If any one of these three is unbalanced, the rest will follow in rust and corruption. The brain won’t work right in thinking, acting or feeling.
Must Review
Just in case you aren’t sure, and want a clear, definitive set of references on all this complexity – I’m loading up this new paper just for you. Download this paper, read it, forward this message and tweet it. This paper will change the way you are assessing challenging cases that just don’t get better with regular psych interventions.
Marc D, Ailts J, Ailts-Campeau D, Bull M, Olson K, Neurotransmitters excreted in the urine as biomarkers of nervous system activity: Validity and clinical applicability [in press]: Neuroscience and Biobehavioral Reviews, 2010
Do drop a comment here after reading this interesting paper:
cp
by Dr Charles Parker on August 29, 2010 · 2 comments
Connections Matter Wikipedia
Intuniv, Glutamate and ADHD Symptoms
Thanks to Intuniv we have a new neurotransmitter to consider – and it must be considered in the context, as with any other ADHD med, of the Therapeutic Window. Glutamate, as you will soon see in these pages, as well as several others [PEA, Dopamine, Norepinephrine, and indeed Serotonin] can all make a difference as we regularly address the specifics of ADHD neurotransmitter corrections. For this post: specific glutamate considerations.
For The Record
These are previous CorePsych Blog posts on Intuniv:
Details About Glutamate
Amy Arnsten, PhD at Yale: See this summary page for details of this interesting ADHD science. This paragraph is from that page:
Goldman-Rakic used a spatial working memory paradigm to uncover the neural basis of working memory abilities, and found that representational knowledge is encoded by networks of prefrontal cortical (PFC) pyramidal cells with shared stimulus properties, engaged in recurrent excitation. [ed note: good working memory diminishes the possibility of ADHD.]
These recurrent excitatory connections depend on glutamate actions at NMDA receptors. Spatial tuning is heightened through GABAergic, inhibitory connections between networks with dissimilar spatial properties (e.g. Rao et al, J. Neurosci 20: 485, 2000). The working memory abilities of the PFC are also highly dependent on the neuromodulatory environment, whereby loss of catecholamines in PFC is as detrimental as destruction of the PFC itself (Brozoski et al, Science 205: 929 1979).
Another reference:
Russell VA, Wiggins TM, Increased Glutamate-Stimulated Norepinephrine Release from Prefrontal Cortex Slices of Spontaneously Hypertensive Rats Metabolic Brain Disease 25: 297, 2010
Bottom line in the office:
1. Excess glutamate alone presents as ADHD with hyperactive and significant ODD symptoms.
2. Diminished glutamate often presents as inattentive, and may be associated with ODD symptoms, but less overt anger.
3. Excess glutamate with both excess dopamine and norepinephrine appears as untreatable with any ADHD meds, even though symptomatically presenting as ADHD. The characteristic refractory, paradoxical response to stimulant meds, and to Intuniv often leads to the diagnosis of bipolar – but the dysregulation is in the neurotransmitters, not the appearances.
4. Number 3 is always associated with other biomedical issues including food sensitivities measured, e.g., by IgG – such as gluten sensitivity.
5. Measure when in question. Why spend more time guessing?
Still don’t get the relevance? Take a look at this video on Dopamine and Glutamate-
Remember, this video is a patent oversimplification – dopamine does modulate glutamate, as does norepinephrine, but the interplay with many other neurotransmitters is not addressed in this short clip.
Stay tuned for more on the ADHD Neurotransmitter details – and sign up for email notifications for CorePsych Blog in the upper right hand corner of this post.
cp
Our multiple CorePsych Blog reports on Intuniv [this the 6th] have kept CorePsych Blog on the first page of Google for many weeks [today #9 on the first page of 199,000 hits], … and why? Hey, I’m not bragging, I’m thanking…
If you think you have it bad with ADHD, just throw picky eating into the problem. Then ADHD can become almost untreatable. Those with picky eating problems often [not always!] have significant problems with the North of the GI tract and immunity which gums up the works.
Just take a look at the hundreds [now nearly 2000] of comments here and elsewhere that highlight the challenges with dialing in ADHD medications for effective treatment. No, I am not asserting it’s all a mess – many do well and have no problems – but it is quite true that the challenges out there are not rare, but rather commonplace, – way too commonplace.
Why should we become very interested in Lyme? Why should those with psychiatric concerns even think about this odd presentation often relegated to infectious disease docs? Simple: Lyme Disease is the Great Imitator
ADHD Medication Rules: Paying Attention To The Meds For Paying Attention is hot off the press – and is available July 4 -> July 11 at the promised early bird discount.
Intuniv Questions Encourage More Specific Maintenance for ADHD
Sorry for the silence readers, I’ve been writing… – ADHD Medication Rules: Paying Attention to the Meds for Paying Attention is done, and the Launch Date is, get this, July 4th. Do you think there’s a significance there? You will soon see that independent thinking is the [...]
“Repeating the same thing, expecting different results” now brings new meaning – as rusty, ineffective activities, no matter what their origin, can begin to feel like repetitive insanity.
Because we already know each other I am sending this out to give you a heads up on a forthcoming special pre-publication offer with – ADHD Medication Rules: What To Do When Nothing Is Working -
This material is provided for general educational purposes only and is not intended to constitute: (i) direct medical advice or counseling, (ii) the practice of medicine including psychiatry, psychology, psychotherapy or the provision of health care diagnosis or treatment, (iii) the creation of a physician patient or clinical relationship, or (iv) an endorsement, recommendation or sponsorship of any third party product or service by the sender or the sender's affiliates, agents, employees, consultants or service providers. If you have or suspect that you have a medical problem, contact your health care provider promptly.
