Episode summary
Mel Robbins interviews psychiatrist Dr. Sasha Hamdani on adult ADHD, with a focus on symptoms that extend beyond attention and hyperactivity to include emotional regulation, overwhelm, sleep and appetite disruption, and fluctuating motivation and energy. Hamdani argues that ADHD is widely misunderstood because diagnostic criteria were developed around highly observable behaviours in young boys, which she says contributes to under-recognition in women and adults whose impairment may be more internalised. She also contends ADHD can be both overdiagnosed and underdiagnosed depending on population and access to care, and describes stigma she says she has encountered from clinicians and school administrators.
Hamdani explains a simplified neurobiology model in which an over-reactive emotional centre and a less responsive prefrontal “filter” can contribute to intense mood swings and difficulty modulating responses. She discusses dopamine as a timing-and-placement problem rather than a simple deficiency, and describes how hormonal stages—puberty, postpartum, and perimenopause—can change presentation in women. A key segment centres on rejection sensitive dysphoria, which Hamdani claims appears in “almost 100%” of ADHD patients, and the pair walk through how neutral cues (including text messages) can trigger rumination and avoidance.
The episode then turns practical: Hamdani advises tracking symptoms (task initiation/completion, sleep, mood) for roughly two cycles in women, seeking evaluation from appropriate clinicians where possible, and considering a range of treatments. She outlines stimulant and non-stimulant medication classes, emphasises therapy and behavioural ‘scaffolding’, and stresses that medication should not be forced. Robbins shares her own account of long-term anxiety treatment before seeking an ADHD evaluation later in life.
