Hi All: Thom - "right on." (A phrase that gives away my age. Isaac Hayes said it best.) I have been on the antistigma road re so-called ADHD for 20 years. (Almost as long as Hartmann.. smile)
It is a tough fight. I wrote a book in 2013 in which I used about half of its contents to report my conclusions from hundreds of client evaluations and followups, and from 25,000 pages of primary literature. I concluded that what we currently call ADHD is clearly not a disorder. Now, 12 years later, the science I reported then has further confirmed my "take" on ADHD. I describe in detail why logic cannot lead anywhere else but "not a disorder."
I also use half of the book to share the data at that time which clearly, by a preponderance of the evidence, showed a huge upside to the so-called ADHD brainset.
In my 2013 book, I quote Dr. Dodson and Dr. Larry Silver:
"As noted in ADHD Sleep Problems: Causes and Tips to Rest Better Tonight!, Dr. William Dodson, M.D. states "If the patient spends hours a night with thoughts bouncing and his body tossing, this is robably a manifestation of ADHD. The best treatment is a dose of stimulant-class medication 45 minutes before bedtime."
"Dr. Larry Silver, M.D., notes that 'Some children and teens with ADHD have difficulty going to sleep at night because they cannot turn their head off. They are fidgety and active in bed. They hear every sound in the house and cannot ignore the sounds.'" According to Silver, medications like Ritalin, Dexedrine, or Adderall at night may help — 'Yes, everyone thinks these medications cause sleep problems. However, when ADHD prevents you from going to sleep, being on these medications counteracts those symptoms.'"
Those two docs were among the few, including me, who got it. The rest, including every pharmacist I ever met, had it all wrong. I ended up writing a 15 page educational handout for my clients to gift to their pharmacists. In my 2013 book (free download at my substack), I address the many myths about ADHD that have been debunked by research literature.
I have written in my book and in several columns over the years calling for changes in language that is badly needed. Calling them stimulants is tantamount to calling ibuprofen "kidney damage pills." In other words, an entire category of meds is being named for the side-effects they produce. The goal of stimulants, when used, and when adjusted, is to avoid stimulation. Stimulation is a side effect, not the actual goal which is to produce a certain balanced effect. When these "stimulants" were first categorized the scientific community knew very little about dopamine. The category was created in the midst of ignorance and described the only "effects" that were observable at that time -- "general stimulation not unlike caffeine stimulation."
Above optimal dopamine is as bad as below optimal. More is not better. "Stimulant" is a very old, incorrect term that not only misleads, but stigmatizes meds, at the same time acting as advertising for diversion. Unforgivably unscientific. I advocate for using scientific terms to describe these meds, which would be "dopamine enhancers," or even more technical "dopamine/norepinephrine enhancers."
I thank Thom Hartmann for his unstoppable efforts to get the message out about the evolutionary mismatch going on with the ADHD brainset. Context matters. Some things are good in some situations, and, at the same time cannot be so great in other situations. (Tell Thom to read my book)
I do still wonder about this, dopamine-wise. I'm not sure she's "fashionable" any more, but back in the day when i was trying to figure things out my husband was listening to San Francisco NPR radio all day long, and Julia Ross would come on. So, she had a book. And in that book was observation that amino acids tyrosine and/or phenylalanine were dopamine precursors. And that dietary sources for such were meat and cheese. Well, there happened to be a family joke anecdote about me in my little high-chair, when the parents cut a little piece off of the (frugal) chuck steak for the baby, baby wanted more MEAT! Cheese good too. Neanderthal says ugh!
Good professional niche? How about Public Defender! Low paperwork, non-stop action, on your feet and talkin' !! I was fortunate to fall into honorable work in good company with black comedy often in play. Here's to the Public Defenders! Wonder if ADHD is overrepresented in the ranks?
I am glad to see this issue addressed. I am an elder who has just come into the in the last six months. As soon as I started reading comments in reaction to ADD posts full of quirks and stumbling blocks, I recognized my many decades long struggle for mental clarity hadn’t even come close to the truth. A couple of therapists suggested I might have ADD but weren’t sure and had no suggestions to address. Then I picked up Thom’s book again and immediately recognized that the hunter gatherer description is my truth.
So I kept reading the comments (the actual posts usually had too many words 😂.) and, because I had studied my brain for years, I could filter out what didn’t seem relevant to me. I never could make the dopamine theories seem natural and I quickly bailed on the ADD label because I didn’t believe it was either a deficit or a disorder. I am loving the ride. 🤗
[free associating from perspective of reformed single-neurotransmitter-theorist layman myself]
I would be wary of single-neurotransmitter-theories underlying ADHD or any brain-disease for that matter given the brains complexity
you mention MPH / AMP as being DA mediated but don't mention viloxazine/atomexetine (NRI), guanfacine or clonidine (alpha-2 agonists), venlafaxine (SNRI), et al. none of which are "DA-mediated" yet have efficacy in treating the disorder
HOWEVER — and this is kind of my point — pop-psychology's proliferation via social-media has led to a preponderance of ppl thinking that "if I increase x, it'll make y happen", see SSRIs re depression, stims re ADHD, but the brain is unfathomly complex and any sort of single NT theory breaks down almost immediately if you examine said NT's role in the brain, take, for example, ever popular dopamine even:
dopamine has several subreceptor types (d1-5, to date) and they literally discover new receptors/NTs all the time, (e.g. imidazoline receptor, sigma receptor, anandamide, orexin, &c), and every DA subreceptor type has vastly different functions
multiplied that by the fact that that changes depending on where even the receptor is—D1 receptors in the VTA (highly implicated in reward/ADHD) when activated lead to anxiolysis... but there are also D2 receptors in the VTA that when activated *inhibit* DA release...
never mind the fact that activation of a neuron by NT xyz then carries an impulse down the dendrites (which connect to thousands of other neurons) which themselves release in response totally different neurotransmitters and you can see where the complexity vanquishes any DA = motivation—a great visual for how complex can be found here https://www.youtube.com/watch?v=8YM7-Od9Wr8&t=56s&ab_channel=naturevideo
regarding genetic argument, while heritability is high there are more than a few refutations of the prevailing logic:
Gizer et al. (2009) — suggesting that dopamine-related genes may not be the primary genetic risk factors for ADHD
Neale et al. (2010) — did not identify any genome-wide significant associations between dopamine-related genes and ADHD, further questioning the central role of dopamine in the disorder
Volkow et al. (2012) — sleep dep decrease in D2 receptors in ventral straitum not accompanied by changes in attentional performance
Hi All: Thom - "right on." (A phrase that gives away my age. Isaac Hayes said it best.) I have been on the antistigma road re so-called ADHD for 20 years. (Almost as long as Hartmann.. smile)
It is a tough fight. I wrote a book in 2013 in which I used about half of its contents to report my conclusions from hundreds of client evaluations and followups, and from 25,000 pages of primary literature. I concluded that what we currently call ADHD is clearly not a disorder. Now, 12 years later, the science I reported then has further confirmed my "take" on ADHD. I describe in detail why logic cannot lead anywhere else but "not a disorder."
I also use half of the book to share the data at that time which clearly, by a preponderance of the evidence, showed a huge upside to the so-called ADHD brainset.
In my 2013 book, I quote Dr. Dodson and Dr. Larry Silver:
"As noted in ADHD Sleep Problems: Causes and Tips to Rest Better Tonight!, Dr. William Dodson, M.D. states "If the patient spends hours a night with thoughts bouncing and his body tossing, this is robably a manifestation of ADHD. The best treatment is a dose of stimulant-class medication 45 minutes before bedtime."
"Dr. Larry Silver, M.D., notes that 'Some children and teens with ADHD have difficulty going to sleep at night because they cannot turn their head off. They are fidgety and active in bed. They hear every sound in the house and cannot ignore the sounds.'" According to Silver, medications like Ritalin, Dexedrine, or Adderall at night may help — 'Yes, everyone thinks these medications cause sleep problems. However, when ADHD prevents you from going to sleep, being on these medications counteracts those symptoms.'"
Those two docs were among the few, including me, who got it. The rest, including every pharmacist I ever met, had it all wrong. I ended up writing a 15 page educational handout for my clients to gift to their pharmacists. In my 2013 book (free download at my substack), I address the many myths about ADHD that have been debunked by research literature.
I have written in my book and in several columns over the years calling for changes in language that is badly needed. Calling them stimulants is tantamount to calling ibuprofen "kidney damage pills." In other words, an entire category of meds is being named for the side-effects they produce. The goal of stimulants, when used, and when adjusted, is to avoid stimulation. Stimulation is a side effect, not the actual goal which is to produce a certain balanced effect. When these "stimulants" were first categorized the scientific community knew very little about dopamine. The category was created in the midst of ignorance and described the only "effects" that were observable at that time -- "general stimulation not unlike caffeine stimulation."
Above optimal dopamine is as bad as below optimal. More is not better. "Stimulant" is a very old, incorrect term that not only misleads, but stigmatizes meds, at the same time acting as advertising for diversion. Unforgivably unscientific. I advocate for using scientific terms to describe these meds, which would be "dopamine enhancers," or even more technical "dopamine/norepinephrine enhancers."
I thank Thom Hartmann for his unstoppable efforts to get the message out about the evolutionary mismatch going on with the ADHD brainset. Context matters. Some things are good in some situations, and, at the same time cannot be so great in other situations. (Tell Thom to read my book)
Take care, Ron
I do still wonder about this, dopamine-wise. I'm not sure she's "fashionable" any more, but back in the day when i was trying to figure things out my husband was listening to San Francisco NPR radio all day long, and Julia Ross would come on. So, she had a book. And in that book was observation that amino acids tyrosine and/or phenylalanine were dopamine precursors. And that dietary sources for such were meat and cheese. Well, there happened to be a family joke anecdote about me in my little high-chair, when the parents cut a little piece off of the (frugal) chuck steak for the baby, baby wanted more MEAT! Cheese good too. Neanderthal says ugh!
Good professional niche? How about Public Defender! Low paperwork, non-stop action, on your feet and talkin' !! I was fortunate to fall into honorable work in good company with black comedy often in play. Here's to the Public Defenders! Wonder if ADHD is overrepresented in the ranks?
I am glad to see this issue addressed. I am an elder who has just come into the in the last six months. As soon as I started reading comments in reaction to ADD posts full of quirks and stumbling blocks, I recognized my many decades long struggle for mental clarity hadn’t even come close to the truth. A couple of therapists suggested I might have ADD but weren’t sure and had no suggestions to address. Then I picked up Thom’s book again and immediately recognized that the hunter gatherer description is my truth.
So I kept reading the comments (the actual posts usually had too many words 😂.) and, because I had studied my brain for years, I could filter out what didn’t seem relevant to me. I never could make the dopamine theories seem natural and I quickly bailed on the ADD label because I didn’t believe it was either a deficit or a disorder. I am loving the ride. 🤗
[free associating from perspective of reformed single-neurotransmitter-theorist layman myself]
I would be wary of single-neurotransmitter-theories underlying ADHD or any brain-disease for that matter given the brains complexity
you mention MPH / AMP as being DA mediated but don't mention viloxazine/atomexetine (NRI), guanfacine or clonidine (alpha-2 agonists), venlafaxine (SNRI), et al. none of which are "DA-mediated" yet have efficacy in treating the disorder
HOWEVER — and this is kind of my point — pop-psychology's proliferation via social-media has led to a preponderance of ppl thinking that "if I increase x, it'll make y happen", see SSRIs re depression, stims re ADHD, but the brain is unfathomly complex and any sort of single NT theory breaks down almost immediately if you examine said NT's role in the brain, take, for example, ever popular dopamine even:
dopamine has several subreceptor types (d1-5, to date) and they literally discover new receptors/NTs all the time, (e.g. imidazoline receptor, sigma receptor, anandamide, orexin, &c), and every DA subreceptor type has vastly different functions
multiplied that by the fact that that changes depending on where even the receptor is—D1 receptors in the VTA (highly implicated in reward/ADHD) when activated lead to anxiolysis... but there are also D2 receptors in the VTA that when activated *inhibit* DA release...
never mind the fact that activation of a neuron by NT xyz then carries an impulse down the dendrites (which connect to thousands of other neurons) which themselves release in response totally different neurotransmitters and you can see where the complexity vanquishes any DA = motivation—a great visual for how complex can be found here https://www.youtube.com/watch?v=8YM7-Od9Wr8&t=56s&ab_channel=naturevideo
regarding genetic argument, while heritability is high there are more than a few refutations of the prevailing logic:
Gizer et al. (2009) — suggesting that dopamine-related genes may not be the primary genetic risk factors for ADHD
Neale et al. (2010) — did not identify any genome-wide significant associations between dopamine-related genes and ADHD, further questioning the central role of dopamine in the disorder
Volkow et al. (2012) — sleep dep decrease in D2 receptors in ventral straitum not accompanied by changes in attentional performance