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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by manowar on June 16, 2001, at 12:41:12
I read a book called "Change your brain, change your life" by Dr. Amen in San Francisco. I found the book to be fascinating and enlightening.
He has an uncommon approach to Psychiatry. His clinic does what is called ‘spect’ studies of his patients. (Similar to MRI’s, but better at showing how the brain is actually functioning). He doesn’t understand why psychiatry doesn’t commonly use imaging technology to diagnose problems, being that the brain is far more complex than any organ in the body.
Anyway, in his book he gives cases and shows the ‘spects’ of people with various type of mental illness including depression, OCD, bi-polar, schizophrenia. He also shows spects of people that have abused drugs, or have had hard falls and brain injuries. What is cool is that you can look at the ‘spects’ and the ‘problem area’ of a subjects brain seems to always correspond with the type of problem he has.I read a chapter about depression and how it normally has to do with the deep limbic area of the brain and that with most depressions, it is actually working too hard. (I seemed to have most of the symptoms of deep-limbic depression, which are most of the standard symptoms of major depression).
The next chapter blew my mind. It was on ADD/ADHD.
I never expected in a million years that I had ADD symptoms at all. But what I learned is that ADD is a problem where the symptoms vary from patient to patient, and no two patients are the same. I found that I have many symptoms of an ADD subtype. I also learned that only half of people with attention deficit have problems with hyperactivity.
The pre-frontal cortex of the brain seems to be the culprit.
Sometimes, it seems that people who think they are suffering from major depression are actually suffering from a subtype of ADD which he calls ‘deep limbic ADD’. He asserts that the ‘deep limbic’ section of the brain works in conjunction with the prefrontal cortex; and if the prefrontal cortex is not functioning properly (not enough activation), it can cause the deep limbic section to overwork, hence depressive symptoms.
He points out that it is very important for the p-doc to differentiate between the ADD subtype and depression, because the treatment is often different.
Anyway, he commonly prescribes stimulants along with anti-depressives to patients who have problems with apathy, low motivation, ect.
My problem is that where I live, most p-docs are very reluctant to prescribe stimulants.
I know that stimulants have an anti-depressive effect. Last year I went to a diet clinic and was given a drug called didrex. Remarkably, as soon as I took the drug my depression lifted. Unfortunately, that ‘side effect’ wore off after several days.
I know that stimulants are very addictive, but I’ve never seemed to have a problem in the past (drug over-usage or addictive behavior).
Dr. Amen talks about stimulants like they are the best thing since sliced bread. (I suppose they are especially with true ADDers)
He also says that they are very safe, and the only problem he has with them is sometimes his younger patients ‘forget’ to take their dose. He doesn’t seem to have a problem with adults overusing the drugs to get ‘high’.
Does anyone have experience with stimulants as an augmentation strategy? From what I’ve read about Adafrinil, could it be that stimulants by themselves be considered as anti-depressants? Or do they just work too quickly, with relatively too few side effects, and make most people feel too good to be effective as anti-depressants? We wouldn’t want people to feel too-good, too-quickly would we:)
Posted by SalArmy4me on June 16, 2001, at 13:06:19
In reply to Are stimulants anti-depressants?, posted by manowar on June 16, 2001, at 12:41:12
http://www.dr-bob.org/tips/split/Stimulants-for-depression.html....I thought you might find the passage below to be interesting:
© British Medical Journal 2001.
Volume 322(7281) 3 February 2001 p 259:"Methylphenidate works in the treatment of attention deficit hyperactivity disorder by increasing levels of dopamine in children's brains, according to a study reported in the Journal of Neuroscience.
Previous research in animals and people had shown that methylphenidate (Ritalin) increases dopamine levels, but the studies involved injections of doses much higher than normally prescribed to children.
To see whether the smaller oral doses of methylphenidate that are usually prescribed to children have the same effects, the researchers, led by Dr Nora Volkow at the Brookhaven National Laboratory in Upton, New York, scanned the brains of 11 healthy men aged 20 to 40 using positron emission tomography to measure levels of dopamine in the brain striatum. One scanning session occurred after the men had taken methylphenidate, and the other took place after they had taken a placebo, which did not contain any drug.
About an hour after the men took methylphenidate, dopamine levels in their brains increased significantly. The drug seems to raise levels of the hormone by blocking the activity of dopamine transporters, which remove dopamine once it has been released.
Dopamine, a hormone that plays a role in feelings of pleasure, is also intimately involved with the motivational process, according to Dr Volkow. Dopamine decreases “background firing” rates and increases the signal to noise ratio in target neurones by increasing dopamine levels in the brain. As a result, the drug may improve attention and decrease distractibility in activities that normally do not hold the attention of children with ADHD.
For example, after taking methylphenidate, an arithmetic problem might become more interesting to a child who is normally turned off by maths, Dr Volkow said. “All of a sudden, it's not boring,” she said.
Previous research has shown that some people with attention deficit hyperactivity disorder may have too many dopamine transporters, which results in low levels of dopamine in the brain. By blocking these transporters, methylphenidate seems to keep dopamine levels high enough for children not to lose interest.
The findings may also help to explain why methylphenidate, when used as recommended, is not addictive, said the researchers. The drug increases dopamine levels—as do many addictive drugs, including cocaine, alcohol, and amphetamines—but the key difference may be the length of time that the drugs take to reach the brain.
The researchers said that a drug must reach the brain very quickly for it to become addictive. On average, it takes an oral dose of methylphenidate about an hour to have an effect on the brain, which prevents the drug from causing the “high” produced by most drugs that stimulate dopamine. Methylphenidate could become addictive, however, when tablets are crushed and then either snorted or injected, which allows the drug to reach the brain more rapidly."
Posted by manowar on June 16, 2001, at 22:57:07
In reply to Re: Are stimulants anti-depressants? » manowar, posted by SalArmy4me on June 16, 2001, at 13:06:19
Thanks, that was pretty interesting.
I have read somewhere that where a kid may have symtoms of hyperactivity, poor grades, temper problems (which I had as a youth), these symtoms can change as a person becomes an adult. Therefore, ADD can be underdiagnosed with adults. Is this true? What worries me about methylphenidate (ritalin) is the way it can be ground up and snorted or injected. Are there any drugs that are like ritalin but don’t have such an addictive profile?
Posted by SalArmy4me on June 17, 2001, at 5:53:39
In reply to Re: Are stimulants anti-depressants? » SalArmy4me, posted by manowar on June 16, 2001, at 22:57:07
Oddly enough, desipramine, an antidepressant, may be useful for ADD alone:
Wilens, Timothy E. MD et al. Six-Week, Double-Blind, Placebo-Controlled Study of Desipramine for Adult Attention Deficit Hyperactivity Disorder. American Journal of Psychiatry. 153(9):1147-1153, September 1996:
"...The magnitude of the reduction in ADHD symptoms with desipramine is similar to that reported in adults with ADHD who received robust doses of methylphenidate. Like methylphenidate, desipramine treatment resulted in significant reductions in the broad categories of inattention, impulsivity, and hyperactivity. The current findings with desipramine, together with previously reported findings with psychostimulants, support the notion that pharmacological agents effective in reducing ADHD symptoms appear to operate through their catecholaminergic properties..."
> Thanks, that was pretty interesting.
> I have read somewhere that where a kid may have symtoms of hyperactivity, poor grades, temper problems (which I had as a youth), these symtoms can change as a person becomes an adult. Therefore, ADD can be underdiagnosed with adults. Is this true? What worries me about methylphenidate (ritalin) is the way it can be ground up and snorted or injected. Are there any drugs that are like ritalin but don’t have such an addictive profile?
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