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ADHD Medications Fix the PM Drop-4 The Mad Drop
ADHD Medications – Fix the PM Drop-3 The Sad Drop
January 24, 2014ADHD Medications Fix the PM Drop-5 The Whatever Drop
February 10, 2014Turn ADHD Medication Side Effects Into Learning Opportunities – #4 The Mad Drop
The most frequent ADHD Medication problem? – Side effects in the afternoon when the stimulant wears off. Learn these 7 lessons from the crash. Prevent treatment failure.
“Intolerable” PM Crash Details Can Become “Instructive”
If you watch more carefully, and truly understand the side effect challenges with stimulant medications, you can help correct your entire treatment protocol.
The only thing more expensive than education is ignorance. [Tweet This]
Ben Franklin
First Post: The Teaching Drop #1/7
#1 The PM Drop Teaches Us How [Link]: – Afternoon ADHD ADHD Meds Can Drop – Turn ADHD Medication Side Effects Into Learning Opportunities
Stay tuned for these next six PM Stimulant Drop videos: If you look forward to the schedule for Stimulant Drop videos – SUBSCRIBE Here For YouTube Updates.
Next Drop Video: The What Drop #2/7
#2: The What Drop [Link]: ADHD Medications simply stop working, Whaaaa??? Don't deny Cognitive Reality. Back to the same ol' straightforward inability to concentrate. Why not overcome the denial and investigate when the meds simply don't work? Why ignore Treatment Failure? In this video we begin to tease out the importance of discerning dopamine challenges from serotonin challenges. Thousands of patients experience problems with this cognitive/affective conundrum because of the woeful inadequacy of the DSM 5 – the diagnostic coding book.
Next Video: The Sad Drop #3/7
#3: The Sad Drop [Link]: This is the absolute most common Emotional crash – Whining, crying and depression, feeling blue, “out-of-it” emotionally on the sad side. This video encourages a switch in clinical thinking to take readers beyond Cognition and Dopamine to consider Affect, Emotion, Feelings and Serotonin. Miss this Sad Drop and you miss more than 50% of the PM Drop ADHD Medication problems.
This Video: The Mad Drop #4/7
#4: The Mad Drop: This PM Drop is, by far, the next most common emotional crash, after the Sad Drop – Anger, rage, exceeding sensitivity to small insults, kick the wall, throw a chair, – look out here I come. And what does the uniformed clinician call it? Right: Bipolar. This video is inform both public and professionals about what it looks like, the denial that exists around Touchy Feelings, and the important, associated serotonin implications – with links to other videos on the same topic. Remember: you can't treat the specific comorbid ADHD condition unless you recognize it!
Mad in the Afternoon: Only 5:13 min
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The Next PM Drop ADHD Medication Videos:
#5: The Whatever Drop: Less frequent, more subtle, but often seen as apathetic in association – Who cares? – not me, whatever, I'm gone…
#6: The Energy Drop: I simply can't move. I'm not able to do anything but sleep. Without a stimulant I can't physically do a darn thing.
#7: The Combo Drop: Puzzling mixed symptoms beg for a more comprehensive perspective that combines these several provocative Drop insights.
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For All 7 Specifics On The ADHD Medication PM Drop:
See & Subscribe: This Video Playlist –
https://www.corepsych.com/7videosPMDrop
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Each of these Drops reveals a specific underlying challenge one can address, only if correctly recognized and understood. Stay tuned and Like This Page below ↓ so your friends can review this brief video on important Mad Drop details that matter everyday.
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Leave a comment ↓ and make sure to Subscribe Here at this YouTube Link: > YouTube …You'll receive an email update the moment we upload each new Drop Posting.
cp
Dr Charles Parker
Author: New ADHD Medication Rules – Brain Science & Common Sense
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I just realized I forgot to mention one of the most important parts… I’m sorry — If it seems like I’m scatter-brained right now, it’s because I am. lol. But I actually didn’t tell you why I think after I skip the meds for the weekend or for a week to two weeks I have a few days of effective control back. On average, if my body produces a lower than amount of Trypsin when my diet and food consumption are normal than my Trypsin levels will continue to stay low. I eat like a normal, CIVILIZED human being when I take the medication, so Trypsin stays low resulting in either little to no activation of the Vyvanse. I do want to stay practical about this because more than likely there is some amount of lysine cleaved away from the amphetamine but being on 70mgs for over 1.5 years, the unique and low delivery system, and the fact that the pancreas as far as I know doesn’t just suddenly “get tired” and decrease the production of digestive enzymes I think the amount converted with such a small supply of Trypsin isn’t enough to have any sort of effect let alone therapeutic.
But the fact that when I skip, I eat a lot more than what my body would consider normal, which would obviously increase digestion. A sudden and abnormal increase in digestion would mean a sudden and abnormal increase in digestive enzymes from the pancreas, which obviously means more trypsin.
I want to tell you one more time that I am not starving myself when I take the medicine… I’m 5’2″, and I’ve never weighed more than 108 pounds except for when I was pregnant but even then I only gained up to 118 pounds. My point is, when I first began stimulant meds I wasn’t aware of what to expect and literally lost 10 pounds in one to two weeks. It happened extremely fast and I realized then and there that if I wanted ADHD treatment I couldn’t afford to lose weight for fear of having a heart attack. So, not only do I eat an average amount of calories, I eat foods high in protein, and I drink 2-3 Ensure Plus shakes every day that I take the medicine. We actually buy them in bulk at Sam’s, each containing 350 calories and 13 grams of protein. When I first began meds and took weekend breaks I actually would be STARVING, appetite returned with a vengeance… I think that is why it’s partly just in my head and the days I skip I don’t have any responsibilities or basically plan to do nothing… I think boredom is part of it, as well.
Not that I really want to put this out there, either…but, “transit time” isn’t exactly great either. I had no idea that average was about two times/day… I’m 3-4 times per week. All this time my mom was right, I am full of cr…. lol. just kidding.
So, there’s something going on with my digestion and I definitely think it’s hindering Trypsin production… it would answer every single question that I have ever had regarding Vyvanse. I know that I need to get to the root of the problem, not just find supplements to make up for the side effects of the problem… but, that takes a lot of time which I’m running extremely low on so while I am searching for the answer to my digestion problem if the Pancreatin supplement helped produce/stabilize my Trypsin level, do you think it would be okay?
I’m already in the process of finding a solution and I have a sneaking suspicion I have a gluten sensitivity since I have suffered from migraines with aura all of my life… and if it’s not that I do think it’s a food sensitivity because when I go on med holidays for a couple of weeks my migraines increase ten-fold. I’m in the middle of reading (actually listening on audible…which is how I managed to read your entire book with ADHD back in full force)The Omni Diet. Have you heard of this diet? I’m almost finished and plan to start her two week plan as soon as I’m done. Gluten, among many others, is one that the diet does away with…
I’m sorry for typing out my life story, most of this is probably irrelevant. I have just been hiding the fact that my meds were gradually not working, making up excuses for my responsibilities at home never being done, and worst of all telling everyone I’m still right on track to graduate. So it just came pouring out… I can’t tell my family because they are all anti-meds and would use it to their advantage. I’m just stuck. And I wanted you to have all the details because you just completely understand ADHD (better than those who have it… that’s rare) and you also completely understand how to treat it. I’ve never had a doctor with your amount of knowledge, patience, and compassion for people with ADHD. And I’ve had three… I don’t even feel as if my doctor now believes ADHD is a real problem. So, any information, advice you can give me is appreciated more than you know.
Thanks, again.
Ashley,
Big thanks for your engaging and most interesting comments. With these excellent details it’s easy to feel that I know you, and I’m sure many others will seriously benefit from your engaging, interesting perspectives that may seem unusual to you, but encapsulate so much of what we see everyday in our consults at CorePsych. These problems detailed w Vyvanse arise far more commonly than appreciated and deserved more informed attention.
This second note does encapsulate why I’m recording these videos – the PM drop is a magnifying glass that will help us see into challenges we didn’t previously appreciate. My take on your quandary:
1. Your astute observation about food sensitivity [the Mount Everest Peak on the Watershed Landscape] is very likely the key that will unlock your consternation. I do strongly recommend IgG testing, specifically qualitative – NOT quantitative. We need specifics, not totals. Qualitative does not drive to the problem, it is helpful, but more like a dash of salt on a serious bacon and egg breakfast.
2. Your insights about Trypsin shed light on the reason why we so much appreciate Trace Element findings thru Tissue Mineral Analysis. Hair analysis may seem flaky, but it works more than 80% of the time in these Roving Therapeutic Window presentations such as yours.
3. You are very likely low on several trace elements secondary to IgG challenges that, in spite of your youth and apparent health from external review [wt and height] – are, in a word, ‘malnourished’ on a micronutrient level – leading to your Trypsin challenges. Trace elements facilitate enzyme activities leading to improved neurotransmitter balance.
4. Two quick references that support further trace element biomedical inquiry:
a. Influences of trace elements on tryptic hydrolysis: http://www.ncbi.nlm.nih.gov/pubmed/6261195 [Nutr Metab. 1980;24(6):343-51. German]
b. Influences of copper in combination with other trace elements on the activity of trypsin: http://www.ncbi.nlm.nih.gov/pubmed/6249767 [Int J Vitam Nutr Res. 1980;50(2):179-84. German]
This is a start!
Look forward to a Brief Chat…
cp
Hi Dr. Parker,
I’m a big fan of yours, long time follower of your blog, and youtube channel. You are doing amazing things in this field and it is so appreciated, so thank you. I have a question about Vyvanse and it is a little off-topic but this is about something I’ve never seen discussed on your blog so I figured I’d just add the comment onto your most recent post.
I am treated for ADHD with Vyvanse; I’m a 25 year old mom, wife, and student, diagnosed at age 22 started with Ritalin XR, then Ritalin IR, and switched over to Vyvanse starting at 20mgs. This dose lasted 3 hours, so I was slowly titrated up a week at a time. 30mgs lasted about 4 hour, 40mgs lasted roughly 5-6 hours, and here’s where it starts to get strange. At 50mgs I would average 5-7 hour coverage, 60mgs also 5-7 hour coverage, and then 70mgs also 5-7hr coverage; there was no increase in DOE nor was there an increase in intensity, which could have been beneficial but I was more interested in the medication just lasting longer.
At 70mgs my doctor explained that it was the highest dose per FDA recommendations and any higher was not an option, I know some doctors do go over but understand why some doctors choose to stick to the set guidelines. He also told me that 12-14 hour coverage really wasn’t common and continued on to tell me that nearly eight hours was basically as good as it gets; a booster was never offered, and I also haven’t ever asked for one so I’m sure that is why it was never discussed. But, he is very conservative when prescribing, which is definitely not a bad thing, so I have a sneaking suspicion an evening IR booster wasn’t an option anyway. So, there I stayed at 70mgs and ultimately started doing very well…
I catered my dosage each day to times when I needed it most and took steps to educate myself on what I could do myself in order to control the ADHD. I know that medication is only half of the treatment, it gave me the focus, clarity, and control I needed to get on top of my ADHD and really accomplish things I never knew I could… For the first time in 23 years I felt adequate, deserving, hopeful and excited about my future. I was proud of myself — I didn’t even know life like that existed for people like me.
But starting last summer ’13 I began noticing one or two days a month that the Vyvanse actually completely stopped working… In fact, the first two times it happened I figured I had just forgotten to take it. This wasn’t my body finally getting accustomed to the first initial effects, I had taken Vyvanse for over a year by that time and those days were long gone. The Vyvanse was equivalent to a sugar pill… and that might even be giving it too much credit. I knew the difference between days on Vyvanse and days off because I often took Saturday and Sunday off, by choice, because it seemed to let my body rest, recharge, and basially “reset.” Plus, I suffered from chronic insomnia for many years before treatment, the medicine didn’t help that or make it worse, but on days that I would skip insomnia was completely gone. I loved that feeling of actually wanting to get into bed. lol
By Sept ’13 the days where Vyvanse was ineffective (sugar pill status) had increased to the point where it was basically 50/50, just as many ineffective days as effective, ADHD symptom control days; this is where I started to really struggle and my life was shifting back into the old version. And now I’m here, and I’m on the verge of having a breakdown; I know I survived 20+ years like this but now that I know what my life could be like it makes it so much harder.
At this point I have one day per week where the medication works…but only if I skip on the weekend. So skip Saturday and Sunday, medicine works great Monday and then nothing at all Tuesday through Friday. I have also taken the occasional one to two week drug holiday this has only been within the past few months because I see no point in continuing when it does nothing and makes no difference. When I start taking it again the results are the exact same every single time: the first Monday through Wednesday, or three days, it’s working again…just like normal but with a slight reduction in effectiveness by Wednesday; Thursday drastically reduced effects, and Friday back to absolutely nothing.
I’ve observed my patterns and the ONE THING that I can tell you that I do different on skipped days is that I eat like a ravenous hyena…it’s not a pretty site. It’s not because I starve myself on days that I take the medication, and not because I’m hungry so I need to gorge myself either… Everything just sounds really good on those days. And I’ll say it again, I do eat normal on days that I take the medicine. Before when the medication worked well my appetite was nothing, literally I was NEVER hungry… After the first couple of weeks I began to lose weight and realized that I was just forgetting to eat during the day; so I sat an alarm on my phone to go off every hour of the day that the medicine was active in my system… When it went off I would immediately eat something that was a decent amount of protein and calories. Problem was solved… on days where the medicine is ineffective my appetite is back to just normal which is a huge difference compared to effective days. So, I am pretty sure the reason I stuff my face to the point of no return on skipped days is just all in my head… Also, just to clarify this isn’t a dangerous amount of food to the point that if I make this a habit I’ll look like Gilbert Grape’s mom…lol. It’s just, for me, an larger amount than what is my “normal.”
So, why does this matter? Well, I’m sure you know that Vyvanse’s prodrug delivery system requires Trypsin to cleave away the Lysine bond which will then activate then amphetamine and without it you will have, well, a sugar pill. Trypsin is released by the pancreas to aid in digestion but only in certain amounts, which slowly activates the amphetamine in small, steady amounts throughout the day. (I’ve got to say, that is pretty genius… well done, Shire!) So, now I have a theory and it may explain every single issue I’ve had with Vyvanse since day one…
What if my trypsin levels are lower than average? This would explain why from 50mgs to 70mgs there was no change in DOE or intensity. (This one is just speculation >>>) But I read somewhere that once you “max out” your Trypsin levels the body will need time to build it back up to an adequate level, so with the extra Trypsin being used to convert Vyvanse is it possible that I have just completely depleted my system of any extra Trypsin and over time it has taken longer and longer to build back up?
I just finished your “ADHD New Med Rules” book and it was very informative; in it you talk a lot about how digestion and metabolic functions play a huge role in successful ADHD medication treatment and that’s when I started to look into digestion. One thing stood out to me: You preach about the protein breakfast BEFORE taking the medicine. But, since day one of Vyvanse I have only been able to take it on a completely empty stomach with 8oz of water… If I eat anything/drink anything besides water it doesn’t work. It has the exact same results as my now ineffective days on the medication, and those results are absolutely nothing. Don’t curse me yet, I do eat your “power protein breakfast” (love it) half an hour after I take the medicine… the half hour somehow doesn’t affect the medicine. This clues me in that I obviously have a digestion problem and Trypsin seems logical.
I can tell you with 100% certainty that the Vyvanse is not being activated/metabolized. I’m in a support group and all I keep getting as a response is, “Are you sure it’s not working because you aren’t actually supposed to feel it’s effects, that’s not the overall goal.” And I want to come unglued!! I’m positive it’s not being activated. My life is falling apart, my ADHD is back full force, my school that I’ve worked so hard for was set to have me graduate in March and now I am on the verge of failing out, my husband walks through the door every single night with a look of sheer disappointment because the house is a wreck, I’m still in my pj’s, my 3 year old is running free destroying everything because I am too overwhelmed to do anything but feel like a failure. And the worst part is that I go into the room, lock the door and claim I’m doing homework for the rest of the night when I really just sit in there to avoid being around him and my son because I’m so ashamed. So, this above all else is proof that the medicine isn’t being metabolized.
There is a supplement called Pancreatin that actually contains Trypsin. If this is my problem and I start taking it, do you think this would fix the issue? Would it be safe to just try and see if it can help?
Thank you so much for reading my novel-long post. Any information you can provide would be so helpful.
Ashley,
Excellent postings, delightfully readable, see my reply on your other comment.
cp