The Patient’s Guide for ADHD Medications: Free White Paper and Audio

by Dr Charles Parker on February 5, 2009 · 53 comments

You Can Stop the
ADHD Medication Madness!
Let’s Move Past Guessing
Into Solid Evidence
And Start Working By Downloading These Predictable Solutions!-> Below
————
But, first take a look at this PR Web Piece On Rules:
- A Special Report Reviewing My Newest Book:
 
ADHD Medication Rules:

Paying Attention to the Meds for Paying Attention

I’m going to make this message short and sweet -who has time for much talk?

Start Here: See if you meet any of these criteria for these 5 complimentary gifts:

  • You think you have ADHD, but aren’t sure about the diagnosis in the first place
  • You have previously failed ADHD treatment with confusing medications
  • You are taking ADHD medications and don’t know what to expect
  • You would love to be treated, but fear the multiple issues with stimulant medications
  • You have a loved one who is taking ADHD medications and can’t figure out what’s going on
  • You are a professional who treats ADHD with stimulant medications and feel confused
  • You are a health professional who counsels patients who suffer with ADHD but are confused by ADHD Meds
  • You are an employer with employees who suffer with ADHD and don’t have clue how to counsel them
  • You are an interested consumer who wonders about problems with meds used for ADHD
  • You wonder about precise diagnosis and are fed up with superficial, vague labels that don’t work
  • You wonder how to get the meds right if you don’t know specific dosing strategies
  • Did I leave anyone out? – Very likely… so,

Next: Sign Up Right Below Here For

1. > Two Complimentary Audio Programs Detailing

  • The Problems With Diagnosis and Treatment, and
  • The Necessary Solutions for the 10 Biggest Problems with ADHD meds
  • A 1 hr program on ADHD Meds for Special Needs Children
  • The System to Keep it All Together With Your Medical Provider
  • And—-

2. > A Succinct Complimentary Checklist Detailing The 10 Biggest Problems with ADHD Medications.

  • And——-

3. > The Game-Changing 23 Page Free Special Report:

Predictable Solutions for the 10 Most Common Challenges with ADHD Medications - specific details directly from my new book: ADHD Medication Rules.

4. > A Sample Digital Chapter from the First Edition of Rules – with an example of the New Cover and Cool New Formatting – Exceedingly readable, indispensable if you or yours are on ADHD Meds -

“Predictable Solutions” Benefits:

  • This Special Report is a comprehensive outline of ADHD Medication Rules – I plan to keep you informed about Rules initiatives – on this email list you will receive Rules updates and planned educational events.
  • You will be better able to understand ADHD meds with this white paper the day you receive it.
  • It contains multiple links to the many posts and references I have been speaking and writing about for the last ~ 4 years at CorePsych Blog
  • Including specific notes on the evolving diagnosis of ADHD
  • Including multiple notes on comorbid diagnosis and ADHD, depression, anxiety, bipolar, brain injury
  • Including specific notes and reference resources on drug-drug interactions
  • Including specific durations of each stimulant medication, and how to use them with dosing
  • Including specific notes on the Therapeutic Window to use with your doc
  • Including suggestions about how to work with your medical team

- For Your Predictable Solutions -

Sign Up Right Here↓To Receive These 5 Complimentary Gifts

 
Predictable Solutions
 

Thanks!
cp

PS:Remember, I wrote ADHD Medication Rules because I have seen it all, have spoken for 16+ years around the country with my colleagues – if there is a mistake with any ADHD medications, new or old, I have made it – and corrected it. Some of my best teachers have been the high volume of insightful patients seen through the years. And, get this, Rules is the only book like it for both patients and family for those who suffer with ADHD medication challenges.

PPS: This system of brain function measurements significantly redefines the ADHD diagnosis and treatment process – with very specific answers. It addresses how to correct problems from previous treatment, and significantly prevents problems with medications from the outset. With ADHD Medication Rules you will have a map for the challenging territory of stimulant medication management.

PPPS: If you sign up now you will place yourself on this mailing list for other specials down the road – some specific training and coaching teleseminars regarding ADHD, medications, and other informed interventions. Thanks, hope you enjoy the Predictable Solutions! - Do drop me a note if you have any further suggestions or remarks after reading it.

PPPS: If you are interested in ADHD Medication Rules => click directly on the Brown/Orange Book Cover on the right front page of CorePsych Blog. It’s also available with comments and testimonials over at Amazon Kindle, or at Barnes and Noble Nook.

- and do let me know what you think!

cp

Related ADHD articles by Zemanta
The Patients Guide for ADHD Medications: Free White Paper and Audio

Digitally available now at Nook, Kindle, Barnes and Noble.
ADHD Medication Rules – PDF For Your Desktop  
ADHD Medication Rules | Paying Attention To The Meds For Paying Attention – Kindle Version


Tagged as: ADD and ADHD, ADHD, ADHD Medications, Adolescent ADHD, Adult ADD, Attention-deficit hyperactivity disorder, biological psychiatry, Bipolar, Medication, Mental health, Missed Psychiatric Diagnosis, Neurodevelopmental, Problems with ADD/ADHD medications, Psychiatric Medications, stimulant dosage, Stimulant medications, Stimulants

  • Pingback: The Coffee Klatch Parent's Holiday Book Wish list - The Coffee Klatch

    • http://www.CorePsychBlog.com Dr Charles Parker

      Thanks for the very kind comments over at your site on that excellent Christmas book list. Loved the opportunity to interview with Marianne and strongly recommend you listen to our program on Blog Talk Radio/the Coffee Klatch, Marianne conducts such a cool interview – just loved the chat with her!
      cp

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  • Cosbun

    when i download the book, will i be able to print it out?  i don’t do well trying to read on computer.  b

    • http://www.corepsychblog.com drcharlesparker

      Cosbun,
      You are asking a great question… I really need to chase down a book deal, it’s just a matter of time as I do have a super name to make some inquiries.
      Thanks for your interest!
      cp

  • Lynn

    Hello Dr. Parker, 

    Tried to order the 3 complimentary gifts and the link does not work. Also the discount code to order your new book does work as well.

    Thanks,
    Lynn

    • http://www.corepsychblog.com drcharlesparker

      Lynn,
      Hang tight on the book, the link now works on the Special Report, give it a try and it comes right down to your machine. Book will be repriced Sept 1 so wait and you can get it from CorePsych or Amazon for about 10$.
      cp

  • http://www.corepsychblog.com drcharlesparker

    Thot I fixed it, now is working well, will log you in… thanks for getting back to me on this!
    cp

  • Bill

    Dr. Parker,

    Like Erich I would like to read “Predictable Solutions”, but the “order here” button doesn’t work.  Can it be sent directly to my email address: covister@gmail:twitter .com?

  • http://www.corepsychblog.com drcharlesparker

    Did you get this worked out? Let me know if not and we’ll get you Predictable Solutions!

    • http://www.corepsychblog.com drcharlesparker

      Fixed just now, anyone who has tried unsuccessfully please give it a shot now, thx.
      cp

  • http://www.corepsychblog.com drcharlesparker

    Please call Sarah on the Service page to chase down the issue tomorrow and she can get into the store to see what’s up and get you straight.
    cp

  • Erich

    Hi, Dr. Parker- for some reason, I cannot get the ‘order’ button above to work at all. May be some kind of script error the web czar might need to look into.

  • http://www.corepsychblog.com drcharlesparker

    Jst1,
    Important additional notes here; http://en.wikipedia.org/wiki/Dextromethorphan#Pharmacokinetics.

    One important but frequently overlooked point in regards to your comments: 2D6 Polymorphism as DXM primary pathway is through 2D6 – and 2D6 is significantly blocked by Prozac, Paxil and to a lesser degree Wellbutrin and Cymbalta.

    “A major metabolic catalyst involved is the cytochrome P450 enzyme known as 2D6, or CYP2D6. A significant portion of the population has a functional deficiency in this enzyme and are known as poor CYP2D6 metabolizers. O-demethylation of DXM to DXO contributes to 100% of the DXO formed during DXM metabolism.[32] As CYP2D6 is a major metabolic pathway in the inactivation of dextromethorphan, the duration of action and effects of dextromethorphan can be increased by as much as three times in such poor metabolizers.[34] In one study on 252 Americans, 84.3% were found to be “fast” (extensive) metabolizers, 6.8% to be “intermediate” metabolizers, and 8.8% were “slow” metabolizers of DXM.[35] There are a number of known alleles for CYP2D6, including several completely inactive variants. The distribution of alleles is uneven amongst ethnic groups; see also CYP2D6 – Ethnic factors in variability.”
    cp

  • Anonymous

    DXM is a synthetic narcotic found in cold and cough medications. If
    taken in large dosages, this medication can cause hallucinations and
    out-of-body experiences similar to PCP. Many teenagers are abusing this
    drug because it is easy to acquire and gives them a sense of euphoria.
    Not only is this medicine available at your local drug store but
    according to the DEA Diversion Control Program, it can also be purchased
    online in a powder form. Teens have no idea of the serious consequences
    that can occur when taking too much of any medication that contains
    DXM.

    Dextromethorphan Addiction

  • Amber

    Dear Dr. Parker,

    I was referred to you by Gina Pera, whose book I’m reading after my husband and I were diagnosed with ADD. We want to begin treatment, but want to make sure we get the right treatment. I suspect it will be tricky. I’ve been treated several times for depression and anxiety and I always get the worst major side effects. Every drug wound up, in the end, making me feel like crap. Side note: I did a little digging on this and discovered something interesting. As a child, my sisters and I hallucinated on cough medicine like Robittussin, which contains dextromethorphan . I found a report/article in the European Journal of Clinical Pharmacology that says 5-10% of the Caucasian population falls into the category of poor metabolizers of many common drugs, and that dextromethorphan is a safe drug to use to test people for this issue–if you react poorly to dextromethrophan (ie you hallucinate, feel very anxious, etc) it means you are in the class of people who can’t metabolize this drug and LOTS (well over 20) commonly prescribed drugs. I believe they applied this discovery in the context of schizophrenia treatment.

    So there’s that. There’s also the fact that my now two-year-old daughter could not tolerate my milk, or any milk proteins during most of the first year of her life. Feeding caused so much pain that she stopped eating and growing, and got an NG feeding tube. We weaned her off two months later, and she was on hypoallergenic formula until being successfully switched to whey-based formula around 12 months of age. A few months later, she started drinking milk with no overt problems. But now I’m wondering if it is a problem. She does seem destined for an ADD diagnosis, given her temperament and high energy level. I want to make sure her diet is helping and not harming her.

    I want to do urine and saliva testing with you, if possible. Though we are not local to your area. Perhaps because I do have ADD, I find this site a bit overwhelming and don’t know where to start. All I know is that my family needs help. My husband and I need to successfully treat our ADD to get our lives under control, and we want to take steps to mitigate potential ADD in our daughter. Testing seems like a good first step. Can you advise how to proceed? I have contacted Sarah through the link provided on your site, also.

    Thanks for your good work!

    Best,
    Amber

    • http://www.CorePsychBlog.com Dr Charles Parker

      Amber,
      Never have met Gina personally, but as a distant colleague and brain science advocate we are Siamese twins on our view that the biomedical interventions for ADHD need serious revision and improvement. Not all are wrong, many are simply not looking at the available and necessary details.

      Your point on the Dextromethorphan is covered explicitly in my book as it relates to ADHD meds especially the path way CYP450 2D6 as documented in this piece on that challenge. Way too many providers either overlook or discount the relevance of 2D6 and I can tell you with great certainty that you are quite right in your concern – and it’s measurable if need be! This genetic point is a variable that should be on the table.

      Regarding immunity, also a genetic point, even an epigenetic point, and my be quite relevant for your unhappy challenges with meds – as you may have that bug yourself…. again quite easily measurable! For your daughter [or anyone] testing is better than conjecture – and can easily be accomplished long distance.

      We do consults all over the US, have a person we are following in Singapore on Skype who flew into our VB office, so CA will not be a challenge. If you want me to write of meds I do have to actually see you in the office, but often can work with understanding docs with the laboratory facts elsewhere.

      Just call Sarah on this Services page and she can hook us up with a meeting. Then take a look at the testing options page on the nav bar for more explicit details.

      Talk soon,
      cp

  • http://www.ADHDRollerCoaster.com Gina Pera

    Hi folks,

    Dr. Charles Parker is the leading light now on comprehensive ADHD medical treatment.

    I encourage you to BUY HIS BOOK AND READ IT.

    It will save you (and your child) many missteps, wrong turns, lost years, and worse.

    If I may say so, he simply cannot tell you all you need to know (or even a fraction of it) here in a post, based on limited information. it’s amazing that Dr. Parker devotes so much time to attempting it. That’s just another of his qualities that make him so special.

    But really you must educate yourself. Read what he has written in the book. Ask your prescribing physician to buy a copy.

    Watch his podcasts. Take advantage of all the information he has generously posted here.

    This education process must happen from the grass-roots level — with us who know the impact of poor medical treatment helping to educate more physicians.

    And if you can, pursue the NeuroScience testing with him. It made a HUGE difference in our house. So many doctors are operating circa 1978. Dr. Parker is operating circa 2050! Make the most of it for yourself and your loved one.

    My two cents!
    Gina Pera, author
    Is It You, Me or Adult A.D.D.?”

    • http://www.CorePsychBlog.com Dr Charles Parker

      Gina,
      Thanks so much! Your work, your vision is changing the lives for so many – after standing in the trenches and asking the hard questions, you do see the patterns and communicate them so well! Your book, Is It You, Me or Adult ADD? takes ADHD understanding and coping to completely new levels.
      cp

  • Julia

    Dr. Parker,
    A few questions (and my history briefly).
    History:
    Childhood — Always did well academically in school, impulsivity and hyperactivity throughout but got by because I was smart and was (hate to say it, but its true – a girl), struggled some with friendships, middle child of 3, very intense, always very low frustration tolerance/anger….aunt and few cousins dx’d w/ adhd, maternal relatives substance abuse, paternal dyslexia…my struggles were significant aside from academics but parents did not want outside help (an aunt who’s a doctor talked to them many times about various possibilities, but they refused) At one point when I was a kid, there was some book on anger management…but I don’t recall much about it. I think I was about 12 at that point.
    Both parents are academics (PhDs), sister has PhD and little brother is beginning his master’s/doctorate this month.

    Adolescence and young adult — had two significant depressive episodes (early high school and 1st yr college) although for completely different reasons. During 1st yr college, took prozac and then wellbutrin was added for 6 mos exactly. I hated being on it. I remember the day I could stop and flushed it all away.

    On own/grad school/working — I taught for 2 yrs and then went to grad school for a year. Have two Bachelors, NYS professional teaching certification in 2 areas, MEd in Montessori. Moved across country for new job and now in 3rd yr teaching at this school. (Montessori, 6-9 yr olds) Had a very hard time the first few months I was here…my priest told me to see a therapist and recommended one. I’ve been seeing him since Oct 2008. Huge changes since then in almost all aspects of my life due largely to CBT and associated skills and subsequent lifestyle changes.
    Mid June and July 2010 finally have much more balance, happier, and do what I need to do, but still very difficult to do those things. I didn’t think it was that big of a deal because it’s the things I’ve always struggled with though I thought it should be better because I had made so many lifestyle changes. My priest thought otherwise and told me to at least make an appointment for an evaluation and see about medication.

    I was against going to a therapist initially; I hated it the first few times..but went because I had to and then later began to see that it was helping at least a little. I was more against this second step of an evaluation and medication — even though it’s come up as a consideration for me at least 4-5 different times in the last 8-9 years. Never went through with it because I did fine in school and I make do.

    But then I did. July 2010. Diagnosed ADHD. She didn’t specify a type at the time, but I’ve done enough reading to know that it’s the combined. (At least as far as the DSM is concerned…which I don’t put too much stock in – it’s the difficulties that matter and how to solve it, not the label. That’s my special ed. certification talking…sorry.)

    Ok, so back to my questions.
    I started on Vyvanse at 30 mg. Main difference was less procrastination, but not much else. From there we went up 10 mg a week with no changes. Also no side effects. Then 70 mg. A new change – less hyperactivity/restlessness and could actually focus/concentrate and pray at Mass. Had a gauge now to judge DOE—seemed to be 10 hrs max from the time of taking it, but always took 1 hr to 1 1/2 hrs to take effect at all. Made sure to eat protein breakfast and no citrus just in case. So about 8 hrs of use. But no changes with misplacing and remembering or impatience (besides the CBT stuff I do) Day 9, that new change went away completely and didn’t come back in the following days. Then I didn’t take it at all for 3 days. The next day I took it later in the AM and have been taking it sense, but I notice no changes now – certainly not the concentration I initially had on the 70 and I’m not sure about the procrastination, which was better even from the beginning.

    I have an appointment on Monday afternoon and she said what I thought she would which would be to change to something else. My question for you is what suggestions you have? Do you have any other advice? When you change to a new one do you start low again? Should I keep taking what I have now until then? I’ve done a lot of reading and I’ve read all your info about the therapeutic window and things to know about meds. It was just so hard for me to even be willing to try this to begin with, and I just want to make sure I make informed decisions.

    OK, well so much for being brief. If you can get back to me before my appointment that would be really great.

    Thank you so much for all your information and willingness to help people. I’m cautious of the internet thing, but you responded to all the other comments in a meaningful way so I thought I’d take a chance.

    Thanks!
    Julia

    • http://www.CorePsychBlog.com Dr Charles Parker

      Julia,
      Super note, thanks for taking a shot at sharing your story. Truth be known: you feel odd because you are so smart and have done so well with handling your changing reality. It doesn’t make sense that you might have ADHD, but that is the precise reason I wrote Rules – you are more typical than atypical if you use the Tennis Rules vs the Golf Rules as delineated in Rules. Your subtlety puts you in that different game, a different medical geography, and you will get it right, be reassured.

      How do I know? Because of the success you have had when the meds weren’t entirely adjusted correctly – and with your new information, you can help your med team get it exactly right. Vyvanse sounds like it’s working, but the DOE at 10 with the long onset combo likely means the dose at 70 was just not right. I have many adults at more than 70 but your doc might be following carefully FDA guidelines. If you stay with the DOE metabolic precision the possibility of coming out the Top of the Window is much less.

      Yes, start low if starting with another med, not nec. if increasing the Vyvanse. The next click, with your doc’s approval and understanding would be increase of 10 to 2x40mg in the AM after that great protein breakfast. Sounds like you are having some easy adjustment problems on the front end, and with no other symptoms like agitation or sleep problems I doubt that you are on too much.

      Thanks for your thoughtful note, you’re getting close-
      cp

      • http://www.CorePsychBlog.com Dr Charles Parker

        Julia,
        So many of your questions are answered there… no problem with your profile, – it’s just like leaving your email anywhere on a download, so I can send updates to all my readers when I do revisions on Rules. – Another benefit: keeping you current with my revisions, no cost for the next edition!

        Please do read the book, everything here will be answered.
        cp

  • Tiana

    Hi, I watched your Cognitive Anxiety video and have come to realize that I have that very severely. My dr. put me on Adderall 10mg IR 2-3 times a day and the first 2 or 3 days was amazing! It was like all of heaven was singing in my head and I was focused and alert. Then it went down hill and everything, all my ADD symptoms included got worse and I was confused, unfocused, moody, irritable and extremely fatigued. I could not get off the couch for days even after the last dose of meds. Well a month later my dr. thought I should try Vyvanse since it is smooth and I was having so much trouble crashing on Adderall. Again, 2 MAYBE 3 days of amazing results, and it was so smooth too and lasting all day. I felt chilled out and nothing bothered me, but now I am less focused with ups and downs throughout the day like 1 hour I feel it is working then the next hour I feel confused again and EVERYTHING is bothering me. I just feel like my symptoms of ADD are made much worse like 10 times what they are normally when I have been on a medication after 3 days time. I feel robotic and less creative, like my emotional side is gone, where as during the first few days everything felt balanced. I sleep very very well at night while on this however, and have had very little side effects to the Vyvanse, where as Adderall I had terrible side effects and generally a bad reaction I think. So after watching your videos and reading your articles I feel that I have Cognitive Anxiety very badly and I am nearly OCD at home about little things around the house. If I where to sum up what I now believe I am dealing with besides ADD it would be, ADD/Cognitive Anxiety/Depression.
    So is there even hope for someone that has every aspect of ADD? I am just seeing a regular family Dr. right now, would you recommend a physiatrist instead? I really have no idea what medications to try next.
    Any thoughts you have I would be greatful for!
    Thank you!

    • http://www.CorePsychBlog.com Dr Charles Parker

      Tiana,
      Best guess is that your stimulant meds significantly amplified your tendency to manage issues thru a subtle Clint Eastwood personality. Serotonin, already dysregulated downward, is aggravated further downward by the addition of DA as indicted in the last part of that ADHD and Anxiety YouTube Video.

      My new book ADHD Medication Rules documents these issues in some detail – especially the appearances when meds are added and these kinds of deteriorations occur.

      Yes, likely a psych will be better, but make sure you find an adult psych with an understanding of ADHD, – as many still think it’s a belief system. See this note over on Gina Pera’s blog documenting her experience with these ADHD Medication matters at Stanford.
      cp

      • Tiana

        Thank you Dr. Parker for your response and all your helpful information on your website. Just an update, I studied your Therapeutic Window theory and tried it out. I managed to very carefully regulate the Vyvanse dose by first cutting the 50 mg in half and it made all the difference. No more leg in the afternoon or fatigue but just enough pick up during the day that i was motivated to do things. Still, OCD/Anxiety/Depression problems so Dr. put me on .5 mg Lexapro. Noticed anxiety gone almost the first day, but not helping much else until he upped my dose to 10 mg and the depression flew away 5 days later and the OCD is so much better. I feel happy and actually focused better then with just the Vyvanse alone. So far, 30 mg Vyvanse and 10 mg Lexapro each morning with a protein breakfast. Not having any side effects of either at this point except the so often talked about sexual side effects of an antidepressant. Having complained to my Dr. about it, he agreed to add Wellbutrin 150 mg (generic though) and 3 days later things seem to be going a bit backwards, my old self seems to be coming through, I feel a bit drugged like its not a great addition. Adding all three nearly makes me feel like I’m back to where I was to start with. Do you think the Wellbutrin addition means I was already high in NE to begin with? I feel slightly depressed again on it and kind of blah but also feel like I could eat tons and if I smoked I would smoke tons. Reason I mention that is because I thought I was suppose to do the opposite. I’m debating if I should cut my Lexapro in half or if I should do without the Wellbutrin even if its a Lexapro side effect antidote. Again thank you for all your help and advice!

        • http://www.CorePsychBlog.com Dr Charles Parker

          Tiana,
          If you were in my office the easy answer to your several interesting questions would be very simple: testing is clearly indicated. All the rest would be significant speculation. Testing doesn’t solve everything, but your odd reaction to the Wellbutrin [your doc made a good guess that didn't work for some specific reason] could be unearthed with a bigger dig.
          cp

  • Rachael B.

    Hi, my son has had ADHD since the age of 7. He has been on Adderall XR 50mg once a day and Clonidine 0.1mg twice a day for the last couple of years. Overall, he’s been doing well except for occasional outbursts and social issues in school with other kids. He’ll argumentative and exhibit aggressive verbal behavior as well. Due to this, his doctor has prescribed Tenex 1mg twice a day in addition to what he is already on. I haven’t started him on it yet. I guess my question is, is it okay for him to be on Tenex and Clonidine together? He hasn’t had any issues being on the Clonidine.

    • http://www.CorePsychBlog.com Dr Charles Parker

      Rachael,
      Shire is recommending against using those two meds in the same family together – as the possibility of a drop in blood pressure or additive effect with the meds is quite possible.

      Having said that… I will tell you what I do – I do what they say.

      Some clinicians are using them together, but my take is that the potential for trouble is there, and I suggest you discuss alternatives. Taper the Clonidine or taper the Intuniv depending the selection of med.
      cp

  • RBC

    I am an adult professional with ADD (not hyperactive). I have been taking Strattera for several years and I feel that it has improved my life (home and work) significantly. Here is the interesting part — the first year or so that I was taking it, it had a terrible effect on my mood. Although my concentration was greatly improved, it made me feel angry and dark and yet very uncommunicative. At that time I was taking mild doses of antidepressants that I had been taking for several years before that. I actually wanted to find an alternative to Strattera and I started to supplement it with L-Tyrosine, which I had taken as a ‘natural’ remedy (with some mild success) before trying any actual ADD medications. I thought perhaps I could gradually get off the Strattera. However, something very unexpected happened — I noticed a tremendous improvement in mood when I took both. So I have stayed on both for several years, very successfully. I gradually reduced antidepressant and am now completely off them. (Clearly my ADD was causing my depression). I take 50 mg (two 25 mg capsules) of Strattera, which is a low dose, and I take roughly 125 mg of L-Tyrosine (I buy 500 mg caplets and cut them into 4ths in a pill cutter). This seems to correlate with the topic of neurotransmitter precursors mentioned in places on this site. Thought you might be interested.
    Before I tried Strattera I had tried concerta and adderall briefly. Concerta made me uptight and angry– got off it very quickly; adderall (along with anti-depressant Celexa I was taking at that point) made me feel wonderful, but did nothing significant for my concentration or focus. As a matter of fact, I had gone from Strattera to adderall, because of the mood issues, and then back to Strattera because the Adderall was so ineffective.

    • http://www.CorePsychBlog.com Dr Charles Parker

      RBC,
      Interesting note, thanks for sharing. Upon reading your story many thoughts come to mind, but of course they are all pure speculation without knowing the specifics on your neurotransmitter levels.

      1. L-Tyrosine is a precursor for both DA and NE, Strattera only hits NE… it’s an NE chicken catcher. The Tyrosine likely corrected a deficit in your neurotransmitters, both NE and DA, and Strattera then collected the guys.
      2. The reason the Adderall and Concerta didn’t work was likely due to diminished DA in the first place.
      3. The Celexa feeling is likely secondary to low 5HT [serotonin], and 5HTP [serotonin precursor] might help fill out that set of chickens if the depression lingers on any level, – as DA will down regulate 5HT levels even with neurotransmitters alone – see the article by Marty Hinz under NeuroAssist here.

      Glad to hear it’s working out – my prediction is that we will all be encouraging Neurotransmitter testing in the near future – why not use the available biomarkers if we can more clearly target the specific imbalances?
      cp

  • http://www.adasa.com.au Bruce McDonald – Attention Disorder Association of South Australia Inc

    Interested to have information for our resources

    • http://www.CorePsychBlog.com Dr Charles Parker

      Bruce,
      Anything we can do to help your mission will be most happy to fill in any blanks, – hope you like the White Paper on Precise Solutions!
      cp

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  • Susan Ross

    Hi Dr. Parker! I am a 40-year old mother with a husband and 3 children. I was diagnosed with ADD 2 years ago, and myself chose Strattera as my treatment. My doctor was open to the suggestion, as it is a non-stimulant and I also have an anxiety disorder. However, I have maxed out the Strattera dosage at 100mg. It no longer seems to have the same effect on me as it did the first few months that I was taking it. My treating physician is not on board with trying something different. What should I say to him to make him understand my point? FYI…I also have been seeing a psychologist since before the initial diagnosis. This is actually the second psychologist; the first one I absolutely adored died from a massive heart attack early last summer. I like the new one, but he seems to think I am doing great! Your input would be greatly appreciated! Thank you!

    • http://www.CorePsychBlog.com Dr Charles Parker

      Susan,
      Each physician has their own comfort zone, and that zone is pretty well built-in during medical school. Change does occur during a life of practice, as each of us digs deeper into the areas of medicine that matter more – and the feeling of wanting to improve old intervention strategies, especially in specific chosen areas of medicine. The non-curious, the extra busy, and those simply not interested in that particular subject, like ADHD, may simply not be the person to consult on the many new options. Further, some still have a considerable bias against specific strategies, as they don’t know the parameters there. Specifically, many continue their discomfort with stimulants, simply because they don’t know how to use them, and want to do-no-harm. Interestingly, some of those same folks will be uncomfortable with measuring and recommending more comprehensive interventions such as using neurotransmitter precursors, as they are not harmful, – but simply don’t fit the institutional mold, and appear too unconventional… it all requires much more reading and comfort with evolving paradigms. The evolution of science is sometimes quite slow – see the Structure of Scientific Revolutions.

      Short answer: The standard of care for stimulants with 40 yo women with ADHD is clearly there, and both stimulants and targeted neurotransmitter precursor interventions can be practiced safely by the docs who are interested. Your problem is simply out of his comfort zone – so find someone who is comfortable and informed. You should be able to call and shop up any doc, as I am regularly shopped up with those interested in what I do. No problem. No reason to pay someone to find out what they do – a phone call to the office with a nurse or admin person, or hopefully the doc themselves, will help you take those important next steps in finding your next best provider for that particular service. You don’t have to change doctors completely, you simply need a second opinion.
      cp

  • Susan

    Is your book out yet?

    • http://www.CorePsychBlog.com Dr Charles Parker

      Susan,
      Thanks for asking – yes it’s done, and will be out quite soon, – just have to rewrite one more time, and get into good, readable pdf format – then should be available in mid to end of Feb-
      cp

  • Stuart Frazer

    Do you have any thoughts on the seemingly explosive growth of the “energy drink” market? Drinks like 5 Hour Energy are clearly advertised as stimulant drugs targeted primarily to young males. 5 Hour Energy’s pitch specifically boasts that it increases “focus” with no resulting “crash.” Are there potential interaction problems with these drinks and ADHD medications? It’s a bit like there’s an arms race in the unregulated stimulant market.

    • http://www.CorePsychBlog.com Dr Charles Parker

      Stuart,
      Right on with your concerns – and yes we see difficulties with stimulant drinks, as well as simple carbonated drinks with more or less average doses of caffeine. The additional problem with the energy drinks is the additional dysregulations with, for example, taurine. The taurine acts as an inhibitory neurotransmitter to smooth out the pump, but some find themselves overdosed on the taurine as well. Even the inhibitory neurotransmitter precursors, such as taurine, can result in dysregulating the emotions.

      As far as interactions: Caffeine can significantly effect stimulants, but is not a direct effect thru the Cyp 450 pathway, as best I can see, – rather just too amplified, coming out the top, and unable to function on the OD of stimulants.
      cp

  • Deb Woodward

    Dr. Parker,
    My son, Mitchell, was diagnosed with ADHD at the age of 5. He has been on concerta for 4 years. He was on 54mg for school and 36mg on weekends. We started going to a highly recommended doctor who specializes in meds for kids(highly trained). He has diagnosed Mitchell as also having general anxiety disorder inwhich he prescribed lexapro (now at 10mg). We started having issues with Mitchells behavior….getting into everything…destructive behavior..almost like the concerta was not working anymore. The Dr. recommended a increase of the concerta to 72mg. After the increase on concerta the behavior seemed to subside a bit…but he started having tics….after our appointment today he has given him intuniv to try. He is now on 72mg of concerta, 10mg lexapro, and now 2mg of intuniv. WOW! I am overwhelmed with all this medication. I feel like he has become immune to the concerta. The lexapro has helped with the outburst he used to have. Is it possible the become immune? What will all this medication do to him? Is it possible to cut the dosage of concerta with the intuniv? Any suggestions
    Thank you for listening!
    Deb Woodward

    • http://www.CorePsychBlog.com Dr Charles Parker

      Deb,
      Yes, you could cut the dosage of the Concerta while on the Intuniv, working in concert with your doc. Without being there, without completely understanding the clinical indication in the first place, it sounds from this description that he simply started too high on the Lexapro, or that the Lexapro is the counterproductive one from some other perspective [just the wrong med]. I would encourage you and your doc to stick with revising/reviewing the dosage and indications for Lexapro.

      Intuniv may be indicated, and it does appear that he is more symptomatic, but I doubt that the symptoms are based upon the original ADHD, but rather suspect, from this note, a primary medication/metabolism challenge. Sometimes ADHD in the first place, the ‘cognitive anxiety,’ is actually more ADHD than based upon depression as described int this Anxiety and ADHD video. Do discuss this further with your doc as well. Challenges like this need more careful review than a brief comment on the Internet.
      Best to all,
      cp

  • Ross

    Please help. I am terribly confused. I came here for the “free” ebook (white paper?) but I don’t see anywhere to download it. I signed up and sent in my email address, etc. but all I got was an email with an advertisement for a book that is coming out (presumably in stores?). Any clarification on where I can download this interesting free ebook would be great! Thanks!

    http://adhdrollercoaster.org/the-basics/all-about-adhd-meds-dr-parkers-free-ebook/#comments

    • http://www.CorePsychBlog.com Dr Charles Parker

      Sorry Ross,
      Will have to fix that page, it’s not clear, but down at the bottom is the link to the pdf document.
      Do run back over there, I will go over right now to provide better directions.
      Thanks,
      cp

    • http://www.CorePsychBlog.com Dr Charles Parker

      Updated and available, try it again at Precise Solutions for the 10 Most Biggest Challenges with ADHD Medications.
      Thanks!
      cp

      • Joebel

        Euhmm

        I’m sorry, but the links for the free ebook are completely impossible for me to find on this page.

        • http://www.CorePsychBlog.com Dr Charles Parker

          Jeobel,
          Please just scroll to the lower one third of that adhdbook page, across from the Medpedia badge, and drop your email and name there in the signup, and you will be forwarded to a page with all the complimentary downloads,
          tnx
          cp

  • julie

    I have a 16 year old daughter with ADHD inattentive type. She has no other co-exhisting conditions. She began adderall XR as a young child and did wonderfully. About the time of puberty, we began on a 2 year struggle of trying to find the right drug/dosage. When we would up the dosage to where it would help her attention, she would become very anxiety ridden, and would lose lots of weight. We were bringing on problems that didn’t exist before meds. Unfortunately, we still do not have a good medication. We truly have tried them all, and in many combinations, and tried many second line medications as well. Currently she is taking 15 mg. of adderall, as well as fish oil supplements. We also have completed cogmed. She is doing ok, but her attention still is not what it should be. She is a child with an IQ of over 140, but continues to get B’s and C’s in high school. Her performance clearly does not live up to her potential. I am a CHADD facilitator, as well as a Parent to Parent educator in my community. I am well versed in ADHD, but continue to struggle finding a better alternative for my daughter. Would a spect scan be helpful, and do insurance companies cover them? Also, is it difficult to find doctors that are versed in this type of diagnosis in Iowa?

    • http://www.CorePsychBlog.com Dr Charles Parker

      Julie,
      The subtlety of these problems, the often unrecognizable comorbidity of issues as she presents do require more careful investigation. Hormones, neurotransmitters and immune challenges all come to mind as possibly contributory factors, – all of which are almost never obvious to those not familiar with those inquires. We do phone inquiry evaluations, and could shed some light on her situation with a consult if you would wish to chase down more details.

      The price of SPECT make it a last choice after all the other less expensive inquiries and lab reviews have been locked down. Caitlin is my Patient Care Coordinator in the CorePsych office for further inquiry if you are interested.
      cp

  • ARS

    Hi;
    We have a beautiful 8 years old son diagnosed with severe ADHD. He is very intelligent and has been placed in ‘gifted’ by the school he attends, after scoring 98% on SATs. He is in 3rd grade. Problem is that although he proves understanding the material covered, he makes so many mistakes that his grades are starting to come down to 40′s%. He has a hard time focusing, has hand tremors and writing is not easy but can do it (done all types of test – no epilepsy, no tumors, conclusion was familial), is loud, impulsive, hyperactive, hums songs, overeats if allowed, has sensory issues (don’t like kisses on face, certian socks, etc) will talk about subject of interest (now-a-days anything computers and games), walks twisting ankles, and tip toes, is friendly, charming, sweet, lovable, independent, cooperative, but constantly challenges boundaries. When younger, around 4 he was a runner, openned and closed doors constantly, had anxiety, once suddenly jumped into a lake – opened gate and ran for it (I was next to him and jumped after). Following the advice of two doctors we placed him on: Focalin 10 mg (walked the walls), adderall up to 40 mg (got deppressed), Concerta 10 mg (made him stick hands into mouth), and strattera up to 40 mg (worked for one year, then not). Teacher’s and I are concerned with his academics – she said focuses not more than 4 minutes at a time, one on one help in class is limited, but, even this is not working out, most days won’t finish work, homework is a huge, huge task everyday.
    Please, help – can you provide feedback – what else can we do for him? We live in South Florida – know of any specialist either psychiatrist or md, or neuro good with ADHD and meds or alternative methods? We’ve done DNA testing w/all good results, pet scans-good, epilepsy-none. Visited three Neurologists – all three prescribed different meds -very confusing. All said he has ADHD. Visited Neuro-Psychologist – said he needed meds and ADHD, saw some signs of Asperger. He was born with an intermittent kidney reflux- seems outgrown, and had genetic history of fatal heart problems in family members at age 45, and diabetis after 60. Some family members consumed alcohol.
    We are desperate to find help for him – it is very hard dealing with this situation, we are truly concerned for his future, plus we have other children which makes it more challenging.

    Any help/suggestion would be greatly appreciated! Thank you.

    • http://www.CorePsychBlog.com Dr Charles Parker

      ARS-
      Complicated ADHD, not one to lean back and make pronouncements over the ethers on a blog. Sounds like you have been very busy, have had numerous good medical checks and yet, something is clearly being missed. His problem is biologic, the evidence is just not in yet. He does need more, multiple levels of further investigation.

      Two points that are most optimistic, but may not sound like it on the front: I’m pleased to hear he got depressed on Adderall, that fact alone indicates possible comorbid issues. He clearly has metabolic challenges and gets toxic on what would be expected to be a reasonable amt of meds.

      As you likely know from reading here, and especially on this particular page, I am not a guy that’s up for speculative adventure, even on a casual presentation I go thru all the details. If you would like me to review it by phone with you please call Caitlin on the Services page – email or phone. After more details I am sure we can at least come up with specific next reasonable fact finding.

      In the meantime listen to the presentation on this page and download there several interesting papers on Neuroscience investigations.
      Talk soon,
      cp

  • Neil Fick

    Hi I live in South Africa and participated in the online ADHD conference. Very briefly I used concerta for 2.5 years. It helped me enourmously. Side effects I didn’t enjoy were really just that from being someone who was very self concious and anxious I became a superhero who didn’t worry to much about other peoples feelings. My compassion and generosity disappeared. When I stopped the medication I went through the hardest time in my life ( I am 50 and a succesfull businessman). It has totally been a mid altering experience and I now, over a year later do not know where to turn. I experienced the worst anxiety of my life and was happy to end it there. Never before have I felt like this. My biggest problems in lfe are:
    THink Think Think. feeling of hopelessness.
    Have abuse alchohol.
    Do not believe I am a depressant because up until stopping the Concerta I never had a don’t care attitude although I often felt low. I believe I am ADHD.
    Poor sleep.
    Cannot translate my thoughts verbally which causes big problems with self esteem and feeling stupid.

    Your suggestions would be extremely grateful.

    • http://www.CorePsychBlog.com Dr Charles Parker

      Neil,
      Yours is a very fixable problem, I can completely assure you. No need to think about ending it when multiple solutions are available. Sounds like you are very much tied up, as many successful people are, with cognitive anxiety – see this post on “Wrecked by Success”

      If you Search Cognitive Anxiety on this Blog you will get about 10 pages with refs, – and if you go over to YouTube you will find this brief review on Cognitive Anxiety.

      Easy recommendation:
      1. do the neurotransmitter NT testing, it is always helpful,
      2. dial in the stimulant for the correct DOE mentioned throughout my postings,
      3. depending on the NT results, I strongly suspect that a small dose of some kind of serotonin support will make your day solid with the stimulant of choice – this in spite of the feeling of “not depressed.”

      Best,
      cp