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ADHD Chatter PodcastPsychiatrist Who Diagnosed 6,000 ADHD Women: 'This ONE Bit Of Advice Helped Them All'
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WHAT IT’S REALLY ABOUT
Psychiatrist explains women’s ADHD: misdiagnosis, masking, RSD, and treatment
- Dr. Mashru argues the most common cross-cutting ADHD experience is feeling misunderstood and “not fitting in,” which often drives masking, people-pleasing, and social exhaustion.
- He describes a frequent clinical pattern where untreated ADHD leads to cycles of anxiety and depression that are misdiagnosed and mistreated (often with serotonergic antidepressants) instead of targeting dopamine/noradrenaline pathways.
- The episode links ADHD to sleep timing issues (delayed melatonin release plus “revenge bedtime procrastination”/doomscrolling), which then amplifies time blindness, forgetfulness, and daily-life impairment.
- Rejection Sensitive Dysphoria (RSD) is presented as highly prevalent though not in formal diagnostic criteria, often experienced as sudden, intense, sometimes physical pain that can trigger rage, shame, and avoidance.
- Women-specific themes highlighted include heavier masking burdens, burnout and emotional overwhelm, and symptom worsening around hormonal transitions (teen years, perimenopause, menopause), with major impacts on relationships and parenting guilt.
IDEAS WORTH REMEMBERING
5 ideasADHD is often missed because distress looks like anxiety/depression.
Mashru notes 70–80% of untreated ADHD involves cycles of anxiety/depression, leading clinicians to label GAD or depression; when ADHD is the driver, correct ADHD treatment can improve emotional wellbeing even more than focus.
Quality of anxiety matters for diagnosis and medication choice.
He distinguishes task-related/social anxiety (common in ADHD) from generalized worry across domains (more typical GAD), warning that treating the wrong pathway (serotonin vs dopamine/noradrenaline) can cause side effects and little benefit.
Rule out bipolar disorder carefully before prescribing stimulants.
He warns stimulants can precipitate mania in undiagnosed bipolar disorder and emphasizes differences: bipolar episodes last weeks/months and can be situation-incongruent, whereas ADHD mood shifts are often same-day and situation-congruent but intense.
Women’s ADHD burden is often “invisible” because of masking and overcompensation.
Women may appear high-achieving while spending extra hours catching up, then “crash” at home; hormonal changes can push a previously coping person into overwhelm, burnout, and relationship conflict.
RSD is common, hard to measure, and can feel physically painful.
Although not a formal criterion, he sees RSD in most patients; triggers (a “quick chat,” a full stop in a message, subtle exclusion) can cause sudden chest-tightness-like distress, tears, and subsequent shame or anger.
WORDS WORTH SAVING
5 quotesOne thing that I hear about from all different spectrums of people with neurodivergence is feeling misunderstood, not quite fitting in their whole lives.
— Dr. Shyamal Mashru
Don't just sit there in despair, right? M- Don't procrastinate by watching only the videos. Watch the videos, it's great, but do something about this.
— Dr. Shyamal Mashru
I think the impact on self-esteem comes from a core belief about yourself, which develops over time, which is, "I am not good enough," or, "I am not enough."
— Dr. Shyamal Mashru
When you start having those thoughts that, "The world is a better place without me," that's a dangerous area to be in.
— Dr. Shyamal Mashru
That remote is a reminder to everyone, that's the ADHD brain, and I wanna quickly touch on this actually, because to me, ADHD, what it stands for, Attention Deficit Hyperactivity Disorder, this is not a deficit, deficit condition. It's a dysregulation condition.
— Dr. Shyamal Mashru
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SPEAKERS
Dr. Shyamal Mashru
guestPsychiatrist specializing in ADHD assessment and treatment, discussing clinical diagnosis, comorbidities, and management strategies.
Alex Partridge
hostHost of the ADHD Chatter Podcast, interviewing guests about ADHD and sharing personal ADHD-related perspectives and show segments.
High quality AI-generated summary created from speaker-labeled transcript.
