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From the Armchair
TALKIATRY’S MONTHLY MENTAL HEALTH NEWSLETTER
This month’s mental health tip
When an anxious thought disrupts your day, try "rescheduling" it instead of pushing it away. Set aside time to revisit it later, and you may find the urgency has faded by then.
Three things a psychiatrist wants you to know about starting an SSRI
With insights from:
Nicholas Tamoria, MD
Chief Psychiatrist
How long does an SSRI take to work? It's one of the most common questions our psychiatrists hear. Here’s what they want you to know about the first few weeks on medications like Zoloft, Lexapro, Prozac, Paxil, and Celexa.
SSRIs can be very helpful, but give them time
Starting an SSRI is a commitment to a process, not a quick fix. These medications gradually increase how much serotonin is available in your brain. (Serotonin is a chemical that plays a key role in regulating mood.) Most people begin to notice improvement after four to six weeks, with the full benefit often taking six to eight weeks at the right dose.
Side effects may arrive—and leave—before the benefits do
During the first couple of weeks, some people experience mild side effects like nausea, changes in sleep or appetite, or increased anxiety. These are usually temporary and often improve before you notice a lift in mood. If side effects are difficult to tolerate, reach out to your clinician rather than stopping the medication on your own. Taking your SSRI at the same time every day helps keep medication levels consistent.
“Working” may look different than you expect
Many people imagine an antidepressant will feel like a switch flipping. In reality, the first signs of improvement are often more subtle: sleeping a little better, feeling more energized, or finding everyday tasks a bit easier. Tracking your sleep, energy, and mood each day, even if the changes seem small, can help you and your clinician see patterns and make informed decisions about your treatment.
DEEP DIVE
ADHD across gender and age
ADHD is a neurodevelopmental condition that affects attention, organization, and impulse control. An estimated 3-5% of children worldwide have ADHD, making it one of the most common reasons children and adolescents receive mental health care.
For a long time, a familiar image of ADHD was a hyperactive child who couldn't sit still in class, often a boy. That image isn't exactly wrong, but it leaves out many experiences of ADHD. For decades, much of the research on ADHD focused primarily on boys, shaping how the condition was recognized, diagnosed, and understood. As a result, many people whose symptoms didn't fit the classic stereotype—including many girls and women—went years without answers.
Here's what to know about how ADHD can present across gender and age.
Why ADHD is often missed in girls
ADHD, short for attention-deficit/hyperactivity disorder, doesn't look the same in everyone. It has three presentations: inattentive, hyperactive-impulsive, and combined. People with the inattentive presentation may have trouble focusing, keeping track of tasks, staying organized, or remembering everyday details. Those with the hyperactive-impulsive presentation may feel restless, interrupt others, act impulsively, or find it difficult to sit still. Many people experience a combination of both.
Compared with boys, girls are more likely to have symptoms that are primarily inattentive rather than hyperactive. They may seem dreamy, disorganized, forgetful, or easily distracted instead of outwardly restless. Because these symptoms are often less disruptive in a classroom, they're also easier to overlook.
Many girls also develop strategies to compensate for their symptoms: double-checking every assignment, relying on detailed to-do lists, or working much harder than their peers to stay on top of things. From the outside, they may appear to be managing well. On the inside, it can be exhausting.
Want to learn more? Read our guide on ADHD and burnout in women.
How ADHD changes over time
ADHD doesn't disappear in adulthood, but it often changes. Hyperactive and impulsive symptoms may become less noticeable with age, while inattentive symptoms can persist or become more prominent. The child who couldn't sit still may become an adult who feels mentally restless, struggles to follow through on tasks, or finds it difficult to stay organized while managing the demands of work and daily life.
For people whose ADHD wasn't recognized in childhood, symptoms that were once overlooked or dismissed may become harder to ignore as life's demands increase. School, work, parenting, and other responsibilities can make challenges with attention and organization more noticeable. Even then, they're often attributed to stress or personality rather than ADHD, which is one reason many adults, particularly women, aren't diagnosed until later in life.
Why anxiety and depression can complicate the picture
ADHD frequently co-occurs with anxiety and depression, and the relationship between these conditions is complex. Children, adolescents, and adults with ADHD are more likely to experience both anxiety and depression than those without ADHD, and girls and women appear to be at particularly high risk.
Research suggests that girls with ADHD are more likely than boys to first receive a diagnosis of anxiety or depression. Those conditions are real and deserve treatment, but ADHD may also go unrecognized. As a result, many women reach adulthood having received care for anxiety or depression without realizing ADHD has also been contributing to their challenges.
If treatment for anxiety or depression hasn't fully addressed what you're experiencing, it's worth asking a clinician whether ADHD could be part of what’s going on. For people living with both ADHD and anxiety or depression, treating ADHD may help improve those symptoms as well.
What a diagnosis later in life can mean
A later ADHD diagnosis isn't a failure, and it's not too late. Many adults describe finally receiving a diagnosis as a turning point, providing a name for patterns they'd spent years blaming on themselves.
Understanding that chronic disorganization, difficulty focusing, or feeling overwhelmed may reflect a neurodevelopmental difference and not a character flaw can be validating. Medication, therapy, coaching, and practical skills can all help people manage ADHD symptoms and improve day-to-day functioning at any age.
If you think you might have ADHD, take Talkiatry's free online assessment to find an experienced clinician who can help.
ON THE SHELF
Book recommendations from our clinicians
No Bad Parts: Healing Trauma and Restoring Wholeness with the Internal Family Systems Model by Richard C. Schwartz, PhD
Learn more about the conditions we treat
ADHD
Anxiety
Depression
PTSD
OCD
Bipolar disorder
Insomnia
Mood disorders
Postpartum
Substance use disorder
Children’s mental health
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