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Here At CorePsych Blog We Are Starting 2011 Early, Right Near DC !
The CorePsych Conundrum:
Have you been thinking about all of this new brain and body neuroscience material, – but just don't have your arms wrapped around the translation from functional neurophysiology to the most effective office applications? Do those Core interventions and clinical applications seem just out of your reach?
Answers Forthcoming – Join Us In Falls Church:
If you are a professional – from psychiatrist to any-other-medical-practitioner-working-with-mental-health-challenges – our CorePsych team is working with NeuroScience Inc. to provide a remarkable educational program you really should not miss – and, head's up, – it's this weekend, Dec, 11, Saturday [Sorry for the short notice, we had such an excellent response to our recent presentations in Denver, we wanted to provide the East Coast with some Holiday goodies for the next year!]
The Presentation Title/Specifics:
Advanced Integrative Medicine: Novel Approaches for Assessing the Neuro-Endo-Immune SuperSystem – Focus on Chronic Conditions and Lyme Disease – The mission: to explain the interesting evolving interface between these three systems: Neurotransmitters, Endocrine Function and Immune Dysregulation for office application – to address those refractory chronic conditions that simply appear impervious to customary, traditional approaches. When you see these details, intervention strategies will multiply.
The Speakers:
Gottfried Kellerman, PhD, Founder of NeuroScience, Inc: An expert in the application of neurotransmitter, endocrine and immune assessments with an abiding mission/philosophic passion for directing those unique bench findings into precise clinical, trench applications. Evolved evidence provides more precise treatment. Gottfried is a warm, engaging speaker with a delightful sense of humor and a deep grasp of NEI SuperSystem with over 150,000 patients reviewed by his team over 25 years of clinical experience. His insights are changing the entire clinical intervention process from psychiatry to infectious disease – and will significantly effect the way we address these multiple issues for years to come. You should come just to hear Gottfried, period.
Sirid Kellerman, PhD, MBA, VP of NeuroScience, Inc: A molecular and cellular physiologist and immunologist with her father's curiosity, her own special view of applied clinical applications, and a fresh, helpful view of deep science investigations with the NEI SuperSystem. Sirid will address her own specific perspectives on the application of specific NeuroScience testing possibilities to unearth heretofore almost completely ignored immune dysregulations. Think about our clinical work this way: if you don't fully understand the basics of neuroimmunology you will, quite simply, miss it, as I have for years. From the mystery masquerader of Lyme presentations, to the basics on gluten and casein sensitivity – if you don't see it you can't treat it. She may be deep into science, but Sirid is just great fun to listen to, and will simplify the details so you can take them with you.
Charles Parker, DO, Child/Adult Psychiatrist: You already know me well from the context of these four years at CorePsych Blog. You know that I have been respectfully shining the light around these dark corners of chronic refractory mental illness, neurotransmitter dysfunction and SPECT brain evidence long before we recently came together as a teaching team. I am personally very grateful to the courteous and understanding NeuroScience team as they have collectively provided rather remarkable outcomes in my office for the many refractory patients seen in our CorePsych offices. This science works, and if I can get it, if I can use these details for my patients, you can too. As they say in recovery: it works if you work it.
Two favorite W. Edwards Deming quotes come to mind in this regard:
“If you can't describe what you are doing as a process, you don't know what you're doing.”
– and, get this one,
“If you stay in this world, you will never learn another one.”
Deming is the guy that set the standards for quality control, continuous improvement, and taught the Japanese how to build cars.
The details for this meeting:
Saturday, Dec. 11, 8AM to 4PM
All slides in handouts, and some special complimentary additions for those who attend.
————-
Fairview Park Marriott
3111 Fairview Park Dr.
Falls Church, VA 22042
703.849.9400
————-
To Register:
Larry Gourdine
larry.gourdine[at]neurorelief.com
443.904.1607
CoreBrain Training
This meeting is but the first phase of a 2011 CoreBrain Training initiative which you can get in on at this CoreBrain Training link – it will be virtual and tuned to the everyday office practice. Plan on it!
Hope to see you there Saturday!
cp
Related articles
- Pharmasan Labs, Inc. Wins Grant for Novel Immune Tolerance Test (ITT)-Cytokine … – Marketwire (press release) (news.google.com)
- New study shows Immune system involved in depression (fonduekid.wordpress.com)
- The unhealthy ego: What can neuroscience tell us about our ‘self'? – ScienceBlog.com (blog) (news.google.com)
- How some brain cells hook up surprises researchers: The untold secret life of the humble microglia (sciencedaily.com)
- CoreBrain Training (corepsychblog.com)
- Is this a neuro revolution? – Varsity (news.google.com)
- Brain chemical finding could open door to new schizophrenia drugs (sciencedaily.com)
- neuroscience for the mental health clinician (health2books.wordpress.com)
13 Comments
Dr. Parker,
I appreciate your approach to the issues that face practice today. I like how your response discusses the real world value of “street” psychiatrists in comjunction with those in academia and performing biological research. Ive read so much from a strictly critical perspective, and then I’ve seen real treatment providing real results and I have found myself caught between those two positions. Thank you.
Scott
Scott,
Thanks for your kind remarks – I very my appreciate your excellent site over at http://www.panopticism.wordpress.com – your exposure to the harsh reality of asylum care is needed in a world of denial and label arrest.
cp
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I like the fact that people are talking about diagnosing, rather then just putting people on pills. Great post.
done!
After the testing, what are some of the typical next steps? Obviously it depends on the specific results, but in general what kinds of things?
I emailed Sarah again with follow-up ? regarding fees.
As far as what is driving the train, I like that analogy. It makes sense! What if the results are “normal” so to speak, in that there aren’t any red flags? I’m guess I’m just trying to understand how this helps from a clinical standpoint. The meds do work – we know that (so the transmitter precursors are at least there…as you’ve said, if nothing’s there the meds wont work predictably but they are working pretty predictably). But clinically, from what I’ve read about the testing here on this blog and elsewhere, it doesn’t really guide toward one medication or another – at least from what I’ve understood.
ok. Thanks. I know I said that’d be my last post for a while, but I just wanted to re-touch base again and verify that we did ask for that kit! Thanks again,
Bob
Bob,
If these tests are normal, we simply didn’t get the actual problem identified. With her presentation it is highly unlikely we won’t find a variety of issues, and each component will have a different target system – right the testing often does not solve the specific med problem, but suggests next steps for the biomedical underlying challenges.
Some of her precursors will be unbalanced, likely low, but with any excitatory symptoms some may be high. Yep, Sarah and I talked about the kit.
cp
Thanks so much,
so everything is ok and will be…stick with the adderall and find an antidepressant that will work. If she reacted that poorly to one ssri, does that mean the whole class of ssris is less likely to work? Or are there finer subtleties in their mechanisms/composition that sort of divide them into smaller subgroups? (what would these smaller subgroups be?) What have you found works well with adderall?
The other issue is cost/insurance…the fewer the prescriptions the better; she currently pays $100/month for the adderall (xr and ir). Adding another scrip for something else could put her up to $160.
Is it possible she might not need that additional ir dose in the afternoon, if/when she and her dr find the right antidepressant? then she could switch to the 50 XR…which would be just one adderall scrip?
But, more importantly, is her health and happiness. It’s amazing to me that she can do all the right things with nutrition (as best as possible – whole grains, protein, veggies, fruit), exercise, cognitive therapy, relaxation, etc…take the adderall….and still struggle as much as she does. Why is that???
Part of it is sleep. When she takes the adderall later, she sticks to the schedule but doesn’t fall asleep easily. When she takes it earlier, she stays up all night even if she’s exhausted, and doesn’t go to sleep. Basically she can’t keep herself from doing one more thing or looking up one more thing. She’s also notorious for over-committing.
Thanks again,
Bob
Bob,
So often a person new to the meds sets out to conquer her world, and if she was that way anyway, look out! 😉
Every SSRI is different regarding post synaptic serotonin receptors so some work better, differently than others. Regarding the meds, if she is pinched on the $ and has a cell phone, do the generic Adderall, unfortunately in these times it’s somewhat harder, often with less compliance with those with ADHD, but will save bucks and keep the person on track. She needs to do a better job of watching her own sleep patterns – often any med later than 4 PM will be a prob, so she can talk with her doc about doing 1/4 on those occasions, or as you say none in the PM.
CBT doesn’t cover over committing which inevitably leads to a victim role – all covered in detail in my book Deep Recovery – written in ’92 but timeless on relationship balance. You can order it from our office if Amazon is out thru Sarah at Service on the Nav Bar.
Best,
cp
Dr. Parker,
Allow me to start off by introducing myself. My name is Bob and I have a very close female friend (confidante, but not in a relationship) about whom I’m concerned. I’ve read your book, several other books, and leafed through many pages on this blog. We’re both well-educated (Masters degrees and I’m working on my PhD in mechanical engineering) and don’t generally support the use of medication. Both of us firmly believe that lifestyle changes/therapy etc are more important and should take a priority. But I actually encouraged her to seek a formal evaluation because she was just struggling too much–constantly frustrated and asking why it was so hard to lead her life, even when she was doing all the “right” things (counseling/therapy, exercise, sleep, nutrition, relaxing/having fun etc…) So….I have some questions.
What’s considered too high of a dose for adderall (total mg/day regardless of IR or XR)?
She takes adderall. She’s 28, in what seems to be otherwise good health, weighs about 125 lbs–but full day coverage seems to be necessary for her (ie. 15 hrs) — which on those days, would be 75 mg total. Otherwise it would be 50 mg XR which gives her 10-11 hrs. Currently she’s prescribed 40 mg XR and 25 IR – one in am and other in pm depending on the day and where the transitions fall. It has made a tremendous difference.
Why do some people need more than others?
Is there a possibility that she could take an MPH product (with the most effective dose wind up being fewer mg of stimulant) and have comparable results?
Other questions that haven’t been addressed by current medication:
1) What would you suggest for extremely intense emotions and quick emotional reactions?
—the little things that used to be a problem are better. It’s the unexpected changes and level of intensity that are the problem…and it’s a big problem.
2) What would you suggest for recurring obsessive thoughts/actions and almost compulsion for to do certain things? The adderall has helped that a little, but not much.
3) She’s so much easier to be around now…but I wouldn’t say she’s happy overall. She thinks about the meds too much (ie figuring out the optimal time to take it, why it doesn’t seem to work sometimes etc) and she struggles with the idea of needing these medicines for longer term. These two things make her anxious or sad or both (feeling this way about 50-70% of the time).
4) When she last went to her dr, she gave him a 2 page typed list of all her concerns and targeted benefits from taking the adderall. She basically told him that something needed to change, but that she did want to keep at it. He recommended starting an SSRI, so she did that night. Only problem was her reaction — very negative (and she hadn’t had many reactions to other medicines before finding the adderall), and it was only a half dose.
a)She told me she did not sleep at all that night. The next day she could not concentrate, felt like her heart was pounding, very uncomfortable especially in the am, on edge, naseous, much higher blood pressure than normal (which had always been 90-100/65-70)… She talked to her dr and they agreed for her to cut the other half even smaller and take that. So she did – she cut the remaining half in half twice and took the equivalent of 1/4 the dose of the first night.
b)Her reaction was still very negative, but not as bad. She did sleep, but woke up with an awful headache. Got moving much later and still experienced the pounding heart, being on edge, and higher blood pressure. She talked to her dr again and did not take it again.
c)The following day, she woke up normally (for her) and felt better. At various times during the day (when she had a moment to sit), she noticed that her heart was still pounding and still on edge a little. Even into the evening she felt that way. This day, I was also able to observe the rebound from her first dose of adderall. It was much more significant than any other day (and she’s been taking adderall for at least a couple months now)…at first she felt tired, then she felt really tired and confused & agitated by the time that 11th hour came around.
Wow — that was a lot. She and her dr are in almost daily communication at this point, so that’s really good. (He’s a psychiatrist, not her gp, thankfully). I just want to help her as much as I can and be supportive. We’re really good friends and I know she would do the same if I were in her shoes. Very loyal, hard working, doesn’t like to take the easy way out, very generous, very intelligent. She also doesn’t accept things very well and so this whole process has been extremely difficult for her. It’s probably taken longer than it should have to find what works because of that!
So basically, what I would greatly appreciate from you is your response – your experience, suggestions that maybe she can make to her dr (or when he makes them, she knows more what he’s talking about…though we have both done quite a bit of research).
I’ll leave you with one last comment she told me her dr said to her at her last appointment: “You would probably like a firm diagnosis, a concrete certain answer. Psychiatry is messier than that. It’s not as simple as the DSM makes it out to be. You are a lot more than ADHD, so really, we haven’t been treating you.” She really appreciated that comment – so much that she remembered it almost word for word and wrote it down. He continued, “I think a part of you is resigned to having this illness, but I know you will be better and you have to believe it too. You will start feeling better; I just can’t tell you when that will be. You’re not the most complicated case and we will figure it out.”
Thanks again for a wealth of information and your commitment to educating the general public. I eagerly look forward to responses to my questions and general suggestions. Thank you again for reading my novel! 🙂
Sincerely,
Bob J.
Bob,
That dosage is not too high for a person with her characteristics… and needs to be titrated on metabolic rate anyway, which it sounds like it has been.
1. Emotionality with stimulant meds, as noted in Rules, can arise from way to many things to hit upon here – most commonly the stims exaggerate underlying depression.
2. That would be an SSRI – clean on 2D6.
3. Bingo, now you’re making my point.
4. Reaction to SSRI – I never start them at night, and, as noted in Rules, only after a good protein breakfast. Does not sound like the right antidepressant.
Her doc sounds like a great guy, will enjoy reading my book [as we are walking the same road]… & sounds like he needs just a bit further insight to help him on his mission. No disrespect – he is a brother on the path.
Thanks back to you for caring and walking that same path with your friend.
cp
After reviewing your book again, would you hazard to say that it’s the cognitive and physical aspects of depression? It’s confusing, because her overall mood isn’t bad — meaning she works through whatever it is well pretty well and manages. Also those intense emotional situations are not usually sadness, but frustration or anger…which she did have before also. It just seems that now they stand out because the lesser frustrations are not there.
it’s like what she told me two days ago: “Bob, I have two choices. 1) I can take the adderall and do better but obsess over it all the time and always wonder more whenever there’s any inconsistency or it wears off (and subsequently be frustrated/angry/discouraged often times), or 2) I can not take it and be frustrated, discouraged, confused and anxious about what needs to be done all the time. How am I supposed to choose which one?”
I encourage her to talk to her dr and have passed on the info you gave me..but she is not all that willing right now to try another antidepressant. She’s reading up on the different SSRIs and SNRIs and anti-anxiety meds besides benzos and all it does is make things more complicated and frustrating for her. She can’t decide.
She’s worked down now to only 25 (I think) of the IR in the am…she said she can do ok at work in the pm sometimes (depending on the type of day), but as soon as she gets home, there’s not much done. So really, that’s not cutting it. But the higher doses don’t either, because then you’ve got the obsessiveness more. It’s weird how thats just gotten worse since that weekend when she took the ssri (and it was not prozac!). I’ve written all this before…I’m just repeating myself. But I want so badly to help her fix it!
1) So is some antidepressant really the answer? Will that work? I don’t know if she can take another failure. All of these things long term just don’t mesh well either with either one of us, but I want to support her. I know we can’t KNOW, but that’s what she needs. She needs that certainty to even try at this point (or at least close to certainty). She’s said as much to her dr.
2) I understand that you can’t give any real medical advice obviously (and not knowing all the details) but what meds have you seen works well with adderall in circumstances like these? Is there any in particular?
3) Finally, why does full day coverage seem so necessary? Is it maybe partly because there’s this other co-morbid condition that’s not really being treated yet, or might she really need that?
Thank you again! (and I’m sure this’ll be my last post for a while! 🙂 )
All the best,
Bob J.
btw – -what does the cell phone have to do with the generic adderall?
Bob,
Without seeing her it is quite reasonable to suggest that she does need more careful evaluation. So many folks do have comorbid biomedical problems, as she sounds like she does, that are chronic and therefore under the radar – not given the respect for their causative contribution to both the depression and the ADHD. Many of your questions belie the challenge with modern psych diagnosis. You are trying mightily to help by re-describing how she looks, and the real problem is not her appearance, her behaviors, but what is driving her train.
She would do well with a neurotransmitter review as it would open the door for next steps. We could do that over the phone, no prob, just connect with Sarah to send out a test kit – we don’t charge for the testing, only the reading of the test and make no money on the test itself.
cp
Bob,
Without seeing her it is quite reasonable to suggest that she does need more careful evaluation. So many folks do have comorbid biomedical problems, as she sounds like she does, that are chronic and therefore under the radar – not given the respect for their causative contribution to both the depression and the ADHD. Many of your questions belie the challenge with modern psych diagnosis. You are trying mightily to help by re-describing how she looks, and the real problem is not her appearance, her behaviors, but what is driving her train.
She would do well with a neurotransmitter review as it would open the door for next steps. We could do that over the phone, no prob, just connect with Sarah to send out a test kit – we don’t charge for the testing only the reading of the test and make no money on the test.
cp