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.
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If you are lost, forget being found with this bible. Don’t be worried, you won’t have to change anything you are doing… it’s the same old 19th Century stuff, trimmed up to tweak the descriptive language, with no improvements there for patient care, and no new science. Boring.
This post is the fifth, with four others, documenting Intuniv Overview, Dosing Details, Drug Interactions and Addiction Indications. Please review all of these posts for more informed use of Intuniv
Can your brain suffer from allergies? Does poison ivy really itch?
Tune in to a very interesting recorded interview I did with Dr Russell Jaffe [Dr Jaffe Bio pdf], saved from a Utah broadcasting system crash 2 weeks ago, this Thursday at 4PM EDT – link here at CorePsych Radio.
Report from the Front: The Gluten-Celiac Question
Just in the office last week: An “acting out” child, smart, second grade, unable to respond to medications with two previous docs repeatedly adjusting meds to no avail. She had canker sores.
Brain changes do appear on SPECT imaging with immune dysfunction: think gluten sensitivity and celiac. Seeing real pathological evidence, bottom to top, does help with believing.
This spring redo is only the beginning of some important new directions with ‘08 postings at CorePsychBlog and CorePsychPodcast. New interviews, new faces and some great information.
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