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ADHD Medication Problems: Why They Don’t Work
ADHD And NeuroScience – San Francisco
April 4, 2011ADHD Misdiagnosed: Beyond Behaviors
April 18, 2011
ADHD Puzzle Complexity
ADHD Problems: The Cause For ADHD Symptoms – More Than Simple Dopamine Deficiency
With just a little more investigation we can see what we intuitively already know well: Those excellent ADHD meds simply not only don't work for everyone – they can become quite unpredictable if we aren't careful. This post both lists the reasons for ADHD medication challenges and provides some easy links for chasing down more details.
ADHD biological complexity with multiple contributory imbalances will spoil good, insightful medical intervention if not better appreciated and investigated. See this CorePsych Blog post for 171 medical conditions which look like ADHD.
First Layer: Neurotransmitter Imbalance Unrecognized
– Dopamine Elevation: If dopamine is already elevated then stimulants will almost always make the patient's ADHD symptoms significantly worse – with anger, feeling stoned, inappropriate impulsive behaviors. Switching stimulants doesn't work as both AMP and MPH are dopamine re-uptake blockers causing more accumulation at the synapse.
– Norepinephrine Elevation: If norepinephrine is already elevated for other reasons, Strattera and Adderall [XR or IR] both with noradrenergic effects causing more accumulation at the already norepinephrine-loaded synapse. When norepinephrine is too high the ADHD symptoms of feeling internally anxious, with inability to sort thoughts in a timely manner can become overwhelming. You can feel, in a word, completely crazy.
– Glutamate Elevation: With all of the posts on Intuniv, now more than eight here at CorePsych Blog, we see considerable promise with new science regarding glutamate neurotransmitters at play. But just like dopamine and norepinephrine, glutamate can be elevated for a number of reasons, resulting again in a poor response to well-intentioned, carefully adjusted ADHD meds.
– Elevation of Other ADHD Neurotransmitters: From PEA [phenylethylamine], to epinephrine, to histamine [all excitatory neurotransmitters] – if any or all of these are elevated the outcome, once again, the overall neurotransmitter balance can become overstimulated with those otherwise useful stimulant medications.
First balance the underlying imbalance, and then the meds work quite predictably! Procedures for laboratory assessment and discussion here on this CorePsych Blog Neuroscience page.
Second Layer: Endocrine Imbalance Unrecognized
– Endocrine challenges: From hypothyroid to insufficient adrenal function to estrogen dominance – if not evaluated can significantly contribute to ADHD symptoms. Endocrine messages can significantly destabilize neurotransmitters, and endocrine levels are easily measured with a number of easily available laboratory tests.
Third Layer: The Foundation Layer | Immune Systems Challenges Unrecognized
Immune system dysregulation: Caused by under-recognized and under-appreciated antigen invaders such gluten, casein, other foods, parasites, bacteria [PANDAS], viruses, will send cytokine messengers up to muck up balanced neurotransmission – and will always create a significant problem with stimulant meds or with neurotransmitters supplements used to turn around neurotransmitters imbalances.
Neuro-Endo-Immune Challenges
These measurable biological, neurophysiological imbalances all conspire to create significant problems with ADHD meds. And if we don't start looking more carefully at these imbalances, and indeed measuring them to see them, we will continue to see those troubled with ADHD feel like medication guinea pigs. Without science, without an operational grid, without evidence, there are simply no targets other than appearances, and ADHD medication adjustments will remain an unpredictable mystery, patients will feel like failures, drug companies will be blamed for problems they didn't cause, and the medical profession continues to look like they don't know what they are doing with ADHD treatments.
Don't Forget
These challenges will be part of that all day presentation out in San Francisco on April 30. See the Events Calendar here for details. Translation from the laboratory bench to the office trench for these next steps in the treatment of ADHD is imperative, it's possible, and, yes, it's sometimes imperfect, – but it works. Biomarkers are real, not imaginary, and they are useful clinically.
If you can't show up in San Francisco, do sign up on this CoreBrain Training list for specific updates on other upcoming presentations – Thanks, hope to see you there in San Fran,
cp
Related articles
- ADHD And NeuroScience – San Francisco (corepsychblog.com)
- Put a Stop to the Blame Game (adderworld.com)
- Spotlight on Meds for ADHD (brighthub.com)
- The Side Effect of an ADHD Diagnosis (adderworld.com)
- Unlikely Bedfellows: Neuroscience and Family Therapy (psychologytoday.com)
- Pandas (bio230fall2010.wordpress.com)
- the addiction-brain connection (addictionts.com)
14 Comments
Thank you very much Dr Parker. I will look into this thoroughly.
By the way as a Brit I have to say I love your accent !
Greetings
Anthia,
What a super compliment – from a Brit yet!
cp
Hallo Doctor, I wonder if you’ve ever come across my problem. I was diagnosed with ADHD earlier this year.
I took Ritalin which hardly made any difference, then I went gluten free which gave me a lot of hope. Finally I was diagnosed with hypothyroidism. To my regret neither of the two medications worked. The levothyroxine left me walking around like a zombie and the armour thyroid threw me into terrible mood swings, I am now worse off than I was at the beginning of the year. Do you have any ideas ?
Warmest greetings from the Netherlands.
Anthia,
If you miss any of IgG challenges, say for example milk, then you will continue to demonstrate insufficient response to meds and to any intervention. My strong recommendation in these cases is to get IgG testing to rule out any mystery rather than the outdated elimination diet, which is often, as you describe, ineffective.
I have two references for you that will elaborate in detail: First go to listen to this Gluten Summit here:http://bit.ly/1aANoCN – it’s free and covers all of these issues much more carefully. Take a look at the brief video at this link to start.
Secondly go to see these guys talk about wheat and milk at my YouTube Wheat and Milk Immunity playlist linked here.
cp
[…] http://www.corepsych.com/2011/04/adhd-medication-problems/ […]
This is a very timely post for me to stumble upon as I am having trouble getting any of my adhd meds to work with the thyroid replacement drugs I take after having my thyroid removed. Initially I tried a range of adhd medications and they all worked well, but Strattera worked the best in terms of executive function. A few months later my thyroid levels started to rise and the adhd meds stopped working. I had my thyroid removed for the sole purpose of being able to resume my adhd meds but it has been a year now and I have had no luck. The only glimmer came when I got some response from the Strattera but then found out I was taking way too low a dose of thyroid replacement. It’s obvious there is some interaction with the T3 and T4 and the neurotransmitters which is blocking the action of the stimulant medications but neither my endocrinologist nor my psychiatrist have any ideas. I would be grateful for any suggestions you might have. So few people seem to understand the chemistry component of thyroid and adhd treatment.
Erica,
This is an interesting and complex question without an easy answer – many variables are likely involved. First of all immune, hormone and neurotransmitter receptors, that whole NEI system can compete with each other if any one is out of balance.
1. My first thought would be to investigate your immune system to consider cytokine competition for those multiple neurotransmitter receptor sites. Likely with thyroid issues that could be a culprit. Two books are Stop The Thyroid Madness http://astore.amazon.com/cpbks-20/detail/0615144314 and Why Do I Still Have Thyroid Symptoms http://astore.amazon.com/cpbks-20/detail/1600376703.
2. Measure IgG to eval possible reactions to food an look carefully at bowel function: See this video playlist on ADHD, Mind and Gut for many more details: http://www.youtube.com/playlist?list=PL321-bGRTfd8aFE_AhB43UnsRTiYAo6me
3. Don’t forget that often adrenal function is also compromised a bit in complex cases and adrenal slowing can look very much like hypothyroidism to the patient, with cognitive slowing that is independent of Dopamine, Norepinephrine, PEA or Glutamate all of these covered in some detail in these CorePsych pages – just Search each one on the front page here.
cp
[…] Visit link: ADHD Medication Problems: Why They Don't Work « CorePsych […]
[…] ADHD Medication Problems: Why They Don’t Work […]
As an AD/HD professional coach having been diagnosed as an adult
since 1994, I have been frustrated that I haven’t yet found a medication
that works well without prohibitive cost in terms of unpleasant side
effects. It seems with all the conferences I’ve attended and phone
bridges on the topic with experts one would think I “should” have found the
answer. But I haven’t.
The result is I don’t take medication, except when I have to,
for sequenced paperwork or other long, linear-boring tasks. My
hypersensitivity to stimulants, which work but with unpleasant side effects, I
suspect, prevents me from experiencing my maximum potential. Fortunately,
I’m high functioning enough without medication in most settings to do very
well. But I long for the greater benefits I have experienced using
medication without the negative presence of the unpleasant side effects
that accompany my better functioning: in follow through, staying on task,
an ability to tolerate boring but necessary tasks and better moods.
My solution for years has been to take a less-than-optimal
dose of medication in order to obtain some of the benefits of a larger dose and
thus limit the unpleasant side effects of too much agitation, headaches,
feeling as if I’m being driven too hard from within and sleep problems.
It may appear as if I just need a smaller dose and taking just a few (single
digit) milligrams of a short acting common stimulant, is the obvious
solution. – But it’s not. I know I am not as fully functional and
focused as when I take a larger (than 3mg) dose. So I know there is better functioning in some ways with a larger dose, yet I cannot take a more beneficial dose due to the
side effects. I feel as if I’m in a catch-22 situation. So reading Charlie’s
points about medication make me suspect my brain is already in an elevated
neurotransmitter state; either dopamine or norepinephrine, or some other ADHD
neurotransmitter.
I suspect many adults and “experts” in the field of AD/HD work/study
haven’t heard these particular points about AD/HD medications and why they
might not be working. We know it happens but up until now, I hadn’t heard or read a detailed reason why. I had the experience of years of conferences
and hundreds of hours of phone bridges and study, yet I hadn’t heard these
specific points which make so much sense to me now.
So I pose this question:
if a so-called AD/HD expert immersed in the study of all aspects of
AD/HD hasn’t heard these salient points, what chance does the average patient
or client have to resolve chronic medication problems; even when they have tried and failed for years to find satisfactory medical remediation?
It boggles the mind. Thank you, Charlie, for myself and all those who have tried multiple types of AD/HD medical interventions, yet still found nothing that worked well with tolerable
side effects. Now I have a new frame and new hope for myself and my clients with which to approach treatment.
Anonymous,
The considerable challenge with the biomedical aspect of ADHD treatment remains, in my opinion, one of the most dramatic and outstanding oversights in medicine today. Thanks for weighing in and do sign up over at the CoreBrain Training link to stay posted on the training that a coach like you will love.
cp
g,
It does boggle the mind… the details that are overlooked in the rush of throwing meds at inadequate labels is pandemic. Thanks much for weighing in! It’s always good to hear from a pro who really gets it.
cp
[…] ADHD Medications Become A Problem Without Good Science | CorePsych … […]
Very interesting – thanks Dr. Parker!