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ADHD Medications: Neurotransmitters to the Rescue
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October 18, 2009Neurotransmitters & Psychiatric Medications: The Turkey Shoot Revisited
November 7, 2009
ADHD New Directions B Tal via Flickr
ADHD Treatments Evolve Dramatically
Remember how that old Maine farmer told the lost city guy who stopped to ask for directions: “Come to think of it, you can't get there from here…” Well, truth be known, the evolving neuroscience is taking us in new intervention directions.
ADHD medications, my friends, are evolving dramatically. Intuniv, the new ADHD medication, [not a stimulant, but rather an alpha 2A agonist] by Shire will be in your pharmacies soon, and the pharmacology, the indications, the new science is simply dramatic.
If you are a professional on any level, and can attend one of the launch dinners in your town, I strongly recommend that you take an evening to see evolved neurophysiology at work. That α2A receptor, that quite different medication, will help change the way we think about medications for ADHD in the future. More about that later, stay tuned to CorePsych Blog for the details, – and watch my YouTube Channel at DrChalresParker for a pithy report on our office findings with Intuniv – likely next weekend.
Neurotransmitter Measurements For ADHD
Neurotransmitter physiology takes us way beyond what we have been doing for years with only stimulant medications. Neurotransmitters will take us further down the line to that holy grail of ADHD treatments: The Natural Way. Do make sure you sign up for updates, because this evolving neurotransmitter information will be the main theme in coming reports – and for today one brief story that I am sure will get your attention:
More than ADHD
52 yo male flies in from California for SPECT functional brain scans and complete brain review after years of failed treatment for ADHD and depression. These basic findings will make your hair curl:
- Prozac 140 mg in the AM combined with Lexapro 80 mg in AM
- Adderall XR 80 mg in the AM
- Neurontin 800 mg 2X/day [given because he looked bipolar with the AMP and the Prozac – go figure]
Does serotonin syndrome come to mind? Are you now with me on my oft cited 2D6 interactions between Ampehtamines and Prozac? Lemme guess… do you think he was, dare I say it… toxic?
He suffered with profound ADHD – he couldn't think, couldn't complete sentences, drifted off with his wife – he looked like a flaming Thinking ADHD subset. His legs were twitching, not only at night, but through the day. He suffered from cognitive impairment/dementia and worried that he had early Alzheimer's. He had significant metabolic issues with transit time slowing for years.
We got the interactions straight, confirmed with SPECT that he suffered from significant metabolic challenges with diffuse hypoperfusion across the surface of his brain.
The Neurotransmitter Watershed
Most important after these obvious issues, with no brain injury and no evidence of Alzheimer's, were the neurotransmitter testing results [spend some time on this page and download the details]. His cognitive world was completely handicapped by low levels of Dopamine and Serotonin, with, as you might expect, elevated levels of Glutamate [more later, stay tuned].
Even with all the dopaminergic drugs his dopamine was below normal levels. The simple reason he didn't suffer from serotonin syndrome: he had so little his serotonin tank was almost completely empty! Yes, for years he has been a picky eater.
Neurotransmitter Lesson: Without the foundation of an appropriate supply of neurotransmitters in the first place no amount of psychiatric medications will turn the treatment tide. You can't get there from here.
You will hear this next measurement phrase repeatedly here:
If you don't look, you won't see the specific problem – comprehensive evidence is that new direction.
With this executive he suffered from pervasive cognitive problems, the SPECT imaging provided a good safety check, and the neurotransmitter testing provided the most effective different medical intervention strategy. My humble opinion: neurotransmitter testing will provide significant different intervention strategies for many with complex presentations.
He is thrilled with his new cognition, is on target in his marriage and at work, and does not suffer crippling brain toxicity. He is on neurotransmitter precursors [natural amino acid combinations] specifically designed to meet his deficiencies. Prozac is long gone, he is on Pristiq and Vyvanse, only low doses of each, and time will tell if he even needs those medications down the road.
Stay tuned for more reports like this one, with more details on the specific process. Best to simply sign up for these blog posts as I will be sending out regular info on these new directions. Neuroscience evolves.
And do forward this post to your friends who are stuck with ADHD Medication challenges. – And BTW, yes, we can provide this testing long distance, as we don't require a trip to Virginia, unless we write for medications.
cp
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19 Comments
My son has been on Intuniv for 10 weeks 1mg.It has been a miracle for him.Life has changedfor us.anything looks possible.He has high func.autism ,adhd and ODD.ODD is gone.The ADHD has improved greatly.He has been on Luvox for 7 monhs before intuniv was added.It hads been great for him.But I see signs of plateauing ofthe Intuniv.Late day activity level up and energy level is increasing.I am considering uping the Intuniv to 2 mg.Should I take out Luvox.Or should I replace he luvox with pristigue or something elase.He tands to be very ocd.Intuniv had little efect on that.Thanks!
Karen,
Glad to hear that the Intuniv is working! Just a quick note on the antidepressant picture: One can almost never predict the outcome of the next med change for those with multiple challenges – as those multiplicity of issues always indicates more challenging biomedical issues underlying, making predictions difficult. You didn’t give the age of your son – but Luvox as I recall is approved for use down to about 10 yo, Pristiq is not. Having said that if Luvox doesn’t hold him a change is in order. Lexapro is approved down to 12 [I often check on acceptable indications if the clinic presentation is sketchy] simply because we are so much on the edge in the first place.
It may seem edgy, but it will be far more predictable to measure biomedical issues with whomever and make the necessary corrections in the inevitable imbalances.
cp
My son is 7 years old.We see neurodevelopmental pediatrician here in Pittsburgh and have had full bloodwork &stool analysis.He definitley has gut issues.We have been caesin free for 3 years after test reavealed the problem.After removal the next test then showed he now had gluten issues.He is an extremely limited eater and I was only able to get him to be gluten free for a short time while on risperdal and he ate anything he saw.Because he is hypoglycemic I wanted him to at least be eating for school.He is a complicated kid!!!Stool analysis revealed NG of lactobacillius,Potential pathogen of klebsiella and citrobacter.So there was a BIG problem!!Any probiotic made him crazy and unable to function normally.A 6 week dose of antifungal was ok but 5 weeks after he had such extreme mental issues it was scary(risperdal pulled him through but stopped after ticks)I believe the antifungal made room for the bad bacterias to multiply hence the terrible mental state that followed.
I told you he was complicated.I have tried so many times to tackle the diet gut issues and have been beaten by the monster of his eating issues.He eats no meat and can’t even be near it .Eating therapy-kicked out because of behaviour.Bet you didn’t think a simple question about Luvox would lead to all of that!
Karen,
Complexity, for me, discourages speculation. It seems so frequent that when challenging presentations occur in psych, we just start on the speculative “try this or that” path. I could pitch in by reviewing records and a phone consult, and know that I would absolutely recommend a more careful and complete IgG – as many kids and adults suffer from multiple allergies. Supplements will be part of the solution as he is malnourished… but all of that would need a more deliberate, thoughtful and evidence based approach.
cp
Hello – what is your opinion of neurotransmitter support for kids with attention issues – I have had an alternative doc recommend TravaCor Jr. pediatric neurotransmitter support capsules which various nutrients and amino acids to support brain function . . .thanks
Michele,
TravaCor Jr is a serotonin precursor and very useful for kids who take stimulants – due to the serotonin/dopamine balance issues as described in this CorePsych video near the end. My plan as a traditional doc: I always measure before I treat, so I know exactly what I am doing with these supplements – and the good news is that NeuroScience accepts/contracts with most insurance plans.
cp
My son has ADHD symptoms and we’ve done meds with some help but improving his diet and cleaning up his gut has been the most helpful. I read that 90% of serotonin is in the gastrointestinal tract and when there’s bacteria it impacts the neurotransmitters too.
Kelly,
I assume you meant “bad bacteria,” as there are always about 3.5 lbs of healthy bacteria in an adult gut. Bad bacteria definitely have been shown to be associated with depression, no doubt, and when you have the bad guys on board they do significantly effect most of the neurotransmitters as immunity arises often creating much amplification of the excitatory neurotransmitters glutamate, PEA, histamine, and often dopamine and norepinephrine – causing intractable agitation not treatable by just psych meds. Psych meds are chicken catchers, and too many neurotransmitter chickens need reduction, not accumulation. You called that one quite right!
cp
[…] ADHD Medications: Neurotransmitters to the Rescue (corepsychblog.com) […]
Unbelievable case! Your metaphors are so great. Don’t even think of retirement. On the contrary, maybe you could enroll some of your retired colleagues to rejoin the fray. Churchill was 65 when he was called him in from the wilderness in 1940.
I posted a missive and couple of questions over at the Virtual conference site. Please check it when you get a moment.
Does Luvox have this interaction problem too? I have an ADD friend who is on it, had a good reaction to dexedrine for a week or so, then had difficulties and quit.
David,
Thanks for your kind remarks, and encouragement… I’m a little past Churchill on the time line, and the war over credible evidence has been smoking for years. The good news: carrier pigeons just back from the front bring evidence to confirm a dissolution of misplaced, non-supported enemy lines, and a confusion with speculative forces!
I will get over to the Virtual site and see what’s up over there right now.
And Luvox is very clean on the main AMP pathway, 2D6, but does block 1A2 and 3A4 so needs it’s own separate attention. Bottom line: stimulant meds are OK with Luvox. Luvox does have a variety of side effects – and if he/she was trying to chase down OCD symptoms, several others often work just as well on the front end. Off label, but Pristiq and Effexor can help if the origin is purely serotonergic.
cp
Re: More than ADHD
Dr. P, I am just AGHAST at the medication atrocities committed on that poor man. How could a doc in any good conscience….
Your book is needed now more than ever….. Thank you for being here.
Gina Pera, author
Is It You, Me, or Adult A.D.D.?
Thanks Gina,
As everything in life, it’s a matter of showing up, and timing. It’s the right time, and since the facts are inarguable, only the curmudgeonly will stay home and await more confirmation.
cp
<<>
** Any details on how one would get this done?
Thanks
John
John,
Check out the links to the page loaded with the info here at CorePsych Blog, and I will load the How To Follow Up there asap.
cp
[…] This post was mentioned on Twitter by drcharlesparker, ADHD Topics. ADHD Topics said: ADHD #ADHD: ADHD Medications: Neurotransmitters to the Rescue… http://bit.ly/4xIutX […]
This is so interesting. I love the cutting edge stuff, because mainstream ADHD treatments don’t seem to work for me. I have ADHD symptoms (Biopolar ruled out) and yet the stimulants affect me as they would someone who did not have ADHD (make me feel high, hyper, & what not). I believe there are biomedical aspects to ADHD that are being completely ignored by the current protocol. I find if I use the natural protocols that are widely used in Autism I feel better. ADHD can learn a lot from the biomedical treatments they’ve been using in Autism for years, IMO (www.autism.com)
Satellite Cognition,
Love your name – takes the reader both in and out at the same time!
A hearty yes, and thanks for joining me in this most interesting set of scientific next steps. One of my successful and retired peers asked me the other day: “When are you going to retire?” I told him “I’ve been out beyond the shore break for my entire professional life looking for the right wave – I’ve seen it coming, caught it, and am having a remarkable, sometimes tubular ride everyday – why would I bail out now?”
The parallel with autism and ADHD is the apparent simplicity on the surface, and the surprisingly interesting and remarkable complexity once we were able to turn on the technology to see what’s going on.
Your situation sounds very much like those refractory folks we intervene on with this Neuroscience testing with subsequent neurotransmitter precursors – coupled with comprehensive measurement of other mitigating factors as clinically indicated.
Stay tuned, I will be writing much more here and am sending out audio briefs on cinch thru BlogTalkRadio on Twitter.
Tnx cp
ADHD Medications: Neurotransmitters to the Rescue…
ADHD Medications: Neurotransmitters to the Rescue
by Dr Charles Parker, CorePsychBlog
November 2, 2009
the evolving neuroscience is taking us in new intervention directions.
ADHD medications, ……