you know, a lot of times they ended up doing pretty well in school.

Andrea 14:50
We become resourceful. I found a way I learned my own systems. I was super resourceful. I could figure it out. I could find a way.

Dr. Hamandi 14:58
A lot of people with ADHD, very intelligent and yeah, resourceful. So you find these workarounds to the system. And plus, if you're blessed with a little bit of anxiety, I mean, that fear of letting people down that kind of propels you going forward. So it's not that symptoms are, have abated or have gotten away, you've just gotten better at hiding them.

Andrea 15:19
Right, exactly. Can someone have symptoms of ADHD but not actually have it? Like, what is it, I make up that it's for doctors and psychiatrist psychologist, it's tricky to kind of figure out like, what's what. Is that fair? I know, I'm not explaining it very well. But I came back with like a plethora of diagnoses and she told me that it's tricky to like, where does your impulse control disorder start and ADHD began? It's hard.

Dr. Hamandi 15:51
So it is tricky. But partially because like when people think about ADHD, they're very hyper fixated on just the focus component of it. And focus is such a multifaceted thing in that you can have focus difficulties from anxiety, you can have focus issues from depression, you can have focus issues from thyroid illness, you can have focus issues from tons of stress. Stress causes focus issues. Like there's so many things hormonal stuff. There's so many things. So really, what you're looking at for ADHD is you're looking at this constellation of symptoms, that tends to be chronic over time. So it's not that, you know, like, okay, the stress resolved and now the focus issue…Yeah, it's not I mean, it definitely can worsen in circumstantial situations, but this is something that's present at baseline.

Andrea 16:44
Okay. Which seems kind of like, I wonder if sometimes it feels like which came first the chicken or the egg, especially like for somebody who's in college, and it's finals week, and, and it just, it flares up. Okay. Interesting. I want to ask you, selfishly, and for my audience listening, talk to us about TMS, which is trans magnetic stimulation. I've also Is it is it also transcranial magnetic stimulation?

Dr. Hamandi 17:13
Transcranial magnetic stimulation yes.

Andrea 17:17
Oh ok. So my doctor wants me to try that because I seem resistant to… I have complex PTSD from a former relationship to actually back to back relationships that had happened over time. And it was, it was awful to long story for another time. But it seems to be like it like keeps kicking up and keeps kicking up. And I've had tons of trauma therapy and like somatic work, and what happens, my experience is that, like, I seem to get better. So it's a lot of three steps forward and two steps back, which is fine, but the progress has felt agonizingly slow. And the medication now doesn't really seem to and I also have impulse control disorder, like chronic cuticle picking, like that type of thing. And so no medication has helped that at all, no supplements, absolutely nothing. So she wants me to try this. And I'm skeptical. And so can you talk to us, like what is it? Who is it for? And then also, what are the I think I read somewhere that the results really vary, and that's what makes me like, oh, well, shit. I don't want to put all this effort in. And my insurance is crap and it's gonna like cost a shit ton of money. But like, right. So that's, that's my experience so far with it. I haven't signed up yet. So talk to us about it.

Dr. Hamandi 18:36
TMS is really for treatment resistant depression. I mean, that was what the primary diagnosis was for. Now, we're trying to branch into different diagnoses. And depending on the machine, some have different qualification, some do generalized anxiety, some do OCD, depending on where it's, where you treat on the brain and where and how deep that penetration is going into. But basically, the theory behind that is instead of taking a medication my mouth and hoping and praying and ends up in the right area, like it passes through your enteric system, goes through your gut, gets into your bloodstream passes through your blood brain barrier gets exactly where it needs to go to kick off those neurotransmitters. We're bypassing all that. So we go straight to kind of the source and then hyper stimulate that area with magnetic impulses to try and get those neurotransmitters to talk to each other. So basically, I mean, it sounds really odd, but basically, you're like for us in our office…

Andrea 19:33
You know, you're explaining it to like the lay person. So thank you for that.

Dr. Hamandi 19:38
Like, I think this is how I understood it as well. When someone like explained it to me, I'm like, nope, don't understand that. Don't understand that. So what this is how it was explained to me. So basically, what's happening is like, in our office, you're sitting in it kind of looks like a dentist's chair and you have this… map out the area of the brain, we figure out where to get this motor threshold to figure out where we're targeting. Then we hyper stimulate that area with this paddle. So you're basically like sitting and watching Netflix or whatever, and you have this treatment thing going on. Have you ever done an MRI or anything like that? Okay, you know that clicking sound that's really annoying? So it's that. So really, it's not painful. It's not anything, it's but it's annoying, it's for sure annoying. So you're getting this repetitive kind of tapping in bursts. What it's doing is quite literally, it's agitating those neurotransmitters into talking. And so over time, what you're expecting is that you should have, you should build and cement good neural pathways because you've kind of forged a pathway over and over and over and over again. It works well for people that for whatever reason, they're not responding to medication. It works well for people that have problems with their gut. So taking medication by mouth is just not going to work. It works well for people that have difficulty with bridging something that psychiatrically medication hasn't figured out yet, like super high anxiety, but really low energy because if you try to boost up their energy, okay, now you're like this anxious psychopath. Or it's like, oh, my god, my anxiety is so bad, so if you squash in anxiety, now you're a zombie. So it's like, there's no like, so trying to find that happy medium. So TMS is a good option for that.

But there are a lot of people that can't do TMS, like people who have metal in their chest, or their head or their neck or whatever indications you can't go through an MRI, apply for this, because it's magnetic. People who you have to tread very carefully with, you know, certain depending on the machine you use and things like that certain psychiatric diagnosis, we're like, no, don't want to treat that. So it's highly dependent on the person. I mean, and for each individual person you're trying to assess, is this a good treatment modality. Now in terms of the variability, I can only kind of tell you anecdotally what I've seen, yeah, I really liked TMS, but that's partially because I'm lazy. I'm lazy, because I don't like I don't really to be totally honest with you, I'm not a huge fan of medication. And I know that's weird as a psychiatrist, because I'm supposed to be throwing pills at you, but I don't like it. I mean, I think the generation of psychiatrist graduated 10 years ago, we've had the benefit of brain scans, we've had the benefit of looking in longitudinal data about risk stratification, with medications and things like that. So we have this healthy fear of medications, we don't want to keep prescribing stuff, we don't want to do super high doses, because we know what it does to the brain. And we know like, yes, if there's a time and a place cool, but I think our rallying mantra is that we want the least amount of medication possible for the least amount of time, right?

Andrea 22:48
That makes sense. No, I'm curious about the results. Because like, because what my psychologist told me, she said that she's only had one patient that did not respond and she said he was inconsistent about going there. Because it's like five days a week, at least the place that's here in Greensboro, it's five days a week for six weeks.

Dr. Hamandi 23:06
Yeah, same with us. So yeah, so it's, it's 30 sessions. And then sometimes you have like tapers after that. Anecdotally, what I will tell you is that I I've had pretty good luck with it. If you asked me my pre COVID numbers, or my post COVID numbers, my pre COVID numbers were way better. And like, after COVID, because like pre COVID, I really didn't have a lot of like, repeat TMS because people did well, and it was fine. And then I think the pandemic just like kind of turned people on their heads. And you know, it was really difficult and there was a lot of collective trauma that we were all dealing with. Even with that, I think a lot of people what I would say is with TMS, I've never had someone who's done worse ever, ever. Like if you're treating the right thing, you really shouldn't ever have that. 40% of people we treat, and they do awesome, like absolutely awesome. And then our goal of TMS is that, you know, we try to wean you kind of lower on your medications, or off. We're actually able, or what I've seen with my patient population that I've been able to wean them off medication and then I literally don't see them again, which is kind of a bummer, but great because I see him at the grocery store and we're cool.

About 40% of people we do the TMS they feel great. We try to wean them off medication and they're like, Ah, I don't feel as great. What the TMSs did is we gave them the opportunity for the medication to work more effectively and almost always we can get them on a lower dose. Those are also people that are pretty strong seasonal variation. So sometimes we can get them off medication but then like if they get weird in the winter, we have we address it with medication if that's the case, or sometimes people do like maintenance bursts of TMS It depends.

About 20% of them. We do the TMS they do feel better. Absolutely none feel worse. but we still are kind of experimenting with medication or they don't have a complete kind of resolution. For those people, you know, sometimes their stuff like they're currently in a situation where there's ongoing trauma, or there's, you know, they're, it's almost always kind of like this multifaceted thing. But you know, that's, and that's just anecdotally, from what I've seen from my own TMS kind of population, not a curated and meta-analysis of the entire TMS population. But that's what I've seen if that's what you're asking.

Andrea 25:33
That's so fascinating. And I hope that in the years to come, it'll get even more specific on what they can treat and it'll just keep getting better, which it probably well, that's so interesting. I heard somewhere and I can't remember where I heard this, that most medications for anxiety, depression, things like that, it's sort of like if you need to change your oil, I don't know if this is a terrible analogy, like you if you lift up the hood to your car, and just sort of like spray oil all over the entire interior of your car and hope that some gets into the right spot. It probably will. But you don’t know how much. It was like right now it's kind of like a shot in the dark, I guess.

Dr. Hamandi 26:13
Oh, my god, I hope not. I mean, who was giving you that analogy? No.

Andrea 26:18
I heard it. I think one of my one of my friends told me that that lives in LA that they were trying to find the right medication for her son. And it was they were going through different medications trying to find the one that was correct. And had also done that, that lead tests or whatever where you tested the red, green and yellow light of which answer better, and I hope in 100 years, I'll look back on like this time and look at mental health and go oh my god, remember when we were doing that? It'll improve so much.

Dr. Hamandi 26:48
Oh, yeah. I'm hoping and I think we're moving more towards personalized medicine just in the first place. Because I mean, the old the old guard of like throwing stuff on the wall that is obviously not the best way to go about things. Right. So now we…

Andrea 27:03
Electric shock therapy and like lobotomies is like Jesus Christ that wasn't all that long ago. That was just a handful of decades ago.

Dr. Hamandi 27:10
We have we have electroshock therapy now.

Andrea 27:12

Dr. Hamandi 27:14
ECT Yeah.

Andrea 27:16
What is…so who would be a good candidate for that?

Dr. Hamandi 27:19
Same people that would be a good candidate for TMS. I don't personally do ECT because I don't like it. And like and for no, I like, I had a bad experience with it. Like the first time I did it in residency someone, like it because you're reducing a seizure like you're quite literally inducing electrical current to kind of hyper stimulate those neurotransmitters like what you're doing in TMS, but this is you're inducing, like the person is under anesthesia. And the body does weird stuff. If you're like, under anesthesia, and you're inducing a seizure, anyway, he pooped. I've never gotten over it. I cannot do it anyway.

Andrea 27:54
Yeah, no, I would want to wear a pull-up or something like that.

Dr. Hamandi 27:58
I mean, I was just like, I can't believe that because of something I did, I made him do this. No way. Never again. Like I have never done it again. That's a bad experience.

Andrea 28:09
Yeah, well, the only thing I think the only, you know, point of reference that I have for that is my grandmother, my dad's mother, and this was probably back in the night, late 1930s, they had like, fostered this little girl and my grandmother, you know, like, fell in love with this girl. They had her for a couple years. And the little girl ended up going back to her parents. And my grandmother was devastated and went into this deep, deep depression. And they did electroshock therapy to try to get her out of it. And from what I understand from my dad, and my uncle, she was never the same after that. And granted, that was a long, that was almost 100 years ago, just what 80, 90 years ago. So I'm sure it's come a long way. And they probably they probably vet people a little bit more carefully now. Especially women.

Dr. Hamandi 28:53
Yeah, I mean, and so the thing is, the thing about ECT is that even though I don't do it, I do recognize that there is a, it sounds absolutely hideous and archaic. But there is a time and a place where potentially it could be useful. And there's actually like, there's a lot of data showing safety being even better than medications in certain situations. So like, it's, it's crazy. I don't like it. I also really don't like it because I don't like to short term memory losse a seizure kind of freaks me out. So I think those are those are kind of my things.

Andrea 29:29
Okay, well, and I also watch Nurse Ratched to which was like, that's probably not helpful.

Dr. Hamandi 29:33
Yeah, at all. Yeah.

Andrea 29:38
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Okay, so what kind of questions should someone ask a medical professional before treatments such as TMS or medication or even going through genetic screenings? We haven't even talked about that yet.

Dr. Hamandi 34:21
Yeah. Um, so the thing about meeting with a psychiatrist is, it's a really collaborative process. Like it's, it's weird. It's not like seeing…

Andrea 34:34
At least it should be a collaborative process.

Dr. Hamandi 34:37
It should be. It's totally should be. And like, I think the thing that's, like, now that I'm thinking about it, that probably every doctor should be more collaborative, but like, what psychiatry . I mean, you're getting information from the patient's own experience, so they're the best gauge of what is going on internally for them, right. So you're trying to funnel that information and organize it and synthesize it in a way that you can formulate a diagnosis and then a treatment plan. So with that in mind, like questions, I'll pivot from that a little bit, of what I would say in order in order to prepare yourselves for like that initial visit is one, I think just kind of formalize and write a, what I love when my patients do is write down or symptoms. Like, because a lot of times like having that clear cut, like you get into the appointment, you kind of you get lost in questions, and it's hard for you to kind of pin down what's important to you. Because what's important to the doctor might be completely different, because they're trying to figure out what your symptoms are, but what you're experiencing is very different. So they might be like heading down the wrong path. And you're like, oh, that's really not that big of a deal. I really want to, you know, this is what I need to focus on.

So writing down your symptoms, and then the other thing is having a clear cut set of like, goals. Like, this is how like, you know, because a lot of times, like, I'll be meeting with people, and I'm like, Well, how would you want us to get better? And they're like, I don't know, I just wanted to get better. And I'm like, that doesn't help me. Like, give me ways. Give me tangible ways that this can improve? Isn't that your sleep could get better? Is that that you? Could your appetite be less? Is it like, what is it what what tangibly could improve? Because those are going to be our mileposts to see and assess if we're making progress. So those are the two big things that I would write and kind of gauging. Because you want to you want to build that relationship? So I guess you're not…Like, really, I wouldn't say that you really need to be responsible for asking questions, because the doctor is primarily going to be asking those questions you need to provide answers and have a clearer idea of where you want to go.

Andrea 36:52
Good. Then I did it, right. I had a I had a note, in my Notes app on my phone. I started writing down as soon as my daughter got her diagnosis, and I was suspicious of my own struggles in that area. Yeah, I started jotting down my symptoms, even if I wasn't sure that they were ADHD related or not. And they were, they were symptoms that that I thought weren't typical and they could have been anywhere on the spectrum. I even wrote on there like how furious I get when people are walking too slow, and I have to walk behind them and I'm not even in a hurry, so there's no rush. And I still am like, infuriated. And even just last night, I follow a couple of people on social media who are experts in autism because my son was diagnosed back then as well. And the toe walking, I thought that toe walkers. Anyway, I toe walk but only in bare feet. And specifically, especially if it's on cement always, like the feeling of cement on my entire foot is like, ugh, just hard things like that.

And, and actually, my psychologist asked me that same question. She's like, what are your goals? Like, out of all those symptoms, just so we can have like some expectation management? What do you want to change? And for me, one of them was nightmares from my complex PTSD. I want them to stop, and that what hasn't stopped. And that's why she wants to send me to TMS. So I'm like, well, fuck.

Dr. Hamandi 38:29
Well, no, it's good. It's good that you're getting like a comprehensive management and you know, the other thing is with PTSD, it's a lot of people expect, like from the psychiatrist side of things, right? A lot of people expect, just throw me a pill man and make this better. And it's like, that's not how this works. Like with trauma, especially, there's so much work that you as the patient have to go through in order to unravel that complicated trauma and rebuild that those healthy neural pathways. And that medication is going to get to you need to do that work in therapy. So the fact that you're working with a therapist, who's suggesting these alternative pathways for you is great.

Andrea 39:08
Yeah, and some days like I think, is this just my normal now like, just am I going to just have nightmares for the rest of my life and nightmare might be a little bit dramatic, like sometimes are nightmares. And a lot of times, they're just dreams with people in them that I don't want them to be in them anymore. They're from my past, and they were my abusers. And it's been an interesting 15-year journey. I'm also curious about genetic screening. So what is that entail? Like, is there like a website you have, like, how do people even start that process? And why would they?

Dr. Hamandi 39:42
So genetic screening is something that really came on the market maybe like 10ish years ago. And it's had a complicated history, and because it has, you know, come onto the market and then people were really into it. And then it fell out of favor for a while because people were like, it's not data driven and then they got more data. So it's been this very, it's been a roller coaster following this kind of journey

Andrea 40:14
Sounds like it's been a roller coaster, like more so in academia, and…

Dr. Hamandi 40:18
I think in academia, and also it, like bleed over in terms of, like, clinical relevance, right? Because even starting in academia, if you're like, okay, well, I don't know how valid this test is, you're obviously not going to use it for your patients. But I will tell you is that on face value, the genetic tests we have available now, and our office uses a couple of different kinds of genetic testing, I actually like. I like. And you know, and that's actually kind of a polarizing topic between our partners, some of our partners are like, I don't use the state in some of us do. And I think the reason for that is because I think that the genetic test is not what everyone thinks it is. Everyone expects a genetic test to give you like, this is my dream medication, it's not, it's not going to tell you that. What it's going to tell you is, these are the things that you're not going to be able to metabolize. So these are bad. And then the rest, you could kind of pick and choose from. There's a chance that your genetic data will come back, and it'll be like, you're totally fine. Like, genetically, you can metabolize all this stuff. So it doesn't give you a whole lot of clinical data. So people are like, I don't know, if you really want to go through the song and dance of like trying to, because insurance almost never covers it. And depending on the company to use, it may or may not be expensive, or sometimes they have a sliding scale. But sometimes we were like, I don't even know why we'd be kind of like it's not giving us that much good clinical data.

What it will tell you is that for people that are super freaked out about starting medications, if you've never started a medication, so I feel like there's some clinical value in like, okay, if you're freaked out, let's do this first and figure out which ones are absolute no’s so then we could take that off your plate and be like, okay, well, if you try one of these, at least it's not gonna be awful. Like, okay, let's go from there. Or, versus someone who's been on tons of different medication and you know, there's one or two left and then it's like, okay, well do we do we see like, is there a reason for this? Like, does a genetic data tell us it like you just are blacked out, like, you don't have the genetic capacity to metabolize this class of medications, and we need to do something else. And some people just find it like, validating like, I knew Effexor didn't work for me. I knew it. :ike, you know, things like that.

Andrea 42:34
Okay, interesting. I thought it was something else. But I'm gonna ask you about that. I wonder if that has to do with in my questionnaire when I was going through all my testing, I was asked about caffeine. Like, do you metabolize caffeine easily? And I absolutely do not. Like I'm the person who cannot drink caffeine after 11am. I always say like, I'm dancing with the devil. Like, but my husband, on the other hand, can have like coffee after dinner and be asleep in a half an hour. And I'm like, what’s that like, because I love coffee, but it just the experience of it. It's so that's why she was want to put me on a stimulant. And I have a history of substance abuse, addiction. So I don't know, but on a stimulant. Also, I have found that and I bet if I had genetic testing, it would have told me something about this, or maybe it wouldn't. I have found a couple of medications, mostly for anxiety and depression. Celexa was one of them and Zoloft did the same thing, where I felt better, depression wise, but I was like, completely emotionally muted. And as a writer, I noticed that I was like writing things and that was just like the facts. There was no emotion in it. It was like it was as if I couldn't in real life be demonstrative with my emotions. I didn't cry, I think at all the whole time I was on Zoloft. And there were moments that happened where I'm like, I should be crying right now. Like, my real life, I would be crying and I wasn't. It was like I couldn't access them to write. And normally I just, writing is the way that I do that. It's the path. Yeah, if I can't figure things out, I will start typing. Is that a sign that maybe it's not a good fit? Or is that just sometimes what happens with medication that that is actually good for people?

Dr. Hamandi 44:16
Um, it depends. So that's…so SSRIs in particular, they are notorious for that. SSRI’s are things like Zoloft, Lexapro, Celexa, they have something called SSRI Apathy Syndrome, where you just feel blah.

Andrea 44:33
I felt like I lost my Andrea-ness. That's how I described it to my doctor.

Dr. Hamandi 44:37
Yeah, a lot of people say that, you know, they feel emotionally blunted or things like that. So sometimes you can have that. Now, what I will tell you is does that mean that that's a bad fit for you genetically? I don't know. Sometimes that is and sometimes it's a dose dependent thing, sometimes it's a gut related thing, sometimes it's a symptom related thing. So sometimes you It might be the right medication for you, but because of other stuff that's going on, you know, it's almost like it's a protective mechanism for that. So there's it's so…

Andrea 45:10
A lot of variables. Yeah. Yeah, I thought genetic testing to also encompass. Like, if you have on your DNA strand… Like so, for instance, my dad struggled his entire life with anxiety and depression, pretty bad, like to the point where he had to be hospitalized a couple of times, and it was awful. And I always felt, and I remember talking to my siblings about this, I always felt like he never got his meds quite right. And so I thought the genetic testing would tell you that, like, yes, this is in your DNA, that, you know, the depression lives here on the allele, and you got it and it's bad.

Dr. Hamandi 45:48
No, and a lot of people, they think that that…Like, I would love that. But I think what, what, and that's what a lot of people think, is in genetic testing, but genetic testing, it has nothing to do diagnostically. It is simply for the medications. It's not going to tell you that.

Andrea 46:08
Are they trying to find that? Like is there research happening where they're trying to find that?

Dr. Hamandi 46:12
So the problem is, is, believe me, man, this is something that everybody wants a piece of, right? Because like, if we could crack this, I mean, first of all, I wouldn't have a job, but it's fine.

Andrea 46:25
Just like change, a job change. Well, I think I think two people want to know for, well, I'm glad, then we get into like trying to make these like designer children and things like that. But, you know, things like perfectionism. Like I've heard that there are theories that the perfectionism hangs out around the same area that anxiety does, like in our genes and things like that.

Dr. Hamandi 46:46
The fundamental issue with gene testing, in order to find diagnosis is that diagnosis one are so multifaceted, and two, we're looking at such complicated genetic data, which can, like complicated genetic data in terms of like depression could really fire on like, tons of different things, and it depending on how its expressed. And so it's not just like, oh, it's like a 15x chromosome, that's where it is. It's like, no way, this is like, so complicated. It can present in tons of different places it could be, you get a little bit of it from your gut, you get a little bit of it from your, like, how you're breathing and your job placement. And like, there's tons of different variables that makes it depression kind of difficult to not only manage, but diagnose because, you know, it's hard.

Andrea 47:39
On the ACE score, you know, like childhood trauma probably plays a huge role in that as well.

Dr. Hamandi 47:43
You're trying to diagnose a constantly moving target. And that's why it's difficult. Now what, what I will tell you is that it would be interesting, like, our only hope of finding something like that out is to do longitudinal and like generational studies of people, that's really where we're going to get like, hereditary data. But as of right now, I don't know anyone has successfully done that. You could do that.

Andrea 48:10
Yeah, that sounds like it would be a century long. I would volunteer my dad passed away, unfortunately. But I could tell you a lot. I could talk to you forever. But I wanted to ask about you wrote a book that's coming out soon. And it's called Self-Care for People with ADHD. And where do you want people to go? Do you want them to follow you follow you on social media?

Dr. Hamandi 48:31
Where you could follow me is going on to Instagram or TikTok to @ThePsychDoctorMD. And, or you can like, type in my name, Sasha Hamadani MD, and it comes up. That's a good resource for information about ADHD. And yeah, this book is coming out Simon and Schuster is putting it out, I think in October of 22. And that is, I'm actually really proud of that. I think that's a good resource. And I, when I was writing it, I wrote it in the viewpoint of like, this is what I wish someone had given me in medical school when I was like, really flattening. Which actually reminds me a circling back to something we started, like, right in the beginning, and I don't even know if it's appropriate to circle back to that. So, you know, you asked me a question, and then I got distracted and I went off on another tangent, you asked me…

Andrea 49:23
I think I asked you two questions at the same time. with ADHD, I should know that I should know better.

Dr. Hamandi 49:28
You shouldn't put us together. Okay. So one thing you'd asked me or like you brought up is like, I don't think I've ever met someone who, whose parents kept their diagnosis from them. I mean, as a parent and you're a parent, I think one of the most interesting things about this diagnosis in particular is like and as I've kind of grown and like seen it both as a patient and as a student and as a as a clinician is looking at that stigma and how, how different it is for women and how you know, you can carry that with you. And like, for a long time, I was really angry with my parents and I felt very betrayed. And then you know, you become a parent and you're like, no, this is like something that they thought was best to protect me during that time. And I've really understood as I've started growing with it and exploring it.

So I think what I like about how I wrote this book, is that it is written in the view, literally, I wrote it like, this is what I want in med school, because it is, what I am proudest of is that it's a way of explaining things. In a shame free and guilt and stigma freeway like this is, these are the facts. This is what made when I was writing it, I'm like, I feel better about this. This is a way of me absolving myself of that stigma. So that's, that's what I like about it.

Andrea 50:49
I find it just fascinating. And I can see, I mean, this is no shame to your parents, I totally understand why they did it. Like I really struggled with. When do I tell my son about his diagnosis? Because he was only five. And I know there's some kids that I've heard, especially in the autism community where they don't tell their children. And that's a personal choice and I don't think that you that's not for me to decide whether you decide to tell your children that or not. But I can see now especially with this younger gen…Did you grew up in the 90s.

Dr. Hamandi 51:22
Thank you so much. I know I mean, I was born in the 80s. But yeah, like formative youth was in the 90s. Yeah.

Andrea 51:29
So still, it's still very much like a little boys thing. But I have found especially on tick tock that this younger generation, I guess it would be like the younger Gen Z and Gen Alpha, growing up in a completely almost like opposite world of how we grew up talking about trauma and mental health diagnosis. And now I think the pendulum has swung maybe a little bit too far. And people are dissecting everything and being hyper aware and hyper observing. And yeah, it's interesting, but I don't know, I think there were probably some benefits to you not knowing.

Dr. Hamandi 52:07
I think so too. And the more I've kind of gone about things and learned and like, you know, I think when I started this pathway down psychiatry, some proper discussions with my parents, and I was like, what is this? And like, what, like, how am I suppose to move forward from… how much of this was like me being drugged into performing and how much of this is my actual capability, because I've literally have no idea. The way that they described it to me, was really important. They were saying, you know, we gave you, you know, we didn't want, you know, we tried the best we could, and we wanted to give you the best chance of moving forward. But at that time, we didn't know how to explain this to you, because you were such a sensitive little kid. And, and to me, that really resonated with me. And that's, that's one of the most important reasons to have that good working relationship with your psychiatrist and your therapist because they're the people that are going to help you bridge that gap.

As a parent, you don't have to have, you don't have to know how to have that conversation. That's not your job. You didn't go to school for that. Like, if you feel like that's something that you need help with, and you want to explain to your kid and you, you have this vision of how it's going to be and you want to handle a delicately work with your provider.

Andrea 53:30
Absolutely. Okay. Thank you so much for your time today. And it's doctor, it's Dr.HamandiMD.com Correct, yes. Okay. And we'll put a link to that in the show notes, and the book, Self-Care for People with ADHD. Thank you so much, again, for your time and everyone listening, thank you for your time, you know how much I value that and I'm so grateful that you come to, you choose to spend some time with me and my guests. And remember, it's our life's journey to make ourselves better humans and our life's responsibility to make the world a better place. Bye for now.

Hi there, swinging back by to say one more thing. You know, I'm always giving advice over here on the show and on social media. And a couple of those things is that I'm always telling you to ask for what you want, be clear about it, and also ask for help. So I am taking a dose of my own medicine and I'm going to do that right now. It would be the absolute best and mean the world to me if you reviewed and subscribed to this show, Make Some Noise Podcast, on whatever podcast platform of your choice. And even more importantly, it would matter so much if you shared this show. Sharing the show is one of the few ways the podcast can grow and that also gives more women an opportunity to make some noise in their lives. You can do that by taking a screenshot when you're listening on your phone and sharing it in your Instagram or Facebook stories. If you're on Instagram you can tag me @HeyAndreaOwen and I try my best to always re share those and give you a quick thank you DM and also you can tell your friends and family about it. Tell them what you learned. Tell them a really awesome guest that you found on the show that you started following. Whatever it is I appreciate so much you sharing about this show.