The complexity of the human brain is unparalleled across living species. And when you take into consideration the vast number of unique variables from person to person, it can become even more abstract. 

With innumerous moving parts, how do we begin to recognize the potential for a mental health condition like depression?

We hone in on the everyday functions of our body.

The good news here is that we all know them: to eat, to sleep, to move, and to connect. The bad news is that these functions can be so subconscious that we forget to reflect on them. So let’s tune in.

Your body is talking

It’s easy to connect the dots looking backward. But by understanding and identifying potential signals early on, you’ll be better equipped to manage depression and thrive while doing it effectively.

Sleep changes

When it comes to sleep, even the smallest shift can be telling. Whether you’re finding yourself buried under blankets for 12 hours or staring at the ceiling at 3 a.m., changes in sleep habits and patterns can be meaningful. If slumber is a vehicle, then sleeping too much (or not enough) is the check engine light. Get under the hood, or find someone who can.

Energy levels

A lack of motivation or sudden loss of energy are two of the most common signals that your system can send when it needs additional support. We know that motivation comes and goes, but if the things that historically filled your cup now seem draining (or if your interest has waned entirely), it’s likely outside the realm of sporadic laziness.

Major — or minimal — appetite

True or false: Depression can interfere with taste receptors. (Hint: it’s true) And when your taste receptors are disrupted, your taste perception follows suit — so you can see where this could lead some to overeating, searching for the satisfaction of the flavors and textures they once loved. On the other end of the spectrum, however, depression and other mental health challenges like stress or anxiety can cause a total loss of appetite. Whether eating too much or not enough, depression’s effect on your relationship with food is a common one. 

A social shift

Finding yourself declining invites or letting messages sit unread? You’re not suddenly antisocial. Depression often makes us feel like we’re watching life happen rather than participating in it. Recognizing this pattern is actually a sign of self-awareness.

Aches and ailments

Like most other things, depression doesn’t exist solely in your mind; it can show up as headaches, muscle tension, or general physical discomfort. Your body and mind are connected— when one is struggling, the other often becomes symptomatic. 

A step (or leap) forward

Whether your body has sent you one or all of these signals, know that depression is treatable and that you’re not walking this path alone. Millions of people experience depression, and many have discovered effective ways to manage it. So start small with simple tasks — setting an alarm in the morning, making your bed, or sending a single text to a friend — or go big with professional guidance or support groups. But no matter the route, this is your reminder that there is light at the end of the tunnel.

The Link Between ADHD and Other Mental Health Disorders

A groundbreaking study from Sweden, analyzing health records of 5.5 million adults, revealed startling figures: individuals with ADHD are significantly more likely to be diagnosed with other psychiatric conditions such as bipolar disorder, depression, anxiety, and substance use disorders. Dr. Barry Herman, Chief Medical Officer at Mentavi Health, highlights the importance of recognizing these comorbidities. “Over 80% of patients with ADHD will have at least one additional psychiatric disorder, with many facing two or more,” he explains. This interconnection underscores the necessity for comprehensive assessments to diagnose and manage ADHD alongside these comorbid conditions accurately.

The Challenge of Diagnosing ADHD and Comorbidities

Identifying ADHD in the presence of other mental health issues is challenging due to overlapping symptoms. Conditions like depression and anxiety can exhibit symptoms similar to ADHD, making it difficult to tease apart the contributions of each condition. Dr. Herman emphasizes the significance of distinguishing these conditions for effective treatment. “Understanding what condition is contributing to what symptoms is crucial. Often, symptoms in depression or anxiety can look like ADHD symptoms, requiring skillful clinicians to ask the right questions.

Telehealth: A New Dawn for ADHD Care

Mentavi Health, under Dr. Herman’s guidance, is pioneering the use of digital health platforms to improve access to mental health care. Through its smart asynchronous assessment, Mentavi offers a comprehensive, tailored evaluation that can pinpoint ADHD and its common comorbidities. This digital approach allows patients to complete assessments at their convenience, potentially reaching those who might otherwise struggle to access traditional healthcare services due to geographical or logistical barriers.

ADHD and Adults

Dr. Herman is optimistic about the future of ADHD treatment, particularly for adults. Historically, ADHD was considered a condition that only affected children. However, it’s now recognized as a lifelong condition that can significantly impact adults. “There’s a huge unmet need for adults with ADHD,” says Dr. Herman. Through innovative approaches like the asynchronous assessment offered by Mentavi Health, there’s hope for better identification and treatment of adults living with ADHD and its comorbidities.

The intersection between ADHD and other mental health conditions is complex, requiring careful and comprehensive evaluation. Dr. Barry Herman and Mentavi Health’s approach to telemental health represents a significant step forward in making mental health care more accessible and effective. By recognizing and addressing the comorbidities often associated with ADHD, individuals can receive the holistic care they need to navigate their mental health challenges successfully.

Sources:

• PLOS ONE
• BMC Psychiatry
• European Archives of Psychiatry and Clinical Neuroscience
• National Comorbidity Survey
• Nordic Journal of Psychiatry
• Psychological Medicine
• International Journal of Adolescent Medicine and Health
• Current Opinion in Psychiatry
• The Primary Care Companion for CNS Disorders

To conclude ADHD Awareness Month, ADHD Online hosted two webinars, the third and fourth in its series of webinars this autumn. Four ADHD experts discussed two topics: Non-stimulant medication options for patients with ADHD and connections between ADHD, depression and anxiety.

Non-stimulant medication

In the third webinar on October 24, ADHD Online’s Chief Medical Officer Barry K. Herman, M.D., a board-certified psychiatrist, and Lakeisha Love, a nurse practitioner who is dual-certified in family medicine and family psychiatry, spoke about non-stimulant medication for ADHD.

Although doctors typically prescribe stimulant medications to patients with ADHD, non-stimulants are also an option — particularly for patients who don’t respond well to stimulants.

“About 20 to 30 percent of patients who have ADHD and are treated with stimulants do not do well for one reason or another,” Dr. Herman said. “Either they … don’t really improve that much with either class of stimulants or they have side effects that are very difficult for them to manage, (including) poor appetite, poor sleep, weight loss, (or feeling) jittery or agitated.”

Non-stimulants usually work for only 50% to 60% of patients with ADHD. But when they’re effective, there may be advantages to using them, the experts said.

“The non-stimulant medications are not scheduled drugs, meaning they don’t carry the same kind of risks that stimulants do for misuse or addiction,” Dr. Herman said.

Patients with ADHD need to be patient once they begin taking non-stimulants, Love said.

“You have to take it over time in order to see the long-term benefits to manage your ADHD symptoms,” Love said. “Typically, it can take about four to six weeks to see the full benefits. But you can start seeing some improvement as early as two weeks.”

During the webinar, Dr. Herman and Love also answered questions about the safety of non-stimulant medications for ADHD during pregnancy, the benefits of non-stimulants for patients with high blood pressure and whether stimulants and non-stimulants have different side effects.

ADHD, anxiety and depression

The fourth and final webinar, on November 2, featured David Toomey, D.O., a family physician with experience in psychological childhood trauma counseling, and Nicole Falcon, a certified family nurse practitioner who specializes in child, adolescent and adult psychiatry. They spoke about connections between ADHD, depression and anxiety.

It’s common for patients with ADHD to also have depression or anxiety.

“Eighty percent of the time, ADHD has a coexisting condition. Fifty percent of the time, people experience anxiety, and about another 15 or so percent is depression, with 7 to 8 percent of that is bipolar,” Dr. Toomey said.

Some patients with ADHD don’t realize that they also have anxiety or depression. The reverse is also true.

“They may get treated for anxiety or oftentimes depression, and sometimes the medicines don’t quite work,” Dr. Toomey said. “We (may) find that really underlying all of it is their ADHD.”

A number of treatments are available for all three conditions. Some medications can effectively treat ADHD while also treating anxiety or depression or both. But some patients need to take more than one medication — one to treat ADHD and another for depression or anxiety.

“I see a lot of patients that still need their antidepressant,” Falcon said. “The stimulant isn’t always effective in (treating) all of their symptoms.”

During the webinar, Dr. Toomey and Falcon talked about the impact that exercise can have on ADHD, depression and anxiety. They also answered questions about the importance of adopting healthy lifestyle changes, possible links between ADHD and autism and whether ADHD medication may cause symptoms of anxiety or depression.

Join our insightful webinar to uncover the relationships between ADHD, anxiety, and depression. Have you ever wondered how these disorders coexist and overlap, making diagnosis and treatment challenging? You’re not alone.

In this webinar, you’ll engage in a dynamic Q&A session led by two experienced speakers:

Dr. David Toomey: With 30 years of practice and a deep understanding of childhood trauma and family medicine, he will shed light on anxiety.

Nicole Falcon, FNP-C: A passionate advocate for holistic mental healthcare, she will explore depression comprehensively.

As a kid, Ian was labeled the ‘ADHD kid’ and even though his teachers observed some of ADHD traits, it wasn’t until years later when he was struggling in college that he sought out a diagnosis and then medication. Like so many with ADHD, Ian also struggled with some of ADHD’s comorbidities including depression and it was the sudden isolation of the pandemic, combined with stressors at work, that added fuel to his most recent bout of the mood disorder. 

This candid conversation is a reminder of all the different ways depression can show up in a person’s life and the power masking can have on a person’s life. For Ian, that masking was without a doubt his reliance on his sense of humor. He also shares how Cognitive-Behavior Therapy changed his life and what tools he continues to use to make sure he stays mindful and balanced. 

Having witnessed patients grappling with ADHD challenges in primary care, Lakeisha Love recognized the limitations of diagnosis and treatment in that setting. She decided to align with ADHD Online due to the founders’ personal experiences with ADHD, which drove them to establish a telemedicine company that could offer global accessibility to proper diagnosis and treatment. Lakeisha was drawn to the mission of dismantling mental health stigma surrounding ADHD and believed in the profound positive impact that tailored care could bring to individuals’ adult lives.

This episode discusses the connection between ADHD, depression, suicide and suicide ideation. If you or someone you know is experiencing suicidal thoughts, there is help. Call or text the number 988 to connect directly to the Suicide and Crisis Lifeline. If you do not live in the United States, here is a list of resources for help and support in other countries around the world.

Having witnessed patients grappling with ADHD challenges in primary care, Lakeisha Love recognized the limitations of diagnosis and treatment in that setting. She decided to align with ADHD Online due to the founders’ personal experiences with ADHD, which drove them to establish a telemedicine company that could offer global accessibility to proper diagnosis and treatment. Lakeisha was drawn to the mission of dismantling mental health stigma surrounding ADHD and believed in the profound positive impact that tailored care could bring to individuals’ adult lives.

This episode discusses the connection between ADHD, depression, suicide and suicide ideation. If you or someone you know is experiencing suicidal thoughts, there is help. Call or text the number 988 to connect directly to the Suicide and Crisis Lifeline. If you do not live in the United States, here is a list of resources for help and support in other countries around the world.

Women with ADHD are at a higher risk than women without ADHD to be diagnosed with postpartum depression (PPD), according to a recent study conducted in Sweden. Researchers found that mothers with ADHD who have no history of depression are 24% more likely to be diagnosed with PPD than mothers without ADHD who have no history of depression.

The Study

Postpartum depression can happen during pregnancy or the first year after a mother gives birth. It can include strong feelings of worry, sadness, shame and fear. It is the most common complication after having a baby, affecting about one in seven mothers who are pregnant or have recently given birth.

More than 77,000 pregnant women participated in the Swedish study to determine whether pre-pregnancy ADHD was correlated with a risk of developing PPD. Those with ADHD were compared to those without ADHD. And the researchers considered — and removed any possible effects from — the participants’ race and ethnicity, social vulnerability, maternal age, single or multiple births, and whether they reported substance use, food scarcity, intimate partner violence and stress. The rate of PPD diagnoses was 6.4% among mothers with an ADHD diagnosis versus 5.2% among mothers without an ADHD diagnosis.

The researchers’ work was prompted by both a March 2023 study that found an increase in ADHD diagnoses among women of childbearing age and 2018 research from the U.S. Centers for Disease Control and Prevention that self-reported postpartum depression symptoms were increasing.

Living with ADHD means managing symptoms like impulsivity, inattention and emotional regulation issues on a daily basis. During the postpartum period, these challenges can be amplified by hormonal fluctuations, sleep deprivation, disrupted routines and the additional stressors of caring for a newborn. All of this can contribute to feelings of overwhelm, anxiety and depression. Women from the Swedish study diagnosed with PPD described struggles with overwhelming sadness, anxiety and a sense of disconnect from their newborn.

Real Mom Experiences

Daniela Aachen, a travel expert and co-founder of Discover Italy, based in Berlin, Germany, has ADHD and experienced postpartum depression after the birth of her child.

“As a woman with ADHD, I know firsthand how difficult it can be to manage the stressors of life while also managing symptoms of a mental health disorder,” she says. “I was fortunate enough to have a good support system in place after my child was born to help me cope with the feelings of depression I was having, but I know that not all women with ADHD are so lucky.

Aachen believes it makes sense that women with ADHD are more likely to experience PPD.

“Women with ADHD can feel overwhelmed as a result of the shift in lifestyle that often occurs after having a baby, and there can be a lack of understanding from partners or friends,” she says. “My ADHD symptoms were heightened, and I struggled more with organization and staying on task.”

Ginelle Krummey is a licensed clinical mental health counselor at Growth Point Collaborative Counseling and Group Facilitation in Marshall, S.C. She’s also the mom of a one-year-old who experienced the interaction of ADHD and PPD.

“I do not have severe ADHD, but I do have neurodivergent traits,” she says. “I experience

plenty of ADHD struggles: impulsiveness, prioritization difficulties, low frustration tolerance, problems following through, errors in executive functioning and hyperfocus.”

The responsibilities of caring for a newborn clashed with Krummey’s typical approach to getting things done, which she describes as a more spontaneous and follow-your-nose approach, doing one thing after the other in a string of impulses.

“Doing this with a child was nearly impossible,” she says. “With the brain fog of hormonal shifts and resulting emotional instability from loss of sleep, nothing felt good or satisfying.”

Krummey says these feelings led to depression, and she would reach the end of each day feeling let down by her circumstances.

“I found myself grieving that I hadn’t done anything I considered valuable,” she says. “It was impossible to be satisfied by the miraculous reality that I was keeping a child alive with my body alone because there was a new set of demands impeding my ability to follow my own interests.”

Recognizing the Symptoms of PPD

Postpartum depression can interfere with a mother’s ability to care for her baby and handle other daily tasks. There are many symptoms; and while they often occur immediately after someone gives birth, they can appear during pregnancy or for up to a year after delivery.

• Depressed mood, severe mood swings or crying too much
• Difficulty bonding with baby
• Withdrawing from family and friends
• Inability to sleep or sleeping too much
• Overwhelming tiredness or loss of energy
• Intense irritability and anger
• Hopelessness
• Feelings of worthlessness, shame, guilt or inadequacy
• Reduced ability to think clearly, concentrate or make decisions
• Restlessness
• Severe anxiety and panic attacks
• Thoughts of self-harm or harming the baby
• Recurring thoughts of death or suicide

Left untreated, PPD can last for months.

Getting Support

Not all women with ADHD will experience PPD, and there are steps that can be taken to manage symptoms, says Aachen. Those steps include seeking help from mental health professionals and engaging in supportive activities like attending therapy or support groups. Focusing on coping strategies and developing healthy relationships can create an environment of support and understanding that helps mothers manage their mental health, she says.

“I found comfort in talking to other mothers who had gone through similar experiences and this helped me feel less alone,” Aachen says. “It gave me strength and helped me to manage my feelings of depression. Not only did I have a better understanding of how to cope, but I also had an invaluable support system in place.”

Ila Dayananda is chief medical officer and obstetrician at Oula Health maternity clinics in New York City. She says that, while every mind is unique, it’s important to understand that ADHD is a significant risk factor to consider for postpartum depression.

“Every woman — but especially those with known risk factors like ADHD — can benefit from a solid support system of family, friends and medical professionals, particularly in the postpartum period,” Dayananda says. “Consultation from not just an OB/GYN but also a mental health professional can offer necessary guidance, diagnosis and resources.”

Amy Braun, a licensed clinical professional counselor with a private practice in Chicago, encourages women who are having issues to look for care designed for new moms.

“The good news is that there are perinatal mental health-certified therapists who specialize in working with new moms with both ADHD and postpartum depression,” she says. “ADHD symptoms during the postpartum period are unique and can have different presentations. It is important that moms with ADHD know that there is help and they can feel better.”

By Diana Kelly Levey

An editorial recently published in the Journal of Attention Disorders highlights a significant spike in ADHD stimulant prescriptions from 2016 to 2021 — with an especially steep increase from 2020 to 2021. And, the data shows, that spike was especially pronounced among women.

The editorial’s authors suggest the increase in these prescription stimulants could be due to a number of factors. Factors include overall efforts to improve education about adult ADHD and expanding access to ADHD care. Other factors include overwhelmed patients seeking treatment during the COVID-19 pandemic and more neurodiversity awareness movements and ADHD information online. And a final factor is likely more companies working with mental health providers and prescribing stimulants online.

The editorial’s authors, and ADHD experts throughout the U.S., are asking other questions about the reasons for the stimulant spike in females. Was it because women bore the brunt of the COVID-19 crisis from an economic standpoint? Was it because mental health issues, including symptoms of anxiety and depression, increased in women during this time?

Or, were doctors prescribing these stimulants to women because they were finally asking for them, or doctors were finally recommending them, after years in which women were underdiagnosed with ADHD?

Stephen P. Hinshaw, PhD, distinguished professor of psychology at the University of California, Berkeley and author of Straight Talk about ADHD in Girls: How to Help Your Daughter Thrive, says he thinks more stimulants are being prescribed to new populations for a few reasons.

“One, because of a legitimate recognition that women can and do display ADHD,” he says. “Second, the pandemic has placed a premium on self-regulation, fast tasking, and adaptation to new norms of communication and work — all of which are challenges for people — especially women — with ADHD.”

Another possible contributor, Hinshaw says, is people are increasingly able to receive stimulant prescriptions online without an in-depth assessment and careful diagnosis. (Read here about ADHD Online’s comprehensive and rigorous assessment and treatment processes.) A final possible contributor, he says, is that too many medical doctors are most familiar with ADHD medications — and not as familiar with other evidence-based, non-medication treatments for adult ADHD like cognitive behavioral therapy.

Over the past 25 years, things have changed in understanding of ADHD, particularly with more research recognizing that populations other than young boys have it, Dr. Hinshaw says.

“Girls can and do have ADHD in childhood … and girls are more likely than boys to show the exclusively inattentive ‘form’ of this condition,” he says. “Yet it’s precisely such inattentive, distractible, and/or poorly self-regulated behavior patterns that are more likely to persist into adulthood.”

In the past decade or so, experts have increasingly come to understand that many adults have ADHD, even though this neurodevelopmental disorder may not have been recognized during childhood or adolescence. And recognition of ADHD in women has particularly increased, because females have been so underdiagnosed historically.

Dr. Hinshaw says girls may have compensated, “with a lot of family support and with a lot of anxiety, to ‘cope’ with underlying ADHD.

Maura Charles, a product management consultant based in Long Island, N.Y., received an ADHD diagnosis last year — at age 48. She has been trying various treatment options to manage the symptoms.

Some of her symptoms came to light during the pandemic. Charles had difficulty completing household tasks despite the extra time at home, found herself devouring books (and going down research rabbit holes in the process), and struggled with to-do lists. But she now understands that some of those issues had been happening for a long time, as far back as she can remember.

In 2022, after less than a year of working with her, Charles’ psychiatrist suggested an ADHD assessment and found that she was at or above the threshold for all of the behaviors that indicate ADHD.

After receiving her ADHD diagnosis, Charles says, she felt relieved in some ways that her behavior and distracted tendencies “weren’t personal flaws.” It took a while to accept her diagnosis, she says. But after reading a lot about adult ADHD and working with her therapist, she came to truly understand that ADHD is a biological condition that wasn’t linked to her personality.

She also says she felt “angry” that previous therapists and psychiatrists never suggested the possibility of ADHD as they worked with her on managing anxiety throughout her 20s and 30s.

The increase in stimulant prescriptions for women has become especially noticeable over the past several years. But for a decade, the fastest-growing market for ADHD medications has been women, Dr. Hinshaw says.

“That’s largely because of the heretofore hidden nature of ADHD in women, along with delayed recognition until beyond adolescence, when post-secondary education, independence, vocational skills, etc. are at a premium,” he says.

For many years, providers assumed that the problem was “anxiety and/or depression” in women — not ADHD, Dr. Hinshaw says. This turned into a historical failure to recognize ADHD in women, he says.

“But only a trained clinician, experienced in differentiating anxiety and/or depression from ADHD — or realizing that they can occur together — can make the real call for their patient,” he says.

In their Journal of Attention Disorders editorial, the authors wrote: “ADHD needs to now take its rightful and more central place in adult mental healthcare.”

Perhaps it’s starting to and that’s why more stimulant medications were prescribed since 2016.

The editorial authors also hypothesize that the increase in stimulant prescriptions may relate to a wider range of providers writing the prescriptions — including primary care physicians, nurse practitioners and professionals working with online providers.

The authors suggest that high-quality education about ADHD and its symptoms is important as these new groups of providers may be more involved in treating people.

“Despite its prevalence, clinicians rarely receive relevant specialized training, and may have misconceptions about, or not even recognize, adult ADHD,” the editorial authors wrote.

Practitioners must understand that ADHD is typically chronic and persists into adulthood, but is often overshadowed by other conditions and disorders that often come with it — including addiction, depression, anxiety and personality disorders, the authors wrote. Practitioners must also understand that people not traditionally associated with ADHD — women, people of color and older adults — can have it.

Although Charles was prescribed a stimulant at first by her psychiatrist, she experienced adverse side effects and quickly went off it. Soon after, she started taking a nutritional supplement — Rhodiola rosea — upon her psychiatrist’s suggestion and her primary care physician’s supervision.

Some clinical trials have indicated the supplement may have anti-fatigue and anti-anxiety effects. Clinical trials are underway to study any possible positive effects for ADHD.

Charles was already taking the supplement to help with perimenopausal symptoms like night sweats. So her psychiatrist simply increased the dosage. So far, she says, she thinks it’s helped with cognitive functioning, like alertness and attention.

She’s also working on getting help beyond medications and supplements. “I started working with an ADHD coach who specializes in helping adults with ADHD,” she says. “So far, it feels very positive and like a way forward.”

Dr. Hinshaw recommends that adults recently diagnosed with ADHD should talk with their psychiatrists and primary care doctors about medication options, as well as meet with a mental health professional to talk and learn about coping mechanisms. They can also find help online or in-person support groups, and seek help and support through work.

He says people find the best results through a combination of medication plus cognitive behavioral therapy, learning organizational skills and time management, and a balanced lifestyle.

“It’s important that adults diagnosed with ADHD understand that there are clear side effects, and addiction potential, from stimulants,” he says. “So work with a trusted and experienced clinician.”

By Beth Levine

“God, always dreaming … Little girl, always running away. Never finishing what you started.” – Gong Gong, as played by James Hong, in the movie, “Everything Everywhere All at Once.”

When Everything Everywhere All at Once swept the Oscars last month, Asian Americans rejoiced in finally being seen in their total humanity. As Anne Anlin Cheng wrote in The Washington Post review of the movie: “To be an immigrant is to live in a fractured multiverse, one riven with geographic, temporal and psychical dissonances.”

But there is another group with geographical, temporal and psychical dissonances that is celebrating being represented realistically — if also metaphorically — in the movie: the ADHD community.

In a Salon interview, the movie’s co-director and co-writer Daniel Kwan noted that the original intent was to create a movie about chaos, which led his team to form the main character, Evelyn (played by Michelle Yeoh, who won the Best Actress Oscar for her role), as a woman with undiagnosed ADHD. Kwan and his filmmaking partner Daniel Scheinert began deep research into ADHD, leading Kwan to suspect that he had it. He has since been officially diagnosed and started therapy.

In the movie, Evelyn, a Chinese American laundry owner — overwhelmed by life, a failing business and an ever-growing IRS problem — is suddenly yanked through alternate universes (or “the multiverse”), where she is an opera singer, a martial arts expert and a chef, among many other identities. She has no time for her sweet husband, Waymond (Ke Huy Quan, who won the Best Supporting Actor Oscar for his role), who is so desperate to capture her attention that he serves her with divorce papers.

Her daughter Joy (Stephanie Hsu, who was nominated for a Best Supporting Actress Oscar for her role) is in a massive depression from her mother’s criticisms, a result of Evelyn’s anxiety about being judged. And part of the tax problem comes from trying to deduct expenses for her never-initiated career dreams: novelist, chef, teacher, singing coach, Watsu practitioner. If you are a person with ADHD, this may sound familiar: the inability to stay rooted in the present; anxiety over how you are perceived; the prickly feeling that you just didn’t get the same operating instructions that the rest of the world has gotten.

In fact, several people with ADHD who were interviewed for this article mentioned that the experience of watching the movie mimicked their everyday experience so realistically that they found it overwhelming and anxiety-inducing. Some had to stop after ten minutes.

“As Evelyn started to experience all of the bizarre events that took place, that feeling of confusion was overwhelming to me, much in the way that Evelyn seems to be confused by it all,” says Nick Priscott, 48, of Danbury, Conn., who was not diagnosed until a few months ago.

Stephanie Sarkis, PhD, a counselor, author and expert in ADHD, anxiety disorders, autism spectrum disorder and chronic pain, adds: “What Evelyn goes through in that movie could be like a Tuesday to somebody with ADHD.”

Here Are Ways that Everything Everywhere All at Once Explores the ADHD Experience:

• Evelyn cannot stay focused.

The movie’s opening shot is Evelyn sitting at a table that holds piles upon piles of tax forms she cannot begin to organize or make sense of. When people talk to her, especially about stressful things, no matter how hard she tries to stay present, she disappears into alternative universes that also demand her attention. The evil taking over the multi-verse that she has been tasked with saving is chaos. As Alpha Waymond (one of her husband’s alter-egos in the multiverse) tells her: “You have so many goals you never finished, dreams you never followed. You’re living your worst you.”

“When people with ADHD are under stress, we can start to drift. We just shut down and retreat to a safe space in our minds; Evelyn’s safe place was a fantasy world,” says Sarkis, who is the author of 10 Simple Solutions to Adult ADD: How to Overcome Chronic Distraction and Accomplish Your Goals and Making the Grade With ADD: A Student’s Guide to Succeeding in College With Attention Deficit Disorder.

• Evelyn is scared of being judged.

Her father has been criticizing her for her whole life, which makes her feel unworthy and ashamed. Even though he has never been supportive, she still craves his approval. She doesn’t want him to know about the tax problem, and throws an elaborate party for him to curry favor,

“This accurately portrays the heightened emotionality that is common among individuals with ADHD, where even a simple sentence of disapproval can feel overwhelming,” says Amira R Martin, a licensed clinical social worker, communication expert, psychotherapist and wellness professional.

• Evelyn’s undiagnosed ADHD is negatively affecting her relationships with her husband and daughter.

Evelyn is heartbroken when her husband surprises her with divorce papers, the only way he feels he can get her attention. “I don’t think she was ever intentionally ignoring or putting him down, but women with ADHD sometimes have no clue as to what’s going on in their interpersonal relationships. She was totally unaware of what she was doing to him and how he was suffering,” says Patricia Quinn, MD, a developmental pediatrician in Washington, D.C., and co-author of Understanding Women with AD/HD.

Her relationship with her daughter is also fraught because Evelyn can’t see how her criticisms have left her daughter feeling worthless and unseen. As Jobu Tupaki (a Joy alter-ego in the multiverse) says: “I was just looking for someone who could see what I see, feel what I feel.”

“That’s the way Evelyn’s father treated her, so that’s the way she’s treating her daughter. And when she realizes this, she knows this has to stop,” adds Quinn.

• Evelyn feels like she is lacking whatever everyone else seems to so easily have to get along in the world.

So let’s discuss the scenes where she and Deirdre (Jamie Lee Curtis, who won a Best Supporting Actress Oscar for her role) have hot dogs for fingers. It seems insane but it’s also how people with ADHD sometimes feel in the world — like something about them just doesn’t work. Metaphorically, they have to play piano with their feet because their fingers don’t work the way everyone else’s does.

But in a hopeful note, they can learn to adapt; they can learn to play a pretty decent Clair de Lune with their toes.

“Because I wasn’t diagnosed until I was about 33, I spent my entire life just thinking something about me was broken or incorrect,” says Ariel Fisher, 35, of Ann Arbor, Mich., who has written about her experience of watching this movie. “And if I just tried harder, and I tried to be more like everybody else, it would make life easier. And I just wasn’t trying hard enough.”

• Evelyn is exhausted.

She is trying to save the family business, repair her familial relationships, and well, that minor detail of being asked to save the universe. The woman is tired.

“The movie represented just how exhausting it can be, having to go from thinking about one thing, and you’re pulled somewhere else,” says Jack Lewis, 30, of Washington, D.C., who was diagnosed with ADHD three years ago. “Evelyn is talking to the IRS agent, and suddenly she is pulled out and is talking to someone else. It’s this whiplash of where your focus and energy have to be and it just wears you out.”

• Evelyn is searching for silence and peace. But once she gets it, she doesn’t know what to do with it.

At one point, Evelyn and Joy become rocks in a completely silent, wide open landscape. “I’m always searching for that moment of silence where the noise will finally stop,” Lewis says. “During that scene, I thought, ‘This is what my mind feels like.'”

Joy urges Evelyn to just sit with the quiet, enjoy it, but Evelyn can’t. It makes her anxious, so she chases Joy over a cliff. “It’s kind of an ADHD thing that you’re going to make something happen when life gets boring,” says Sarkis.

Everything Everywhere All at Once Can Help People With ADHD

The movie shows that people with ADHD can learn to adapt, and even thrive.

Quinn even suggests that it would be a good movie for people with ADHD to discuss with their therapists, to use as a jumping off point for how they feel.

At the end of the movie, Evelyn recognizes her patterns that have been holding her back and that, while she may be imperfect, it doesn’t make her a bad person and it doesn’t make her incapable. She can, in her own way, learn to play Clair du Lune with her feet.

In one of the last scenes, Evelyn is once again at the IRS offices and once again becomes distracted. Deirdre asks if she is listening and Evelyn says, “I’m sorry, what did you say?” But she says it calmly and with a smile. “We get to witness her have that magical moment of being okay with the reality of who she is,” says Martin.

The movie also validates, even celebrates, the ADHD experience, which can help viewers with ADHD feel seen and not so alone in their struggles. It can also help neurotypical viewers in understanding ADHD.

Fisher notes: “As someone who was diagnosed as an adult, and thinking about all of the other children, especially girls, who don’t get diagnosed until later in life, this kind of representation offers them an opportunity to see themselves more clearly than my generation did or any generation before.”

Priscott, in an email, goes even farther: “It illustrates the way in which life can come at people from so many directions, and can be so utterly overwhelming. It suggests the idea of a multiverse, where people could have been anything, but what I take from that is that people have picked up skills in their lives that they don’t even realize they have. As such, if people are able to clear their mind, they can utilize far more of their innate capabilities than they currently do. By doing so people can work through all of the clutter in their lives and mental state, and can drill down to finding what is important in their lives, what brings them joy (pun absolutely intended), and can learn to get the best out of their lives, and out of any challenge that faces them.”

And that, Sarkis says, is what is important about great art: “It’s something that you can see yourself in. So it might be somebody struggling with depression or anxiety, and they can see all of that and know they are not alone. And that’s what this movie can do for people with ADHD — give them a space to be seen, understood and even celebrated.”