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DSM 5 Diagnosis: Psychiatric Institution Lockdown
February 14, 2010Depression, 5HTP and L-Tryptophan: Laboratory Markers Matter
April 4, 2010
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Notes from the CorePsych road
It's been busy here, so I'll take just a moment to keep you updated.
Brief report from the Mississippi Delta:
Imagine this – I took a vacation… The White Boys and Wives Blues Excursion: Five, count them, surprisingly compatible couples in a White Van for a full 7 days, touring up the Blues Highway in the MS Delta from New Orleans, through Natchez, Vicksburg, Yazoo City, Greenwood, Greenville, Clarksdale and Memphis – a memorable trip through a heartland of change. Our guide: a native of Yazoo City who grew up to become an ad man in Va Beach.
We hit many plantations [including Linden where the closing scene from Gone With the Wind was filmed], the Natchez Trace, blues clubs, [most notably Morgan Freeman's Ground Zero Blues Club in Clarksdale, MS], Eudora Welty's home in Jackson to name just a few. We also stopped for pictures at this Crossroads> in Clarksdale where many of the Delta Blues originals such as Muddy Waters, Howling Wolf, and BB King passed through heading north to Memphis – Highways 61 and 49 both head north out of the dramatic social and economic challenges associated with king cotton. I told you I picked cotton for several years in my childhood, so the trip brought back some interesting memories. If you have the time, The Blues Highway is a trip back in time to an important piece of our collective history.
Changes At CorePsych
1. Good News: I have finished oft mentioned ADHD Medications book! If you haven't signed up for the notification and discounted special, do so right now, as I plan to have it out in the next 2 weeks.
2. Keep your eyes peeled for the CoreBrain Wellness Store coming very soon – it will facilitate your keeping up with supplements without having to work through our Patient Care Coordinator. It has many bells and whistles, including simple scheduling for appointments, right there on the Internet.
3. I have several interesting training modules that will be available soon –
a. The Brain School 101, a DVD discussing the use of SPECT imaging for diagnosis that makes it easy to understand how SPECT is used effectively.
b. The Impulsive Brain will be on DVD and out soon – all 6 hrs on ADHD, Bipolar, Brain Injury and Addictions.
c. Several CD's on ADHD, Holistic Psychiatry and the use of neurotransmitter precursors will be available soon – are in production.
Next project: more specific blog postings on the why and how with measuring neurotransmitters and using neurotransmitter precursors to augment challenging psychiatric presentations.
cp
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14 Comments
I wrote awhile back about my 12-yo son who was on Adderrall XR for about a year and thriving on it, except that he had not gained a pound and literally every meal was a struggle to get hin to eat anything (I credited my own forcing him to eat for the fact he hadn’t lost any weight over that year, otherwise I’m sure he would have if left to his own devices. Meal times were just a nightmare.). We stumbled upon Intuniv and discussed it here and with our doctor. We began to titrate him off the Adderrall at the same time we were ramping him up on the Intuniv. He started at 1mg, then went to 2mg (stayed there for a couple of weeks), then went to 3mg. The getting on Intuniv and getting off Adderall took about 8 weeks. He’s been on 3mg of Intuniv now (alone), and NO Adderrall, for about 6-7 weeks. I have noticed that his attention span is not as well-controlled on Intuniv as it was on Adderrall, or the 2 together. But, my main concerns are really 2 other things. #1, his continued drowsiness …. we give him his Intuniv at about 5-7pm each night, but he seems to drag well into the following day. Mornings are hard because he does not want to wake up, is irritable from grogginess, and will keep trying to lay back down. I’m constantly having to stay on him to get him to eat, brush teeth, get backpack together, etc. so that he makes it to school on time. He just seems to have no “umph.” By afternoons it’s a little better, though. #2, he has always been a willful child, but he has become almost defiant and disobedient lately, at practically everything I ask him to do. I know this seems strange to say, but he doesn’t seem to imminate much joy either. It’s like he’s in a fog, perhaps. So my questions are, do you think this might not be the right medication for him? I had such high hopes, and am fearful of going back to a stimulant for the appetite issues. On Intuniv, his appetite HAS picked up considerably, and he has already gained about 3 pounds. But, I just don’t think in my gut this is right somehow for him. Also, his grades have slipped in school from all A’s, to this last report card 3 (lower) A’s and 3 B’s. I know that’s still good, but it’s another indication of an underlying problem, IMO. Any advice? Thanks so much.
Ellen,
This is one of those situations where it would be somewhat foolhardy to render any kind of definitive answer, as you so correctly point out, without further testing. In my practice at this point with any child, we just jump on Neurotransmitter testing for that next investigation on the highly likely underlying problem.
Quick thots, not recommendations:
1. Looks like he may be depressed with the motivation and attitude
2. Did you try low dose Vyvanse with the Intuniv,
3. If so, was the previous dose of Vyvanse dialed in correctly with DOE of ~ 10-12 hr?
4. Adderall is considerably more stimulating than Vyvanse.
IMHO – guess work is just that, you do need some more precise investigations,
We can do that eval long distance if you wish [can’t do meds unless we see him here, but can make recommendations for your doc], just go to the Admin page and give Deborah a call.
Tnx,
cp
Dr. Parker, I am all over your blog. You really GET adhd and all the nuances. I’ve learned alot here and can’t wait for your book to come out.
My question, which I haven’t been able to find an answer to otherwise, is this:
If Vyvanse has a potentially 14 hr DOE (the half life is 14 hours) then how does one avoid a toxic build up if you take the med the same time every day? Its working beautifully for my 12 yo son. (we just started it ).
Many thanks if you are able to answer!
Andrea,
Thanks for your kind remarks.
Vyvanse simply does not build up if the half life is only 14 hr, as it is gone in that time. Vyvanse will only build up if the metabolism is slowed by other drug interactions or slowed metabolism for a host of other reasons, some genetic. And BTW, for 12 yo, I don’t try to take it to 14 hr, as with kids it seems to become a bit counterproductive and out the Top of the Window after 12 hr. With adults we often see, both in the office and the literature, good results with a 14 hr DOE.
Thanks,
cp
Thank you Dr. Parker.
Interestingly, although this 120 pound 12 yo is only taking 15 mg of Vyvanse (the lowest dose available in Canada is 30 mg and I dissolve in water and give him exactly half) a 7:30 am dose “seems” to last till lights out at 9:30 pm. It kicks in within an hour and I can’t really tell when its worn off. I haven’t fully tested it out by having him do homework at 9 pm so I don’t truly know what his focus would be like, but he is pleasant and cooperative right up to bedtime–which is not typical. And he sleeps and eats pretty well too! I think he’s floating in the window.
Andrea,
Sounds like the DOE is correctly covered here – a good float thru the window! Watch for insomnia, agitation thru the day and appetite suppression as definitive Top of the Window signs. Also remember you can cut the dose to 10mg by dividing the 30 mg dose into thirds. Sounds a bit basic, – but some have missed that point and get stuck.
cp
Wow! That’s great Dr.”Red Dog” Parker sounds good to me! Blues music is my own choice of therepy. I just bought a CD I found by “Mississippi John Hurt” re-mastered from 1928 recordings. Avalon Ms., I think, is where he was from. Many Remakable “Delta Blues” guitar players in Ms. I bet. Hope you take pics! Have a great time!
Impulsive Brain…I will be looking foward to that!
Scott.
Scott,
Loved the trip, the company and the people we met out on the road. Stayed at the Shack Up Inn in Clarksdale, enjoyed the BB King Museum in Indianola – and one of the most memorable moments: BB on video – walked down a road… out to where he was born. We all expected a shack somewhere, and he stopped in the field, slowly turned around and said… “This is it.” A real gentleman to all who all we talked to about BB, in and about the Delta.
cp
Thanks for the links Dr. P! Some very interesting and inspirational subjects about the men and women who had the courage and talent needed to bring Delta Blues to the world! Robert Johnson’s short life shows me how lucky I am to be alive. The sorrow he had to endure, and overcome is overwhelming. To me it is like a groaning deep in my soul that can be released through playing and singing the blues. It just comes out naturaly if we let it….out. Thanks again!
Scott.
Thanks back at you Scott. Just saw a documentary that Robert Johnson likely was killed by the owner of the club he was playing in, – as Johnson was fooling around with his wife!
cp
That’s a blues song I may think about writing, when I look deeper into Johnson’s history. The subject of fooling around and cheating is a common theme in many lyrics written by blues singer/songwriters. This will be quite a challenge for me to find words and play the proper tempo with respect to the feelings that I have about that. My Dr. suggested that playing my guitar may be a good way to exercise my motor skills and therapeutic mentally, when my wife told him about my frustration and fear that my ability to play was lost a few yrs. ago. I don’t want to lose. I will try hard to use this chance I see to do this. Thanks again Dr. Parker!
Scott.
Scott,
Several interesting aspects do arise from his frivolity: ‘Cheating don’t work,’ and no one at this moment even knows where he is buried. Looks like PTSD with death of his wife in childbirth, failure at his first attempts, and typical celebrity egoism on his return from TX. The upshot: death and none know where he is buried… but they have several grave sites down there, some great quotes on what he said before he died. Interesting legacy that he never experienced whilst living. Alcohol was the killer – as it was with Son House.
Best wishes with your guitar!
cp
Holy cow! You’ve been busy, Dr. P. I want to know what amino acids you’re taking so I can follow suit! 🙂
That trip sounds like a blast! Seven couples in van on a road trip — the stuff feature films are made of. I’m glad you took time for a well-deserved vacation.
Looking forward to all your new goodies.
Gina Pera
Gina,
I left out the remarkable people we met along the way, our blues nicknames [mine? ‘Red Dog’], the radio interview in Greenville, – just down from Robert Johnson’s grave site – where, through a web feed at a blues station, we connected with listeners in Japan who wanted to visit us in Va Beach! Small world…
BTW, only 5 couples – but 10 people in a van making informed decisions for a week demonstrates evolved group process! 😉
cp