- To Change Your Mind - Details Matter
ADHD Medications with Depression: Seven Significant Problems
Brain and Immunity: Dr Jaffe CorePsych Radio Update
March 24, 2009ADHD and Bipolar: Controversy Explored at CorePsych Radio
April 8, 2009Depression and ADHD: Often Confusing – Listen on CorePsych Radio [handout for the program at this link] 
- Advancing Technology: The laboratory findings have changed so dramatically that the new information seems unreal. I was at a meeting recently with molecular and cellular physiologists arguing “old news” about how the intergenomic cross talk occurs between a nucleus of a cell in communication with that cell’s mitochondria. These systems can significantly effect neurotransmission.
- SPECT and other brain imaging systems can actually see where specific neurotransmitters, such as dopamine, become active in the brain.
- Antidepressant medications have become increasingly more effective and more widely used for treating more than depression.
- We know much more about the CYP 450 metabolic pathways, and how they can, and do, interfere with certain medications causing drug-drug interactions.
- The world of stimulant medications has changed even more profoundly in moving from first and second generation stimulants to now a third generation stimulant. [First Generation: immediate release such as Ritalin or Dexedrine; Second Generation: extended release such as Concerta, Adderall XR; Third Generation: prodrug – Vyvanse with a different time release process unaffected by acid-base balance or transit time] Many do not appreciate these differences.
- The trend to using antipsychotics and mood stabilizers [e.g. Risperdal and Lithium] for ‘impulsivity' that doesn't appear to fall under the label of ‘hyperactivity' appears in increasing frequency with diminished awareness of the complexity of ADHD comorbidity. These are seen on the rise with multiple second opinions in my office – resistance and confusion about ADHD diagnosis.
- We can be much more confident regarding side effects and medication predictability than we were even 5 years ago, leading to a false sense of security with partial ADHD diagnosis – if a little ADHD then they must be all ADHD. In psychoanalysis, we called that process ‘the incomplete interpretation.'
Please join me as we take a full hour to look at the many angles on depression and ADHD challenges. And check out the links below for more info.
See ya there,
cp
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5 Comments
Another great post, Dr. Parker!
I know there’s been a fair amount of discussion among researchers and professionals about “fracturing” off the different ADHD subtypes into separate disorders altogether. Any thoughts on this? Although there are the 3 main traditional subtypes of the disorder (hyperactive/impulsive, inattentive, and combined), it seems that the prevalence of all of these comorbid disorders (depressive or anxiety symptoms, conduct disorders, obsessive-compulsive behaviors, Tourette’s symptoms, etc.), may warrant even further subtyping of ADHD.
Also, all the relatively new studies out there about specific alleles of key “ADHD genes” and how these gene forms can play a significant role in regulating the impact of a particular medication really makes me wonder if the drug-gene interactions or effects are as strong as the drug-drug interactions for these different medications for ADHD and related disorders.
The new treatments out there, including newfound “off-label” uses of antidepressants or mood stabilizers for ADHD symptoms (some which have surprisingly effective results), makes me wonder if we’ve got some of the underlying causes of the disorder entirely wrong, or are missing a huge piece of the ADHD puzzle.
Thanks for keeping us all updated on your work. I had no clue that SPECT was actually capable of tracing actual neurotransmitters (I thought it was limited to measuring blood flow patterns to different brain regions)!
Nicholas,
Excellent questions and thanks for your kind remarks. I likewise much appreciate your blog work/writing and feel a kinship with your parallel mission to educate public and professionals regarding the collective next steps we should be taking to be offer more precise treatment – both targets and trajectories of specific medical/nutritional products.
I am certain a renaming of ADHD functional entities will not be adopted as a common practice soon, & anticipate that my book, which delineates more precise easily recognizable functional subsets, will be perceived by the academically inclined as controversial and unnecessarily confusing ‘because we have it right now.’ On the other hand, street folk will appreciate the practicality and precision of the new think on ADHD treatment. That’s why I’m writing it first for patients and their families.
Regarding alleles: No doubt they will soon become more relevant and genetics creeps its laboratory way into our offices and becomes more easily available. At this moment the best we can do is measure the genetic polymorphic changes with CYP450 – especially with 2D6, as these can help break out different rates of metabolism for AMP products at this moment: see http://www.genelex.com.
I can tell you we are indeed missing huge parts of the puzzle, I do quite agree with you, and expect an interesting shift in neurotransmitter focus quite soon with the launch of a new product this fall… not at liberty to write about it yet – it will be quite interesting. The science is there, but, as always, broader use will help understand the larger implications and effectiveness of this new product – not a stimulant.
Stay tuned for these next missives and the next CorePsych Radio, next week: I’m going into very interesting innovative discoveries with specific neurotransmitter precursors – what, why and how we can use them – and, bottom line: they have several roles – help the pharmaceuticals, sometimes even replacing pharmaceuticals all with a much deeper understanding of the cellular physiology.
Thanks
cp
Your points are exactly why I am deeply into this book. No doubt in my mind that a large chasm lingers between good contemporary science and the very process of labeling what we are treating.
Dr. Parker,
I left a comment on another thread regarding amphetamine + memantine and now I cannot see it. Perhaps I was doing it wrong? Did anything come across on your end?
Didn’t see it then but am reviewing it now.
cp
New blog post: ADHD Medications with Depression: Seven Significant Problems http://tinyurl.com/dy7kun