“When Dopamine and Norepinephrine Work Together, It is Easier for us to be Focused and Motivated.” —Sarah Daccarett, MD
Attention Deficit Disorder (ADD) and can include hyperactivity (ADHD) is a form of neurodiversity represented by differences in neurotransmitter chemistries. These neurological variations are to be recognized and respected as we would any other human difference.
ADHD has long been associated with childhood, but in recent years, there has been a noticeable rise in the diagnosis of ADHD among adults. This phenomenon has sparked interest and raised questions about the nature of ADHD, its prevalence, and the factors contributing to this increase. Traditionally, it was believed that it diminished or resolved with age. However, research and clinical practice now recognize that ADHD can persist into adulthood, albeit often with different manifestations:
- Memory/recall difficulty
- Word finding is impacted
- Difficult time completing tasks
- Inability to concentrate
- Anxiety
- An innate feeling of anxiety if a person sits still for a long period of time
What is contributing to the rise in adult ADHD?
- Increased awareness and knowledge. One significant factor contributing to the rise in adult ADHD diagnosis is the increased awareness and understanding of the disorder among healthcare professionals, mental health practitioners, and the general public. This growing awareness has led to improved recognition and assessment of ADHD symptoms in adults.
- Shifting cultural attitudes. Cultural attitudes toward mental health have changed, reducing stigma and encouraging individuals to seek help for their symptoms. This has led to more adults seeking professional evaluation for potential ADHD symptoms they many have experienced since childhood.
- Recognition of gender differences. There is growing recognition that ADHD manifests differently in women compared to men. Historically, ADHD was more commonly diagnosed in boys, potentially leading to under diagnosis or misdiagnosis in girls and women. The increased awareness of gender differences has contributed to the rise in adult ADHD diagnosis, particularly among women.
Is it Adult ADHD, or is it Hormone Deficiency?
As women get near the age of 40, hormone deficiencies often lead to brain fog, anxiety and inability to concentrate. Women often report poor memory recall, difficulty finding the right words and having a hard time completing tasks. They report sleep disturbances and restless legs. They also describe an overwhelming sense of anxiety if they sit still for a long period of time and they often wake up with this anxiety. Once these women start hormone replacement therapy they also find most of these ADHD-like symptoms disappear or improve significantly.
ADHD symptoms and low hormone symptoms can overlap because low dopamine and epinephrine are the hallmarks of ADHD. Estrogen is needed to make dopamine and epinephrine in women, so when it is low, they can present with ADHD, or worsen existing ADHD.
This can also often be the case for individuals who have struggled since childhood — they too improve on hormone replacement therapy because estrogen boosts dopamine production. Individuals with genetically inherited traits that potentially make their ADHD worse may need additional natural therapies, but they do see the benefits from hormone replacement therapy — on their anxiety, mental capacity, memory and focus. Before we dive into why estrogen benefits ADHD, but first lets discuss why traditional therapy has its limitations and potential long-term consequences.
What is the Long-term Consequence of Traditional Therapy for ADHD?
With the rise in awareness and diagnosis, practitioners will often put women over 40 on a pharmaceutical stimulant to help them get through their day.
Traditional medications include:
- Amphetamine/dextroamphetamine (Adderall, Adderall XR)
- Lisdexamfetamine (Vyvanse)
- Methylphenidate (Ritalin, Concerta, Metadate, Daytrana, Quillivant XR and Methylin)
- Dextroamphetamine (Dexedrine)
- Dexmethylphenidate (Focalin)
Amphetamines stimulate the adrenal glands to produce more and more cortisol over the long-term. In the short-term elevated cortisol helps us through stressful situations. However, in the long-term, cortisol also shuts down “non-priority” functions like reproduction and the immune system, which is a natural survival mechanism to help us deal with the stressor. This impact on the immune system makes the body more susceptible to pathogens like viruses, bacteria and fungi. In addition, when cortisol is high, little to no bone growth and little muscle growth occurs. Overall, there is reduced thyroid function, blood sugar imbalances (weight gain despite low appetite), insomnia, osteoporosis, lowered immune function, infertility and increased abdominal fat.
High cortisol is also why women on stimulants have a difficult time losing weight despite the fact that they don’t eat much while on them.
High, chronic cortisol also causes increased gut permeability because it breaks down the GI lining by slowing down motility and the process of digestion. High cortisol can be the sole reason for having a leaky gut. Some people experience constipation and/or reflux (“heartburn”). This breakdown of the GI barrier leads to lower BDNF in the brain. BDNF is basically food for brain cells and it plays a role in neurogenesis throughout our lives. ADHD individuals already tend to have low levels of BDNF and it is worsened by chronically elevated cortisol. Cortisol is also a direct neurotoxin resulting in impaired cognitive performance, or “brain fog.” In the long-term amphetamines result in reduced focus by increasing brain fog.
Could Estrogen be Effective for Adult ADHD in Women?
Recent research has shed light on the potential role of estrogen in ADHD, specifically its impact on dopamine, a key neurotransmitter involved in ADHD. Dopamine is a neurotransmitter that plays a crucial role in various cognitive functions, including attention, reward, and motivation. Decreases in dopamine activity have been linked to ADHD symptoms. Estrogen has been found to influence dopamine transmission, thus implicating its potential role in treatment of ADHD.
1. Estrogen's Influence on Dopamine:
Estrogen has been shown to modulate dopamine levels and activity in the brain. It affects dopamine receptors, transporters, and the enzymes involved in dopamine metabolism. Some studies suggest that estrogen enhances dopamine function, potentially improving attention and cognitive processes associated with ADHD.
2. Estrogen’s potential influence on norepinephrine
Estrogen has been found to influence the synthesis, release, and reuptake of norepinephrine in the brain. It may enhance the availability or activity of norepinephrine, leading to increased levels of this neurotransmitter. The interaction between estrogen and norepinephrine is complex and the precise mechanisms and effects are still being explored.
3. Estrogen’s impact on the cholinergic system:
The cholinergic system, which involves the neurotransmitter acetylcholine, plays a role in various cognitive functions, including attention, learning and memory. Although ADHD is primarily associated with low dopamine and norepinephrine, research has also implicated the cholinergic system. Estrogen has been found to influence this system, including increasing acetylcholine, and acetylcholine receptors and enzymes involved in acetylcholine metabolism. Although the research findings are not entirely consistent at this point, it is still very promising.
4. Perimenopause, menopause and ADHD symptoms:
Some women with ADHD report worsening of symptoms during perimenopause and menopause when estrogen levels are lower. This supports the notion that estrogen may have a regulatory effect on ADHD symptoms, mood and cognitive functioning.
5. Estrogen and Treatment:
Research exploring the effects of estrogen-based therapies on ADHD symptoms has yielded mixed results. Some studies suggest that hormone replacement therapy (HRT), may have a positive impact on ADHD symptoms, particularly in women.
Promising Future Directions
While the connection between estrogen and ADHD is intriguing, it's important to approach the topic with caution and consider several factors:
- Individual Differences: Each person's experience with ADHD is unique, and the impact of estrogen on symptoms may vary among individuals.
- Comprehensive Treatment Approach: Estrogen alone may not be a stand-alone treatment for ADHD. It should be considered as part of a comprehensive treatment approach that may include medication, behavioral therapy, and lifestyle modifications.
Estrogen's potential role in ADHD and its impact on dopamine, norepinephrine and acetylcholine pathways provide intriguing avenues for further research and potential therapy. Preliminary evidence suggests a potential link and by advancing our understanding of the interplay between hormones and ADHD, we may gain insights that contribute to more personalized and effective treatment approaches for women with ADHD.
A holistic approach to neurodiversity is needed to help anyone who believes they may be suffering from ADHD symptoms. Often hormone deficiency when women enter into their 30s and 40s (and beyond) will present with ADHD-like symptoms and estrogen deficiency should be considered by any provider. Stimulants used to treat ADHD have been shown to raise cortisol long-term and also has a potential increased risk for Parkinson’s Disease. Estrogen therapy isn’t known to carry these same risks and side-effects. Additional natural therapies can be used in connection with hormone replacement therapy, especially in those women with more severe symptoms, or who carry genetic traits that make them more susceptible to neurotransmitter imbalances.
At Inner Balance we support neurodiversity as well as a holistic natural approach to treatment. Hormone replacement therapy is beneficial for women who have both hormone deficiency and ADHD-like symptoms. It can also potentially improve ADHD in those who have had it since childhood.
“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”