We’re Way Beyond Labels at CorePsych
Psychiatric meds simply won’t work if we don’t understand the entire neurotransmitter process. In this new game of pure neurotransmission, numbers do matter. Without the numbers, meds simply don’t work.
Simply Put:
When I was a kid growing up in Angola, IN, my friends and I learned valuable lessons in an interesting context: Catching Chickens. One brief note will suffice to make my point here: You can have a number of big guys in a chicken coop with only a few chickens, and you will run around all night trying to round them up.
Big guys can bump into each other and create a toxic evening if you load the coop full of guys with nothing to do. But, if you place 100 chickens in that same coop, only a couple of guys can quickly get them all herded up at one end, without heavy breathing.
Deep Axiom: More chickens makes for better neurotransmission.
Chickens and Neurotransmitters
If we take a few moments to think about it, the same thing happens at the synapse. If you don’t have enough neurotransmitters already on board, it is only common sense that you can bring in the biggest SSRI, and SNRI guns, and you won’t make a sufficient connection to fire the neurons. You need more neurotransmitters to get the job done. The SSRI and SNRI big guys can’t herd what isn’t there, and often they simply can’t make an impact, thus twisting up all of the results – both in studies and in the office.
At the Virtual Holistic Health Conference coming up Jan 26 & 27 I will be covering the details of how I measure neurotransmitter levels, hormone levels and immune system challenges to facilitate modern psychiatric chicken catching.
Evidence works for targeted turnarounds.
Listen to This Brief Overview
Hope to see you there – slides in PowerPoint/pdf available upon sign up with all the details.
cp
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—>Tweet this post below! For ADHD Medications: Download complimentary white paper Precise Solutions now, – and get ready for the complete version of ‘The Patient’s Guide’ details to follow. Get Neurotransmitter Details Here
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I have Tourette syndrome, ADHD, OCD, take clonazepam 1.5 mg before bed to prevent nightmares. Have been on numerous meds over past 10 years. 2 weeks ago tried Intuniv. 1 week @ 1 mg, 2 days @ 2 mg. Each night I was sleeping less and less, by 2nd day of 2mg I only was sleeping 2 hours at night: totally the opposite of what one would expect with combo of Intuniv +aclonazepam. What do you make of this “paradoxical reaction”? I once was put on Imipramine for depression and became euphoric & psychotic. My mother was an alcoholic, my younger brother has very obvious fetal alcohol syndrome. I am 56 years old. I slept 8 hours last night so tomorrow will try 1 mg Intuniv every other day.
Chris,
The most interesting challenge with so many of these ADHD and Intuniv inquires, in yours and many others on other Intuniv posts, [see this link to all Intuniv posts and this specific post with 174 inquires] is the apparent puzzle of these paradoxical and apparently unpredictable reactions. What we clearly have out there with you, and others, is the revelation we have been witnessing for years, that more neurotransmitters are involved with ADHD than simply dopamine, norepinephrine and serotonin. Especially challenging: the complex presentations with more going on than simply ADHD – more genetic issues, and, as we have been noting in these posts, more underlying chronic metabolic issues.
The likely explanations are many and do require a more careful review of all comorbid issues. One easy one, seen quite frequently with OCD and Tourette’s is the fact that excitatory neurotransmitters can be significantly increased and, since Intuniv actually facilitates glutamate excitatory neurotransmission, it could be simply pushing you out the top of The Therapeutic Window.
Now, I am considerably past speculation and guessing. I use specific measurements of 12 urinary neurotransmitters to help understand the neurophysiology, and very specific questions to chase down comorbidity. Cutting down the dose may prove helpful, but after 10 years I do strongly suggest you set up a time to chat on the phone as we can review your situation and send testing kits out to explore the details. You can call our Patient Care Coordinator here, and set up a time to review the details.
cp
Hi Dr. Parker, thanks for your reply to my last post. It’s been a while. I have a couple of questions for you. To quickly summarize info from my previous posts and to update you on things since, my son is 8-yrs old and my husband and I would classify his ADHD as “rabbit” type – with over-focused and rigid thinking. He loves to argue, is very oppositional to us, worrys a LOT about even little things, has a hard time shifting from one thing to another (if he’s doing something he doesn’t want to stop till he’s finished), always wants to have his way, EXTREMELY emotional and VERY EASILY frustrated. When he get’s frustrated he goes from calm to TOTALLY out of control before we can begin to intervene and help calm him down. He’s extremely smart (at or near the gifted range) and most of his frustration comes when he misses 1 word on a spelling test (which very rarely happens) or has the slightest trouble grasping a new math concept. He always understands the concept after being showed one time but, the problem is that he gets so upset right from the beginning that he’s unable to listen at that point and you can’t explain anything to him. I have to add that this doesn’t happen every time but, most of the time. Sometimes he is able to let his mistakes roll off his back but not very often. He will say he’s stupid and idiot, etc…. When this happens it can ruin his whole day – he gets “stuck” in the negative cycle. It’s almost as if things comes so easily to him so much of the time that when something doesn’t come easy he doesn’t know how to handle it. He also has some of the traits of the “piglet” type as I read it referred to the other day – the excessive worry, startles easily etc. He has been taking Vyvanse since May of last year and it has done wonders for his focus and attention at school. He is having an amazing year at school academically and is at the top of his class. From the very beginning with Vyvanse, almost all of his behavioral issues at school went away and he immediately enjoyed school. The only issues at school are when he gets something wrong like I mentioned above and he tends to be overly concerned about what the other kids are or aren’t doing. He says he just want to help the other kids but his teacher said it comes across as “bossy.” Unfortunately the Vyvanse helps him tremendously at school but doesn’t do much for the home environment. Mornings are almost unbearable because he is LOUD, rude, inappropriate, argumentative, disrespectful, etc. Most of the time he’s thinks he’[s being funny and doesn’t understand that his behavior is inappropriate. Evenings are better because the Vyvanse is still working but by dinnertime it’s still difficult. For this reason and the fact that he was losing too much weight on the Vyvanse, before Christmas, his physician suggested we try Intuniv. So, we stopped the Vyvanse and began with 1 mg Intuniv and worked up. At 1 and 2 mg Intuniv he was initially tired but it passed. At 3 mg, it didn’t pass and he was falling asleep at his desk. We gave it some time but ended up backing down. The Intuniv really didn’t help with his focus and attention at school and he went back to the same issues at school that he had before we started the Vyvanse initially. We actually didn’t feel the Intunive was really having any effect on his hyperactivity and behavioral issues so we decided to wean him off completely and go back to just the Vyvanse but at 40 mg instead of 50 mg in hopes of improving his appetite. Thisdid work. When we did that we discovered several things:
1. The Intuniv WAS working on his classic hyperactive ADHD symptoms. We just didn’t realize how much until we stopped it. I think as things get better (but still not great) you tend to forget how bad things were before. Once we stopped the Intuniv, we realized that it did “tone” him down. It lessened his figiting, brought his volume down, decreased how much he drove his sister crazy, etc. Made him generally less annoying. Which is wonderful because when he’s not being annoying his is a sweet, loving, funny, kid.
2. Intuniv didn’t do anything however for his focus and attention. Or at least not enough. Vyvanse is definitely the best there.
3. He has trouble sleeping with Vyvanse and takes Melatonin. With Intuniv he didn’t need the Melatonin but was falling asleep in the car.
4. Vyvanse effects his appetite alot. Intuniv doesn’t.
SO, his doctor suggested we try a combination to see if we could get “the best of both worlds.” So we added the Intuniv back at 1mg and gradually worked up to 3 mg again. At 3 mg Intuniv and 40 mg Vyvanse, he wasn’t the happy child that normally is. It toned him down too much. He didn’t have the problem of falling asleep at his desk like he did with just the Intuniv – actually he wasn’t tired at all. I guess the Vyvanse offset that. But, he barely smiled, became extremetly emotional, became frustrated easier and more often than usual. It was horrible. So, again we backed down. We decided to back all the way down and start again at 1 mg and go slower, give it more time. Which brings me to the present and to my questions. I’m sorry for such a long intro!! Today is our 2nd day back at the 1 mg Intuniv with the 40 mg Vyvanse. Questions:
Have you experienced patients with situations like our where the emotions have been out of control when combining Intuniv and Vyvanse? It definitely appeared that he was “out the top” of the window at 40 mg Vyvanse and 3 mg Intuniv. Do you think that we might need to cut back on the Vyvanse? I’m afraid to do that because the Intuniv really doesn’t seem to address the focus and attention at school. I feel that a combo of the two might be the answer for us but fine tuning the dosage of each is difficult. Also, I was wondering how you feel about Extress and Attend? Would they be worth trying? And, one more question, what about the ADHD elimination diet where you eliminate things for two weeks and gradually reintroduce them. I should mention that I am very diligent about high protein breakfast and while I’mnot extreme, I do limit processed foods, additives, food coloring, sugar, etc., and eat mostly organic fruits and veggies, etc. Thanks in advance for your response.
Tracey,
Very interesting problems and a few suggestions for your medical team’s consideration:
1. I do agree with your doc about the best of both worlds, and have seen significant improvements with using Vyvanse and Intuniv together. [no drug interactions with these two]
2. The dose is likely part of the problem, but may also prove insignificant if other issues are present. With comorbid conditions we often feel like we can never get the dose right, that the Therapeutic Window is narrow, and dosing is almost always too much or too little.
3. An additional point with every unpredictable person: metabolic challenges associated with undiagnosed comorbid conditions. We see these every day, multiple times on my own patients that first appeared to do well, and very often in second opinions – which we provide very frequently. If you would like to chat about your boy’s situation do call to set up a time to review more completely.
4. Another thought, which I am not suggesting you do without more careful consideration with your medical team, is to look for comorbid depression. See this CorePsych YouTube Video – the last few mins – for an explanation of those comorbid conditions and the relevance for med adjustments.
cp
Dr. Parker,
Brought my son to see you after we’ve seen a zillion people over the last 10 years. With your help, I think I might actually be seeing some light at the end of the tunnel in terms of figuring out what is going on with him & how we can help him find the right tools to deal with/overcome all these challenges. Over the years, we’ve been given a host of different diagnoses & tried a host of different meds for my son for ADD/Depression/Anxiety & none has been a good solution because he has a pretty sensitive stomach & every single med he’s been prescribed has had negative effects on his stomach, so he refuses to take them. So he’s gotten nowhere.
As far as taking meds, I’ve always concentrated on getting him just to EAT breakfast…period! Now that I’ve seen the importance of protein through your blog, I’m hoping that the power breakfast and its high protein content will be the solution we’ve been looking for. But, I have a suggestion – what could be easier than a smoothie!? I’ve been making smoothies for my boys for years after they fell in love with them while we were stationed in Panama (they were made with ice cream there – which was high in sugar, fat, & lactose) & returned to the states to pay a hefty price for something so quick & simple to make at home! I found it a yummy way to incorporate healthy foods into something they saw as a “special treat” (I still used fruit but substituted yogurt). Then I started adding a scoop of protein powder, some natural peanut butter, oats, a little soymilk, etc. as a drink before running since I ran too early to digest a breakfast before my morning runs.
Should I be concerned about the amount of carbs in the smoothies I make if I’m using: fresh/frozen unsweetened fruit, 1 scoop of protein powder (he gets chocolate protein powder as it’s the only way to get him to drink these – the rest of us use vanilla protein powder. Both have only 2g of sugar/carbs), lowfat vanilla yogurt (I might try and substitute the greek yogurt mentioned in a previous blog), about 1/2c – 1c of light soymilk (depending on the consistency you want), some old fashioned oats, & 1T natural peanut butter? The ratio should be more protein than carbs, correct? The only carb I’m seeing is the oats. Let me know if I’m missing identifying any carbs that I should be aware of…Thanks for your help. Look forward to our next appointment & future progress with my son’s challenges!
Wish us luck. We start today.
Marci,
Please write this up in recipe form and I will be happy to send it out – it sounds like a great alternative. No, don’t worry about the carbs if you are focused on the protein – and with your boy best to get the breakfast in period! Luck with meds means diminishing the time to improvement. Something will definitely happen if we keep at it. Thanks for your input, and quite agree with your Panamanian Protein!
cp