A look at dopamine, ADHD, and the brain’s constant battle between pleasure and pain.

I was diagnosed with ADHD this year at the age of 34.

It was less of a “diagnosis” to me than it was a complete validation of my entire life experience. Everything clicked into place and suddenly made sense.

My quirks, my habits, my pains, my ways of seeing and interacting with the world aligned so perfectly with what I had come to learn were blatant characteristics of ADHD all along.

So, obviously, I began researching and realized just how much I was really getting to know myself. It makes me feel empowered knowing that I’ve taken the time to slow down enough to get to know me, my thoughts, my tendencies and I’ve given myself the ability to be honest enough with myself to ask questions like why do I do that? without any malice or judgment — only sheer curiosity.

Because if I know myself, I can change myself. Change myself to be better: a better partner, a better friend, a better coworker, family member.

So, this is some of what I’ve learned along my journey to knowing myself. I get into what ADHD is, the physical differences between the ADHD and “neurotypical” brain, the role dopamine not only plays in people’s every day lives, but how it affects those with ADHD on a more extreme level.

Let’s dive in!

First, let’s talk about ADHD because if you were like me, I simply always associated the condition with being a super talkative, hyper, fast-moving person and didn’t realize it is actually quite complex; it manifests in many different ways, at many differing severity levels, and fluctuates in the way in which it manifests over the years.

ADHD, or Attention Deficit Hyperactivity Disorder, is a neurodevelopmental disorder that affects millions of people worldwide (it’s believed to affect about 7% of the global population, according to Dr. Laura Gouge).

While it's often associated with hyperactivity and impulsivity, it's a complex condition with a wide range of symptoms that can manifest in many different ways at varying levels of severity.

• Waves of hyperfocus and/or hyperactivity. Obsession with a new project or hobby, excessive fidgeting, restlessness, the feeling of not being able to “slow down”, and difficulty sitting still. Feeling impulsive, not thinking things through, saying what's on your mind before thinking, or making big, important life decisions quickly.

• Waves of feeling unmotivated, tired, uninspired. Feeling like the smallest tasks or chores are impossible. Things like exercise, cleaning, cooking, and working become impossible or we find ourselves making excuses to skip doing these things for things we find more “interesting”.

• Procrastination. Feeling unmotivated to take action on a project or work until you have to or until the very last minute.

• Disorganization and messiness. Lack of organization systems or difficulty keeping spaces tidy once organized.

• Difficulty focusing or finishing tasks or projects. Impaired ability on how long you can focus, and simply finishing tasks is difficult. The ADHD person is someone who has 10 projects in their house that you can’t seem to finish.

• Time blindness. Difficulty gauging how long tasks might take, but also having a "now or not now" mentality.

This is not an exhaustive list of ADHD symptoms or characteristics, but incorporates the key few. If you want to learn more about ADHD, speak to your local physician or read up on trusted sources like the NIMH (National Institute of Mental Health) or Mental Health America.

Research has also shown that the ADHD brain is physically different from neurotypical brains:

• Prefrontal Cortex: This part of the brain is responsible for executive functions like planning, organizing, and impulse control. For those with ADHD, the prefrontal cortex may be less developed or less efficient.

• Dopamine System: Dopamine is a neurotransmitter involved in reward, motivation, and attention. People with ADHD may have imbalances in their dopamine system, causing difficulties in these areas.

• Basal Ganglia: These structures in the brain play a role in movement and motivation. Abnormalities in the basal ganglia may contribute to the hyperactivity and impulsivity often seen in ADHD.

Aside from the physical differences between ADHD and neurotypical brains, the ADHD brain also functions differently — in the way we think, learn, solve problems, and process information. And while these brain differences provide valuable insights into the ADHD brain, it's important to remember that ADHD is a complex condition influenced by a combination of genetic, environmental, and neurological factors.

An “Interest-Based” Nervous System

Typically, when people hear ADHD, they assume it means the inability to focus. But contrary to popular belief, those with ADHD don't have a deficiency in the ability to focus — quite the opposite, actually.

According to physician Dr. Laura Gouge, the reality is those with ADHD can focus intensely (at incredible levels, in fact, according to Dr. Gouge) when they’re passionate about something. Dr. Gouge calls this an interest-based nervous system: a nervous system that allows someone the ability to hyperfocus on things that genuinely interest them but struggles with focus and motivation on what they perceive to be uninteresting.

This can obviously present its own challenges when we’re in phases of our life when we have to do things that naturally don’t interest us: manual chores, folding clothes, your day-to-day job, meal prepping for the week, texting someone back, or starting a project you’ve been putting off, etc.

While I realized I exhibited a majority of the characteristics of ADHD, this idea of an interest-based nervous system and the alternating waves of hyper-fixation followed by fatigue and lack of motivation hit home for me — this had been my lived experience for as long as I could remember. Since I was a little girl, I would find myself getting crazy fixated on a hobby or a home project in my head and I would have to act on it. I’d buy the materials needed, I’d stay up well into the night planning and prepping until I couldn’t hold my eyes open… only to find myself never starting or finishing weeks, days, months, years later.

It was like after the excitement high wore off, everything about it seemed less appealing.

A big part of the reason? Dopamine.

Diving into dopamine

Dopamine is a neurotransmitter that is commonly associated with feelings of happiness or pleasure. The truth, however, is that dopamine doesn't make you feel much of anything -- it's more accurate to say dopamine drives the motivation behind the actions we take to achieve that accomplishment in the first place. Whenever you need to do something, your brain triggers a release of dopamine to motivate you to get you going and do that thing. And when you complete that task, your brain releases a little more dopamine to signal to the brain, 'These actions are rewarding; let's remember this and do it again!".

In her book Dopamine Nation, Dr. Anna Lembke illustrates dopamine as a seesaw of pain vs. pleasure in our brains: Anytime we’re consistently going toward pleasure and not balancing it with some form of pain or discomfort, our brains will hit a point where it’s impossible to get any more pleasure from what we're pursuing.

The seesaw, then, has to go in the other direction and make you feel pain or discomfort to help bring your levels back to baseline and return to homeostasis.

This process happens for everyone, not just those who live with ADHD. But for those with ADHD it can be more extreme. Where a neurotypical brain is perhaps able to regulate itself back to homeostasis more easily, an ADHD brain takes more time or may become chronically imbalanced.

Because this process is more extreme or difficult for those with ADHD, it means we really feel the highs and we really feel the lows because we’re usually in one of the extremes and not maintaining balance. We typically tilt the seesaw fully toward pleasure, which ultimately leads us to experience that inevitable come-down of pain which, for me at least, manifested with fatigue, exhaustion, and lack of motivation.

Conversely, it means if we aren't interested in doing something or performing a seemingly easy task, it can reallllllyyyy feel like a hard chore. A laundry pile becomes Mt. Everest. The dishes become a ginormous pile you couldn’t possibly tackle yourself. Your car tag renewal goes un-renewed for 2 years (guilty).

But the good news is that it is possible to rebalance your dopamine levels and get yourself out of the cycle of extreme highs and lows of motivation.

The sources of dopamine you chase matter a lot

There's a reason our brains crave or become addicted to certain foods, drinks, or activities. The inventions of hyper-palatable foods, social media, online shopping, on-demand streaming, instant package delivery, and more in recent decades have driven our world to prefer instant gratification and ease — and to avoid inconvenience or discomfort at all costs.

The problem with this, if you recall the seesaw metaphor, is that when our brains begin to try to rebalance our systems and come back to baseline, our brains may try to overcompensate so much for all that pleasure that our levels can't get back up to baseline. So we feel tired, exhausted, and unmotivated for longer periods, likely to end up chasing the same sources of "cheap", "quick hit" dopamine later just to feel good. This is the never-ending dopamine loop.

The good news is balancing your dopamine levels is possible, and it's something I have to actively work on every day. The most important takeaway, though, would be to always start your day doing something “hard”.

Think of dopamine like blood sugar: When we eat super sugary, additive-filled foods, our blood sugar spikes very quickly, and because these foods have little to no nutritional value, our blood sugar then plummets, leaving us with the infamous sugar crash we’ve all likely fallen victim to at one point in time.

The same process happens with dopamine — quick, “cheap” hits of dopamine like caffeine, scrolling through social media, or buying something online (which are all perfectly fine things to do, btw) are considered artificial sources of dopamine because they really take no effort to receive. They’re quick, easy ways to get a hit of dopamine. But as quickly as they come, as quickly as they go. It’s why you feel you need to keep scrolling social or checking your phone or inbox for messages. You need the next hit of dopamine because the last hit didn’t last very long, and so it continues. It’s like the seesaw is moving as fast as possible, one side to the next, stuck in the circle of up-and-down.

It might be helpful to think of these as easy, cheap ways to get dopamine, where they don’t offer much value and oftentimes leave you feeling worse later. On the opposite hand, there are much better, valuable ways to chase your hits of dopamine and the good news is they often last longer and are more fulfilling and satisfying.

Activities like getting real sunshine on your skin. A really good gym session. Going outside for a walk. Laughing with a friend. Watching birds outside. Playing with a dog. All of these give us that hit of dopamine we’re chasing, but our satisfaction from them lasts much longer. It’s like the seesaw is lowering you down slowly toward equilibrium.

Achieving balance is not an immediate or permanent thing and requires constant attention and involves engaging in activities that provide long-term satisfaction and fulfillment rather than quick, fleeting pleasures.

These are some of the ways I (personally!) try to keep my dopamine levels balanced and have heard from others to be helpful. Hopefully they help you!

• Delay morning caffeine

• Do something 'hard' first thing in the day

• Mindfulness and focusing on what’s happening in this moment, right now

• Go outside for walks or spend time in nature

• Spending time with loved ones

• Boundaries with technology and having “tech-free” times during my day

• Exercise and strength training

• Sauna time a few days a week

• Nourish my body with healthy, whole foods

• Abstaining from alcohol

• 8 - 10 hours of sleep each night

• Limiting blue light, especially after sundown

• Get outside in the sun as much as possible during the day