Leah Falland: Normalizing Mental Health Treatment
By: Ruby Wyles
Despite a strong family history, including her older brother being diagnosed as a child, professional runner for On Athletics Club, Leah Falland, just recently received a diagnosis of ADHD aged 29. First speaking out about her mental health struggles in 2017, Leah has been at the forefront of raising awareness and breaking down stigma around mental illness in athletics. Until this Fall, Leah has had to deal with the pitfalls of misdiagnosis and inappropriate treatment, alongside a plethora of mental and physical highs and lows. With the full support of her husband, coach Dathan Ritzenhein, and sponsor ON Running, Leah committed to finding answers. We are fortunate that Leah shared with us how being diagnosed with ADHD has changed her life and the way she sees herself: past, present and future.
In the midst of a deep depressive episode, Leah was first diagnosed with anxiety and depression in 2017. At the time, these labels appeared to fit, giving Leah a newfound understanding of her brain, her thoughts and feelings, alongside a way forward and hope for the future. Leah was one of the first to bravely share about her mental illnesses, advocating for awareness and self-compassion in a letter to her former self, titled “Dear Struggling Runner”.
LF: In 2017 I went to get help; I was in California and wasn't near my family and I didn't have the resources or help that I needed. I waited way too long, and when I finally went in I was really, really, really low and the psychiatrist just ended up diagnosing me with clinical anxiety and depression, and put me on an SSRI (a type of antidepressant medication). After that I did cognitive behavioral therapy, and I took a break from the sport, I stopped racing. I told myself I would treat this like I would treat any other injury, by pouring my energy into rehabbing my brain.
While running can be therapeutic, running should never replace therapy. Over the last five years, Leah, treating her mental illness like a physical injury, tried a variety of different strategies, finding the most benefit from cognitive behavioral therapy (CBT) and dialectic behavioral therapy (DBT).
LF: Cognitive behavioral therapy and dialectical behavioral therapy really, really helped me, alongside just reading a lot more to understand mental health, having conversations with different people and building out my support team. I was able to forgive myself a lot for those heavy emotions. The SSRI did help with some of the anxiety and sleep, but it didn't eradicate the really tough symptoms. I had to learn how to ask for help really early on, which has definitely helped me a lot in my professional career.
However, with mental health there is often no permanent cure, and even with all the resources and support around you trouble can still strike. Fast forward to late summer, once Leah’s race season had ended and the whir of training, traveling and competing wound down, she was alone with her thoughts. Even on her break with family she knew something was still wrong. Her low ran deeper than the disappointment of not making the US Olympic Team, persisting even after she bettered a 5-year old steeplechase PR a couple weeks later. Physically healthy and running her best, inside was a different story.
LF: After the Olympic Trials this year, even though I have so much support, I felt my brain doing that thing again: I just couldn't slow my thoughts down and I wasn't sleeping well.
Looking back now, I can see how the classic ADHD symptoms were just amplified because I was under a lot of stress and I had had a traumatic event. The goal that I'd had in my mind for so long was no longer there and I was just kind of free floating. My structure was gone, Dathan and the team were in Europe, and then my foot started hurting.
I knew something was wrong mentally and so I went to talk with an integrative psychiatrist. It's a very thorough diagnostic process: they looked at my blood work and family history of mental illness, I spent hours and hours on the phone, and an hour and a half on paperwork. And I was given the official diagnosis of ADHD.
As we talked, Leah radiated a sense of relief and optimism: finally, she feels she identifies with her label of ADHD. For Leah, the puzzle pieces have fallen into place, and this new diagnosis has brought her considerable insight into decades of misunderstood quirks, coping mechanisms and challenges.
LF: ADHD makes a lot of sense, it runs in my family with my brother and my parents. ADHD is one of those things where you do find ways to cope, and I have become an excellent coper! I'm not necessarily glad that I didn't get diagnosed until I was 29, but it's made me really resourceful; I’ve had to learn a lot of different ways to work with my brain and figure stuff out.
Now I'm in the process of just looking back at my life, on those moments that you lay awake at night and think about “why did I do that?” or “why didn't I do that?” For me, ADHD impacts my motivation; I can have the best intentions and set goals for myself that I really want in the moment, but they will scare the shit out of me because I can't get myself to do it. And if that happens enough times, you just start to lose confidence in yourself and you stop trying certain things.
Emotional regulation is another issue with ADHD, and ever since I was a little kid, I just thought I was really sensitive. It feels like this thermometer in your brain that goes up, up, up to the point where I’ve got to go to a different room and just cry it out. As I’ve gotten older, I’ve found breathing exercises and cognitive behavioral therapy really helpful.
This sensitivity further manifested in Leah as a deep and self-limiting insecurity, and, in fear of not living up to assumed expectations, Leah adopted more coping strategies.
LF: I think everyone kind of knew I was goofy and a busy brain, and humor is probably something that I've always utilized to cope. When I find myself talking too much or messing up, I just make a funny voice or make a joke out of it.
I figured it out but I definitely struggled a lot in school and college. I chose my major, what classes I took, and what I allowed myself to do based on people’s expectations of me. Even though I knew I was intelligent, I struggled so much with time management and staying on task: if I wasn't interested in something my focus would quickly shift to the things that were more interesting to me. I internalized a lot of shame because I felt like I was letting myself down.
While Leah developed coping strategies and work-arounds of her own to improve her attention and focus, without the correct support and treatment, they came at a cost.
LF: I started drinking coffee in middle school, and I would bring a thermos to school in sixth grade. I figured out that coffee actually made it easier to go to classes and do better.
I found ways to cope, but they didn't help me with my self esteem. I really struggled there, and I found myself in bad relationships because I was accepting poor treatment that I thought I deserved. I had to work really, really hard to build my self esteem up, and running helped me a lot because I was actually really good at something!
Mental illnesses are too often missed or misdiagnosed, and incorrect diagnoses can prevent people from getting the help they need, exacerbating thoughts of hope: Leah’s resilience and commitment to finding answers is admirable. The last couple of years Leah felt increasing cognitive dissonance between her diagnosis and reality: in spite of engaging in appropriate treatments for anxiety and depression she felt little relief.
LF: I was really low leading into the diagnosis because I was scared and really traumatized by previous experience. The diagnosis of anxiety and depression didn't really help long term, it wasn't the answer, and it made me distrust the doctors and distrust myself. I knew something wasn’t right, but the thing I’m being told it is doesn’t feel right either.
Humans have evolved to survive stress, and instinctively we seek out the path of least resistance, employing a variety of coping mechanisms. For years, Leah inadvertently found herself self-medicating with running, needing exercise to trigger the release of dopamine her brain was lacking. Without a doubt, the key to running success is consistency, but this daily dependency on running trapped Leah in an injury cycle.
Since diagnosis, Leah has begun treatment with Vyvanse, a stimulant medication prescribed to resolve the imbalances of the neurotransmitter, dopamine, in the brains of people with ADHD. Due to potential performance enhancing effects, Vyvanse is banned by the World Anti-Doping Agency (WADA) and the United States Anti-Doping Agency (USADA) for use in competition only. A strong proponent of clean sport, Leah is applying for a therapeutic use exemption (TUE) to allow her to continue drug treatment once her season begins in 2022.
The positive impact of this medication was immediate! Right from the first dose Leah felt her brain begin to calm and focus better. For Leah, medication is only part of a treatment plan, and she continues to benefit from and advocate for therapy too.
LF: I recently started taking a low dose of Vyvanse, a stimulant medication that’s a little easier on the brain and more gradual than things like Adderall. The first day that I took it, something clicked. I swear, I woke up and I normally need a pot of coffee to get going and all of a sudden I didn’t!
Typically it feels like I have 5 to 10 different pathways in my brain just all going at once, it's like traffic in LA in my head! When I take my medication it’s like that magnetic click when you plug your MacBook in, everything just clicks right in my brain: I am calmer, I can organize my thoughts and stay on task better.
Since Leah first spoke out about her mental health in 2017, many more have continued the conversation in an effort to dispel some of the stigma and spread hope to anyone struggling.
LF: In the last like five years, there's been more candid conversations from professional athletes about their mental health struggles. That has helped me realize that just because you struggle with certain things doesn't mean it's a death sentence for your career. Even though sometimes it can be difficult, it's not something that's impossible to work through and sometimes use to become a better athlete. You have this unique perspective on thoughts and on how to relate to people because millions and millions are affected by mental illness. This way to connect turned it into a positive: yes, sometimes it really sucks, sometimes it's dark, and sometimes I don't want to talk to anybody, but there are times when I'm feeling a lot better, and I've worked through something and I feel like I'm equipped to help other people move forward in life.
As Leah and so many others have now brought to the fore, you can be highly successful and still struggle with mental illness. However, in order to achieve your full potential, accepting the difficulties and seeking out the right support has to come first: finding help is a sign of strength and courage not weakness.
Some good Leah quotes:
LF: I told myself I would treat this like I would treat any other injury, by pouring my energy into rehabbing my brain.
LF: It feels like this thermometer in your brain that goes up, up, up to the point where I’ve got to go to a different room and just cry it out.
LF: I'm not necessarily glad that I didn't get diagnosed until I was 29, but it's made me really resourceful; I’ve had to learn a lot of different ways to work with my brain and figure stuff out.
LF: Typically it feels like I have 5 to 10 different pathways in my brain just all going at once, it's like traffic in LA in my head!