ADHD Unboxed, Minds in Motion! with Dr. Stacy Greeter

Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week I am joined by Dr. Stacy Greeter to discuss the dynamic world of ADHD, exploring treatment options, medication nuances, and breaking down stigma surrounding this condition.

Dr. Stacy Greeter is double Board certified in both child/adolescent and adult psychiatry with a private practice in Bradenton, FL. Dr. Greeter graduated Summa Cum Lade from Duke University and went on to University of North Carolina School of Medicine on a full scholarship. Dr. Greeter completed her residency at Northwestern Memorial Hospital and continued there to complete her fellowship in child/adolescent psychiatry. She loves sharing her passion for psychiatry with other professionals with her Psychiatry Bootcamp for Primary Care online lecture series and enjoys finding creative ways to teach complex psychodynamic concepts, such as her How to Become a Psychiatry Jedi series. Dr. Greeter is a strong proponent for collaborative care between disciplines. She runs a multi disciplinary mental health professionals book club.

0:00 Intro and Busting ADHD Myths
03:43 ADHD 101: Basics & Diagnosis
06:22 Living with ADHD
08:46 Meds & More
15:07 Stimulants & Non-Stims
22:08 ADHD Meds: The Good, The Bad
26:47 Risks of Skipping Meds
29:27 No One Size Fits All
31:16 ADHD & Pregnancy

Connect with Dr Stacy Greeter
Website: https://www.stacygreetermd.com/
Email: drgreeterfrontoffice@gmail.com
Phone: Phone (941) 413-0834

Connect with Dr. Kerry Reller
My linktree: linktr.ee/kerryrellermd
Podcast website: https://gethealthytbpodcast.buzzsprout.com/
Facebook: https://www.facebook.com/ClearwaterFamily
Instagram: https://www.instagram.com/clearwaterfamilymedicine/
Clearwater Family Medicine and Allergy Website: https://sites.google.com/view/clearwaterallergy/home

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#ADHDawareness #MentalHealthMatters #Neurodiversity #PsychiatryTalks #StigmaFreeLiving #WellnessJourney

Transcript

Kerry: 0:28

All right. Hi, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller. And today we have a very special guest, Stacy Greeter. She is a doctor down in Bradenton, Florida. And tell us a little bit about who you are and what you do, Dr. Greeter.

Stacy: 0:43

Hi, thanks so much for having me on, Dr. Reller I'm Dr. Stacy Greeter, and I am a child, adolescent and adult psychiatrist. Also joining me is my doggo, Tiki. Tiki, saying hi.

Kerry: 0:57

That is a podcast first. I love it.

Stacy: 1:00

Everybody should have an animal with them on the podcast, right? Right? Okay, so I love psychiatry and the opportunity it gives for such, like, intellectual and emotional stimulation while really, going in depth into what is most authentic within people and helping them understand themselves. I have two psychiatric PAs at my practice, Bethany and Kira and I love teaching them on an ongoing basis. And One of my passions is teaching other doctors, like primary care doctors and therapists in the community about psychiatry so that we can level up primary care to increase access to psychiatry. So to that end, I have a hobby where I make fantasy themed PowerPoint presentations on different psychiatry topics, like how to become a psychiatry Jedi, or autistic minds are magical, which is Harry Potter themed. You can find those on the website. They're open to anyone. Stacy Greeter, MD. It's s t a c y g r e e t r md. com under psychiatry boot camp. And I myself, am an autistic ADHD er and share that to help reduce stigma because I have the privilege of being openly autistic and ADHD, working for myself in private practice and want to help others feel less alone. Yeah. Yes.

Kerry: 2:25

I love that. And I love that you're trying to educate other doctors to like me, who can obviously use more tools to understand and treat our patients. And you mentioned a big thing, too, which is access. And I think a lot of people do have trouble accessing psychiatrists during this time. You think it would have been better after COVID and telemedicine developing, I do think it has improved, but obviously it could get better. So those are two good tools. Mm

Stacy: 2:51

I think that there are multiple aspects of the issues with access. 1 aspect is identification and recognition that someone has a psychiatric need. So, leveling up primary care docs to recognize that would help. And then there's the part of actually getting a psychiatrist or therapist.

Kerry: 3:12

Yeah, absolutely.

Stacy: 3:13

and. So, I think that I would love to see more primary care doctors, perhaps referring for a 1 time consultation for the differential diagnosis assessment and to get started on a plan, especially if a family can't afford to continue with psychiatrists, many of which don't take insurance and then having a collaborative communication with that psychiatrist about moving forward.

Kerry: 3:39

Yeah, the other part is they don't often take insurance

Stacy: 3:42

Yes,

Kerry: 3:43

Yeah, we struggle with that in our area. But anyway, oh, go ahead.

Stacy: 3:48

No, you go ahead.

Kerry: 3:49

I was just going to say what we were going to talk about today. So if you Okay, so we I brought you on today to talk about ADHD. And you mentioned that you are a person who has ADHD as well. So how can you define what is ADHD? Tell our listeners about that.

Stacy: 4:04

so attention deficit hyperactivity disorder is a little bit of a misnomer because it's not an absence of attention. What it is, is that it's harder for the frontal lobe of someone with ADHD to Consciously choose what they focus on and what they tune out, so the brain will naturally hyper focus and go really intense into something an ADHD mind is interested in. On one hand, if an ADHDer has a passion, they're a force of nature in terms of pursuing that passion. But if it's a task that's less interesting to them, it is like almost physically painful to try to make themselves stay focused on that task. So it's an attention dysregulation issue. Other issues are difficulties with impulse control, stopping and thinking before acting. The strengths of the ADHD mind, and I don't think that we talk about them enough, honestly are divergent, creative thinking, connecting things that a neurotypical brain doesn't tend to connect, resilience, bouncing back from a stressful situation, and problem solving, creative problem solving skills, and they tend to get things done really fast when that brain is properly stimulated.

Kerry: 5:24

That is so

Stacy: 5:25

properly, yes, yes, there's a video you can look at online. It's really cute. I think it's helpful for both adults and kids, but it's meant for explaining ADHD to kids and I sent it to you so you could put it in the

Kerry: 5:38

notes Sure.

Stacy: 5:39

that you have for the show under amazing things happen. ADHD. It's a really cute video. Yeah.

Kerry: 5:45

Well, yeah, we'll definitely put that in the show notes.

Stacy: 5:48

ADHD isn't something that's caused by bad parenting or bad nutrition, certainly lack of sleep or poor nutrition can make your focus worse, but it is a brain type. We call it a neurotype,

Kerry: 6:02

and what does that mean? What is a neuro type name?

Stacy: 6:05

that, okay, so a neurotype means, It is a type of brain that is different than the typical brain, okay? So, we refer to the neurotypical brain for someone who doesn't have ADHD, dyslexia, autism are some examples, of different neurotypes. And they have strengths and weaknesses.

Kerry: 6:28

Yeah, absolutely. I don't think I've ever heard anybody focus on the strength. So it's really nice to hear that. You know, you bring out the important

Stacy: 6:35

things And so we refer to that as a neurodiversity affirming model of care versus a deficit focused model of care. So neurodiversity affirming means that we don't view the inherent style, neurotype style as bad or needing to be fixed or needing to look as neurotypical as possible. Instead, the focus is on helping that individual be as authentic as possible and also as functional and interpersonally as effective as possible. Okay, so they're embracing the ADHD creativity and that's part of themselves while asking for accommodations, taking medication to help with attention dysregulation, impulsivity, time blindness, etc. Does that make sense? Yeah. Okay.

Kerry: 7:28

Okay. Yeah. Yeah. So let's go back to like diagnosis and stuff. So when someone is suspicious that their child or themselves may have it, what are the steps that they should do?

Stacy: 7:40

in an ideal world, right, I would see a psychiatrist if you have access to a child psychiatrist for the initial diagnosis and starting meds and then continue with a pediatrician. If you don't have access to that, you could start with your pediatrician and I'll explain a little bit the differences there. Our pediatricians are amazing, are really doing the best they can, but they have, 15 minutes to 20 minutes in a visit, and it's really hard to differentiate the ADHD diagnosis from so many different things that could look like ADHD during that given time. Also going in parents and kids may have a lot of different stigma, feelings, hesitations, fears about starting medication. And so with the psychiatrist, with that psychodynamic psychotherapy. Relational background, we can really explore a parent's fears, a parent's hopes and also explore with the child, their fears and their hopes and help them see medication in a healthier way. So we have that opportunity, at least, you know I think that so the 1st step is, is to reach out to a medical professional.

Kerry: 8:53

Absolutely. Yeah. And then if it's a pediatrician or primary care, they can divert to psychiatry. Like you mentioned, maybe a one time referral just for evaluation and diagnosis. And then what about for treatment? What are the different methods of treatment for it? I mean, you mentioned medication,

Stacy: 9:11

For ADHD, we have multiple different types of medication generally stimulant medications are first line simply because they work the best and they work right away. But that doesn't mean that there isn't a role for parent training, psychotherapy accommodations. I think. We should view this as holistically as possible. And so medicine is the piece that gives a child the ability to regulate what they focus on and what they tune out and gives them self control, we can't do that with therapy. Unfortunately, it doesn't treat those core symptoms. once they have that improved self control capacity to regulate their attention, and they work with a therapist, they're able to use that to focus on, so the therapy makes them want to focus on the things that are really good and healthy for them. Okay, meds instill a capacity for focus. They don't instill a desire or a healthy relationship with your parents and such, such that you want to do what they're asking you to do, right? And the parent understanding ADHD, knowing what they need to accommodate instead of punish. Very important. Then there's the role of therapy in the child being able to understand how their neurotype is different, both a blessing and a curse. Make peace with that, okay? And unfortunately, the later a child is diagnosed in life and started on medication, generally there's a lot of, self esteem and trauma work to do because they've had a long standing experience of knowing that they are under functioning and repeatedly offending people, being called disrespectful, etc. There's a lot of therapeutic work to be done on that end,

Kerry: 11:09

yeah, absolutely. So you're kind of thinking, yes, you need the medicine in order to do well with the therapy, basically.

Stacy: 11:16

In fact, studies show that when they do these really complicated therapies with ADHD kids, they don't separate from placebo and unless the medicine is on board.

Kerry: 11:25

Okay.

Stacy: 11:26

I mean, think about it. If you can't focus and you don't have self control, and then someone's doing therapy telling you what you should do, but then you don't, your brain just can't do it, that's just more aggravation and frustration for everyone.

Kerry: 11:38

Absolutely. Yeah. So what, what kind of accommodations were you referring to? When I think of accommodations, I think of school accommodations, but you mentioned home accommodation. What are the things that you would see or recommend?

Stacy: 11:50

Okay, that's a good question. a home accommodation could be, you get a warning before a transition to a new activity right out of a preferred activity, because when you hyper focus on something that you really love, you're in this, like, flow, creative, really intense state, and it's like painful to be ripped out of that. And they're always like, why is my kid having a meltdown when they have to stop the video game or whatever, like, they're in an intense, intense level of focus that's painful to be ripped out of. So a home accommodation is having timers. I like the egg timers that you can actually see as they tick, tick, tick, beCause time blindness, the inability to judge how much time is passing is really impaired with ADHD kids and having a schedule and checklist, visual schedules, visual reminders. those are some home accommodations. Also giving them lots of wiggle breaks, like they have a wiggle chair at dinner, maybe. ADHD doesn't just impact school. I think that's really important. I think that's something that, and it doesn't just impact children. ADHD impacts relationships across the board and self esteem we find that in adulthood, adults who continue their stimulant medication in adulthood have lower rates of divorce, have lower rates of cavities, actually, have lower rates of car accidents, which makes sense, and lower rates of ER visits, just overall better health, because your ability to regulate your focus, delay gratification, like instead of doing video games all night, I'm going to go to bed because that's the healthier thing for me in the long run. Delaying gratification, your ability to stop and think before you say something to your spouse, all of that is impacted by ADHD.

Kerry: 13:46

those are really, really important comments that you make. I mean, I know one of the things that I was going to ask is how it is impacted. But it's every aspect of life. And I know when we do the evaluation, we're looking at home and school, but You bring up a whole lot more points. It's also obviously going to affect people in the community and things like that as well. Like your interaction with other people, grocery store, wherever, right. Especially if you have the decrease of impulse control and everything. Yeah.

Stacy: 14:14

then just I mean a lot of the school accommodations Gosh, I find yes, there's specific things they get like extended time Or a wiggle break, but a lot of it honestly is just having something that educates the teacher about what to not punish them for and what does provide support for. Like just yesterday, a patient came in, they kept getting in trouble in class because they need to fidget and they chew their tongue and the teacher keeps thinking they're chewing gum and they keep getting in trouble for making like gum chewing movements. But literally like their body needs to move to be able to focus. And so to be like, Hey, you're going to, you're going to wear this jewelry. Yeah. That you chew on to school and the teacher is going to get a note that this is what you need to be able to focus in her class. That kind of thing,

Kerry: 15:04

Yeah. No, that sounds very helpful, but

Stacy: 15:06

so, and then, and then from the neurodiversity model, we're telling the child, good, you're chewing. That's how your brain focuses. We're not trying to, like, no, that's bad. Don't do that. That doesn't look right. Okay? Keep chewing. Keep finding socially acceptable ways for you to get your body's needs met that are gonna be different than other bodies and other brains.

Kerry: 15:34

So how do they go about doing that? Like giving the teacher a note or

Stacy: 15:37

I write a letter for the teacher.

Kerry: 15:39

Okay. And then.

Stacy: 15:41

So, the website chad. org, they have a list of different academic classroom accommodations for ADHD.

Kerry: 15:50

Okay. Yeah. That

Stacy: 15:51

In, in the workplace as an adult and I also tell kids, I'm like, hey, hang in there because someday, someday you will become an adult. You will have more agency in your life. Now that I am an adult, I can chew gum. During my appointment with you, if I so choose, actually and show you I'm doing this to help with my focus and I can have a fidget and you can have a fidget. We can both be using our fidgets. And I'm not going to accept email communication from patients. It's only voicemails because my ADHD brain will function best with just the one form of communication. And the front desk must send me written messages instead of telling me things just in passing. Okay, so those are ways that I'm accommodating myself in the workplace too. And using that as a model for my patients.

Kerry: 16:45

Yeah. Absolutely. Those are really good ideas too. I mean, knowing what your brain accepts the best and making sure to educate for you, your staff or whoever,

Stacy: 16:53

Yes, yes, that's important.

Kerry: 16:56

Yeah.

Stacy: 16:56

But not everybody, unfortunately, like I'm in a place of privilege and freedom, and not everyone is in that place to be able to even disclose at their workplace that they're not neurotypical.

Kerry: 17:10

Yeah. So you mentioned there are different types of medications. We didn't really go into that. So can you explain that a little more

Stacy: 17:18

So the American Academy of Child and Adolescent Psychiatry has parent medication guides and they are separated by diagnosis. The gist of it is that stimulants activate your frontal lobe, and the frontal lobe is your executive functions, so you're better able to regulate attention and self control. Okay. They acted on dopamine and norepinephrine. They kick in at the beginning of the day, and they wear off at the end of the day, and they cause a decrease in appetite pretty much across the board. They're kind of like a Goldilocks medicine, sort of like too low a dose of stimulant, you're bouncing all over, not treated fully.Too high a dose of stimulant and you might be overly inhibited or flat like that zombie effect. Right? So you want to get it just right. I really want to encourage parents and the children and adults. Do not settle when it comes to ADHD meds, okay? Don't be like, eh, you know, this has this terrible side effect, but okay. No, there's a lot of options out there. Keep adjusting. So then, the non stimulants. So stimulants include Adderall and Ritalin and everything in that family. The non stimulants are Stratera and now Kelbree is kind of a new kid on the block in that It's Q. E. L. B. R. E. E. If you want to know how to spell that. And they're acting on the noradrenergic system. And the pros is that they last 24 7. So, your impulsivity in the evenings can be controlled. They don't have as robust an impact on focus as stimulants do generally. But they don't lower appetite as much. And so they're kind of like second or third line there and then

Kerry: 19:08

but they can be used by themselves. Sure. Thank you.

Stacy: 19:10

they can be used by themselves or you can combine them with the stimulant to get away with the lower dose of stimulant. Because the higher doses cause a certain side effect for you, but you still need more help. And then the other great combo the alpha adrenergic agonists like guanfacine and clonidine when combined with stimulants. So nice because they have less side effects in combination than either medicine alone because Stimulants tend to elevate heart rate and blood pressure and guanfacine and clonidine lower heart rate and blood pressure and tend to cause sleepiness. So I knew I used like Clonidine because it's more sedating to help ADHD minds shut down for bed, which is a common issue. And then guanfacine can really help if you just need help with impulse control mostly. It's awesome for impulse control and it's awesome for anxiety and PTSD and rejection sensitivity dysphoria. But it's not as great for focus as stimulants.

Kerry: 20:13

I've seen people using that and I did not really know why that one was added on. Yeah, so that's helpful for me.

Stacy: 20:20

so think about it. Like I don't know. They're like, hey, Jimmy, he takes his Adderall XR, it wears off, and we can't give him a booster dose of Adderall because he won't eat dinner, and he won't sleep if we give it too late at night, we really just need him to be like, not, you know, running around hitting his brother, right? guanfacine that lasts 24 7 so that he has more impulse control in the evenings.

Kerry: 20:45

Yeah, that sounds like a really good addition. That is just the cough medicine, right?

Stacy: 20:49

No, no, no, no, you're confused with quifenazine.

Kerry: 20:52

okay.

Stacy: 20:53

Yeah.

Kerry: 20:55

So if

Stacy: 20:55

yeah, yeah, quiet. That's okay.

Kerry: 20:57

it sounds so

Stacy: 20:58

Qyphenosine is mucinex and guanthasine. G U A N F A C I N E Also called intunive. And are you familiar with what rejection sensitivity dysphoria is? Okay. Rejection sensitivity dysphoria is common in both autism and ADHD. It means an intense fight flight response like sympathetic nervous system is turned on trauma response to rich perceived rejection and people with ADHD and autism are used to being bullied, rejected, told that they're annoying and having difficulty understanding why and tend to anticipate that and take it very hard. And it's like I'm a bad person. Okay, and a fun fact is that meds like guanfacin can help with that, they're good for emotional reactivity. And then we have others farther down the treatment algorithm, Modafinil, Amantadine, Welbutrin, off label. I think something that I want to emphasize is people are like really afraid of stimulants, but they really are first line and they work well, and we have tons of data on them.

Kerry: 22:08

So what are the side effects? You didn't

Stacy: 22:10

Decreased appetite is the most common one, and then a lot of the ones can be idiosyncratic, like this person was like, Oh, Adderall made me feel edgy, but Ritalin was great, or yeah, but Adderall, I didn't like how it felt, but Vyvanse smoother felt great, you gotta try different ones out. They also can increase heart rate and blood pressure, and so we monitor that. I mean, that's really for our older populations.

Kerry: 22:35

Good point. Yeah.

Stacy: 22:37

I have seen a lot of older adults with high blood pressure have lower blood pressure when they start their stimulant because they have less stress in life. So that's interesting, right? It's complicated what we're doing. And they are controlled substances because they can be abused, especially in the Adderall family. But it's important to know that when Adderall is abused, it's like 300 milligrams crushed up and snorted. And when we're prescribing it, we're prescribing like 10, 20, 30 milligrams, so much higher dose and totally different delivery mechanism, for it to be giving euphoria,. Your child is not going to get addicted to or euphoric when they swallow and take the medicine as prescribed. But because people can alter the medicine by crushing it up and snorting it in high doses, that is why it's a controlled substance.

Kerry: 23:36

And obviously needing appointments for controlled substances creates some stigma too. And people don't like, Oh, I have to go, see my doctor and get my medicine

Stacy: 23:44

pharmacies give people a really hard time

Kerry: 23:46

yeah, that

Stacy: 23:47

too really sad. Yes, like, okay, I changed the dose and they're like, well, they already picked it up. Are you sure? You know, I'm like, well, it's a new dose. So they need a new dose. Now, please, please, please fill it like I kind of have to send messages, begging for people to get their medicine. It's hard. And it's hard having ADHD. And then having to keep up with that, like people rightfully complain that ADHD treatment is not ADHD friendly.

Kerry: 24:17

Yeah. I mentioned the shortage because I was having to call multiple pharmacies or prescribed to multiple different pharmacies. And obviously, that's not something that the DEA wants us to do. So people were having trouble getting their medication one because shortage and two because they're getting the runaround as well. And it's frustrating that they had to go through that. But I do think it is better I think of the shortages COVID related, but yeah,

Stacy: 24:40

don't know, I just focus on psychiatry.

Kerry: 24:44

well, it's hard when you have to kind of do your work twice, like you send in the medicine and expect them to get it. And then, finds out next visit, they never got it, you know, it kind of defeats the

Stacy: 24:54

purpose I think. It is tough. I think the toughest thing, though, is maybe talking about stigma, just people's attitude, like patients may feel very mixed feelings about taking medication, medication can be a symbol of badness, a symbol of deficit, a symbol of wrongness, a symbol of otherness, not belonging, right? And then to add on to that a pharmacist who's like, Oh, do you really need to pick up this medicine now? Not to hate on the pharmacist too much because they're struggling, right? But then you're standing in the pickup line, and another parent's like, Ugh, you drug your kid? There's so much stigma. I feel like being a child psychiatrist, every time I do a new intake assessment, I think it's like going into a new job interview where the person who's interviewing you has heard 10 vicious rumors about you that aren't true from the get go when it comes to ADHD and autism and medication, and it is sad, like, from my personal experience, I wouldn't have been able to become a psychiatrist if I did not have access to ADHD medication as a child. And I had my ADHD diagnosis from way the get go, right? My autism diagnosis didn't come to me until age 40, like, this year and I wish so much that I had that sooner. And I think there's so much stigma against medication against diagnosis that anything we can do to reduce that and help people understand how healing and fulfilling it can be to have good medication treatment and an accurate diagnosis for yourself, I think would be a winner.

Kerry: 26:46

Yeah. So what are the risks of not treating ADHD?

Stacy: 26:50

Yeah, so not treating ADHD leads to a higher risk of depression, anxiety, and substance abuse, unfortunately, and then higher rates of, like I said, under unemployment, divorce, car accidents. I think that treating ADHD earlier in life alleviates a lot of risks and more pain and low self esteem from underperforming as well as decreasing the stress and conflict within the family.

Kerry: 27:26

Mm.

Stacy: 27:27

I really encourage not just the child who has the ADHD diagnosis to be receiving treatment, but the entire family to be receiving treatment. That is really, really key because the entire family is impacted and the parents are the Biggest game changer when it comes to therapy in terms of their ability to have a child have a healthy perspective on taking medicine, a healthy self esteem, promoting perspective on having ADHD. Helping children understand that even though they couldn't have done this type of school work without the medication that the credit is solidly on them for doing the school work. Okay. It's very important for kids to develop that sense of self efficacy, like, I can do stuff I'm competent, right? And self agency. I have some autonomy and freedom. So, instead of like, Oh yay, the medicine made you focus on your homework. No. Okay. The medicine gave you the ability to focus and you really used that. You did this work. I use an analogy of like, a colorblind painter. He's a painter and he finally gets glasses that help him distinguish red and green. And suddenly his painting is much better. But who's the artist? Who did the painting? The painter. Now, he couldn't have done it without the glasses, right? But the medicine is a tool, okay? The child gets 100 percent of the credit and encouragement.

Kerry: 29:15

And it's probably really important to do the positive reinforcement and pointing that out.

Stacy: 29:19

Yes. Yes. Otherwise, kids are like, I don't want to stop my medicine to prove I can do it on my own. Right? Right? So give them credit. Yes. Mm hmm. Mm hmm.

Kerry: 29:27

So speaking of stopping medicine. Yeah. Speaking of that, like so if a child gets a diagnosis and they continue medication throughout school years what is the recommendation? I mean, I'm assuming you continue it through work, but is there like a way or something where they may come off it or typically not recommended or

Stacy: 29:46

it is individual specific, so I think our goal should always be, use every resource at your disposal to live your best, healthiest life.

Kerry: 30:00

I like that!

Stacy: 30:00

And, I mean, and medicine is just a tool. And so is healthy nutrition. So is regular sleep. So is physical activity, right? So is psychotherapy. Now, that being said, okay, I do have, so as a general rule, I think medication helps adults too.

Kerry: 30:20

Mm hmm.

Stacy: 30:21

But with stimulants, it's so easy to start and stop them. There's no withdrawal, right? You know, it's the one psychiatric med that you could take it one day and not take it the other, kind of low commitment that I do have a lot of adults who are like, I don't really need it unless I'm driving for a long time, or there's a long work meeting, or, you know, etc. And I'm not going to take it on the weekend, and people do have side effects, and even with all our best effort, They may say, I don't feel quite as, impulsively creative when I play my music, when I take my stimulants, so I'm not going to take it then.

Kerry: 31:03

Mm hmm.

Stacy: 31:04

So there isn't a recommendation one size fits all at all. It should be really based on their needs.

Kerry: 31:14

absolutely.

Stacy: 31:15

And just to comment on ADHD in pregnancy, there's a lot of great new data out on safety of stimulant medications during pregnancy that we want to monitor during pregnancy for high blood pressure and for fetal growth.

Kerry: 31:32

Mm hmm.

Stacy: 31:33

And that's a complex decision, too, of whether or not to stay on medication when you have ADHD during pregnancy and while breastfeeding.

Kerry: 31:42

Definitely, like you mentioned, it's an individual basis, a lot of things, what you're saying is funny, because I said, I do a lot of obesity medicine, it like is paralleling that right with impulse control and the pillars, like you mentioned, sleep, exercise, stress, nutrition, it's all kind of Interrelated and the medication in those cases is also just a tool, right?

Stacy: 32:05

Yeah, I think it's interesting how people are like, I'm holistic, so I don't take medicine. And I'm like, actually cutting out one of the tools is considered reductionistic, not holistic.

Kerry: 32:17

Interesting. Yeah.

Stacy: 32:19

But okay.

Kerry: 32:21

Yeah. Well, is there anything else you'd like to share with the listeners about ADHD today?

Stacy: 32:27

Well, I think that... I gave Dr. Reller a list of different resources about ADHD to learn more. I love the How to ADHD YouTube channel and I just want to encourage people that if you're struggling and you're questioning you do deserve to investigate it and see if medication or psychotherapy or these other things could be making your life more fulfilling. And that ADHD can be extremely painful, but it is both a blessing and a curse. And to think about the resilience, the creativity. The humor and the vivaciousness of the ADHD years as well as the challenges.

Kerry: 33:17

Absolutely. Focusing on the positive. Really good. So where can people find you?

Stacy: 33:22

I'm in Sarasota, Florida. My website is Stacy Greeter, MD. Dot com s t a c y g r e e t e r m d dot com under psychiatry boot camp. You can find video recordings of the psychiatry presentations I do for the community. And I have my two PAs, Bethany and Kira, they have pretty much immediate openings, and their rate is like 60 percent of my rate, so much more affordable FYI to improve access. And that's where you can find me. Thank

Kerry: 33:56

So you do telemedicine in Florida, right?

Stacy: 33:59

I do both in person and telehealth.

Kerry: 34:02

Awesome. Okay. Well, thank you. I did want to say I looked at the you do is that you do ADHD YouTube channel.

Stacy: 34:09

Yeah. How to ADHD.

Kerry: 34:11

Thats it. They had lots of good resources there for anybody looking for stuff. That was cool. But I will, have to look at everything else you shared with us. So, and I'll post all that in the show notes too, but thank you so much for coming on the podcast today and meeting with us and everybody tune in next week for our next topic.

Stacy: 34:28

Thank you, Dr. Reller.

Kerry: 34:29

You're welcome.