Dopamine Dilemma: Unraveling the ADHD Epidemic and Our Reliance on Medication

From Michael Phelps to the COVID-19 Pandemic: How Stress, DeltaFosB, and Society's Dependence on Stimulants Shape the ADHD Landscape

In the 2020-2021 financial year, over 1.5 million prescriptions for ADHD medication were issued in Australia, as reported by the Pharmaceutical Benefits Scheme (PBS) data. The number of prescriptions for some stimulant medications has skyrocketed, coinciding with the arrival of the COVID-19 pandemic and a thirty percent surge in anxiety medication usage. This increase in prescriptions suggests that ADHD is being diagnosed more frequently and that more people are turning to medication to treat and manage their symptoms. But is this massive increase in medication merely a band-aid that might actually be making the problem worse?

American swimmer Michael Phelps serves as a cautionary example of the dangers of relying on dopamine stimulants as a 'cure' for ADHD symptoms. Holding the title of the most successful and decorated Olympian of all time, Phelps boasts an impressive collection of 28 medals. He has set numerous records, including the most Olympic gold medals (23), the most Olympic gold medals in individual events (13), and the most Olympic medals in individual events (16). Despite his extraordinary success, Phelps has struggled with ADHD, anxiety, depression, and addiction throughout most of his life.

Phelps was born in Baltimore, Maryland, in June 1985 and spent his childhood in the Rodgers Forge neighbourhood of nearby Towson. The youngest of three siblings, Phelps' mother, Deborah Sue "Debbie" Phelps, worked as a school principal, while his father, Michael Fred Phelps, was a retired Maryland State Trooper with a background in football during his high school and college years.

In 1994, when Phelps was only nine years old, his parents went through a divorce, which left a lasting negative impact on him and his sisters. In his autobiography, "Beneath the Surface," Phelps revealed that the divorce left him and his siblings feeling hurt, confused, and insecure. The relationship between Phelps and his father became strained for years after the split.

The breakdown of his parents' marriage and the subsequent changes in his family dynamics led to feelings of instability and emotional distress. Phelps struggled with inattention, hyperactivity, and impulsivity, which affected his performance in school and social life. At the age of 12, Phelps was diagnosed with ADHD and prescribed Ritalin, a common medication for treating the symptoms.

Phelps' two older sisters, Whitney and Hilary, were competitive swimmers, and his mother believed that introducing Michael to swimming could provide a positive outlet for him. Phelps began taking swimming lessons, and soon his natural talent for the sport became apparent. Swimming provided him with a structured environment where he could channel his energy and focus on a single task.

As Phelps continued to swim and compete, he discovered that the rigorous training and discipline required in the sport had a profound impact on his ADHD symptoms. He found that the physical exertion from swimming served as an outlet for his hyperactivity, while the repetitive nature of the sport and the need to concentrate on technique helped improve his focus.

Under the guidance of his long-time coach, Bob Bowman, Phelps trained intensely, often swimming for hours each day, six days a week. Bowman recognized Phelps' potential early on and challenged him to set high goals, providing the structure and discipline he needed to excel in the pool. As Phelps grew older and more accomplished, his ADHD symptoms became more manageable, and he was able to taper off his medication.

Was the sudden and significant change in Phelps' family life related to his ADHD diagnosis? From a biochemical perspective, the answer is probably yes. When we are under sustained stress, as Phelps was around the time of his parents' divorce and afterward, our brains implement a coping mechanism to make us more resilient. When we encounter stress, our brains produce DeltaFosB. In response to stress, deltaFosB can promote neuronal plasticity by regulating the expression of specific genes involved in the growth, development, and function of neurons. This, in turn, allows the brain to make adaptive changes in response to stressors, strengthening its ability to cope with and recover from stress.

For example, deltaFosB can enhance the brain's ability to form new connections between neurons (synaptogenesis) or strengthen existing connections (long-term potentiation), which are essential processes for learning and memory. These adaptive changes help the brain become more resilient to stress by improving its capacity to learn from and adapt to new challenges and stressors.

However, deltaFosB can be a double-edged sword. It is a powerful short-term coping mechanism, but if the stressors are long-lasting, the increased expression of deltaFosB can cause changes in the brain's reward system, leading to lowered sensitivity to rewards and potentially contributing to the development of anxiety, ADHD, depression, and addiction.

How did swimming help Phelps get off ADHD medication? The answer lies in the intense focus required to train at the levels he did. The training stimulated his reward system as much as the drug did, making Ritalin unnecessary.

The accumulation of deltaFosB due to repeated exposure to stress leads to changes in the brain's reward system that result in a decreased sensitivity to the effects of dopamine. Dopamine plays a significant role in focus and attention. It helps regulate the brain's ability to filter and prioritize information, enabling us to concentrate on a specific task or pay attention to relevant stimuli while ignoring distractions. When deltaFosB accumulates, it means that more stimulation or higher levels of dopamine are required to achieve normal focus and motivation. In males, this often manifests as hyperactivity, and in females, passive inattention.

In people with ADHD, dopamine levels and the overall functioning of the dopamine system are disrupted, leading to difficulties with attention, focus, and impulse control. This is why medications like Ritalin and Adderall, which increase dopamine levels in the brain, can help improve focus and attention for those people.

Intense exercise, such as swimming for two hours a day, six days a week, stimulates the release of dopamine in the brain. This increase in dopamine will contribute to improved mood, focus, and motivation, leading to the well-known "runner's high" and the general sense of well-being and satisfaction experienced after an intense workout. The exercise takes the place of the drug by stimulating dopamine enough for the person to function normally despite their elevated deltaFosB levels.

Does exercise cure ADHD? Unfortunately, the answer is no. Stimulating dopamine with drugs or exercise helps a person with ADHD have normal levels of focus and attention in the short term, but it doesn't reset deltaFosB levels. If anything, the continual dopamine stimulation makes the problem worse in the long term, because each dopamine hit encourages the brain to produce more deltaFosB, which primes the brain for addictive behaviors.In 2014, Phelps was arrested for driving under the influence (DUI), which led to a six-month suspension from USA Swimming and the loss of his financial support from the organization. This was his second DUI arrest; the first one occurred in 2004 when he was just 19 years old. Phelps has been very open about the fact that he has struggles with addiction, anxiety and depression throughout his career.

What does reset deltaFosB? The only way to rest deltaFosB is stop stimulating its production. DeltaFosB has a relatively long half-life and can remain elevated in the brain for several weeks or even months, depending on the individual and the specific behavior or substance involved. By avoiding sources of chronic stress and the addictive behavior or substance, deltaFosB levels will eventually decrease, and the brain's reward system can begin to return to a more balanced state and put us on the path to recovery.

Following the 2014 arrest, Phelps realized he needed help and entered a 45-day inpatient treatment program at a drug rehabilitation center in Arizona. Since completing his rehab program, Phelps has stayed sober and become a vocal advocate for mental health awareness and the importance of seeking help for addiction issues. Phelps' enforced isolation from addictive substances helped him reset his deltaFosB, which in turn assisted him in maintaining abstinence. However, this is not easy. Elevated deltaFosB creates cravings for more stimulation and drives addiction. If it were easy to just stop, it wouldn’t be an addiction. To achieve this, we either need the resources and time to enter a lengthy rehab or the support of others who know and understand what we are doing and can help us keep our lives free from dopamine stimulation. Preferably, we have access to both.

We now live in a society where dopamine stimulators fill our phones, our pubs, and our TV screens. Add to this a mass source of chronic stress in the form of COVID-19 and the job losses and lockdowns that followed, and it would be astounding if ADHD diagnoses and stimulant prescriptions weren't skyrocketing. However, as Michael Phelps discovered, while these drugs do provide a short-term solution, long-term they become part of the problem. If we don't want to be part of a society where most people are addicted, anxious, and depressed, we need to come up with better solutions—and we needed them yesterday.