ADHD Medications: More Than Going Fishing

[David Baxter PhD]

ADHD Medications: More Than ?Going Fishing?
by Dr Charles Parker ? 0 comments
June 21, 2009

Out in Cally last weekend, I asked this affable angler a basic fishing question: What are you fishing for? His answer: ?Anything that bites??

Sounds like typical fishing, - but it isn?t my way, and I hope isn?t yours.
No, his objective, today and everyday, is not targeted precision. It?s ANYTHING?

Medical science makes the new office/fishing wisdom simple: with neurotransmitter biomarker testing, we can match the hatch [they biting on Mayflies?]. We still need that careful clinical interview, just as we do with SPECT brain imaging ? but with this kind of less costly evidence [most insurances cover it], we can see where the excess and the deficits exist. No longer will our conversations focus only upon serotonin, dopamine and norepinephrine? but twelve neurotransmitters, many you haven?t yet heard about.

Background on all this fishing stuff
Yes, I do love to fly fish, from the Madison River in MT for rainbow trout, to bonefish, to stripers in saltwater, right here in Va. Beach. I tie my own flies, have written an article for Fly Fishing in Saltwaters, and, don?t tell anyone, have saved road kill [great fly tying materials ? the Boy Scout way] ? and if I had some more time, I would be out there in my kayak chasing those stripers.

But now I?m fishing for a different, more challenging fish: ideas that work for people ? with no risk, using the best technology, at the best cost point.

So? how does fishing relate to brains and psych? Very simple ? fly-fishing is about understanding the details of the natural world, seeing, then understanding what?s there in the water in front of you. If you aren?t looking and thinking, you may think your fishing ? but it?s just passing time. - ?Anything that bites will be just fine? just doesn?t work in the context of what we now know about brain physiology and insect hatches.

Why all this fish fuss?
Just back last night from, dare I say it, a remarkable ?fishing day? with the NeuroScience folk talking about what I consider to be, get this, nothing less than: the future of psychiatry. One of the presenters, Eileen Wright MD, I?ve heard on CD, but seeing her live, listening to her psychopharmacologic understanding of sleep, - beats some of the deepest pharma researchers I?ve heard ? and as you know, I have been seriously listening. Sleep, ADHD, Depression and Anxiety - just what exactly are we trying to find and fix?

Stay tuned here to the CorePsychBlog - I will keep bringing you up to date on neurotransmitter measurement [and correction] specifics. I spelled out these details in several CorePsych Radio Programs, and put up some links to downloads on the psychiatric implications of neurotransmitter measurement here.

Just read this excellent paper on neurotransmitter testing to get you started - and I will teach you how to ?match the hatch.?

 

[Atlantean]

"Sleep, ADHD, Depression and Anxiety" is it common to experience all four of those issues? I know that trying to treat hem has been extremely difficult and I ended up way over medicated (500mg Seraqueal, 5mg Clonopin, 400mg Thorazine, 600mg (just started this one) Lithium) and actually everything is working really well except for the sleep.. I still struggle with it, and I have tried taking the thorazine and clonopin at different times, and no matter what I do there is a problem, either Im too hungover to work, or they dont work at all, or I take it at ten and dont sleep until 4am and cant wake up at all, and its just extremely frustrating.

I was actually talking to my mother (a nurse and hospital supervisor) who reccomended seeing a sleep doctor, but who would refer me? My shrink, my GP, or my certified nurse practitioner who handles most my meds? Im going crazy, I have always been nocturnal and experieced sleep issues, but it seems like the older I get, the worse they get. I dont know. I wish they would just give me seconal or one of the old tried and true sedatives. LOL-oh wait- I think thats what we were trying to do with the thorazine.

Anyway, been gone a while, Im not dead and nothing bad has happened, I have just found a job that I keep extremely busy with, but I love it and am very happy to be doing it. So, hi everybody. Sorry for the long-winded rant.

'-)

Edit: BTW, Va Beach-you probably drove through my neck of the woulds to get there. You should have dropped by and said hi!

 

[David Baxter PhD]

That was Dr. Charles Parker in Va. Beach.

As to your questions, it is not at all uncommon for someone with bipolar disorder to experience issues with insomnia, depression, and anxiety. Throw ADHD into the mix and it would be very surprising indeed if those symptoms were not present.

Dr. Charles Parker had a recent post about ADHD and anxiety. You should be able to find it on his blog.

 

[David Baxter PhD]

Here you go: ADHD and Anxiety: We Are Missing Cognitive Anxiety

 

[Atlantean]

lol, oh, thanks. I thought it was just you speaking your words of wisdom. '-) missed or overlooked the part where someone else wrote it. All the same, if you ever feel like going to the beach, feel free to drop in. :-D

PS thanks for the info.

PPS funny you mention the BP issue. I am convinced I dont have it, though I have been told since I was an adolescent by several different MHPs that I do. I think I just have ADHD and Hypomania and anxiety. Most my depressive moments are directly attributed to environmental factors, not random episodic events. But what do I know, Im just the patient. *sighs*

 

[David Baxter PhD]

funny you mention the BP issue. I am convinced I dont have it, though I have been told since I was an adolescent by several different MHPs that I do.

I really hope this doesn't come across as patronizing because that isn't my intention.

However, you might be surprised to find out how many of the bipolar clients I've seen have said exactly the same thing, even though it's blindingly clear to most external observers that there's no question about the accuracy of the diagnosis.

Bipolar disorder comes in different forms: Not everyone experiences the mania, or at least not regularly. And not everyone experiences regular cycles of depression.

 

[Atlantean]

I dont take it as patronizing at all, but how frequently could it be that someone is just hyperactive, and not type 2 otherwise unclassified hypomanic without depressive characteristics? especially in an individual that was on incredibly high doses of ritalin as a child? Or are you saying the child was actually BP2 all along, and never had ADHD? incidentally, just for more background info, the ritalin never helped as observed by all.

I know to an extent I am contradicting myself because I have commented on my severe depressive bouts, but again these were generally directly related to things like miscarriages, bad relationships, or other environmental factors.

Its not like I have some issue with being BP, if I was it wouldnt bother me and I have no stigmas about it, I just question it. Especially when seraquel and lithium didnt have any effect on my hyperactivity or insomnia.

Thats just it- nothing has ever worked. The only thing that has ever helped me, was just me working through my issues and letting go of residual effects of traumatic and painful life experiences, and building a healthy, happy life. Having my job gives me something to focus my insane amount of energy on, and so I find that therapeutic. I actually have a BF now, and hes older and very mellow and laid back, and he has had a very grounding effect on me. While this pleases me, I know it puts me in a vulnerable position should the relationship dissipate. But for now, things are going well...hyperactivity and insomnia aside.

---------- Post added at 01:17 AM ---------- Previous post was at 01:10 AM ----------

Another question I have, as I was aware and as you mentioned, BP comes with only hypomania (without depression) and only depression (without the hypomania). Isnt it directly contradictive to diagnose someone as bipolar (which would indicate the manifestation of both extremes) when both extemes arent being expressed? How can that be BP? If anyone could make me understand that direct contradiction, I would willingly accept a diagnosis of BP. But it contradicts all logic.

 

[David Baxter PhD]

I dont take it as patronizing at all, but how frequently could it be that someone is just hyperactive, and not type 2 otherwise unclassified hypomanic without depressive characteristics? especially in an individual that was on incredibly high doses of ritalin as a child? Or are you saying the child was actually BP2 all along, and never had ADHD? incidentally, just for more background info, the ritalin never helped as observed by all.

That's quite possible - it wouldn't be the first time a bipolar child was misdiagnosed. And if you were "nyperactive" but the ritalin didn't help at all, that increases the probability that ADHD was a misdiagnosis, IMO.

I know to an extent I am contradicting myself because I have commented on my severe depressive bouts, but again these were generally directly related to things like miscarriages, bad relationships, or other environmental factors.

That doesn't rule out bipolar, though. The whole intrinsic-extrinsic or "vegetative"-reactive (vegetative is the wrong word here) distinction is really outdated now.

Its not like I have some issue with being BP, if I was it wouldnt bother me and I have no stigmas about it, I just question it. Especially when seraquel and lithium didnt have any effect on my hyperactivity or insomnia.

Fair enough. And I'm certainly not goingv to insist that the bipolar diagnosis is the correct one for you - that would be just another form of online diagnosis which is foolish. On the other hand, the fact that those medications didn't work for you doesn't mean the diagnosis is wrong. It may simply mean that they weren't the correct medications for you.

Thats just it- nothing has ever worked. The only thing that has ever helped me, was just me working through my issues and letting go of residual effects of traumatic and painful life experiences, and building a healthy, happy life. Having my job gives me something to focus my insane amount of energy on, and so I find that therapeutic. I actually have a BF now, and hes older and very mellow and laid back, and he has had a very grounding effect on me. While this pleases me, I know it puts me in a vulnerable position should the relationship dissipate. But for now, things are going well...hyperactivity and insomnia aside.

I'm happy to hear that. Certainly, creating more stability and predictability in your life will help to alleviate your symptoms, whether it's bipolar or something else.

Another question I have, as I was aware and as you mentioned, BP comes with only hypomania (without depression) and only depression (without the hypomania). Isnt it directly contradictive to diagnose someone as bipolar (which would indicate the manifestation of both extremes) when both extemes arent being expressed? How can that be BP? If anyone could make me understand that direct contradiction, I would willingly accept a diagnosis of BP. But it contradicts all logic.

Diagnosis is a complicated business, Atlantean. I think our conceptions of the bipolar spectrum are still evolving - go back a decade or two and noone was talking about Bipolar I and Bipolar II - there was just Bipolar. But based on my own observations, there are associated personality features that are common with bipolar but not with the alternative (differential) diagnoses. Similarly, while bordelrine personality disorder is sometimes misdiagnosed as bipolar disorder (or vice versa), there are personality characteristics that I feel are diagnostic of borderline and not of bipolar.

I don't know what exactly your physicians were observing when they arrived at the bipolar diagnosis but I assume that if they were competent they were observing something that they felt was definitive (i.e., pathognomic).

 

[Atlantean]

*smiles* thank you for all your feedback. Sometimes I think it seems like Im fighting labels, when in all honesty Im just struggling to find the right labels, and being a very concrete black and white thinker, sometimes the grey gets lost in transit.

I really value your opinion, Dr. Baxter. And I hope I dont come across as argumentative, that certainly isnt my intent. Its just years of frustration, dealing with diagnosis after diagnosis, trying medication after medication, and all it has led me to believe was that I am a result of my life experiences, which cant me medicated away. I fairly recently was enlightened to the fact that experiences can actually change brain chemistry which opened my mind up to trying medications again, but I really feel like they have gone overboard, and my therapist even acknowledges that I am over medicated and is in the process of reducing my medications. For two years now I have been trying to get off the Thorazine which I can only do once I find a suitable alternative that works, but that has just opened me back up to the pharmaceutical merry-go-round that I so dread. And I guess Im getting to the point where I feel a sense of despair, because of so many things I have tried, all without success. Its just an exasperating situation, and I dont know if I should just give up, though with the situation with my son I feel I cant go off my meds because I think it will look bad, so I just keep taking them, and the resentment builds and builds. I hate the meds that dont work, I hate the diagnosis's that dont fit, I even am coming to hate the people with their magical litte prescripting pads that are only too happy to dole out their little chemicals, happy to slap the first label on my forehead that comes to mind. I am just at the end of my rope, and struggling to manage and fix things my way, which so far has been the only thing that has gotten me anywhere.

 

[David Baxter PhD]

You're not coming across as argumentative.

I know that finding the right medication can be frustrating. All I can say about that is that most people are successful if they persevere in the trial-and-error process. Looking at current research, at some point we may have practical ways of determining more precisely which medications are likely to work for an individual and which ones to avoid for that individual but at the moment we're stuck with trial-and-error.

 

[Atlantean]

Thanks for understanding. I was feeling exceptionally frustrated and drained last night, so I probably vented a little more than I normally would have. Thanks for listening and for all your advice.