ADHD medication can seem to work beautifully one week and barely help the next—and that shift can leave you wondering whether your dose is wrong, your medication has stopped working, or something else is going on. On The Dr. Brighten Show, Dr. Jolene Brighten brings together a board-certified psychiatrist, a pediatric psychologist, and an ADHD nutrition educator to talk through medication expectations, nutrition and side effects, changes across the menstrual cycle, and the overlap between ADHD, depression, and PMDD.
What You’ll Learn in this Episode
This ADHD medication conversation is about more than choosing a prescription. The panel discusses what medication can realistically help with, why medication is only one part of ADHD care, how appetite and daily routines can affect the experience of taking medication, and why follow-up with a prescriber matters. The guests also explore why some women notice a change in their ADHD symptoms before their period, how PMDD can differ from depression, and why changes in a teen’s behavior deserve curiosity rather than quick judgments.
ADHD medication can help without fixing everything
A major theme of the episode is setting realistic expectations. Dr. Agnes Kwan Simone explains that people may start ADHD medication expecting every symptom to disappear or their focus to become consistent all day. The panel offers a more specific way to think about whether medication may be helping: look for meaningful changes in the areas you and your clinician are targeting. For example, someone who previously struggled to focus for even a short period might notice that they can stay with a task longer.
The episode also makes room for smaller improvements. A medication may help with focus, attention, sitting still, or task initiation without making every task easy. A person might be missing fewer deadlines or interrupting less while still struggling with a messy home or procrastination. The panel says that those remaining difficulties do not automatically mean medication has failed. They may point to skills, systems, or other supports that medication does not teach on its own.
The guests caution against treating medication as a quick fix for every aspect of ADHD. Dr. Simone discusses medication as one tool in a larger treatment plan, while Dr. Anne-Louise Lockhart emphasizes that medication does not automatically teach a person what to do with the extra pause or focus it may provide. Skill-building remains important, particularly for children and teens.
Medication and therapy can have different roles
Dr. Lockhart describes therapy as a place to learn and practice skills. She discusses evidence-based approaches for children, including cognitive behavioral play therapy, and approaches for older children and adults, including cognitive behavioral therapy and solution-focused therapy. In the episode, she explains that therapy can help people understand patterns in what they think, feel, and do, and work on different ways to respond.
The conversation also focuses on collaboration with a therapist. Dr. Lockhart encourages people to ask about their diagnosis and treatment plan, and to work with their clinician to set goals. The panel’s point is not that every person needs the same combination of treatments. It is that patients should understand the plan they are following and have a chance to discuss whether it fits their needs.
Stimulant and non-stimulant medications are not interchangeable choices
Dr. Simone explains the basic distinction between stimulant and non-stimulant ADHD medications. In her description, stimulant medications affect the central nervous system and increase dopamine and norepinephrine, which she connects with executive functions such as focus and attention. She notes that stimulants are controlled substances and that clinicians consider a person’s medical history, potential risks, preferences, and concerns when discussing medication options.
The panel addresses stigma about ADHD medication, including the claim that prescribed stimulant medication is equivalent to illicit drugs. Dr. Simone pushes back on that comparison and describes prescribed ADHD medications as well-studied and relatively safe for many people when used as directed, while also acknowledging that side effects and risks exist. She mentions that stimulants can increase heart rate and blood pressure and that some people do not tolerate their side effects.
The discussion is not an invitation to start, stop, or change medication based on a podcast. It is a conversation about questions people can raise with their prescriber, including what each option is intended to help with, what side effects to watch for, and what follow-up will look like.
Food, appetite, and the end-of-day crash
Annika Joya, MS, author of The Eat to Focus Cookbook, talks about eating enough while taking ADHD medication. She describes how appetite suppression can make it difficult to notice hunger or follow through on eating, even when someone knows they need food. The panel discusses low-effort ways to make eating more accessible, such as choosing something simple for breakfast, keeping food visible, or placing snacks somewhere easy to reach.
Joya also describes the difference between low appetite and feeling unable to make yourself eat. She uses “I want to want to eat” to explain the experience of looking at food, knowing it tastes good, and still struggling to chew or swallow it. The guests discuss body doubling as one strategy: eating with another person, calling someone, or making a meal a shared activity.
They also talk about the afternoon crash some people experience as medication wears off. Joya suggests noticing whether you have eaten enough, including protein, and mentions having food around 4 p.m. Dr. Simone asks patients about food and hydration when they describe feeling poorly at the end of the day. The panel also discusses using reminders and making food easier to see as ways to reduce the number of steps required to eat.
These are examples raised in the episode, not a personalized nutrition or medication plan. The guests encourage people experiencing difficult symptoms to discuss them with their clinician.
Side effects deserve follow-up
The panel emphasizes that people should tell their prescriber about side effects rather than silently enduring them or assuming they are a personal failing. Dr. Simone describes following up with patients within the first month after starting a stimulant or changing a dose, and often sooner. She also says that patients can contact her between visits to report concerns or discuss how they are responding.
The episode covers appetite suppression, medication wearing off, and emotional changes. Dr. Lockhart notes that some children can experience emotional dysregulation as medication wears off, which can surprise parents who were only warned about appetite effects. The guests discuss how a change in formulation or medication may sometimes be considered with a prescriber.
Dr. Simone also talks about screening for other concerns and monitoring for adverse effects. Her approach, as described in the conversation, includes asking patients about their experience rather than requiring them to track symptoms every day if that would add another burden. The larger message is to stay in communication with the clinician managing the medication.
Why ADHD medication may feel different before your period
One of the episode’s central questions is why some women feel that ADHD medication works well for part of the month, then seems less effective before their period. The panel discusses the luteal phase—the week or two before menstruation—and the drop in sex hormones, including estrogen, that Dr. Brighten describes. Dr. Simone explains the proposed connection discussed in the episode: estrogen can affect dopamine, and when estrogen drops, some women may feel that their medication is not working as well.
The guests acknowledge that there is limited research on this reported experience. The conversation is meant to help listeners recognize a pattern they may want to discuss with their clinician, not to conclude that every premenstrual change in focus or mood has the same cause. The episode encourages paying attention to how symptoms vary across the cycle and bringing that information into a care conversation.
The panel also discusses Symtrio, referred to in the transcript as a newly FDA-approved ADHD medication with a different mechanism of action. Dr. Simone explains that it affects norepinephrine, dopamine, and serotonin. At the time of the recording, she says it was not yet on the market. The guests express interest in what further experience and research may show, including whether its effects on serotonin could be relevant to emotional regulation. They do not present it as an established treatment for perimenopause.
PMDD, depression, and ADHD can overlap
The episode examines how ADHD, depression, and PMDD symptoms can be confused or can occur together. Dr. Simone describes PMDD symptoms as occurring during the luteal phase and resolving shortly after bleeding begins. She contrasts this pattern with depression, which Dr. Lockhart explains can involve changes in sleep, interest, energy, concentration, appetite, and mood.
The guests note that depression in a young person may not look like an obvious, sustained sadness. It may show up as irritability, loss of interest in activities, changes in friendships, disrupted sleep, or a shift in how the teen is functioning. Those changes can be misread as attitude, laziness, or normal hormonal behavior. Dr. Lockhart encourages parents to notice changes and get curious, while also recognizing that adolescence itself brings development and shifts in behavior.
The panel also discusses birth control and mood. Dr. Brighten refers to an association between birth control and depression that needs further study, and explicitly notes that the association does not establish causation. She encourages attention to changes in mood or functioning after starting birth control, particularly for teens, and suggests involving trusted people who may notice when someone withdraws or loses interest in activities.
Track patterns and plan support
Dr. Lockhart describes helping patients track symptoms in a way that works for them. Seeing a recurring pattern can make a symptom that felt random easier to discuss. If a person notices that irritability, brain fog, or difficulty functioning tends to appear before their period, they can consider what support they may need during that time and bring the pattern to a clinician.
The conversation includes practical examples of planning ahead: asking what helps, arranging social support, making time for movement, or adjusting commitments when possible. These are not presented as a substitute for care. They are examples of responding to a pattern with support instead of treating each difficult week as a personal failure.
The episode closes by returning to the importance of being understood. Dr. Lockhart shares a story about a teenager whose family worried she was depressed because she withdrew after a lot of social stimulation. After assessment, Lockhart says she did not have a clinical diagnosis; she was introverted and needed a different understanding of how she recharged. The story illustrates why a behavior that concerns others deserves thoughtful assessment rather than an automatic label.
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Frequently Asked Questions about ADHD Medication, Periods, and PMDD
The panel discusses reports from women who feel their medication is less effective in the week or two before their period. Dr. Simone connects this possibility to the hormonal changes of the luteal phase and estrogen’s relationship with dopamine, while noting that research on the experience is limited. Discuss recurring changes with the clinician who manages your treatment.
In the episode, Dr. Simone describes possible improvements in focus, attention, sitting still, and task initiation. The panel stresses that medication is not expected to eliminate every ADHD symptom or teach skills such as time management and organization on its own.
The panel suggests noticing whether you are eating enough, making food visible and easy to access, using reminders, and trying body doubling by eating with someone else. If appetite changes or difficulty eating are concerning, bring them to your prescriber or another qualified clinician.
The guests describe PMDD as tied to the luteal phase, with symptoms that improve shortly after bleeding begins. Depression can involve changes in mood, sleep, interest, energy, concentration, and appetite that are not limited to that part of the cycle. The episode encourages discussing symptom patterns with a clinician rather than trying to diagnose yourself from one symptom.
Dr. Lockhart suggests paying attention to changes in functioning, such as disrupted sleep, loss of interest, changes in friendships or activities, and increased irritability. The panel also emphasizes listening to teens and seeking professional support when concerns persist.
No. In the episode, Dr. Brighten says herbs are not replacements for medication. She discusses limitations in how herbs are studied and describes her observation about saffron and ADHD medication response as anecdotal, saying that more direct research is needed.
This episode features Dr. Jolene Brighten, board-certified in naturopathic endocrinology and author of ADHD and Women; Dr. Agnes Kwan Simone, a board-certified psychiatrist; Dr. Anne-Louise Lockhart, a pediatric psychologist board-certified in clinical child and adolescent psychology; and Annika Joya, MS, author of The Eat to Focus Cookbook.
The conversation is educational and does not replace individualized medical or mental health care. Medication, diagnosis, and treatment decisions should be discussed with a qualified clinician.
Citations
- Medication alongside behavioral and skills support for children and teens
Wolraich ML, et al. “Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.” Pediatrics. 2019;144(4):e20192528. The AAP guideline supports medication and behavioral or training interventions as parts of pediatric ADHD care. It supports average treatment patterns in children and adolescents, not the claim that stimulants are always more effective for every individual. - Prescription stimulant benefits and risks
U.S. Food and Drug Administration. “FDA Updating Warnings to Improve Safe Use of Prescription Stimulants Used to Treat ADHD and Other Conditions.” 2023. Use this for the discussion of stimulant misuse, abuse, addiction, and the importance of taking medication as prescribed. It also cautions against describing prescribed stimulants as risk-free. - ADHD medication and substance-related events
Quinn PD, et al. “ADHD Medication and Substance-Related Problems.” American Journal of Psychiatry. 2017;174(9):877–885. doi:10.1176/appi.ajp.2017.16060686. In this observational study, medication periods were associated with 31% lower odds of concurrent substance-related events for women and 35% lower odds for men. This supports an association, not proof that medication prevents substance use disorder or reduces “substance use tendencies” by one-third.
- Reproductive hormones and ADHD symptoms across the cycle
Roberts BA, Eisenlohr-Moul T, Martel MM. “Reproductive Steroids and ADHD Symptoms Across the Menstrual Cycle.” Psychoneuroendocrinology. 2018;88:105–114. doi:10.1016/j.psyneuen.2017.11.015. This 35-day study followed 32 women with daily hormone samples and symptom ratings. It offers preliminary evidence of hormone-linked symptom variation; it does not establish that falling estrogen causes ADHD medication to fail. - Premenstrual stimulant dose adjustments
de Jong M, et al. “Female-Specific Pharmacotherapy in ADHD: Premenstrual Adjustment of Psychostimulant Dosage.” Frontiers in Psychiatry. 2023;14:1306194. doi:10.3389/fpsyt.2023.1306194. This is a case series of nine women, so it is useful as preliminary clinical evidence, not a dosing guideline. - ADHD symptoms across the cycle in stimulant-treated participants
Zaritsky R, Reed SC, Evans SM. “Changes in ADHD Symptoms and Mood Across the Menstrual Cycle in Females Treated With Stimulants: A Pilot Study.” Journal of Attention Disorders. 2026. doi:10.1177/10870547251400038. This pilot followed 30 stimulant-treated participants with daily surveys. It supports further attention to cycle-linked symptom changes, while remaining preliminary. - ADHD and increased likelihood of provisional PMDD
Broughton T, Lambert E, Wertz J, Agnew-Blais J. “Increased Risk of Provisional Premenstrual Dysphoric Disorder (PMDD) Among Females With ADHD: Cross-Sectional Survey Study.” The British Journal of Psychiatry. 2025;226(6):410–417. doi:10.1192/bjp.2025.104. Among 715 participants aged 18–34, the study found higher rates of provisional PMDD symptoms in the ADHD groups. Because this was a cross-sectional survey using self-report measures, describe the result as an association, not a confirmed clinical diagnosis or causal relationship. - PMDD assessment and prospective symptom tracking
ACOG. “Management of Premenstrual Disorders.” Clinical Practice Guideline, 2023. This is the clinical guideline for diagnostic and treatment context.
Eisenlohr-Moul TA, et al. “Toward the Reliable Diagnosis of DSM-5 Premenstrual Dysphoric Disorder: The Carolina Premenstrual Assessment Scoring System (C-PASS).” American Journal of Psychiatry. 2017;174(1):51–59. doi:10.1176/appi.ajp.2016.15121510. The validation study used daily symptom ratings across multiple cycles. - Hormonal contraception and depression in young women with ADHD
Lundin C, et al. “Hormonal Contraceptive Use and Risk of Depression Among Young Women With ADHD.” Journal of the American Academy of Child & Adolescent Psychiatry. 2023;62(6):665–674. doi:10.1016/j.jaac.2022.07.847. This Swedish registry study found associations between oral hormonal contraception and depression outcomes in the population studied. It cannot establish that contraception caused depression in an individual.
- Saffron as an adjunct to methylphenidate in adults with ADHD
Pazoki B, et al. “Efficacy and Safety of Saffron as Adjunctive Therapy in Adults With ADHD: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.” Advances in Integrative Medicine. 2022;9(1):37–43. This is the adult trial relevant to the episode’s mention of saffron alongside methylphenidate. It does not test saffron as a PMDD treatment. - Saffron alongside methylphenidate in children and adolescents
Khaksarian M, et al. “A Comparison of Methylphenidate and Combined Methylphenidate With Crocus sativus (Saffron) in the Treatment of Children and Adolescents With ADHD.” Iranian Journal of Psychiatry and Behavioral Sciences. 2021;15(3):e108390. doi:10.5812/ijpbs.108390. This eight-week trial included 70 participants aged 6–16. Its findings should not be generalized to adult women or PMDD. - Saffron and fluoxetine-related sexual dysfunction
Kashani L, et al. “Saffron for Treatment of Fluoxetine-Induced Sexual Dysfunction in Women: A Randomized, Double-Blind, Placebo-Controlled Study.” Human Psychopharmacology. 2013. doi:10.1002/hup.2282. The study involved 38 women taking fluoxetine for at least six weeks, followed for four weeks. It is a small trial of a specific SSRI-related concern, not evidence that saffron is broadly effective or appropriate for everyone taking an SSRI. - SSRI sexual side effects
FDA-approved fluoxetine prescribing information notes possible sexual dysfunction, including decreased libido and delayed or absent orgasm. Use the label to support the side-effect discussion; individual risk varies.
- Multinutrients and adolescent irritability (BEAM trial)
Rucklidge JJ, et al. “Efficacy and Safety of Micronutrient Treatment for Irritability in Adolescents: 8-Week Double-Blinded Randomized Placebo-Controlled Trial (BEAM).” Journal of the American Academy of Child & Adolescent Psychiatry. 2026. doi:10.1016/j.jaac.2026.01.013. The trial studied 132 adolescents with moderate-to-severe irritability. In the subgroup of 30 participants with DMDD, 64.3% in the micronutrient group and 12.5% on placebo met the study’s responder criteria. It did not show that the formula “got rid of” DMDD or ODD, and it did not report a 50% reduction versus placebo. I’d revise that line before publication - Cortisol and oxidative-stress markers after methylphenidate
Garre-Morata L, et al. “Changes in Cortisol and in Oxidative/Nitrosative Stress Indicators After ADHD Treatment.” Antioxidants. 2024;13(1):92. doi:10.3390/antiox13010092. This before-and-after study followed 59 people with ADHD for three months of methylphenidate treatment and reported changes in several markers. It does not substantiate every magnesium, iron, or cortisol statement in the conversation, nor prove a general metabolic benefit. - The new medication discussed in the episode
FDA’s 2026 drug approval list records SIMTRIYO (centanafadine) as approved July 24, 2026. The FDA label identifies it as a norepinephrine-dopamine-serotonin reuptake inhibitor and CNS stimulant, while stating that its mechanism in ADHD treatment is unclear. The transcript’s “Symtrio” and “sentanaphidine” spellings should be corrected, and the “not yet FDA-approved” wording should be updated for any current episode notes.