Episode 2: Deep Dive into ADHD Medication Part 1 with Henry Shelford and Dr. Shyamal Mashru

Henry and Dr. Shyamal talking about the various aspects of ADHD Medication. Dr. Shyamal is a consultant psychiatrist practicing both in the NHS in Adult ADHD service and in his private clinic, ADHDHealthClinic. You can contact him through his website: adhdhealthclinic.co.uk. The clinic also has its own page on ADHD and Medication.

You can watch the video interview on YouTube here. 

TRANSCRIPT:

HENRY SHELFORD: Hello, I’m Henry Shelford, CEO and co-founder of ADHD UK. Today, we’re doing a deep dive into the major pharmaceutical treatments for ADHD. It’s obviously a big topic: What do they do? How do they work? I’m delighted to have Dr. Shyamal Mashru here again to talk you through it.

DR. SHYAMAL MASHRU: Hello again, Henry. How are you?

HENRY SHELFORD: Great, thank you. We’re going to start with the big question: Why do people take ADHD medication? What does it do, particularly for the symptoms of ADHD?

DR. SHYAMAL MASHRU: Yes, obviously a very big topic. Looking forward to this one. In terms of medication helping with ADHD symptoms, I think the first question is: What kind of symptoms are we looking to treat? Broadly speaking, I see an improvement in three categories of symptoms in most patients.

The first category would be the inattentive symptoms of ADHD. This includes improvements in task initiation with less procrastination, overall productivity, and sustaining attention on one task at a time instead of jumping around from task to task. Executive function improves as well—things like being more aware of time, better time management, and improved organization. You’re more likely to take action on your to-do list or add things to your diary. Working memory can improve to an extent, but in my experience, that’s one of the hardest symptoms to treat with medication alone.

Of course, medication isn’t the only answer. Pills don’t create skills. Developing good habits, perhaps with a coach, is crucial.

The second category of symptoms I generally see improvement in is hyperactivity and impulsivity. Patients describe feeling internally calmer—less fidgety, less restless. They can sit through work meetings or university lectures more easily. Impulsivity improves as well. I’ve had patients tell me their partners or colleagues notice they’re more attentive in conversations, not going off on tangents, and actually listening better. Impulsivity can also manifest in habits like substance use or alcohol use, and I’ve worked with patients who’ve been able to reduce or eliminate those behaviors over time with medication.

The final category, though not currently part of the diagnostic criteria, is emotional regulation. A massive area of improvement is in feeling less emotionally overwhelmed. Patients often say they feel emotionally calmer and happier. Sometimes, this impact is even more significant than improvements in attention or concentration. Many patients tell me they’ve tried antidepressants with no success, but ADHD medication has made a profound difference in their emotional state.

HENRY SHELFORD: Thank you. It’s so important to talk about the symptoms. What do you say to people who argue, “Well, everyone could do with a bit of that”? There was even a recent article comparing ADHD medication to amphetamines used by the Nazis.

DR. SHYAMAL MASHRU: My first response would be: Why would anyone want to take something into their system unless they truly need it? Medication comes with risks and side effects. Every pill has its price. That’s why it’s essential to see an expert to determine if you even need medication. Not every diagnosed patient needs medication; I might recommend coaching instead, depending on the individual. Taking medication unnecessarily can result in side effects outweighing any minor benefits.

HENRY SHELFORD: What happens if someone without ADHD takes ADHD medication?

DR. SHYAMAL MASHRU: Not much, honestly. It might feel like drinking a strong coffee—a slight increase in focus for a brief period—but because their brain doesn’t need the additional stimulation, it can lead to agitation or discomfort. Studies even show negative impacts on studying and exam performance for people without ADHD taking these medications.

HENRY SHELFORD: When I first started medication, I hoped it would be like the movie Limitless—perfect focus and memory. Obviously, it’s not like that. But why not coaching first? Why not try non-pharmaceutical interventions before medication?

DR. SHYAMAL MASHRU: It depends on the individual. ADHD is a spectrum condition, and people present in different ways, with varying levels of severity and impairment. I look at the person in front of me. For example, someone who is psychologically minded and reflective might do very well with coaching initially. They may never need medication. However, someone who is severely impaired, with ADHD affecting their relationships, work, and education, might need medication first. Even then, I often recommend adjunctive coaching after they’ve stabilized on medication. It’s about tailoring the approach to the individual.

HENRY SHELFORD: That makes sense. After diagnosis, I’ve noticed people take one of three paths: long-term medication, temporary medication to build skills before stopping, or no medication at all. Does that sound right?

DR. SHYAMAL MASHRU: Yes, absolutely. Everyone’s journey is unique. Some people need medication long-term for consistent benefits. Others use it temporarily to learn coping strategies and then manage without it. And some prefer to avoid medication altogether, relying on coaching or lifestyle changes.

HENRY SHELFORD: I recently had someone ask if there’s a supplement that works like ADHD medication. What’s your take on that?

DR. SHYAMAL MASHRU: There’s no supplement that truly mimics ADHD medication. However, high-intensity aerobic exercise has been shown to significantly improve symptoms. Supplements might provide placebo effects, which can still be beneficial. For example, magnesium can help with sleep or side effects like jaw clenching, but its impact on core ADHD symptoms is limited.

HENRY SHELFORD: Let’s talk about what happens when someone starts medication for the first time. What patterns do you typically see?

DR. SHYAMAL MASHRU: There are three common experiences. Some people feel an immediate, almost magical improvement in focus and productivity during the first few days, but this effect often diminishes as their body adjusts. Others feel very little at first because they’re starting on a low dose. And then there are those who find it works well initially but notice the effects don’t last as long over time. The key during titration is to find a steady dose that provides consistent benefits without significant side effects.

HENRY SHELFORD: What about the concern that medication might change someone’s personality or reduce creativity?

DR. SHYAMAL MASHRU: Medication doesn’t change your personality. It helps you manage tasks you’ve struggled with, but it won’t make boring tasks suddenly enjoyable. As for creativity, most patients find their ability to execute creative ideas improves, even if the number of ideas remains the same.

HENRY SHELFORD: What about cases where someone has both ADHD and autism? Can medication affect their autistic traits?

DR. SHYAMAL MASHRU: Yes, stimulant medication can sometimes amplify autistic traits, such as social withdrawal. For example, a person might become quieter in conversations. This highlights the importance of tailoring treatment to each individual’s needs.

HENRY SHELFORD: Is ADHD medication addictive?

DR. SHYAMAL MASHRU: No, it’s not addictive in the traditional sense. Patients don’t crave it like they might crave cigarettes or other substances. However, they may feel its absence when their symptoms return, similar to how someone might miss their glasses if taken away.

HENRY SHELFORD: Thank you so much, Dr. Mashru. This has been incredibly insightful. We’ll continue this conversation in the next session, where we’ll dive into the specific medications and how they work. To everyone watching, remember that ADHD UK is a charity that relies on your support. Please consider donating to help us continue providing resources like this. Thank you, and see you next time.