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So what was I talking about again???? Oh yes, 'Brain Fog'!

So what was I talking about again???? Oh yes, 'Brain Fog'!

by Siobhan McNulty in Blog
Many of us use the term 'Brain Fog' these days when we forget something or if our brain feels a bit fussy. But what exactly is it?
In the following blog, 4th year secondary school student (transition year), Clara Gallagher discusses brain fog and how people can tackle it. Clara was doing some work experience and research with us in Melvin Pharmacy.
Keep reading, this is really interesting. 

What is brain fog?

Brain fog is a term for slow, fuzzy, and sluggish thoughts. Brain Fog is not a medical or scientific term, but a term given to a variety of symptoms including poor concentration, slow thoughts, forgetfulness, mental fatigue, sluggish thoughts, lack of clarity, mental confusion and feeling out of it.  Brain fog can be experienced by anyone of any age, even children. 

What does this mean for people?

People experiencing these symptoms can also struggle to concentrate, remember things, think clearly or put thoughts into words and often can find information exhausting.

Who does Brain Fog affect?

People with
  • ADHD ( Attention deficit hyperactivity disorder),
  • chronic stress,
  • sleeping disorders,
  • eating disorders,
  • nutritional deficiencies,
  • hormonal changes,
  • menopause
  • long covid
  • and other complex conditions are more susceptible to brain fog, such as hypothyroidism, fibromyalgia, dehydration, multiple sclerosis, dehydration
  • taking drugs that induce drowsiness. 
Many of the symptoms of brain fog, such as memory loss, are accustom to ageing, so a person age must be taken into account, although brain fog can be experienced at any age with many different causes.

Brain fog has similar symptoms to

  • sleep deprivation
  • stress
  • minor head injury
  • recovering from Covid
  • recovering from other infections
  • menopause

 

 

It is common for those who suffer from anxiety and depression to have brain fog.

Lets look at the causes of Brain Fog more closely!

  1. Stress - Stress can cause increased blood pressure, weakening the immune system which can cause depression and mental fatigue.
  2. Lack of sleep - Poor sleep quality can interfere with how well your brain functions, leading to poor concentration and cloudy thoughts.
  3. Hormonal change - levels of hormonal progesterone and oestrogen increase during pregnancy. This change can affect memory and can cause short-term cognitive impairment. Hence the term 'baby brain'. Similarly, during the time of your period (menstruation), many women will also suffer pre menstrual symptoms - one of which is brtain fog. ((At the bottom of the page we've listed some supplements aimed at alleviating pre menstrual symptoms such as poor memory and concentration, and mood swings). 
  4. Similarly, during menopause drops of oestrogen levels can cause forgetfulness, poor concentration and cloudy thoughts. (At the bottom of the page we've listed some supplements aimed at alleviating menopause symptoms such as poor memory and concentration, as well as hot flushes, mood swings, fatigue and joint ache). 
  5. Diet -Vitamin B12 supports a healthy brain, but a vitamin B12 deficiency can affect how the brain functions causing brain fog. Vitamin B12 is found in almost all animal food stuffs, and often lacking in people who are vegan and vegetarian. It can also be lacking in people with certain anaemias, and taking medications such as metformin. 
  6. Those who have allergies or food sensitivities may experience brain fog after eating dairy, peanuts or aspartame.
  7. Screen time. Blue light can affect cognitive function. Spending to much time on screens can cause concentration problems.
  8. Medication. Brain fog can be a side effect of taking medicine particularly pain and sleep medicine. Antihistamines, particularly the drowsy ones can cause brain fog.
  9. Covid. Those suffering from covid 19 or long covid often find themselves suffering from brain fog. Covid itself can affect cognitive function, but also the psychological factors related to the pandemic can maintain and strengthen the symptoms of brain fog.
  • Anxiety related to the pandemic. Fear around the uncertainty of the virus led to increased levels of anxiety which causes worry and self-critical thoughts which affects concentration and can lead to many symptoms of Brain Fog.
  • Low mood related to the pandemic. Many people experienced low mood during the pandemic due to being lonely, worried about the future, experiencing loss in some way during the pandemic in some way and being unable to see family, family and socialize. These experiences leave people feeling down and in a low mood which can trigger short term cognitive impairment

    Tips to reduce Brain Fog

    Give yourself a break.

    Give yourself time to rest and allow yourself to relax giving you time to improve your performance, concentration and self-control. Having proper time to rest and unwind does not include grabbing for your phone, which can cause more problems, but spend time
    • Meditating
    • Taking a nap
    • Socialising with friends and family
    • Doing a hobby
    • Getting fresh air
    These activities give your mind time to reset and decrease stress.

    • Eat to feel well
    Making nutritious additions to your diet can help your health hugely.
    · Foods high in antioxidants
    Help reduce oxidative stress in the body resulting in a healthier mind and body. For example - blueberries, oranges, and nuts.
    -Staying hydrated is vital in mind and body health as the body is 75% water. Dehydration can affect memory and mood.
    -Fish. Fish is a nutritious brain food full of Omega-3 fatty acids, which is associated with lower rates of cognitive decline. Vitamins including fish oils is a great way to ensure you are getting all the nutrients such as omega-3 fatty acids found in fish.
    • Omega 3 cannot be made by the body. We only get them in food. Fish oil primarily contains two types of omega-3 fatty acids — EPA and DHA. However, EPA and DHA are usually found in 'fatty fish' which many of us do not eat.

     

    • If you choose a supplement, ensure you do your research. The way they are procured (made during manufacture) will ultimately determine how effective they are. It should be cold pressed. In addition, it should contain somewhere in the region of 500mg + of EPA and DHA combined (max 2000mg) or 250mg of DHA on its own. If its brain function improvement your after, opt for more DHA than EPA, or indeed just choose DHA/

     

    • Cheaper brands of Omega 3, may not fulfil all your requirements, as the extraction process of fish oils is expensive - therefore, they may be making false claims. Often you will see fish oils marked as 1000mg of fish oils - but they are filler oils, are the amount of actual useful components is very low.
    One Omega 3 fish oil that Melvin Pharmacy recommend is Revive Mastermind - it contains only DHA, 350mg. It also contains uridine and choline. Uridine is used in DNA and RNA synthesis, and is part of neurotransmitters. Choline is a precursor to Acetylcholine, an important neurotransmitter involved in memory. The Omega in Mastermind is from Marine Algae and not fish, therefore doesn't have a fishy taste, and is suitable for vegitarians.

     

     

    You can purchase Mastermind from Melvin Pharmacy by following this link

    Revive Mastermind 30 Sachets – Melvin Pharmacy Ltd (shopifypreview.com)

    • Exercise
    Exercised is linked with improved brain function. Exercise encourages proteins that improve brain function - endorphins, serotonin (our happy hormone) and dopamine. Exercise can also reduce anxiety, depression and distract us from stressful or upsetting thoughts.
    Activities such as  
    • Walking
    • Jogging
    • Yoga
    • Gardening
    • Stretching                                
    Are simple ways to ensure you are getting exercise.
    • Reduce coffee and Alcohol intake
    Caffeine causes jitters, headaches, insomnia, upset stomach and rapid heartrate which can affect your brain function. Excess of 4-5 cups of coffee a day is not recommended. Similarly alcohol is both a stimulant and a depressant which significantly impairs cognitive impairment. Once the level of alcohol decreases in your body, it can cause headaches, fatigue, anxiety and other symptoms of brain fog. Chronic alcohol use can lead to further cognitive impairment and neurological disorders such as dementia.

    • Prioritise sleep
    Getting enough sleep in vital in a person’s overall especially their mind health.
    · Try to go to sleep at the same time everyday
    · Avoid nicotine and caffeine which can interfere with sleep.
    · Keep your room dark.
    · Wind down at least an hour before sleeping by putting away electronics.
    - Don't take sleeping tablets, as they may make brain fog worse. If you want to take something natural to promote sleep, we recommend a non stimulant supplement with high quality magnesium. 
    One example is FabU R&R, formulated by an Irish Pharmacist called Laura Dowling. This can be used by men and women.

    Is there a 'cure' for Brain Fog?

    Brain fog is temporary and generally is related to lifestyle so some small changes should relieve you from brain fog and help you maintain a healthier lifestyle.
    However, if brain fog is disrupting your life, please seek help from your GP or pharmacist. There may be a treatable cause, for example, low B12 levels, side effects to medication, menopause, depression or pre menstrual symptom.
    Below are some supplements we mentioned for brain fog associated with menopause (these are safe to use with HRT). Cleanmarine and Revive Menoactive should not be taken by women with oestrogen positive breast cancer, or a close family member. This is because they contain isoflavones which are similiar to oestrogen. FabU Meno and Peri can be taken by women with a history of breast cancer. Click links for more advice. 
    Also below, are supplements we recommend for menstrual brain fog - click link to learn more
    Also below is a general supplement for brain fog for Men and Women 
    I hope you have enjoyed this blog - below are some useful resources

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    Alcohol - and the negative effect it has on your health.

    Alcohol - and the negative effect it has on your health.

    Do you need to rethink your drink Throughout February and March, the Health and Social Care Board (HSCB) has asked pharmacies to focus on and highlight alcohol use within NI. The campaign recognises that many people enjoy a drink out with family or friends, but it is a powerful drug and we need to be careful how we use it. The campaign focuses on harm reduction, not passing the recommended max weekly limit, and having several alcohol free days per week. I will discuss this, but I also want to take this a step further and outline some of the health benefits from alcohol reduction and the truck load of health issues that alcohol can contribute to. Unfortunately, there is now lots of evidence that suggests even drinking 1 unit of alcohol per day can increase your risk of breast cancer.  I myself gave up drinking alcohol approximately 3 years ago. Although I would have classed myself as a 'low level drinker', rarely passing the limit of 14 units of alcohol per week, I never thought I'd identify as someone who no longer drinks! I was doing a health detox and I knew alcohol was probably contributing to my weight gain. So I decided to take a break and I never restarted. And when I started to feel the health benefits of quitting, I wish I'd stopped sooner. Before I come back to my experience, I want to discuss alcohol usage within NI, and some of the negative health related effects of drinking alcohol. I was actually shocked at the profound effect alcohol can have on your health, even at low levels. I hope I don't sound like the alcohol police, but I do have a responsibility as a health professional to highlight anything that can negatively affect your health. Most people enjoy drinking alcohol sensibly and other than an occasional over indulgence, generally drink responsibly. However, it is becoming more evident that even low levels of alcohol usage can be very damaging to your health.  Here are a few facts -  The Northern Ireland Health Survey shows that in 2022/23 over three quarters (77%) of adults aged 18 and over reported that they drank alcohol. Over four fifths of males (81%) and almost three quarters of females (74%) were drinkers. The Department of Health (DoH) recommends not exceeding 14 units per week for both males and females. A quarter of male respondents (25%) reported drinking above recommended weekly limits, while this was true for almost a tenth of female respondents (9%). Drinking prevalence tends to decrease with age. In 2022/2023 over four fifths of those aged 18 to 54 reporting drinking alcohol, while around three quarters of those aged 55 to 74 and around half of those aged 75+ reported drinking alcohol. Those aged 18 to 34 were less likely to drink alcohol three or more times a week than all other age groups.  In 2022/2023, over four fifths (82%) of those living in the least deprived areas were drinkers, while three quarters (75%) of those living in the most deprived areas reported drinking alcohol. As with most activities, drinking alcohol carries a degree of risk. Ok, so lets see where your alcohol intake is at - (this will also help define what I mean by low level, moderate level and wholly dependent alcohol usage is) Click on the link below to see the Alcohol MOT more clearly https://www.publichealth.hscni.net/sites/default/files/2023-12/Alcohol_MOT_Part1_2022.pdf     Be honest and add up your score. If you score more than 8 or more then alcohol could be harmful to your health. A score of 20 or more indicates a dependency on alcohol and I will link groups and organisations that can help. What are the harmful affects of alcohol? So, we all know many of the harmful affects of alcohol. Generally however, what we know is about extreme alcohol usage or social issues.  For example, alcohol abuse is cited in 50% of marriage breakdowns 55% of domestic abuse cases. The perpetrators where drinking prior to assaulting their victim. 14% of sexual offences 40 - 50% of suicides. 17% of all road traffic accidents  But we tend to not highlight the health effects as much.  Did you know this -  Women are more likely to develop breast cancer from low level drinking than they are from using HRT. The same HRT patches that were snatched off women over night 20 years ago when one report WRONGLY suggested HRT was strongly linked to breast cancer. So we didn't warn women about the risks of alcohol and breast cancer (which is higher), but we stopped their HRT!   It is estimated that 1 in 10 cases of breast cancer are directly related to alcohol. Alcohol increases the amount of oestrogen in the female body. You do not need to be a heavy drinker, drinking 1 unit of alcohol per day, increases your risk.  This actually blew my mind! So low levels of alcohol usage are linked with breast cancer in women and high alcohol use is linked with breast cancer in men! You are more likely to develop cancer of the mouth, oesophagus, liver and  stomach and throat if you drink alcohol.  Regular drinking above recommended max limits can increase your blood pressure and cholesterol levels.  Regular drinking of alcohol lowers your ability to fight infection. It can reduce your libido. People with lower body weight need to be much more careful than those of heavier body weight when they drink alcohol as they are more prone to the affects of alcohol. Hence the term 'light weight'. This is why teenagers need to be very careful with alcohol! People who both smoke and drink regularly are more at risk of alcohol related disease than those people who drink the same amount of alcohol but don't smoke.  And then we have all the falls and accidents related to alcohol!     For me, giving up alcohol has been overwhelming positive. I initially stopped temporarily to lose weight, but I kept it up for the health benefits.  I might have only indulged in 2-3 glasses of wine a week, but without it, I have more energy, less brain fog, sleep better and I have better exercise tolerance. I'm also was less anxious on a Monday morning and I did lose a bit of weight!      But, while on this detox and starting to feel better I actually reading about all the negative effects of alcohol on my health. When I read about the breast cancer risk, I suddenly had a 'pull goal'.  A pull goal is a goal that was more appealing to me than drinking was. While I wasn't a heavy drinker, I was reading facts that suggested even drinking one unit of alcohol a day was bad for your health. 1 in 2 people will get cancer in their lifetime, with breast cancer being one of the most prevalent cancers in women. So if I can push that one down the road a bit further, I decided I would. As I kept reading - I established a link between alcohol and menopause! Yes ladies - the good news keeps coming. So high levels of alcohol are thought to make flushing worse (although I should point out - low levels may help flushing).  I'm linking some info about alcohol and menopause here  https://www.ascert.biz/alcohol-and-menopause/ A point I wish to make here, is any reduction in alcohol is beneficial for your health. Complete abstinence is not for everyone - I totally understand that.  If you drink everyday, drinking every other day is a huge reduction. The more days between drinks the better. If you drink 6 pints a night, reducing the 4 pints a night will benefit you. Its hard to break habits. But the worse thing you can do, is do nothing.  Below shows you the number of units in alcoholic drinks. Be aware - the guidance is now the same for men and women, max of 14 units per week. You should avoid drinking all 14 units on the same day and leave several alcohol free days between drinks. If you are worried about your drinking, or that of a partner, family member or friend, I will link some groups that can help. https://www.ascert.biz/self-help-resources https://drugsandalcoholni.info/the-ni-dacts/western-dact/ You can also pick up some info in the pharmacy I hope you enjoyed this blog - and let us know if we can give you any further help!

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    Drug Shortages for Dummies - but who's the dummy here???

    Drug Shortages for Dummies - but who's the dummy here???

    Have you heard this line lately? - I'm sorry, but we don't have your medicine in stock.  Have you gone to 10 different chemists, all telling you the same thing? Have you eventually had to have your prescription changed to something else? Well I'm here to try and explain why there are so many drug shortages, and explain why I've gone with the heading - Drug Shortages for Dummies. I'm definitely not referring to the reader. But you'll have the wait until the end until I explain it!   Drug shortages is becoming a common theme across community pharmacy in NI, and is frustrating for everyone, not least for the poor pharmacist who's having to have these difficult conversations everyday with patients and their carers.  Before I get into the nitty gritty of the causes and problems caused by these drug shortages for patients, please be aware your pharmacist will have done their upmost best to source your drug. Up to an hour a day is being spent in most pharmacies trying to just source routine drugs that we normally sourced in a few seconds by clicking an order button on the computer.  Prior to having to admit we cannot source your drug your pharmacist will have   -rang several wholesalers to see if they have it. -if the wholesaler does have it, the price may have been inflated by the manufacturer. They pharmacist may then have to ring the BSO (business service organisation) in Belfast (that is, the people that pay us for our drugs), and see if they will pay the inflated price.  -if the BSO has said they aren't sure if they can cover that inflated price, depending on how much we stand to lose the pharmacist may buy it in anyway - hoping the BSO will send out correspondence to say it will be covered later in the month. (see below) -if the wholesaler doesn't have the product, the pharmacist has most likely rang their GP practice and spoken with the practice pharmacist and they have mutually agreed a way forward - for example, the patient will be changed to a different drug and appropriate monitoring carried out by clinic and pharmacist of both! Then the pharmacist will communicate this to you. Phew! Did you get all that?! That's one drug for one patient...but so many of our patients are affected by this, that this process is repeated and repeated daily.      So what ultimately does a drug shortage mean?  Ultimately its the patient that pays the highest price. There are incidences when life saving medications are unavailable - for example, penicillin was as rare as hens teeth when there was a spike in scarlet fever and strep A a few months back. The fear was so real that we would run out of antibiotics that a 'serious shortage protocol' was put into place in NI and across the UK. This basically meant the pharmacist had the discretion to choose from a list of other suitable antibiotics if a GP prescribed penicillin and it wasn't available. This was to ensure that GP surgeries and Emergency Departments weren't awash with worried patients looking for antibiotics.  It also puts huge stress on the NHS. Everyone working within the NHS will feel the impact. If you have to change a patient to a different drug, their ailment may not heal as well. They may need to have new bloods and monitoring done. A number of psychiatric drugs were unavailable, and patients who were stable for years had to change their medications and some clinicians have reported relapses/inpatient stays etc.   It also increases the financial burden on the NHS. Many alternatives are more expensive than the previous drugs patients were on. Or occasionally where a drug is available but is it limited supplies, manufacturers will hike up the price. The BSO (see above) many not increase the price they pay pharmacies (or not do it promptly) and pharmacies are running at a loss.   Last week, I paid over £5.00 for atorvastatin 80mg, and to date the BSO have said I'll be paid £1.32 per pack. No concessions have been made - so I'm at a loss every time I dispense atorvastatin - which is several times a day (every 3rd script I receive has atorvastatin on it). The BSO may issue a concessionary price in August for drugs dispensed in August, but last week was July. So will I get paid for those???? Who knows! Be mindful when you hear HSCB representatives say they've invested more money into pharmacy than ever before. Its paying for the increased price of drugs, it definitely isn't going into my pocket. But the spin doctors have vertigo spinning that line! What types of drugs are unavailable   A full list of drug shortages in NI can be viewed here Shortages Information (hscni.net) By far the biggest shortage is Hormonal Replacement Therapy (HRT). Almost half of the drug shortage list is made up of HRT products. This is extremely distressing for the patient. After years of perhaps not knowing what was wrong with you and then getting a miracle cure and having it snatched away is very cruel. I know some readers will say that its hardly life or death, but actually, for some women it has saved their lives! And its the sheer volume of patients this affects - 51% of the people on the planet are female. If we all women are fortunate enough to live to aged 50, we'll all go through menopause. And 20% of us will probably have troublesome symptoms that require HRT of some form. I'm not going to do the math on this one - but its affecting a lot of women - so much so, there's a  public petition gone to parliament to beg MP's to improve the supply chain of HRT.    Then as I said, there was a UK shortage of penicillin caused by a spike in Strep A and scarlet fever infections - but in addition - there is also a world wide increase in syphilis. This is impacting supply.   At the moment we're facing a huge shortage of drugs called GLP1's. These are wonder drugs in the treatment of type 2 diabetes. In addition to the blood glucose lowering capabilities of these drugs, they are great at helping diabetic patients lose weight (increased BMI is the greatest risk for developing diabetes). They aren't licensed for weight lose alone, so you can only take it if your an uncontrolled diabetic with a BMI > 28. They are also not first line treatment for diabetes, but have a very important role in management, both with helping weight loss and ensuring some patients blood glucose come back to pre diabetic levels. I have found this shortage particularly challenging as its so hard to ring a diabetic patient who has got their diabetes and weight under control, only to tell them we have to change them to something else. Unfortunately, lots of patients regain the weight when these drugs are stopped.    Other drugs affected by the shortage are alendronic acid for osteoporosis, atorvastatin for high cholesterol, some anti epileptics, and medications for ADHD. The list is endless, and I'm sure you don't want me to go through it one by one. In addition to prescription medications, we have disrupted or limited supply of basic over the counter medications such as liquid paracetamol, Nurofen, Solpadeine, cold and flu preps   I currently estimate that if  I add the atorvastatin situation in, drug shortages are affecting about 50% of my patients.  So what's causing the shortage Like most people, you'll probably automatically say Brexit. So far, it doesn't seem to be the issue. It actually a world wide issue, and the Republic of Ireland, the rest of Europe and USA are facing the same problems.  The problem simply seems to be supply and demand. Better detection of health problems means more demand for medicines across the world. In addition, if there is a peak in a particular condition, such as Strep A, we are likely to see a shortage, and on this case it led to an acute shortage of penicillin. HRT demand has also been off the scale since its safety has been proven against its small increased risk of breast cancer by those taking it. Contraceptive medications and ADHD medications have also seen a massive increase in their usage. But supply and demand is only one issue. A quarter of medicines supplied in NI are supplied by UK, a quarter is supplied by Europe and a third is supplied from India.  UK suppliers are reporting its increasingly difficult to trade in UK due to labour costs, ingredients costs etc. In addition, many of these companies where working under tax breaks, and they are about to expire. Could they leave the UK? We'll see.  Importing medicines is also proving difficult. Believe it or believe it not, there's a shortage of shipping containers! This makes its v difficult to get medicines here in a timely manner. The devastating effects that covid had on the population of India has meant their labour force has shrunk, which is having a huge effect on us. India has also reported difficulties in sourcing raw materials for certain products. In addition, there's a lot of bureaucracy around getting new drugs on to the market in the UK. So if you are the only supplier of a branded drug and your patent has expired, it is a lengthy process for another drug manufacturer with a cheaper alternative to get their drug on the market.  Poor planning within the marketplace and lack of communication around drug shortages from the manufacturers to pharmacists has exacerbated drug shortages.  So there you have it - Drug Shortages for Dummies! And I said I'd explain this heading at the end. I cannot help but feel pharmacists are the dummies here, because if your local shop keeper bought in a loaf of bread for £5.00 (before profit) and you offered to only pay £1.32 for it - do you think he'd sell it to you? I think we all know the answer. It's clear the current situation is unsustainable. But to stop dispensing would mean the system will collapse even quicker.  So next time we tell you we don't have your medicine in stock, be aware we're dying inside!   Thanks for taking the time to read this, Siobhan x      Negotiators warn statin shortage is having 'serious impact' on pharmacies as price spikes - The Pharmaceutical Journal (pharmaceutical-journal.com)   Fixing the UK’s medicines shortage crisis - The Pharmaceutical Journal (pharmaceutical-journal.com)

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    Attention Deficit Hyperactivity Disorder in Adults. Do I have it?

    Attention Deficit Hyperactivity Disorder in Adults. Do I have it?

      When we think of ADHD, we often think of it as a disorder that only affects kids. There are many articles and webpages about kids, and I will link some here. But in this blog, I am going to focus on adults, as the number of adults being diagnosed with ADHD is on the increase. A article in the Belfast Telegraph in January 2023 stated the following Northern Ireland’s health and social care trusts are experiencing demand capacity issues for adult ADHD services, with some unable to take any more referrals. One trust said the rate of annual referrals had risen to almost five times the figures recorded between 2017 and 2020. In a letter to a GP, the Northern Trust (NHSCT) said their referral rate had jumped from 125-140 per year to around 400-500 per year. Northern Ireland health service struggling to keep up with demand for adult ADHD services | BelfastTelegraph.co.uk   So, I'm not going to specifically focus on medication and other treatments, I will link them. What I mainly get asked by adults is, 'Could I have ADHD or ADD, and how do I get diagnosed? So I'm going to focus on this. And I'll be honest, when I started researching this, I was quite shocked at how difficult it is to navigate the diagnosis system. But I'll come back to that. So to begin, with more and more adults are being tested for the condition what exactly is ADHD? Attention deficit hyperactivity disorder (ADHD) is a condition that affects people's behaviour. People with ADHD can seem restless, may have trouble concentrating and may act on impulse/hyperactivity. Some people may not have symptoms of hyperactivity but just trouble concentrating. This is called ADD, Attention Deficit Disorder.  Symptoms of ADHD tend to be noticed at an early age and may become more noticeable when a child's circumstances change, such as when they start school. Most cases are diagnosed when children are under 12 years old, but sometimes it's diagnosed later in childhood. Sometimes ADHD was not recognised when someone was a child, and they are diagnosed later as an adult. The symptoms of ADHD usually improve with age, but many adults who were diagnosed with the condition at a young age continue to experience problems. People with ADHD may also have additional problems, such as sleep and anxiety disorders.   What kind of Disorder is ADHD? ADHD is a ‘neurodevelopmental disorder’. These are disorders that can affect lots of different brain functions, including learning, communication, movement, emotions and attention. Neurodevelopmental disorders start in childhood and for many people are life-long. This means that they can’t be ‘cured’. Instead, people with neurodevelopmental disorders can benefit from support and changes to their environment. People who have one neurodevelopmental disorder are more likely to have another one, such as: autism spectrum disorder coordination difficulties speech, language and communication disorders Tourette’s syndrome dyslexia dyscalculia. If someone has ADHD that isn’t recognised or treated properly, this can negatively affect their mental and physical wellbeing. What causes attention deficit hyperactivity disorder (ADHD)? The exact cause of ADHD is unknown, but the condition has been shown to run in families. Research has also identified a number of possible differences in the brains of people with ADHD when compared with those without the condition. Other factors suggested as potentially having a role in ADHD include: being born prematurely (before the 37th week of pregnancy) having a low birthweight smoking or alcohol or drug abuse during pregnancy ADHD can occur in people of any intellectual ability, although it's more common in people with learning difficulties.   How Common is ADHD in adults? ADHD affects about 3 to 4 in every 100 adults. People with ADHD can be of any background, but ADHD is more common in people who have: a sibling or close family member with ADHD epilepsy other neurodevelopmental conditions, learning disabilities or learning difficulties mental illnesses a history of alcohol or drug misuse been involved in the criminal justice system an acquired brain injury been in care Or who were: born prematurely diagnosed with ‘oppositional defiant disorder’ or ‘conduct disorder’ as children thought to have a mental illness like anxiety or depression as children. ADHD is more commonly diagnosed in boys than in girls. However, in adults the diagnosis of ADHD in men and women is more equal. This might be because, as children, boys are more likely to show hyperactive and impulsive symptoms, which are more noticeable. When it comes to diagnosis, girls and women might be more likely to: have undiagnosed ADHD not be referred for assessment for ADHD receive an incorrect diagnosis of another mental health or neurodevelopmental condition. How do I know if I have ADHD/ADD Below is a list of the core symptoms of ADHD. For someone to be diagnosed with ADHD, these symptoms need to cause significant difficulties in at least two areas of daily life. For example, home, education or employment, relationships and housing. Generally its accepted you need 5 or more symptoms across 2 areas of your life to have ADHD or ADD. There are lots of other experiences that people with ADHD report having that might not be covered here. I have included examples that cover a broad range of ages, from young people who are still in education, to people who are in the workplace. Inattention Hyperactivity and impulsivity Lack of attention to detail Fidgeting or tapping hands or feet, squirming in seat Struggling to focus on tasks or activities Leaving your seat in situations when remaining seated is expected Struggling to listen when spoken to directly Feeling restless and having a lot of energy Not following instructions, and failing to finish work, chores or other duties Difficulties playing or taking part in leisure activities quietly Trouble organising tasks and activities Talking excessively Avoiding or disliking tasks that require mental effort over a long period of time (such as schoolwork, homework or housework) Blurting out an answer before a question has been completed Losing important things (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, glasses, mobiles) Struggling to wait your turn Getting easily distracted Interrupting or intruding on others  Being forgetful   Making mistakes at school or work, or in other activities     Not all of these symptoms will be obvious to others. People with ADHD will often develop ways to hide their symptoms, and doing so can be very exhausting and negatively affect their mental health. How is ADHD diagnosed? You might have used a questionnaire or quiz to find out whether you have ADHD. Questionnaires can help with the assessment process (I'll link one below) but ADHD can only be accurately diagnosed with: a comprehensive interview a consultation-based assessment These reviews are not carried out by your local doctor. They must be carried out by a specialist in this area - for example, a psychiatrist.  NICE (the National Institute for Health and Care Excellence) have guidelines for diagnosing ADHD. Regardless of where you are in the country, your assessment should follow these guidelines. A thorough assessment report would include, at least, all of the following: the role, qualifications, and experience of the person assessing you discussion of your ADHD symptoms and whether these meet the criteria for a diagnosis. This is usually supported by structured assessment tools and questionnaires a full review of your mental health information about your childhood, development, schooling, and your ability to function in areas of daily living (this is important - it is deemed you cannot have ADHD as an adult, unless you had it as a child. reviewing any physical health problems information about you from others who know you, especially how you were as a child, if available Diagnosing ADHD in adults is more difficult because there's some disagreement about whether the list of symptoms used to diagnose children and teenagers also applies to adults. In some cases, an adult may be diagnosed with ADHD if they have 5 or more of the symptoms of inattentiveness, or 5 or more of hyperactivity and impulsiveness, listed in diagnostic criteria for children with ADHD. If you find it difficult to remember whether you had problems as a child, your specialist may wish to see your old school records, or talk to your parents, teachers or anyone else who knew you well when you were a child. For an adult to be diagnosed with ADHD, their symptoms should also have a moderate effect on different areas of their life, such as: underachieving at work or in education driving dangerously difficulty making or keeping friends difficulty in relationships with partners If your problems are recent and did not occur regularly in the past, you're not considered to have ADHD. This is because it's currently thought that ADHD cannot develop for the first time in adults.   What should I do if I'm an adult and I think I have ADHD? I've linked a website here. ADHD UK - Homepage - ADHD UK If you believe you may have ADHD or ADD, you could do the questionnaire on this website to alleviate or confirm your fears. Now, it is not definitive in anyway, and will not be used to make a formal diagnosis - PLEASE don't go into your GP and tell them you read my blog, you did the questionnaire, now you have ADHD, and you want treatment asap!!!! The questionnaire could rule in or out ADHD or ADD as the cause of your symptoms, and  could be part of a conversation with you and your GP, especially if your answers are strongly indicating you have ADHD. What happens next will depend on your conversation with your GP. The website will also cover this. But if your GP believes you may have ADHD, or needs a second opinion, they will refer you to a psychiatrist, or someone specialising in ADHD. This expert will do a more comprehensive questionnaire with you, establish your childhood history, mental health history and other parameters as set down by NICE Guidance.  Now the services within each trust area across Northern Ireland differ. Some trusts are setting up specialist ADHD clinics for public access and doing pilot projects to see how they run. The trust Melvin Pharmacy is part of (Western Trust), does not have a specialist ADHD clinic, and your GP will refer you to adult mental health services, and they will put you on their waiting list. You will still be assessed by a specialist in ADHD, but the waiting times may be longer.  Many people opt to go privately for their ADHD assessment. If you choose to do this, there are a few important pieces of information you should bear in mind Private assessments In addition to NHS services there are many providers who offer ADHD assessments privately. If you have an assessment elsewhere, specialist NHS Adult ADHD services will check that your report includes all of the detail above before accepting you into the NHS service. This is because prescribers of ADHD medication need to ensure that they have all information required to prescribe safely, and for the right condition. For this reason, before getting an assessment from an alternative provider you should make sure that it will be accepted by your local NHS service. So check with your GP, if you go privately, will they be able to act on the psychiatrists findings.  How attention deficit hyperactivity disorder (ADHD) is treated For children with ADHD, although there's no cure, it can be managed with appropriate educational support, advice and support for parents and affected children, alongside medicine, if necessary. For adults with ADHD, medicine is often the first treatment offered, although psychological therapies such as cognitive behavioural therapy (CBT) may also help. Here is a link to medical and non medical treatment Attention deficit hyperactivity disorder (ADHD) - Treatment - NHS (www.nhs.uk) How can I help myself as an adult with ADHD/ADD?     There are a number of things that people with ADHD can do to support their overall health and wellbeing. 1. Tell the people around you how they can help As with any health condition, people often want to help but don’t know how, and end up giving unhelpful advice. Tell the people in your life about the things you do and don’t find helpful. 2. Try to get some regular exercise Regular exercise is good for everyone. In people with ADHD, it has been shown to significantly reduce symptoms related to anxiety and depression, which can make ADHD symptoms worse. Exercise has not been shown to have a positive impact on hyperactive, impulsive, or inattentive symptoms. 3. Get enough good-quality sleep Not sleeping well can make ADHD symptoms worse. Developing good sleeping habits can be challenging, but there are some things you can try: Develop and maintain a comforting bedtime routine, e.g. having a bath, listening to music. Go to bed and get up at the same time each day, including at weekends. Avoid screen time for at least an hour before bedtime. Do not consume sugar, caffeine or alcohol within a couple of hours of bedtime. Get enough exercise during the day. Keep the bedroom dark and quiet. If you can, leave a window open for fresh air. 4. Aim for a regular and balanced diet A large study has shown that there is a relationship between inattentive symptoms and unhealthy eating habits, including eating foods high in added sugar. An unhealthy diet negatively impacts physical health and possibly mood, which could make it more difficult to manage ADHD symptoms. 5. Driving By law you must tell the Driver and Vehicle Licensing Agency (DVLA) about any condition that may affect your ability to drive safely. If you’re not sure if your ADHD, or your ADHD medication affects your ability to drive safely, speak to your doctor. If ADHD does affect your driving and you do not tell the DVLA, you can be fined up to £1,000. If you’re involved in an accident you may be prosecuted. You can find out more about this on the DVLA website.   I hope you have found this useful. There is so much information here, but take your time digesting it. I think from doing research, the system is difficult to navigate, especially if you are an ADHD suffer. You have to go to your GP, be referred to mental health/ specialist in this area, attend several appointments, get a diagnosis, start medication, attend counselling and live your life...all against a background of ADHD/ADD. There has to be an easier way, or a one stop shop where you can have all this done in a streamlined approach. Please let me know if you found this blog useful Siobhan xxxxx     www.rcpsych.ac.uk      Royal College of Psychiatrists Attention deficit hyperactivity disorder (ADHD) - Diagnosis - NHS (www.nhs.uk) ADHD UK - Homepage - ADHD UK        

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