[xyz-ihs snippet=”cVita-Scheduler”]Precise Targets & Dosage: Create Medication Predictably

It’s not what you look at that matters, it’s what you see.
Henry David Thoreau

Grab a cup of coffee, sit down and do yourself a favor, – please go through these 8 videos in detail. In these videos, ~ 30 min, you will see the specific answers to many of your questions and frustrations.

To forward the short link to this playlist: http://bit.ly/medtutr for friends and family who need this essential, effective ADHD Treatment & Diagnosis Information. The videos are in order, start with the first here below on the big picture, and the other 8 videos will follow in sequence. First diagnosis, then treatment. Makes sense.

When you see them all you likely will change your thinking about the current state of ADHD diagnosis and treatment – all based upon brain science, not appearances.



More Video Tutorials In Playlist Format

ADHD Meds Tutorial – Overview: http://bit.ly/medtutr – Start With These Basics
ADHD Meds Dosage: http://bit.ly/dosevids – The Most Important Yet Overlooked Detail
ADHD Meds Problems – Mind and Gut: http://bit.ly/mindgut  – Treatment Failure Details
ADHD Meds & Allergies – Milk and Wheat: http://bit.ly/mawimmun – Science Specifics
ADHD Meds & Allergies – Street Immunity: http://bit.ly/IorWJs  – Science Translated

Subscribe to Parker YouTube: http://www.corepsych.com/youtube


ADHD Medications: The Afternoon Drop Becomes Educational!


ADHD Medication Drops In The PM become educational

Complimentary Special Report on ADHD Meds
For more info don’t forget to take a look at this complimentary 23 page Special Report: Predictable Solutions For ADHD Medications – The 10 Biggest Problems.

New Book: ADHD Medication Rules Are A Must, Not A Maybe
If you looked at these tutorials, you need my new, comprehensive ADHD Medication book, the only one of its kind, – on this frequently mismanaged and over looked subject: New ADHD Medication Rules: Brain Science & Common Sense.  Available at this link in pdf, at Nook and at Amazon Kindle… go over and see what others are saying at Amazon here, and available as well on Audible.

Thanks for your feedback! Drop a comment here if you think we should add/video another ADHD topic. More coming on the metabolic issues that confound dosage and effective med management.

Dr Charles Parker
Author: New ADHD Medication Rules – Brain Science & Common Sense
Connect & Subscribe To CorePsych News: This Link
Connect & Subscribe For YouTube Updates: http://corepsych.com/youtube
Complimentary & New: 23 Special Report: Predictable Solutions For ADHD Medications


  1. Dr. Parker,

    I realize this question may be difficult to answer, but I need to ask YOU. Recently, I purchased your book: New ADHD Medication Rules and haven’t found it there.

    Okay, I’m a 51 year young male who was diagnosed with ADHD/Depression 10 years ago by Dr. Ned Hallowell. His thorough diagnosis saved my life, and the knowledge I acquired helped me raise my ADHD son!

    It has been a long and difficult road to find the right treatment plan and/or proper medication managent. It seems like most prescribers in the Boston area don’t know or improperly treat ADHD Adults. I remember reading something you wrote about giving lectures here in Boston. You said the medical community was reluctant to change their ways with regards to treatment

    Anyway, how much is to much stimulant medication??? I currently take 30mg 4 times a day of generic Adderall. Just recently I convinced my doctor to change my medication schedule to: 45mg, 30mg, 30mg & 15mg. I have continually asked for a moderate increase, but he says NO. When I run out or realize my dosage is tappering off (DOE), my Executive Functions, impulsivity, hyperactiveness or sedentary behavior takes over…forget about getting anything done!

    Please help.

    Jim (Dedham, MA)

    • Jim,
      My favorite question in this kind of presentation is at once funny and dead serious. “How many times a day do you go #2?” Down load this simple Transit Time Test and do it: http://corepsych.com/ttt

      Then look at these vids: http://corepsych.com/gi to tell about your likely metabolic challenges. We can eval you long distance if you wish: http://corepsych.com/appointments. The answer is there, we see this all the time, it’s related to your metabolism.

  2. mandy

    Hi Dr Parker,
    Thanks so much for all your info!! Pretty interesting! 🙂
    Im usually been pretty sensitive to medications… been comfortable on 20mg of Vyvanse for past3-4 years… however I tried 30mg which made my head much more clear… then I felt really dehydrated and bp spiked… so i went back to 20mg….and they both resolved. Now a month later i now feel like 20mg doesn’t work at all, I gained 10lbs all of a sudden and feel really tired and don’t have much energy…i feel like my tolerance has changed and id like to try the 30 again, with a better diet and more detox water… am i crazy to think that?

    • Mandy,
      Changing sensitivity to ADHD medications is, almost always in my experience, tied up with either an immunity issue that preexisted [and has intensified over time from downstream metabolic compromise – Video: http://www.corepsych.com/tw ], or a slowing based upon other drug interactions [ http://www.corepsych.com/2d6-video ] that can occur over time.

      Not crazy at all, makes perfect sense to try it again with your doc’s approval. An additional easy test is the Transit Time Tool to download instructions here: http://corepsych.com/ttt – it might reveal some contributory GI issues which could create that metabolic compromise.

      The fact that you’ve already been “pretty sensitive to medications” argues for the first suggestion – so then go see this video playlist: http://corepsych.com/gi

      Hope this helps,

  3. Matt Cheney

    Hi Dr Parker,
    First of all let me thank you for putting together such an informative helpful book on the subject of medication management. I just bought the audio version and listened to it all in one day. It has helped me beyond measure as I was beginning to lose hope I’d ever get it right. I’m a 42yr male who has only been diagnosed only about 2 years ago with ADD inattentive type. My life has only worked out as well as it has because my weaknesses are my wife’s strengths so I’m lucky in that regard.

    I work as a paramedic so my days are long and grueling sometimes up to 14 hrs long. I started on a slow release dexamphetamine that worked well for about 6 hrs but a second one that day would leave me too wired and in my line of work getting to a big emergency with the adrenaline pumping it’s just too much. I’ve recently started on Concerta, 54mg, and that works brilliantly for about 6-8hrs but I get the rebound when it wears off and can’t work out when or if I should take another one (I only have the 54mg Concerta). I can also use my 10mg Ritalin IR but it interferes with the slow ascending /descending profile of the Concerta too much and I’ve had disastrous results when I’ve got it wrong . When I get the sweet spot the methylphenidate is the perfect drug for me as it’s smooth I can be calm and my brain is firing on all cylinders whereas I found the amphetamines get the whole body firing and in my work that can work against me. Also the methylphenidate I have far better sleeps and wind down more easily than the amphetamines.

    Sorry for the length of this email but can you please offer a suggestion as my Dr here in Australia doesn’t seem to have the knowledge I need to assist me with this. That’s why I’m so grateful and appreciate your hard work as it’s a very frustrating topic that most don’t want to know about.
    Best regards
    Matt Cheney

    • Matt,
      Thanks for your kind remarks – your story is the reason I wrote New Rules.

      The very first suggestion that springs out is that you and your doc both need to look at one video and one playlist.
      1. Single video on dopamine and serotonin balance: http://corepsych.com/balance
      2. Playlist on the PM drop as instructive for comorbidity: http://corepsych.com/drop

      My guess on this small amount of info is that you are dropping from serotonin issues, not dopamine. Your drop sounds like a mix of an energy drop [referencing metabolic issues] and a serotonin drop [manifesting as vulnerability without emotional depression] – outlined within the playlist link.

      For energy questions and follow up in that regard see this video playlist explaining measurements and considerations for gut issues. http://bit.ly/mindgut

      For more info on IgG see the videos linked on this PDF: http://corepsych.com/tests14

      For the simplest way to effectively take an inexpensive look at potential bowel/GI issues download these instructions on the Transit Time Tool: http://corepsych.com/ttt

      Hope this helps,

  4. Carol

    Dr. Parker,
    My grandson is 9 years old. He has taken Vyvanse that caused him to chew his fingernails to the quick and did not help with his attention in school. He was then found to have a severe allergy to milk and has since been taken off all dairy. He was then put on Quillivant-no help. He was then put on Kapvay. This made him have meltdowns and what we thought of as psychotic episodes. He was then put on Adderall. This worked somewhat better, but he was moody and difficult. We cut his dose in half and he was much happier, but could not get anything finished in class. Now he is frustrated because of his difficulty in school and we are at our wits end. Just wondered what your thoughts on this is. Thanks

    • Carol,
      More often than not milk allergies are associated with other allergies that remain undetected. I recommend complete IgG testing with a company such as the one on the PDF linked below.

      There are several other causes all of which need biomedical investigation: Candida, trace element imbalances, and methylation issues all linked with video explanation on this PDF: http://corepsych.com/tests14 Review these tests and don’t hesitate to schedule a complimentary Brief Chat here with Desiree: http://corepsych.com/services

      • Carol

        Thank you for your reply. We had the IgG testing done in March of 2014…he showed high allergy to casein, yogurt, cheese, mozzarella cheese. He showed moderate allergy to baker’s yeast, whey, milk, and goat cheese. He showed low allergy to orange, beef, radish, garlic, pumpkin, coffee, sesame, crab and brewer’s yeast. Our dr. said to take him off of all dairy, so we did. He has not improved. Could these foods be interacting with the adderall? We have been working on this since he was 5. I am a teacher in his school and I see first hand that he is not learning. We have to do something, but our doctor’s have not been any help. I am so thankful to have stumbled onto your site.

        • Carol,
          I would have to look at the results and fully understand what you’ve done pharmacologically. Next step: Organic acid testing, OATS, as outlined in this PDF on the second page: http://corepsych.com/tests14

          Then take a look at Walsh Protocols there on the top of that page. Those two tests will help with a number of other contributory issues. I would expect possible Candida, based only upon the brewer’s yeast finding, and one or two of the other Walsh issues are very likely at play. Yesterday I reviewed findings w a mom from Boston and her son has 1. Pyrrole challenges, 2. Overmethylation, 3. Copper excess… all three. No wonder he isn’t getting better!

  5. Mik

    Dr Parker,

    I don’t know where to start, I realized I have ADHD less than a year ago but I’m still waiting for an actual diagnosis, I’m 45 and I’ve been seeing psychologists and psychiatrists since I was 16, everyone had a different opinion and a few spotted several nuances of different commotbidities, but in the end they could never figure out what I had.

    I turned to writing to put in order my thoughts and in the last 9 months I’ve been trying to skim as much as possible a 60 pages diary, and I’m still in the process, as it could never stop.

    My goal is to make someone else understand how I really feel and how sometimes it’s so difficult to connect and communicate those experiences.

    If it can be helpful to me and to somebody else I can post here a few bits of my work. I’ve been working as a professional writer and translator from and to Italian, as it was the only job that wasn’t causing me problems, I guess this can be a good opportunity to discuss on some topics that can actually be useful to anyone is feeling trapped in a condition hard to diagnose because hard to describe.

    I will be glad to post with your permission some of my work, here or anywhere you can think is more appropriate.


    • Mik,
      If you’re a writer put it down in chapters even 1 page per chapter and we can consider helping you publish the entire work – eBook, ePub, or I have a publisher that might take it as a paperback, under my CoreBrain Imprint. Consider working w me and I can help you get it out. An Italian version would be very cool, and we can consider an English version?

      Write in .doc, send it over!
      On the Path,

  6. Dan

    i was diagnosed with ADD about a year after I received a promotion at work. im 28 years old. its been about two months trying different medications. I started with concerta 18mg. it work great for the first two days then the benefits went away. After two weeks i went up to 36mg. My focus was great again for about two days then i felt like focus was bad again. I went up to 54mg but then i felt like stressed and my focus was worse then before medication. after 2 weeks I went back down to 36mg with no benefit. The medication would work better some days than other days. My doctor thought my gut might be to blame. I am currently on Daytrana to bypass any gut issues. i’m confused why i only feel focus when dosage is increased but then stresses me out. My doctor doesn’t know what the next step is. She thinks i may have an anxiety disorder. concerta was only effective when i took the medication on an empty stomach. I dont know what else to try. I have not tried an adderall type medication.

    • Dan

      other medications i take are advair

    • Dan,
      Advir not a prob. Generally speaking anyone, yes anyone, who has troubles as you have manifests burn rate, metabolic problems. You can find out many details about burn rate and the Therapeutic Window if you carefully review objectives in New ADHD Medication Rules. Also see my videos, especially the Dosage playlist at http://youtube.com/drcharlesparker.

      Without an evaluation it’s likely that an AMP like Vyvanse would work well, but I hesitate to suggest anything without first fully understanding the problem you are describing. This brief report simply doesn’t cover the complexity of the possible issues. If you would like a Brief Chat to consider an assessment see http://corepsych.com/services.

      Hope this helps,

  7. Pam Findlay

    So far things seem to be falling into place. Secondary depression seems to be controlled with the Zoloft in place of the Prozac. I’m grateful that my GP is willing to work with me. I’m in a holding pattern for mabout a month to be sure all are moving ahead positively. My next question would be is there a problem using Claritan-D with Vyvanse? I have a slew of allergies, and I was reading some comments about antihistamines.
    I really do appreciate your comments and information for “non-medical” people like me!

  8. Em Walker

    I think I have made it through all your vids now and working my way through all or as many as I can of your blog posts.

    Two things, I completely recognized myself in some of your descriptions of anxiety and adhd. I have been considering talking to my doc lately about maybe some medication for myself. And am wondering what kinds of things you would recommend.

    As you know from my previous comment on your gluten post, I have one special needs kiddo. Truth be told, I also have another special needs kiddo as well. He was just diagnosed on the spectrum with ADHD at a whopping 4yrs old! His ASD is a mild case really but, combined with the ADHD is a bit challenging and as I’ve mentioned before, my oldest has Tourette Syndrome, ADHD, OCD, ODD, sensory challenges, etc. On top of this, I do have OCD myself (the actual disorder, not the jokingly neat freak kind). So, to say that I might be a tad anxious a lot of the time anymore is maybe an understatement!

    Besides anxiety, which I actually physically feel, I also recognize myself hands down in one of your ADHD descriptions. Which sort of, quite honestly blew my mind! I’m the avoider type, which I never knew existed. I prefer to stay home, do not by any stretch of the imagination like to go out. I do both though, which I learned to do with my OCD. I have assumed all these years that this was part of my OCD and that it would always be this way. But, as you describe if I have to participate in something I can’t focus on what to do or when to do it, I react in both the acting w\o thinking or vice versa. It’s driven my maternal family nuts for years. I won’t give in to it as best I can when it comes to my boys and their care but, there are days I feel absolutely ridiculous in my head!

    Anyway, I wanted to thank you for all this information that we can, as parents/patients can take to our doctors and have a conversation!
    Lastly, I am wondering since I do have two special needs boys in tow, what would be a safer medication to maybe discuss with my own doctor? I don’t want to be overly tired, foggy in the head or anything similar.

    I appreciate your time – again, and can’t thank you enough for opening a dialogue that we can use with our doctors!

    Warm regards,

    • Em
      Thanks so much for your kind remarks and motivation to spread the word to our national medical community. Docs do listen to their patients, are motivated to search for answers, but often appear hesitant for some reason to hear data from colleagues. Thanks for being there, and best wishes to your and your family moving forward. It sounds like your Executive Function is working exceedingly well on several levels!

  9. Pam Findlay

    Thanks much for your reply. I will show the same to my GP who has been quite helpful. I did not list any medications, but I am still taking 20mg of Prozac. (When all the other medications did not help I enrolled in the original Prozac studies, and have stayed with it; though I know you don’t advise it. My one question is……, is Vyvanse the best choice for my difficulty in speech recognition?

    • Pam,
      Sorry to affirm your suspicions that I would have a problem with Prozac – but you’re right. First let me reassure you, I’m not the only person talking about drug interactions between AMP like Vyvanse and Prozac the 2D6 blocker – those interactions are available right in the PI -package insert, page 2, Drug Interactions CYP2D6: Here’s a page from Drugs.com.

      My recommendation: Do switch antidepressants to one clean on CYP2D6: Effexor, Pristiq and it’s generics, Celexa, Lexapro, and Zoloft are all quite clean. Moderate inhibition with Cymbalta and Wellbutrin – making these last two a distant second choice.

      Speech recognition problems can arise from a number of causes and Vyvanse is only indicated for PFC dysfunction. If your slowing with speech is secondary to a relative toxicity [which by the way could take 4-5 days to clear] then the Vyvanse, by accumulating could be contributing. My experience with Prozac: even MPH products like Concerta and Ritalin can create problems – but in that case the MPH contributes to Prozac accumulation.

      • Pam Findlay

        To follow-up our last conversation; I went to my Gp last week. I had not been on Prozac for a week and the first thing my GP did was reduce my blood pressure medication. He prescribed 25mg of Zoloft to replace the Prozac, and pushed up the Vyvance to 60mg. Realizing I only had about six minutes; (about the allowed interview in managed care), I hit him with everything I had in the first 2! He is willing to work with the program and make any changes that are reccommended with explanation. I’m staying on this course for a month. When I go back I am having fasting bloodwork. Are there any tests you think should be added to the list?

        • Pam,
          Not know his list puts me at a disadvantage, and suggestions on the fly appear quite capricious – so will await more specific inquiry points. Best of luck!

  10. Pam Findlay

    Dear Dr. Parker;
    I have followed your insights through several seminars and your online site for awhile. I’m at a point where I have some basic questions. I have first of all, followed the metabolic process so I know when the medication “kicks in;”(Vyvanse 50mg). I had lap-band surgery in 2006, so I eat several small meals during the day. Perhaps that is why I have not had any side effects. However, considering the “therapeutic window,” I drop off about 5pm. I am not a morning person, so I’m only getting about 7 or 8 hours of controlled focus. Though I am now working out a retirement schedule, I used to focus activity easily until 10pm. I chose Vyvanse because I have difficulty processing conversation and I do have some hearing loss besides. When I ‘drop off’ I literally head for bed. For years I was treated for depression, so this ADHD ‘thing’ is new. Should I up the Vyvanse, or take something else later in the day?

    • Pam,
      My first and most often successful impulse is to recommend to you talking to your doc about pushing the Vyvanse to 60mg. Most often you will get about 2 hr more in the PM and that might just be what you need. This is a link for the ADHD Med Dosage Playlist – it will give you oodles of more info.

      Further, although you didn’t say it explicitly, it does sound like you might have a bit of residual depression – and if so, depression often will worsen if not addressed simultaneously with the ADHD. See this link for a video on ADHD and Depression. Just a thot…

  11. Sandy

    Hello Dr. Parker,
    My son was diagnosed with ADHD-inattention in the 3rd grade and was prescribed 20mg Vyvanse. As soon as he started the medication he did wonderful, making good grades and able to focus in school. By 4th grade his dosage went up to 30 mg, continues to do well in school. He is now in the 5th grade and continued on the 30 mg dosage. About a month ago his father noticed that he was twitching his nose and puckering his lips together. These facial movements began to increase and would show when he was home from school (according to his teachers they never saw him do this). His doctor stated that this was very rare with the use of Vyvanse and suggested that he go down to 20 mg. He did fine the first week and now the facial movements are back. My son stated that he’s doing these movements due to his glasses and states that they are bothering him. I asked him if he realizes when he is making these particular faces. He stated that he does, however I will catch him making the face and ask him if he knows he just did it, he will play it off and say yes.
    Dr. Parker have you heard of facial movements on children taking Vyvance?? I have done some research on the internet and have come across some similar topics. Some state that when their children are more stressed out they tend to make the facial movements. My son has some OCD traits and at times has some tendencies to over think things. Any thoughts??
    Thank you,
    Concerned Mom

    • Sandy,
      All stimulant meds can cause facial tics, even minor tics can prove troublesome, and your doc is right it is less common, tho not ‘rare’ that Vyvance contributes to tic behaviors. The jury remains out on what-to-do, simply because each person brings their own complexity to the table.

      In our offices we approach each of these problems from several angles, each of which have proved useful in different situations, depending on the person:
      1. Neurofeedback [search for commentary and links here] has proven useful in the 90% range of frequency – not always. Often the tic will move through various presentations [face, arm, grunts for example] and then leave. Our neurofeedback team does a great job with tics, even more serious disturbances than your guy.
      2. Metabolic testing: We see value everyday with looking at metabolic variables such as IgG, Tissue Mineral [TMA] imbalances, neurotransmitter challenges, all referenced in these pages with links to the process and value, some links for tic disorder. TMA is the secret weapon here, and can provide significantly improved data that can be corrected – search ‘copper’ for a couple of articles on that process.
      3. Psych meds can sometimes help: specifically Intuniv or generic Tenex, but even tho these are glutamate interventions they can also create tic disturbances. The med changes make sense, are easy, not harmful, – Intuniv treatment recommendations are documented in many Intuniv articles here.

      Quite often we wind up using all of these interventions… so skeptics from the outside could say something inane like ‘placebo effect.’ The only problem with that suggestion is that a number of these intervention do work on their own at times. And, as you might suspect we do have some failures, just can’t get them right with these levels – and are open to suggestions from any readers.

  12. John Y

    Hi Dr. Parker,

    I’m in week 2 of 30mg vyvanse and I’m VERY irritable from 9AM-3:30PM or so. I take the pill at 8AM. I feel great in the evening, and actually experience slight elation around 3:30. Is this indicative of over dose, or under?

    • John,
      Always hard to say definitively exactly what conclusions to reach in that first two weeks. Main issue , take after breakfast, a protein breakfast and watch this vid on starting in small doses: http://youtu.be/cXDCHp2_cAg

      My left field guess: use the water titration technique listed in the video copy above, cut the dose down to 15 mg, start more slowly then watch for the DOE…. you might simply be a slow burner, time will tell.

  13. Jenni

    My Vyvanse works great when it is working. The problem is, is that it doesn’t work long enough. I work a ten hour day and have to get up at 5 am just to get it to kick in by the time I work as a dental assistant. I have heard vitamin C will have it wear off quick, high protein will help, Magnesium will make it last longer, ect. Any of this true? Also if I would split my dose of 60 or 70 mg in half when would be the latest you would suggest I take the second half to keep me from being able to sleep at 8-9pm? I have tried 30-35mg around 5:30am to get it to kick in at 7:30am and have taken the second from 7:30-noon. The first dose is weak and wears off enough to start to feel unfocused around 10am. The over lap is strong but I feel focused. I’m a 115lb female. I workout 30-50 min a day 5-6 days a week, not strenuous, just Pilates or something like it. I make sure to eat 5-6 small balanced meals even if I’m not hungry during the day. I do take very high potency vitamin and supplements from my naturapath. Any suggestions??? I have been trying to get this right since June and am getting frustrated and can’t get in to see my medical provider until Novemeber.

    Thank you, any help would be very much appreciated,

    • Jenni,
      Don’t worry about the vit c with the Vyvanse, not as relevant due to the prodrug release.

      Mg not likely to help and protein is always recommended period. Protein is the building block for neurotransmitters.

      Your plan is good with the split process to get a longer than run, but my experience is that most often one dose in the AM will cover for 12 hr when dialed in correctly on the right dose. If you have 70 and it burns 10 hr, and you want 12 hr, best to see if your doc would go to 2×40=80mg as 10 more mg will often carry you that additional 2 hr then you don’t have to continue to mess with all the titration problems.

      If not then I suggest you be sure to take the second 1/2 dose before 11AM, as after that, for most people, the burn will keep you awake past bedtime.

  14. josh

    Dr Parker,

    Ive been struggling with finding medication that works for me. They help in that it increases my focus and can multi-task but i get too many sides. My theory is that i have too little dopamine and too much norepinephrine. When i take the meds i feel as though i am in a constant state of fight or flight. I become nervous and panicky. My heart rate is around 120-130 and becomes even worse with exercise, the feeling of panic is worse with exercise as well, especially following the exercise. My muscles get extremely sore especially my lower back and shoulders. I experience soreness instantly when running jumping or lifting. My hands have poor circulation and i get rashes on them. Also i say the meds help focus but i can rarely even utilize this because all i can do is focus on the uncomfortable andrenergic feeling. I have tried adderall vyvanse concerta provigil desoxyn wellbutrin and concerta plus intuniv, all with the same result. I am now going to try beta blockers with concerta to lower the heart rate but i feel this will only take away the physical sensations of adrenalin and not the panic in the mind. Just wondering if you’ve encountered patients with this problem and if you could offer me some sort of help i would greatly appreciate it. it is incredibly frustrating just trialing so many medications, especially when they dont make me feel so great and i cant focus on living life just finding a solution to this problem.
    thanks in advance,

    • Josh,
      Your remarks, while unique and painful to you, are surprisingly commonplace in my experience. You do need to jump on IgG testing [qualitative not quantitative, the default review], and find out which foods are a problem… but that is only the first step. Sometimes it doesn’t work if the neurotransmitters are simply too unbalanced, and I do think you are quite right about your clinical guess – I would guess the same thing – but that doesn’t mean either one of us is right. A guess often just doesn’t match up with good data. If you get into a bind schedule a meeting with me – we do consults internationally, so that won’t be a problem – and when I see your details I will be able to be much more definitive.

      Accolades for seeing what many in the field completely miss! Now the imperative: chase down those biomedical details!

  15. Sheila SMC

    Hi Dr. Parker,
    I’ve been in session with a Psychiatric practice with my attending PhD and a therapist for 6 months now. I read your book, “ADHD Medication Rules..” and also downloaded the PDF when I started looking into ADHD for myself. I’ve entertained (lol) about 6 different Psych’s over the course of my adult life, the previous diagnosis being for “Bi-Polar.” It seems they (the psychiatric professionals) really migrate to that one. It seems to be anything to stear clear of ADHD will do. Anyway, I’ve truly never been manic in my life–sometimes “elated” when things miraculously work out, but never manic. My nephew is Bi-Polar so I know exactly what it looks like and behaves like. As I was saying; from the Kindle edition of your “Meds..” book I copied and pasted “me” from the subtype of “thinking, thinking, thinking…not acting” together with a few other descriptive passages that summed up where I was and printed it off for them to read. I think you named it “cognitive constipation” which, if it wasn’t so debilitating it would sound somewhat comical. It’s not at all funny though when one is living it.
    The course of treatment for me went like this: I was prescribed 30 mg. of Vyvance right out of the gate. I took that for one month and reported that it seemed to be floating “over” my head and that I wished I could just reach up and grab some of it and stuff it in my ears–see if it hit the target from there! I think after reading your book that I was most likely way out of the window! I was then prescribed 50 mg. and the first month on that the same thing occurred. The second month on 50 mg., I knew for certain it had to be from a different manufacturer as I don’t think there’s a generic for Vyvance yet, but with the first one from that batch I was aware of the difference in the composition of it. It wasn’t floating above me but it wasn’t throwing the main breaker in my mind either, which is what I had hoped to get a handle on ASAP. It didn’t help with focus and had no motivating qualitites to recommend it as the best one for me either, so that was the end of that trial. I reported to him that I felt the Vyvance “did no harm” and I was never aware of it tapering off at all, it just didn’t do any good either. Well, except that my back didn’t bother me near as much, as in, not until late in the evening. I broke my back close to 20 years ago. I do remember dreaming again where I haven’t remembered any dreams in years, maybe decades, other than nightmares, which most people would remember I imagine. That was cool and I slept “a lot” better, which was way cool for someone who couldn’t fall asleep without Ambien until taking the Vyvance. “Splain” that one..
    I was then prescribed 20 mg. Ritalin three times a day. My Pharmacist only had so many of one generic and gave me what he had of another and I had to forfeit “x” amount as they didn’t have enough for the entire prescription. So, I figured it didn’t really matter because who knew if it would work or not? Both generics were different, of course, and that left me wondering exactly what it is the FDA does in monitoring the quality of our pharmaceuticals? That’s not my point though, although I did happen across an article, I believe it was from here or your friend, Madelyn’s (?) website about the difference in generic brands and to leave word on the blog. Anyway, (again), I had to report to them that the Ritalin wasn’t helping turn the volume down at all and I was only motivated for the first three hours and even after the second dose I had no other benefit, same with the third dose, it never rose any higher than the initial dose but at least it worked within thirty minutes where the Vyvance took two hours and by then my thoughts were already in overdrive. I had no better focus and was still chasing my short term memory down all day long and my wall calendar that month looked exactly like the previous ones, like a tick, tack, toe board where I always rearrange appointments and cancel and reschedule a few times–you know, the usual stuff that takes place. 🙂 I really wanted to find something that worked for me as the anxiety of living with cognitive constipation as well as typical ADD everything else, really gets to be a bit much–if you know what I mean?
    I’m taking Wellbutrin (generic) now and it’s the best antipressant I’ve ever taken in my life and believe me I’ve taken quite a few. I started to feel like a little voo-doo doll that each doctor would stick a different antidepressant colored pin in. Depression was always only one small piece of the puzzle. My Dr. now has me taking only the Wellbutrin and nothing other than my black-hole depression is any better. Don’t get me wrong, I’m very glad that I stepped away from the black hole.
    Dr. Parker, I think they’ve given up on me because the “canary in the coal mine,” the Ritalin, didn’t work for me. Other than doing much better as far as the depression goes, I’m no better off than I was 6 months ago, in fact, I can say I’m even more frustrated and anxiety ridden than before I started down this road which is looking more like a dead end. My therapist says I should “try to let my thoughts go on by me without being judgmental of my past failures and faux pax’s” —“What?!” They’re not hearing me! I can no more control my focus or memory or the constant flood of thoughts right now than I can the weather, that’s why I went there in the first place! If I could handle this myself I sure wouldn’t be breaking my neck and putting every other appointment off just so I can get there, reasonably on time–for the most part… I’m not sure they’re equipped to deal with the complexities that I present. I’m maybe not “typical” because I’ve used every trick in the book to work around this disorder my entire life and my zanny personality and outrageous sense of humor bought me some wiggle room along the way. What is “typical” ADD anyway?! I don’t think there is such a thing.
    Is Ritalin the last great hope for me? I would think something else might be worth trying to see if we couldn’t shut down a few breakers in here and allow me some cognitive breathing room. I’m desperate for help and don’t know what to say to the Doctor responsible for the medication. It seems to me like he’s just resigned himself to the fact that the canary’s still alive and therefore there’s nothing more he can do for me. I’m really tired; really burned out and feeling absolutely hopeless.
    I’m the recipient of a disorder that’s genetic, chemical, neurobiological, and I can’t control what’s going on up there in the “doposphere” but I understand it “is” treatable and usually with amazingly good results. I thought getting the best treatment result was the Psycho-pharmacologist’s job, you know the PhD that I’m neglecting everything else in order to get to my appointments with. No? It seems cruel to leave me feeling that I’m hopelessly untreatable. My therapist’s exercise in mindfullness is way beyond me at this juncture.
    Any suggestions? I don’t want to feel intimidated into not asking my Dr. to try something else but at the same time I know how the mindset of the well educated sometimes works. What to do?
    (I really didn’t mean to write a first chapter for a book–sorry about that!)

    •  @Sheila SMC Thanks for the good read on *Rules,* I do think you’re almost there, as you’re asking the right questions.
      Quick anecdotal take on dreams and stims: relief during the day, and slight stim at night keeps you more in a REM state.
      Without talking to you this could be the prob and worthy of talking to your doc:
      “The course of treatment for me went like this: I was prescribed 30 mg. of Vyvance right out of the gate. I took that for one month and reported that it seemed to be floating “over” my head and that I wished I could just reach up and grab some of it and stuff it in my ears–see if it hit the target from there! I think after reading your book that I was most likely way out of the window! I was then prescribed 50 mg. and the first month on that the same thing occurred.” = Likely too much.
      Sounds like you likely went out the top of the window right out of the box on Vyvanse. I won’t ask you to reply on this, but as a screening test, do the Transit Time [http://bit.ly/ttnew – too long or short needs increased attention] – as you very likely have a metabolic background problem. If you were slightly overdosed on that small amount that suggests that you should, in retrospect consider starting at a lower dose – even 1/2 of 20mg to begin to get a better take on DOE. Never mentioned DOE so you either were underdosed or overdosed – sounded like OD. A further confirmation of OD is the fact that it took the Vyvanse 2 hr to come into action. See this article, and review in *ADHD Med Rules* symptom 4 in Coming out the Top: http://ezinearticles.com/?ADD-ADHD-Treatment—7-Tips-on-Finding-the-Elusive-Top-of-the-Therapeutic-Window&id=1257427 And likely 20 Rit created a similar problem.
      Review these matters, watch that corn and talk with your doc about microdosing to first find the Therapeutic Window.

      • Sheila SMC

        Thank you for your reply, Dr. Parker and thanks, too, for making your expert advice available to all lay people and professionals. It’s wonderful that you chose to share your vast knowledge with all of us. Truly remarkable and greatly appreciated!
        I’ve a little more background for you. Before I actually believed that being in a constant state of high anxiety could actually manifest itself in biological ways, I went through a good year of tests and procedures chasing down stomach pains and lightheadedness to the point of fainting sometimes. When it was all over and I was still dealing with it, my GP prescribed Xanax to lighten the load of dealing with all of it. Lo and behold, the symptoms disappeared and haven’t come back in over two years. I wouldn’t have believed it except that I lived it. While investigating the possible causes of those strange manifestations I had an entire battery of tests and procedures which ruled out every gastrointestinal ailment there is. The Internist did a gastroscopy, oesophagoscopy, where he examined the lining of the oesophagus, stomach and duodenum. He did blood/serum screening to check for anemia and anti-endomysial antibodies as well as endoscopic biopsies from the top of my small bowel to rule out coeliec disease. A colonoscopy showed nothing. I now have monthly liver and kidney function evaluations because I’m taking oral Lamisil for the yellowing and thickening (sounds better to me than what it actually is!) of my big toenail from where I had my foot in a cast for ten weeks. So, as far as any other problems with medication I don’t see any at all. I’m in great shape internally for my age, so far, and I don’t want to have to recind that statement any time soon. I really need to get a lot more exercise but I honestly don’t have the motivation it takes–I would love to have the wherewithal to do what I know I should. I didn’t mention it but the last batch of Vyvance and into the Ritalin, I began an exercise routine to my Pandora Motown station! Love that Motown sound. It petered out to once a week and is now only sporatic after stopping the Ritalin. The Ritalin had me feeling really nervous in my stomach and like there may have been a boogie-man just around the corner! Well, not exactly paranoid, more like waiting for the other shoe to drop kind of feeling. No clarity of thoughts or organization of responsibilities, no help with what I needed the most. I do miss the exercise though.
        I don’t really eat that much, I’m just a little woman, but I eat real food in smaller portions throughout the day. A lot of fruit, much more lean than red meat, more fish varieties, veggies, whole grains and nuts. I stear clear of sugars and artificial food as often as humanly possible. When I do use sugars and milk and the like I buy Certified Organic and I’m a Farmer’s Market shopper. Including my husband and most of our family, with the exception of my lovely mother-in-law, I see way too many Americans overeating and eating make-believe food. Sorry if I offended anyone, I usually don’t even mention these sorts of things as I’m not a fanatic at all. I have my offenses too–I’m just not telling! Just wanted to give Dr. Parker a more complete picture. My transit time is perfectly normal.
        I had to back out a long paragraph from the first post as I was over the limit. Imagine that–me being long-winded. I’ll give the DOE from what I observed. Another thing is, I wasn’t really given the low down on what it was exactly that I should have been looking for in the first place. I had my own pre-conceived ideas after reading more than a few blogs about other’s experiences with the most well known medications. It seemed that the greater majority had experienced profound relief (toot de sweet) after the first dose. I’m a bit jealous of their success and would love to join them on “I Now Have a Life” Street. Anyway, back to the DOE. The Vyvance was not “effective” as I said but it lasted all day with no discernable drop off whatsoever. It’s a very clean, steady drug, it just had no effect on quieting things down up there and in taking 1 and a half to 2 hours before it was even noticeable there was no way I could back out of the noise level and confusion by then. I need to capture my thoughts as soon as possible in the morning. I related that I slept better than in years and loved the dreaming part but I believe I was way out of the top of the window as you said. I literally perceived it as floating over my head–that’s exactly what I told my doctor as well.
        The Ritalin seemed to wane after about three hours. I say that because the nervous stomach would begin subsiding about that time, as if easing up on a taught rubberband. I never had the benefit of a volume adjustment or of feeling clear-headed or able to organize my day at all and no motivating ambitions. When I’m stuck I’m really, really stuck! I don’t know if this will ring any bells with you but I’ll relate it anyway. I felt very much aware of my outer covering of skin. Does that mean anything to you–have you ever heard it before? I don’t know how else to explain it except just like that. Strange. So, then with the next dose (pres. 3 x’s a day) the nervousness came back and I didn’t get any other benefit than the first dose. Same with the third. There was no drop off with that either, I just became aware that it was pretty much leaving my system. No drop-kick when it wore off. Perhaps that happens the longer someone’s been taking it? I don’t know if that’s true though. I did tell my doctor the truth in that I juggled the dosage around a bit seeing if I could find the right dose myself. I don’t see where I did well with that at all. First off I had no way to guage what I should have experienced, I only knew what I’d “hoped for” and that never materialized.
        I’m not looking for a miracle cure but I really am looking to dam the flood tide upstream so I can work in the hear and now. When you’re a prisoner of your mind you absolutely can’t stem the tide by “thinking more” about trying to not think about thinking too much! Impotence is the word of the day — almost everyday for me. “Frozen in time?” I’m pretty near to being chiseled out of Bronze!! The seemingly insurmountable frustration, the product of my own making, that’s kept me a prisoner of a life lived in instant replay, you know, “Where could it possibly have gone when I just had it in my hands two seconds ago?” or “How could something have just disappeared from the time I walked down the hallway and back again?” That’s more than difficult to translate when you can’t capture the sequence of events that just played out. It’s as if there are Gremlin’s that mess with you all the time and they won’t be happy until you’re a complete basket case! : >) You lose your orientation in space and time and you move as if outside of what just transpired because that’s exactly how you perceive what you can’t account for–you can’t account for the missing object or the time it took to misplace whatever it is you now can’t find. Your anxiety gets worse the more often this happens because it gets repeated dozens of times a day, everyday. Same thing with appointments that come and go without you. I honestly didn’t have any more hope of getting through to anyone this time either but I forced myself to give it just one more try because I felt I was very near to self-imploding. I was also looking to hire some “Gremlin-Busters” to come in and capture those little critters that were messing with my head. : >) Anyone else have an infestation of Gremlins?
        Is electric shock therapy still used in any cases today? Labotomies?

        • Sheila SMC

          I wish my word pad document had spell check.  That’s “tout” (de sweet), and “here” (and now) not “hear.”  But the next time I make those kinds of mistakes just ignore them–okay?  I probably missed some others anyway.  Is it just me or has anyone else noticed how often ADHD people misspell words and transpose them in conversations? 
          Yikes; maybe they should add that to their new and improved diagnostic criteria!

  16. jhp333

    DR., Could you speak further about the effects of going outside the top of the window. I was on no ADHD meds and started at 45mg Vyvance…. way to much…went down to 30mg… still to much(causing headaches, insomnia, overall feeling of being fried). I was ready to give up on ADHD meds in general, but thought i might try a micro does. I took 15mg…. less fried feeling, but still present and the insomnia persisted…  Today i took 10mg and so far attention is up, brain does not hurt and we will see about sleep tonight. What are your thoughts on very small doses?  or is just not the right medication for me?

    •  @jhp333 Exceedingly interesting point, seen everyday in the office. Two issues with this “unpredictable” presentation arise:
      1. Genetic polymorphism, smaller CYP 450 2D6 pipeline slows down passage with subsequent accumulation – a genetic causality [Percentage likelihood on this causality in the 30% range as i recall at this moment]
      2. More common, in the 80% likelihood, IgG issues with subterranean food sensitivity not easily seen.
      Simple solution, checked with your doc, just keep up the very small dose. Dose is directly related to these basic metabolic variables [and others] not age, body weight or gender.

  17. Stay tuned over here, posted a comprehensive reply to this important question on the blog dashboard, with refs, and for some reason it’s not popping up over here… This question is a big deal for so many!

  18. crawmaa

    I’m a 43 yo female treated with 70mg Vyvanse for ~3 years for ADHD.  I would say Vyvanse reduces distractability and it also helped reduce my daytime sleepiness, but I still struggled.  In addition my psychiatrist has treated me for depression with Prozac which was recently increased to 60mg.  I’ve listened to your video’s in which you note the “incompatability” of Prozac and  Vyvanse and brought this information to my psychiatrist who politely denied any problematic interactions with the 2 drugs ( I shared with him your website in case he wanted to hear it from a peer).  Last year, I was also diagnosed with narcolepsy and began medical treatment with a neurologist ~1 yr ago with Xyrem 9mg qnoc and 250 mg Nuvigil qd.  Several months ago, my blood pressure began a steady elevation and I was diagnosed  with HTN.  My IM doctor had me stop Vyvanse in order to get my blood pressure managed.  I remained on Nuvigil for daytime sleepiness and tried Strattera for my ADHD while my IM doctor added/adjusted meds to get my blood pressure down.  This was less than adequate treatment for my ADHD and I had increasing problems at work and ultimately requested FMLA  to focus on getting BP down, until I could safely return to taking Vyvanse again.  I am back on Vyvanse now and have had some improvements, but I’m about to return to work and I worry I won’t overcome the challenges I have @ work.  I’ve had years of counselling and even began seeing someone who specializes in ADD 4 months ago.  I’m concerned about the combination of meds I’m on and disappointed that after months and months of tweeking, this is as good as it gets.  I like my doctors but I feel the complexity of my comorbidities  warrants more collaboration and assessment.  I live in Austin, TX.  Any suggestions, recommendations re: my quest for optimal management if my ADHD would be greatly appreciated.

    • Jennifer,
      Just down in Austin, loved dancing the two-step over at the Broken Spoke with Two Tons of Steel, and down with Bells of Joy at the gospel brunch at Stubbs, – outstanding.

      Many still indicate that there is no interaction, but just Google “drug interaction between Vyvanse and Prozac” and this “Drugs.com” is the first on the list on that page: http://www.drugs.com/drug-interactions/prozac-with-vyvanse-1115-648-1475-2533.html. Yes, I have two posts out of 977,000 results on that same page [the day of this reply], and these reported interaction findings are well within the lit and not “Parker Dreams.” I’ve been reporting these problems since 1996, they are documented in the major books on drug interactions as well, and, quite simply, your doc needs to read the lit. He sounds like a nice guy, this is not personal, it’s just that that combination can aggravate HBP as you are accumulating the AMP creating a higher dose phenomenon by the accumulation thru a blocked 2D6. Just ask your GP to change the antidepressant to Venlafaxine, – not a problem – usually 75mg ER = 20 mg Prozac if he’s wondering.

      Effexor, Lexapro, Celexa, Zoloft and Venlafaxine [generic for Effexor] are all clean on 2D6 [don’t block it] and should significantly help that HBP, and a cranky attitude that you didn’t mention but likely had, as folks get irritable and very touchy on those two drugs… – and that irritation years ago was my first clue to this pervasively overlooked and potentially dangerous interaction.

      Hope it works, – do keep us posted.

    •  @crawmaa looking for the reply, should be flying thru the ethers any time!

    • @crawmaaJennifer,
      Just down in Austin, loved dancing the two-step over at the Broken Spoke with Two Tons of Steel, and down with Bells of Joy at the gospel brunch at Stubbs, – outstanding.
      Many still indicate that there is no interaction, but just Google “drug interaction between Vyvanse and Prozac” and this “Drugs.com” is the first on the list on that page: http://www.drugs.com/drug-interactions/prozac-with-vyvanse-1115-648-1475-2533.html. Yes, I have two posts out of 977,000 results on that same page [the day of this reply], and these reported interaction findings are well within the lit and not “Parker Dreams.” I’ve been reporting these problems since 1996, they are documented in the major books on drug interactions as well, and, quite simply, your doc needs to read the lit. He sounds like a nice guy, this is not personal, it’s just that that combination can aggravate HBP as you are accumulating the AMP creating a higher dose phenomenon by the accumulation thru a blocked 2D6. Just ask your GP to change the antidepressant to Venlafaxine, – not a problem – usually 75mg ER = 20 mg Prozac if he’s wondering.
      Effexor, Lexapro, Celexa, Zoloft and Venlafaxine [generic for Effexor] are all clean on 2D6 [don’t block it] and should significantly help that HBP, and a cranky attitude that you didn’t mention but likely had, as folks get irritable and very touchy on those two drugs… – and that irritation years ago was my first clue to this pervasively overlooked and potentially dangerous interaction.
      Hope it works, – do keep us posted.

  19. Jelaura

    I am concerned about something you said in your video blog, (the first one about DOE), where you said do not mix methyl amphetamines and amphetamine salts.  My son needs an afternoon dose of a short acting stimulant, which in the past has been adderall- amphetamine salts short acting.  Unfortunately, because of the shortage of this medication, his doctor has prescribed ritalin short acting. What do we do in this situation?

    • Jelaura,
      Sorry, I think you misunderstood: amphetamine [AMP] salts do mix well with mixed AMP salts. *Methylphenidate* is different than *amphetamines.* Yes there are *methamphetamines* – but those are street drugs also know as meth, and aren’t appropriate for ADHD treatment, even though some try to use them for same.

  20. Mcw,
    This is a problem nationally as the absolutely misinformed are still, after these many years, in a state of panic about amphetamine products. This is why Harvard was years behind common practice as they had no idea about how to use them, feared the word AMP, and simply wouldn’t get involved in studies. Out on the frontier we were waiting for comments from the bastions of objective thought, and they simply weren’t considering thinking objectively. Politics spin the day.

  21. Mcw4rosy,
    Send them a copy of my “Predictable Polutions for ADHD Meds” if you find it helpful. In only a few pages it outlines why folks are having so much trouble with stimulants and what can be done to correct those issues.
    Fr^e here at http://www.corepsychblog.com/adhdbook


  22. Lin,
    The food allergies absolutely need identification and correction. We all suggest IgG in our office and that food problem if not corrected will chase you through your middle age years if you don’t jump on it and correct it. Type in IgG in to SEARCH and many posts and comments will arise for your review.

  23. Micheal,
    Many big thanks for dropping a note over at Amazon – you will likely enjoy the CoreBrain site when we nail it up – some serious interviews and deeper thinking about all things psych and mind that get lost in the labels.

    Appreciate,- long distance high five!

  24. milesaugust

    Dr. Parker,
    I am new to this world. My 6 year old son very clearly has ADHD with only the inattentivness portion. He is so “out of it” during school that he produces no work. He takes 10-20 times the amount of time needed plus many many re-directions just to do the simplest of tasks. He is just thinking of interesting things, telling stories, examining other things, creating art etc. Obviously this has led to big problems at school as he can’t produce any work. 

    Yesterday we tried our first medication, the Daytrana patch. We put it on at 9am, and had a few hours of nothing noticeable. Then at about 3pm our sweet polite child became a raging violent monster. He raged, sobbed, screamed, hit, destroyed things and was generally out of control from 3pm to 2am! We took the patch off at 4pm and anxiously waited the 2 hours for it to leave his system. We thought the hysterical rage would then end, it didn’t. He was literally out of control for 10 full hours after removal of the patch. 

    So obviously we do not want to try another stimulant! We talked to our doctor today who wants to start him on Intuniv tomorrow. I’ve read up on it and it seems like it’s designed for children with the hyperactivity component more than anything. I’m wondering if this type of drug alone, will benefit our son. I would so welcome your thoughts on this. I feel very alone with no one to talk to and very guilty for putting my son through the chaos of yesterday.

    Thank you

    • Miles,
      Sorry to be so late getting back! Your son’s reaction is not typical, but does raise several issues for your medical team to consider:

      1. With a big drop in the PM always consider a mild associated depression. All stimulants make depression worse when they wear off in the PM. This is discussed in my book in considerable detail.

      2. Intuniv is often an excellent alternative to straight dopamine reuptake inhibitors [stimulants]. If he has a problem with Intuniv, which is possible, then he does have another problem lingering in the background: Immune challenges that can be measured by IgG testing. Some don’t agree with IgG findings, we use them often with excellent results. Type IgG in the Search Box here for more info and in the Rules book as well.

      Hang in there. There are explanations for any problems and good results are around the corner.. the percentages are with you, it’s just that he has a slightly different biomedical problem.

  25. Mcw4rosy

    Dr. Parker. It’s been six months since I last wrote you. I’m 49 years old. About 5 years ago I realized I was mentally exhausted; a lifetime of being miserable and unable to make decisions. I couldn’t stop my racing thoughts. I went to a few Phychiatrists and they prescribed antidepressants (SSRI’S). None of them worked. They actually made me feel worse. Then I found a great Neuro-Psychiatrist. He started me on Stimulant medicine. I tried most of them. I found your website and watched the ADHD med tutorial videos. The eight videos are a great addition to my ADHD knowledge. My next decision was to take Vyvanse. Now I’ve finally purchased your book ADHD Medication Rules. The books is a MUST READ for anyone with ADHD – or anyone seeking knowledge regarding ADHD, Serotonin, Dopamine and much much more. I have no medical background but I’m able to read and re-read the Rules book. My notes are streamlined – allowing me to laser focus on my ADHD. I want to thank you and encourage you to continue your open and bold work in the area of ADHD. Michael

    • Michael,
      You made my day! Please do go over and drop a comment at the Amazon Kindle site to share your take on *Rules.* Rules is a low cost way to save years of confusion! Big thanks!

  26. Found your website through a google search. I was looking up ADD medicine titration. I watched your 8 video spots. I’m 49 years old. About four years ago I went to three different Psych Dr’s. All three said the same thing. You have ADD. I started seeing a Neuro Psych Dr. He’s been effective and I work well with him. I’ve tried most of the meds and I have my opinions about each. BUT, I watched all eight of your video spots – twice. Quite often I’d pause them and take notes. I made a appointment with my Dr. and told him about my find. Some of your points (prior to viewing your videos) were revealed to me by my Dr. “DOE” is the key. I didn’t understand that I could take a little more (10mg) in the am and it might help push the effectiveness another two hours. Vyvansse is it for me. One pill (60 mg) in the morning and a day of clarity. Beyond 12 hours of effectiveness. Thank you for your help. Thank you for being bold enough to put it out on the internet. I can’t listen to any anti medicine people. They haven’t a clue what it’s like to “live like a hermit.” Or as you say “shut up, leave me alone…” Thanks again. Mike

    • Many thanks Mike. The details do make a considerable difference – and it puzzles me why we simply haven’t made that important change with all the extant info out there!

  27. Victoria Clifton

    Dear Dr Parker

    I have a 5 year old boy (almost 6) who has recently been on Strattera over the last 2 months (this is the first time on any adhd medication), he started on 18mg, then after 5 days 25mg and then after another 5 days 40mg and at which we decided to stay with this dosage.  We thought at the time this was right as he did seem to improve and pre-school agreed, however looking back the first two dosages seemed to work better, now I feel he is even worse, moody, grumpy and after 7 weeks he started with stomach pains and occasional vomiting.  After consulting with his doctor, was told to stop for 1 week and try again, if the problem continued then it was obviously the medicine and they would try something else.  Today I started him back on 40mg and after his breakfast he started feeling sick (always give him the medicine after his breakfast). So having read/listened/you tube editorials that you have on your blog, I am now wondering if he had reached his top of the window on 40mg, so it’s not the medicine but incorrect dosage.

    He went see a neurologist at CHKD. He was also diagnosed with Tourette’s (vocal) and Sensory Processing was diagnosed almost 3 years ago for which he sees an OT twice a week. 

    I am a little lost with his conditions and not knowing what the right thing to do is, not sure if the OT is doing any good, his vocal noises did stop for a while, but have definitely come back.

    I would be very grateful of any advice you could offer for when I contact them again about the sickness on Monday, thinking to ask for a lower dosage?

    Kind regards


    • Vicki,
      Your guy absolutely needs a deeper workup, more directed to his neurotransmitter and immune situation. Why do I jump to that conclusion? Quite simply if he were my patient I would have tried to talk you into that course of action right from the first visit knowing what i now know about tic disorder. We have seen so many suffering with tic that correct with immune testing and food antigen recognition.

      Reminder: this is medicine, so no promises – but the *percentage of improvements* always improve with more information in the direction I’m reporting here.

  28. Julia

    Regarding meds, I would just like to say that different generics are different—at least for adderall IR.
    Below are my individual responses

    corepharmaceuticals — correct dose for me = 25 mg…lasted 5 hrs to the T, effective within 30 minutes, had heart palpitations in what I call my “quieter moments”

    barr/teva —- correct dose = 20 mg….lasted about 4 1/2 I think?  I only took it a couple times, because it made me feel very just dull I guess.  I was achy all over and had a bad headache.  Later learned they put saccharin in theirs, and that is my best guess as to why I felt that way.

    sandoz — correct dose = 30 mg…lasts 5-6 hrs, effective in about an hour or so…it has a more gentle on and off so it’s harder to tell.  more like vyvanse in that regard.

    you can guess which one I’m on now.  My dr’s (psychiatrist) still trying to tweak other stuff; I doubt that it’ll ever pan out, but I’m hopeful.  ugh.  don’t like all the trials and side effects though.  But he’s a great dr and they’re aren’t any other red flags in terms of other non-psych problems.

    • Julia,
      Many thanks for the interesting and thought provoking analysis of your own DOE presentations on these various generics. Appreciate this input and look forward to others weighing in on these matters with the generics.

      Always saw differences with Ritalin, but less with Adderall. Great info!

  29. Hello Dr. Parker,

    It’s your friend Ibrahim. I just wanted to say “hello” and to let you know how impressed I am with your blog and the quality of content you have put out there. I’m sure this is an excellent resource for people out there who are looking for the services you provide, or to learn more about this health topic.


  30. Hi Dr. Parker, I was logging on today to ask you a question and what I watched was and and is my question, as we have talked about before about a year ago the adderall had changed my life. I am taking a 20 mil. in the morning at 6 am then at 10 am and the third at 2:30 and now I feel like i am back in 5 th grade I just can’t seem to pull the trigger and its getting worse my mind is always full now and have noticed this slide for about 3 months, due to the economy I don’t have insurance and nobody to talk to and I think I am on a roller coaster and seems as it only works for a couple hours or so and now my mind is worring about when is it going to wear off and this is robbing my quality time of work and family function. Dr. please help me im falling back to 3 rd grade and I don’t like it there.

    Thank You Dr. Parker for all you do in caring and understanding this gift

    • Ron,
      Without talking directly to you this will be a massive guess, but an attempt to consider options.

      My take on matters like this: I always consider that the dose is too much, not too little. I always err on the side of insufficiency rather than possibly create a toxic, frozen situation. The top and bottom of the Therapeutic Window often look the same, – that”s why it takes some time to penetrate the confusion and figure out exactly what is going on… and even then we sometimes don’t call it correctly. At this moment my first guess is simple: you are on too much and need to back off the dosage with your docs approval. My “technique’ for these matters, simple cut the dose in 1/2 and observe, knowing it often takes about 3 days to detox if on too much stim meds.

  31. Lynn

    I look forward to that new book! 🙂

    • Lynn,
      Redoing the current one to be sent out to everyone who is on the purchase list, and the next one will be a serious addition with all the details on neurotransmitters.

  32. Lynn

    Dr. Parker,
    So I had read your book and watched some of this videos before you actually posted them here directly.
    I’m wondering what your comments would be on a few thoughts/questions I have —

    1) Regarding the current constructs of ADHD —
    a) we have the DSM: inattentive, hyperactivity/impulsivity (which really aren’t the same…but doesn’t matter anyway because its vague), and combined.
    b) construct as deficits in executive functions
    c) your construct as thinking ADHD, acting ADHD, and avoiding ADHD…each with similar subsets
    d) we have Amen’s 6(+) subtypes which I don’t remember at all

    Obviously the first is too vague and purely descriptive, which is why other constructs have developed. What I’m wondering is what your view as far as the executive function construct is? Also if, according to your construct, individuals could struggle with some combination of thinking, acting, and avoiding…? And any comments in general on these various constructs.

    2) Research shows (with any aspect of psychiatry) that the most beneficial treatment is usually a combination of therapy/skills training/counseling/education and medication as needed. What I’d like to know is if the severity of difficulties is high despite good lifestyle habits/management strategies etc and a patient is also taking medication….is it viable that someone could re-train their brain so to speak? Through skills training/education/therapy etc, can people really change their brains so that the targets of the medicine are met that way instead and just as easily? (even though obviously it takes more work upfront) an example could be lack of clarity in thinking, or not being able to remember or access what you’re trying to communicate…

    3) Research also shows that ADHD (particularly in adults; though obviously this research is limited) is rarely on its own. It’s not just a question of attention or thinking, but regulating so many things and therefore affects so many other areas that can have other diagnoses – especially if the ADHD is severe. That really, if considering the executive function construct, these other diagnoses also show a lacking in some of those same functions — but perhaps not as many? Obviously if there’s major depression that should be treated first, which you emphasize in your book. But what about other areas? (I’m thinking anxiety, obsessive and compulsive tendencies w/o actually really matching ocd, low energy in AMs or early PMs/high energy other times, perfectionism, mood swings within a day, autism/aspergers, sensory and/or auditory processing, ……….and so forth).
    What are some things that you see? What advice and/or treatment options are there? How good do you/your patients try to get things?

    I had more, but can’t remember it now, and I need to sign off for the day. Looking forward to your insight though! 🙂 Thanks.

    • Lynn,
      Your questions are so deep and comprehensive I really must sit down and write another book! Bottom line: many of the brain retraining methods are helpful and I indicated they would not be addressed in a med book.

      Regarding constructs – I use what works well for communicating with the folks I see in the office, based on brain function not so much on opinions about appearances. My point is basic: move beyond the superficial and let’s work on tools that more closely correlate with SPECT and other forms of brain evidence.

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