ADHD diagnosis actually is a real problem with real answers, not simply a media finger wag.
ADHD diagnosis is but one of the topics of current media heartburn. Just look around, everyone is talking about the problems with the use of psych meds in general. From Tom Cruise in his interview with Matt Lauer, to the guys at the gym, to mothers, to some of our colleagues in the medical profession, the ADHD diagnosis concern is real, and you don't have to look far to see real problems with denial and missed opportunities.
Meds can make people worse not better. Psych meds can also cause dangerous problems with meds for other conditions. The use of psych meds is rising exponentially and serious problems tag along behind.
Why the problems?
Simple: we aren't thinking. Moreover we aren't thinking about thinking. Many are living in the 1970's, both providers and the public. Psych problems are not like sinusitis, and psych meds for ADHD or Bipolar, for any complex or simple emotional problems, often need more insight than a reflexive dusting of neurotransmitters. With advances in technology we can actually see brain neurotransmitters in action: and prove how they work.
In these pages we will discuss, and you can comment on, dramatic changes that are sweeping through our electric evolution in the core understanding of psychiatry – including diagnosis, meds, the brain, how chronic under-the-radar medical conditions effect brain function. All of us, we as professionals and we as the public, can contribute new perspectives to this dialog.
Let's start with the basics. At medical meetings some call this the “take home message.” Hopefully with these missives we take it home, and take it out.
Diagnostic 3 Rs
Years ago when I was a kid, looking too young to practice psychiatry in Philadelphia, we considered the three Rs as basic education. Today psych meds require a different series of 3 Rs for our basic education, for any intervention.
1. Right Diagnosis: We will be spending some interesting moments together here talking about how we can actually get the right diagnosis. Modern technology from SPECT [brain imaging] views, to tests for allergens in the bowel [more later]. Yes the bowel is connected to the brain, I'm not kidding.
2. Right Medication and supplements: All psych meds/supplements are not alike, even meds within med families can differ. This stuff is easy and is basic. If we know it, we can use it. Yes metabolism and metabolic pathways sound like a big deal, but they are so predictable. Stay tuned for info on Prozac or Paxil added to Adderall and how these meds together can create big problems.
3. Right Dosage: Dosing medications effectively is the single most common problem today with psych meds and with supplements. We see this every single day with second opinion reviews, have seen it with ADD meds for years, and repeatedly see dosage issues with the other psych meds as well. The take out message: Adjusting the dose with body weight in mind is Paleolithic news. Small kids can be fast metabolizers and need a larger than expected dose of meds, and big giant guys may burn meds very slowly, requiring a tiny dose. Later I will tell you the details of how and why to adjust the dose of meds. ADD meds require even more focus because they don't last all day.
When you see the reasons for all these problems and see answers, the mystery, the belief system, the hocus pocus about psych meds vaporizes. With basic science we can go from voodoo to predictability to credibility. Right diagnosis, medications, and dosage depend upon functional science, not ineffective labels.
I look forward to chatting with you more about the 3 Rs. Stay tuned, ADHD is but one of the profusion of everyday problems –