Intuniv

Sharp Eyes - Johan J.Ingles-Le Nobel via Flickr

Intuniv for ADHD Sets the Stage For Improved Attention Inquiry
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…  Google first page is a direct result of the excellent and informed questions from our thousands of CorePsych Blog readers out there – you readers have been looking for answers to the complexity of ADHD Appearances. Thank you for over 469 comments and questions!

- Yes, you read that right, we are collectively suffering from a National ADHD Myopia – short-sighted, anachronistic perceptions, treating vapors and impressions, needing immediate Big Vision correction. And don’ t plan on the new DSM 5 to help you out – it only reshuffles the Go Fish cards already on the clinical table. Just like our friend the owl, we can’t hit the target if we can’t see it. Sharp inquiries bring more definitive targets. New eyes are required.

Too Many Are Having Big Trouble Using ADHD Appearances
Diagnostic imprecision is rampant throughout the land [has been for years], and, for those finger-pointing ADHD ranters thinking ADHD is a belief system: you’ll be disappointed, there’s no one to blame for this  imprecision. We simply have not caught up with the functional brain science [detailed in my new book: Rules] – and almost no one is paying attention to the nuances of multiple molecular and cellular imbalances. The ranters, including Tom Cruise [from my first post ~ 4 yrs ago], are, in point of this fact, somewhat correct: we direct our treatments by appearances, not the underlying science.

Intuniv Staging for Deeper ADHD Inquiry
At first blush it appeared that adding Intuniv to our ADHD pharmacopoeia would solve a number of problems – most especially the problem of associated anger with ADHD – and, for many it has indeed added significant treatment benefits, as documented in those previous CorePsych postings. The interesting and unexpected outcome, however, appears to be of greater interest – what about the many who didn’t improve? What about those that deteriorated? The many questions beg for better answers: just exactly what is ADHD, and, what is not? Even more to the point: what are ADHD spectrum disorders on a neurophysiologic level?

The inarguable benefit that Intuniv has delivered to the inquiry, to the ADHD birthing table, is a number of new, unanswered questions, and helpful new extrasynaptic activities that begin to address the extensive underlying biology of ADHD. Many of these abundant questions have previously only been resolved by throwing atypical antipsychotics at mood disordered individuals who suffer with a dual diagnosis of ADHD.

The Glutamate Tipping Point
As noted previously: Intuniv, the glutamate agonist, can helpfully increase glutamate, a neurotransmitter that specifically effects both cognitive and affective centers in the prefrontal cortex associated with working memory- but what if the glutamate is already high for other reasons? What if the ADHD symptoms are associated with/a result of an upstream abundance of glutamate? The unhappy end result of using Intuniv under this circumstance is relative Glutamate Toxicity. In the office, and frequently seen in many of the Intuniv questions here at CorePsych Blog: glutamate toxicity results in marked emotional deterioration, rage, even appearances of semi-psychotic behavior. – This phenomenon is not the rule, but is sufficiently common that we should have it on our thoughtful, sharp eyes radar.

For this reason, especially with refractory individuals, we measure [among 11 other neurotransmitters] glutamate levels, – and we do see glutamate increased in those individuals with significant immune disorders that present comorbidly with those ADHD Appearances. And, yes, Intuniv does not work well for those with elevated urinary glutamate – regardless of your take on the neurotransmitter science. [This observation is replicated regularly, and encourages improved appreciation of more routine neurotransmitter testing.]

Now, after these brief days of Intuniv practice, we have even more new science, new inquiries, new neurotransmitters to talk about. We’re beyond dopamine and norepinephrine as the only neurotransmitter relevant for ADHD treatment. Now we know that glutamate imbalances can provide ADHD Appearances through excess glutamate. These many mechanisms of excess glutamate vary, but are increasingly understood as associated with changes in glutamate decarboxylase, the enzyme that breaks it down.

Beyond Appearances: Deep Dive Into Immunity and Amino Acid Neurophysiology
For those who want to dive deeply – more into the science take a look at one of these 50 papers on the relevance of Glutamate Neurotoxicity – this one appears as a report of considerable interest:

–Matthews CC, Zielke HR, Fishman PS, Remington MP, Bowen TG: Glutamate decarboxylase protects neurons against excitotoxic injury. J Neurosci Res; 2007 Mar;85(4):855-9

Academia Is Not Translating The Science For Clinical Application
Yes, the platitude folks are still thinking the Sun revolves around the Earth, as they are deeply embedded in beliefs and ADHD Appearances, not science. Gina Pera, ADHD maven and author of Is It You, Me or Adult ADD? recently re-experienced this dilemma with no less an august facility than Stanford as they discussed the indications for stimulant medications from what appears as an antiscientific, gossip-oriented perspective.

Stay tuned for more on neurotransmitter information -
cp

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• New Book – The Patient’s Guide for ADHD Medication Rules by Dr. Charles Parker (adderworld.com)
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Make sure you take a look at these pages!
ADHD Medication Rules Purchase
“Rules” Affiliate Link
Neuroscience Details

Tagged as: ADD and ADHD, ADD/ADHD medications, anger and ADHD, Attention-deficit hyperactivity disorder, CorePsych Blog, glutamate, glutamate toxicity, Intuniv, Mental health, Non-stimulant ADHD drugs

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