Do stimulants change your personality?
That's what I'm talking about today.
I'm Dr. Tracey Marks, a Psychiatrist,
and I make mental health videos.
If you look up this question on the internet,
you will probably find that the short answer is no.
I've done my own research and on very reputable sites
like WebMD,
where someone asked this question and the answer was no.
But if you really do a deep dive into the research
on how these medications effect the brain,
the longer answer is, probably.
And I think the reason for the no answer is because
of how we define personality.
Your personality is really something that develops
in adolescence to early adulthood,
and is based on a number of factors
including your genetics, your environment,
how you were nurtured, etc.
Probably the most popular personality disorder
that we hear about is Narcissistic Personality Disorder.
And I would agree that it is going too far
to suggest that these medications could make someone
a narcissist.
But in my own experience in treating patients,
I've seen how these medications have changed the way
that people behave and feel.
Would this be considered changing your personality?
Probably not, but I do believe that when you are taking
the medications they effect aspects of your personality
like how you express yourself.
But this effect on your behavior is temporary,
and it resolves when you stop taking the medication.
My own clinical experience is not research-based,
and it would be considered anecdotal
based on a small sample size of people who I've seen.
So the disclaimer here is that this is my opinion,
and my opinion is that stimulants can cause
flattening of your emotional expressions,
irritability, sadness, and even depression.
It can be similar to the emotional blunting
that you can get with anti-depressants,
and I did a video where I explained this side effect.
I think it's easier for adults to appreciate
that they're behaving or experiencing things differently,
but for adolescents it can be hard for them
to see the medication as the culprit.
They can just sink into a depression
and have angry outbursts, isolate themselves,
or just think that this is how they are
or this is how life is.
I scoured the internet looking for articles
to support my opinion, and I found very little.
I did see articles though, that talked about
how stimulants affect the developing brain of adolescents,
and probably negatively impacts neuroplasticity.
This article was very hard to decipher,
and I have it and others listed in the description.
But that's not the effect I'm talking about.
This has to do with whether stimulants permanently change
the way you process information if you start
taking them before your brain is fully formed.
The human brain fully matures somewhere between
the mid to late 20's.
But I did find a couple of articles that talked about
ADHD and emotional regulation,
and this is how I feel it supports what I see in real life,
that for some people stimulants can blunt your emotions.
And there are several areas of the brain
that are involved in executive functions like attention,
concentration, ability to complete a task
or delay an impulse.
And one of the major regions is the pre-frontal cortex,
this is where the medications for ADHD work in the brain.
They increase norepinephrine and dopamine
in this area of the brain.
People with ADHD also have impaired mood regulation,
and this isn't to the extent that you would see
like in Bipolar Disorder.
We're talking about being overreactive,
like jumping to a quick conclusion,
before you have a chance to give it more thought.
So here's where I think the emotional blunting
comes into play.
The emotional reactivity that you get with ADHD
shows up on functional imaging as heightened activity
in the medial pre-frontal cortex.
Stimulants reduce the reactivity in this area,
and therefore have the effect of making the person
with ADHD less reactive.
And this is supposed to be a good thing,
and many people will experience it this way.
If that's you, you may feel like you're less sensitive,
or you have the ability to hold back on your thoughts
before speaking.
But maybe with some people, this effect goes too far,
and blunts you down to where you feel and appear flattened.
Also there's research that shows a bell-shaped
response curve to the stimulants.
At low doses of the medication,
you get improved emotional regulation
and cognitive function,
but at high doses you go backwards and see
irritability and impaired cognitive performance.
So when it comes to developing depression symptoms,
another possibility is that your dose puts you
past this point on the curve,
and you're in the zone of feeling irritable
and having a low mood.
Because of the differences in metabolism and body weight,
it's hard to know what dose will have this effect.
It's normal to develop a tolerance to the medication,
such that you need more over time to get the same effect.
You're still getting increased norepinephrine and dopamine
in your pre-frontal cortex,
it just doesn't have the same beneficial effect.
So you increase the dose, and you increase the amount
of norepinephrine and dopamine,
and you start to respond again and your attention
and focus improve.
But because you have even more norepinephrine and dopamine,
that higher dose may put you into the bad zone
when it comes to your mood.
Now these are just my hypotheses for whatever that's worth,
but the flattening, the feeling like an emotional zombie
or feeling outright depressed,
is a real thing when taking stimulants,
despite the fact that there's not much
written about it in the literature.
And I've seen this lack of literature thing before.
For years, Psychiatrists like me,
little folks in private practice who aren't
on the forefront of research,
knew and saw that withdrawal from certain anti-depressants
gave people brain shocks.
I did a video on this that you can watch
at the end of this video,
the link will be in the description.
And for years, I never saw much written about it.
It's only been recently that I've seen articles
about the phenomenon.
In fact, one of the articles I saw was based on
online research from people in a mental health forum
talking about the effects.
So the researchers surveyed those people
and got their feedback.
Some articles have been critical
of the American scientific community,
for ignoring the issue for so long.
So I suspect this issue with stimulants
may be a similar situation,
and at some point in the future,
we may see more written about this.
But to be clear, I'm not against the use of stimulants
to treat ADHD.
For some people they're a game changer.
It's like the medication turns on the lights,
and makes you feel that you really are smart,
and you can do well.
But this issue of emotional blunting,
or depression when taking them,
is just something to look out for,
especially in children and adolescents.
Changing the stimulant to a different drug may help.
It really has to be a personal decision
whether or not you take medication for your attention,
or whether you allow your child to take stimulants.
Those developmental years are very important,
and it can be hard for a child to recover
from a rocky academic start.
But on the other hand, there are studies that suggest
that these medications can have more permanent change
in the brains of children and adolescents
than it otherwise would in adults.
If your attention deficit, or hyperactivity
is causing serious functional problems at work or school
or even in your home life,
then the risk of taking stimulants may outweigh
the negative, or any negative effect that it may have
on your emotional expression
or on your child's brain development.
I talk more about ADHD as a brain disorder in this video.
See you next time.