ADHD Medications: More Than ‘Going Fishing’

Vyvanse for ADHD: The Complete Story on CorePsych Radio
June 18, 2009
Neurofeedback with Kurt Othmer on CorePsych Radio
June 22, 2009


Metaphoric ‘psych' fishing report from out on the Santa Monica Pier: –

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.'

Talk soon,

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  1. Josh says:

    Dr. Parker,

    Are you talking about testing urine, serum, or plasma levels of neurotransmitters (or their biomarkers)?

    I’ve heard that these don’t give a whole picture. Wouldn’t you agree that proper neurotransmitter function is defined highly by where in the brain neurotransmitters are active (what lobes), the sensitivity of receptors to NTs in question, etc?

    I seem to recall children with ADHD have one (or a few) part of the brain the lags behind in development and, thus, dopamine function is decreased there while normal in most other parts of the brain.

    • Josh,
      Appreciate the reconnection – know you are busy and time is tight…

      Most of your questions about NT testing are available here at Useful References– in fact there are two easy reviews with refs. Bottom line on the specificity question: operational concept: Biomarker vs ‘Definitive Dx.’ Remember that the current problem with most of psychiatry is the inevitable issue of descriptive dx [diagnosis] vs functional dx. Biologic evidence does not necessarily directly relate to the office description, but does, nevertheless, have significant treatment implications if understood in the context of the office presentation.

      Biomarkers, as with C reactive protein and blood lipids [neither diagnose *heart disease*] they imply, but don’t diagnose in the descriptive sense [which is the only way everyone is thinking!] – same with SPECT. Amen is clear on the front end that SPECT does not dx, but the problem with the SPECT is the same as urine biomarkers for brain neurotransmitters: the psychiatrist in the office is still the determining factor – nothing in psych should be cookie cutter, and just because a patient has a low urine serotonin doesn’t mean they are clinically depressed – they may, e.g., be a compulsive gambler. Just because someone has a hot basal ganglia on the right doesn’t mean they are *absolutely* self critical.

      You will be interested in the implications of NT testing – I can report that we have seen some very significant improvements in my office with otherwise refractory folk by directly customizing the neurotransmitter precursors to adjust for low or high levels.
      Don’t work too hard!

  2. Nick Tompanis says:

    When we’re talking about affecting brain functioning in a positive manner, probiotics are surfacing as an option to enhance mental clarity and sharpness:

    Probiotics Affect the Brain-Gut Axis Say Several New Studies
    Here at Truth About Probiotics, we have always believed in the vital role probiotics play in our health. Considering that the human body is 90% bacteria and 10% human cells, it’s no wonder these microscopic organisms affect every area of our wellbeing. Now, new research is coming forward to suggest that the gut really is the second brain. A new Johns Hopkins Study that was just released revealed that one-third of your daily caloric intake goes directly to your brain! So, imagine if you are not eating correctly, and your body is not absorbing all the nutrients from those foods??? That’s right, your brain performance, memory, etc will probably suffer as a result. Because probiotics maximize your nutrient absorption during digestion, they can enhance your mental clarity and sharpness!
    Another study coming out of Canada has found that probiotics influence the brain-gut axis, especially in the areas of stress management and even weight loss! Other experts came forward to share their belief in probiotics as a solution for troublesome chronic diseases like IBS. More research is coming forward to suggest that probiotics can actually reduce anxiety and other psychological functions of gut imbalance. We hope you now realize as we do that the future of probiotics is bright and amazing, as we learn more about these good gut bugs. Click on the link below to read the full article:

    Here’s another professor sharing his thoughts on the positive value of probiotics with brain performance:

    Could probiotics affect behaviour?
    By Stephen Daniells, 23-Jun-2009
    Related topics: Giving voice to the issues: Exclusive interviews, Probiotics, Research, Probiotics and prebiotics, Cognitive and mental function, Gut health
    Increasing knowledge of how the gut and brain is opening up the possibilities for probiotics. At the 5th International Yakult Symposium in Amsterdam, Stephen Daniells met Professor John Bienenstock from McMaster University to find out where the current thinking is with probiotics and brain health. Go to this website:

    Links between the gut and the brain, the so-called gut-brain axis, are opening up possibilities for probiotic bacteria to play a role in brain health, be it behaviour or irritable bowel syndrome.
    Professor John Bienenstock, director of the Brain-Body Institute at McMaster University in Canada told Stephen Daniells in Amsterdam that research in this area is at a relatively early stage.
    “As for human applications at the moment, it is really just the beginning,” said Prof Bienenstock.

    • Nick –
      Sorry to be so late in reply, thanks so much for your thoughtful addition to this post… probiotic interventions also derive from much more insight than just throwing some meds on the symptoms. Very good refs, – will have to spend some more time with them and get some more specifics here.

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