Wouldn't it be wise to somehow have a test that will determine which neurons are lacking in a specific person, and then take medications based on that. For example, if an ADHD patient has severe lack of dopamine and mild lack of norepinephrine, then a drug that has a NE (http://en.wikipedia.org/wiki/Norepinephrine):DA (http://en.wikipedia.org/wiki/Dopamine) ration of 1:3 can be prescribed. If another ADHD patient has mild lack of both, then a drug that has a NE (http://en.wikipedia.org/wiki/Norepinephrine):DA (http://en.wikipedia.org/wiki/Dopamine) ration of 1:1 can be prescribed, and so on. I've heard something called "TAAT" that might help with this procedure. Not sure, though.

Please offer your comments

Actual quantities of neurotransmitters available at a given time, or how well the neurotransmitters bind to and activate receptor sites? Lack of dopamine is a problem in Parkinson's, but the mechanism at hand for ADHD is thought to be more complicated.

Can't participate in a science discussion here, but can give you some personal experience on your topic.

Both my son and I did the TAAT therapy, which is amino acid therapy. We worked with a physician that tested our neurotransmitters through a urine test (which is a controversial topic in itself) that then went to a lab for processing. The test results were very interesting, and I believe would be a great marker for which medication group to start with, and also the groups to avoid. It would be a great tool to eliminate a lot of the painful and frustrating trial and error of a medication journey. For example, from my own results, I presume I would not do well with a stimulant-type of medication as my dopamine levels tested on the rather high side, and one such as Adderall would push me further into anxieties and possible exacerbation of OCD tendencies.

He tested very low on dopamine, and one of his main supplements included mucuna prurien bean extract (L-Dopa), and seemed to help him. We discontinued the therapy because he was not consistent with it, and there is some question of long-term safety and efficacy.

the only way to do this is a post mortem brain disection, be my guest to have your levels checked i am just fine thanks :D

Wouldn't it be wise to somehow have a test that will determine which neurons are lacking in a specific person, and then take medications based on that. For example, if an ADHD patient has severe lack of dopamine and mild lack of norepinephrine, then a drug that has a NE (http://en.wikipedia.org/wiki/Norepinephrine):DA (http://en.wikipedia.org/wiki/Dopamine) ration of 1:3 can be prescribed. If another ADHD patient has mild lack of both, then a drug that has a NE (http://en.wikipedia.org/wiki/Norepinephrine):DA (http://en.wikipedia.org/wiki/Dopamine) ration of 1:1 can be prescribed, and so on. I've heard something called "TAAT" that might help with this procedure. Not sure, though.

Please offer your comments

Good post on an important subject.


This is not my area of expertise and it has been a while since I took neuro but I have done a little reading and such. This reflects my understanding and is subject to error.

The problem is not always in the amount of a neurotransmitter but can be in other areas. For example one may have enough dopamine in the system but the receptor sites have a layer of protein which decreases its sensitivity and ability to fire the neuron in the time allotted. Another is having too many uptake pumps and thus not allowing the dopamine to stay in the synapse long enough to trigger the neuron firing.

These are two of the things that immediately came to mind. As I understand your post, the, the test you propose would not address either of these.

Something that has me fascinated is the idea of doing a gene map and prescribing meds according to this. Some genes, for example, decrease the sensitivity of receptor sites and thus Adderol might be better for this as it increases the amount of dopamine in the synaptic cleft (the space between two neurons where neurotransmitters work) giving the neuron a better chance of firing. Other genes can cause an increase in the amount of reuptake pumps (pumps that pull the neurotransmitters back in to reuse) thus a reuptake inhibitor such as Ritalin which would leave the dopamine in the synaptic cleft longer again giving the neuron a better chance of firing might be the drug of choice. Barkley was discussing this as being possible in less than a decade probably sooner.

Wouldn't it be a wonderful tool?

It is an any case a really interesting subject.Thanks for posting.

Dizfriz

Something that has me fascinated is the idea of doing a gene map and prescribing meds according to this. Some genes, for example, decrease the sensitivity of receptor sites and thus Adderol might be better for this as it increases the amount of dopamine in the synaptic clef giving the neuron a better chance of firing. Other genes can cause an increase in the amount of reuptake pumps thus a reuptake inhibitor such as Ritalin might be the drug of choice. Barkley was discussing this as being possible in less than a decade probably sooner.

Wouldn't it be a wonderful tool?

What's stopping this from happening now? Aren't gene maps available with current technology?

What's stopping this from happening now? Aren't gene maps available with current technology?

No.

This is an area of hot and heavy research and is possibly the currently most active research area in the field of ADHD.

A lot has been found out and we are getting a much better understanding of the genetic basis of ADHD. More to be done however.

Again good question.

Dizfriz

the only way to do this is a post mortem brain disection, be my guest to have your levels checked i am just fine thanks :D

Spinal Tap could do the trick. But I wouldn't want to have a spinal tap just for this.

There are a few problems with this methodology. Firstly, any measurable neurotransmitter levels would fluctuate through-out the day and under various circumstances. Finding a baseline for any given patient would require measuring these levels over a period of time. The fact that these neurotransmitters are in your brain and don't cross the blood-brain barrier make this very difficult with current technology.

Secondly, this method assumes that the problem is singularly because of a lack of a particular neurotransmitter. In fact, it is likely that there are other circumstances, far more difficult to measure, which share some responsibility for the disorder. This includes transmitters running in reverse, misfiring, and receptor sensitivity (or a lack thereof).

Until we can get down to the molecular level to observe and measure neural activity in real time, customizing a medication to accommodate for ADHD is going to be a difficult task involving some level of best-guess work.

Spinal Tap could do the trick. But I wouldn't want to have a spinal tap just for this.

There are a few problems with this methodology. Firstly, any measurable neurotransmitter levels would fluctuate through-out the day and under various circumstances. Finding a baseline for any given patient would require measuring these levels over a period of time. The fact that these neurotransmitters are in your brain and don't cross the blood-brain barrier make this very difficult with current technology.

Secondly, this method assumes that the problem is singularly because of a lack of a particular neurotransmitter. In fact, it is likely that there are other circumstances, far more difficult to measure, which share some responsibility for the disorder. This includes transmitters running in reverse, misfiring, and receptor sensitivity (or a lack thereof).

Until we can get down to the molecular level to observe and measure neural activity in real time, customizing a medication to accommodate for ADHD is going to be a difficult task involving some level of best-guess work.

If a gene map can be used, do you think that would take care of the problem?

If a gene map can be used, do you think that would take care of the problem?

I'm sure that would be helpful, but it would be yet another blunt tool. The brain is a very pliable machine, and while a great deal of who we are is determined by our genetic structure, much of who we are is also determined by our experiences, the environment around us, our behavior, and our beliefs. How much belongs to either category is impossible to say, but enough of it is immeasurable. A genetic map would be a great way to find a medication to accommodate for an inability to produce a certain protein in a simpler organ like a kidney, of example. But the brain is incredibly complex, and the relationships of its various parts are not simple. No other organ will suddenly pick up where a kidney left off because they are all too specialized. The brain is a very different kind of organ. What it lacks in one space, it may make up for in another and the person who uses it may never show any symptoms at all.

Think of your brain as a village. Every village needs a baker. Without a baker, the village suffers from a lack of bread and all of the deficits that accompany it. But a village is a complex system, and might find other ways to adapt. Households take turn baking for everyone, a young person learns how to bake and becomes a new baker, everyone adopts an alternative to bread such as rice, or everyone just learns to get by without bread. If you take away the baker, it's impossible to tell just what will happen without him. Ultimately, the town's experiences and local environment will determine how much they can cope, if at all.

There's really only 2 meds, so why bother testing if you could. Methylphenidate or Amphetamine. If one doesn't work, switch to the other.

Yeah Straterra and off-label meds, but those are sort of a add-on meds to the 2 meds that actually do something.

Way to many other neurochemicals are responsible for how the brain works. Glutamate, Cortisol, GABA. etc. It wouldnt be very reliable to test the big three neurotransmitters considering how many other things are responsible for the brains functioning. Neurology is still in its infant phase and theres far to much we dont know.

Way to many other neurochemicals are responsible for how the brain works. Glutamate, Cortisol, GABA. etc. It wouldnt be very reliable to test the big three neurotransmitters considering how many other things are responsible for the brains functioning. Neurology is still in its infant phase and theres far to much we dont know.

So can it be expected that the field of ADHD treatment won't advance much in 5 or 10 years?

Bah, I was looking forward to a full robust treatment ready to go within the next 10 years. :(

Bah, I was looking forward to a full robust treatment ready to go within the next 10 years. :(

Its depressing but were still treating schizophrenia in the exact same way we did almost 60 years ago. While the side effects of anti-psychotics have gotten less its still the exact same method of action as thorazine. The newer anti-depressants are starting to look more and more like the old tricyclics.

But there is hope in glutamate, someone over at pfizer has created a new drug that addresses schizophrenia in a brand new way. Theres supposedly glutamate modulating anti-depressants in the works.

Alot of it has to do with Big pharm companies being unwilling to throw money at researchers to create novel drugs and the novel drugs we are seeing mostly emulate existing ones (provigil).

So dont expect much untill we start manipulating genes at a consumer level.

So can it be expected that the field of ADHD treatment won't advance much in 5 or 10 years?

Bah, I was looking forward to a full robust treatment ready to go within the next 10 years. :(


What you seem to be looking for is a cure for ADHD. I do not think this will happen in the foreseeable future. What you will see is better control of he symptoms.

A good aid for understanding the dynamics of ADHD is to compare it to diabetes. There is no cure for diabetes but there are a lot of ways to control it. If you quit doing the control methods you are right back to where you started.

ADHD works pretty much the same. Better control of symptoms is the primary goal in the field.

A lot of the current research is focused on finding the genes and parts of the brain involved with ADHD. From this will likely come better control methods. There have been some new treatments such as Strattera but mostly we see better ways of delivering the types of medications that have been used for the past 50 years or so (Ritalin has been around over 50 years).

I wish I could encourge you on some major breakthrough but I do not see that even having a chance of happening until much more is known about the genetics and neurochemistry the parts of the brain involved.

I will tell you that treatments and knowledge have vastly improved over the last 30 years since I was involved with raising a child with ADHD.

There is hope, but for better treatment, not final solutions.

Dizfriz

Who knows what the future will bring. I doubt there will be a cure for ADD but better drugs to treat the symptoms will probably be discovered in my lifetime (I think so anyway, IMO ;P)

Great post!

I think that's a really interesting idea, we're getting a lot closer to achieving that than most of us realize! I mean, we're starting to do similar things with individual gene therapies, right?

Seriously, though, I think one of the major roadblocks to some of these "custom design" drugs for ADHD is the difficulty in delivering them to specific areas in the brain. I know, for example, that one of the main sites of deficiency for ADHD near the front part of the brain (the prefrontal cortex, or PFC). However, with some other forms of ADHD or other neurobiological disorders, certain brain regions may have dopamine levels that are too high in dopamine. How can we direct the desired chemicals to the right regions of the nervous system and keep them out of the wrong ones? That might be one of the toughest steps to implement.

The other thing we'd need to overcome would be "tolerance" to certain pharmaceutical or amino acid therapies. The body has so many built-in balance and counterbalance systems, that if we were to try to buld up levels of an important chemical (that is deficient in an individual with ADHD or a related disorder), then the body can start to "adapt" or push back to achieve previous levels. I think that might be a big part of the "rebound effect" when dealing with medications, and may also be why suddenly stopping certain medications can be dangerous. Any ideas?

Again, great post!


Wouldn't it be wise to somehow have a test that will determine which neurons are lacking in a specific person, and then take medications based on that. For example, if an ADHD patient has severe lack of dopamine and mild lack of norepinephrine, then a drug that has a NE (http://en.wikipedia.org/wiki/Norepinephrine):DA (http://en.wikipedia.org/wiki/Dopamine) ration of 1:3 can be prescribed. If another ADHD patient has mild lack of both, then a drug that has a NE (http://en.wikipedia.org/wiki/Norepinephrine):DA (http://en.wikipedia.org/wiki/Dopamine) ration of 1:1 can be prescribed, and so on. I've heard something called "TAAT" that might help with this procedure. Not sure, though.

Please offer your comments

I knoticed when I first started taking medication it seemed overly potent. Less than two days later though the driving energy, mild euphoria, and racing thoughts dissappeared and I was left with the improved concentration and calmness the I was taking the meds for in the first place. My assumption was that in areas of my brain that dopamine receptors were not understimulated, rapid overstimulation took place after first taking the meds. To compensate, these receptors downregulated cutting off the euphoria and energy. Conversely, dopamine receptors in my PFC where brought to a normal level of stimulation and were not overstimulated and therefor did not downregulate.

I don't know very much about neuroscience at all but thats my ignorant hypothesis. :P

my brain requires 60mg Ritalin 4x/day, 180mg
I'm prescribed 180mg Ritalin per day.
I have to renew my medication early with my family doctor who won't touch the doses as my psychiatrist wrote them. I haven't seen my psychiatrist in 2 months since getting out of jail where I saw him atleast once visit per week to touch base
where I worked up to this point for a year now and things still need work( I now require more medication to function as one would suspect since I haven't had my medication "tuned" lately hence my predicament... I see my new psychiatrist tommorow! Good thing cause I only have enough medication for tommorow and thats what im sick of having to worry about! Im a college student and this is where I dwell in my daily dilemma.

what?

Using (supposed) neurotransmitter levels to find a good medication doesn't make a lot of sense as any results would be cryptic at best, and the only really accurate way to get a proper assay is via lumbar puncture. Plus, interpreting these levels would be very difficult for most physicians, and would not translate to a good medication choice. It is far more likely that issue is at the receptor sites, and is not a function of free monoamines.

He tested very low on dopamine, and one of his main supplements included mucuna prurien bean extract (L-Dopa), and seemed to help him. We discontinued the therapy because he was not consistent with it, and there is some question of long-term safety and efficacy.

This sounds like bad medicine! If you are to give a child l-dopa, at least use the pure drug form, not something that could potentially contain nicotine and n,n-DMT (even though it is not orally active). "Supposedly" low dopamine levels (especially via urinalysis) does not automatically warrant augmentation with l-dopa, especially considering l-dopa's high side-effect profile and lack of a proven safety record in children...

I am glad you are no longer giving your son this!

Good post, you really got me thinking. Unfortunately I can’t afford to spend very much time on this sort of thing. I really should have just stopping thinking about it in the first place but I couldn’t resist, and I will share my thinking for the last ten-twenty minutes because I liked it and plan to research into it a bit more when time is more permitting. Hope you like it.

I have an idea to determine the amount of a specific neurotransmitter inside some ones brain. I don’t know if there’s already a way or not, but I have somewhat of an interest in biology and so regardless of what better way there is, this method should be attempted simply because the technique of using radio wave interference could prove useful in other applications outside the focus of brain chemistry. It’s basically just a very not well planned out proposition for an experiment.

I propose I build an enzyme. When the enzyme binds with a neurotransmitter like dopamine… The magnetic properties of the protein will change in a detectable some way.
Maybe I can get the protein to use ATP and somehow generate a current?
Maybe I can get the protein to connect one copper piece with another copper piece, and this would boost the signal being transmitted from the protein.

-oh, even better, why don’t I have the protein have a series of these copper arrangements, and in the “off” position they would be stacked on top of each other, but when dope is bound, the copper “octopus-like legs” would fan out, thus mildly interfering with the transmission of radio waves.

This protein is getting kinda big… There’s really no safe way to get it into the brain intact, other than maybe intravenously… and even then what negative effects could it have. Forget negative effects for now though, I just want to use it inside of test tubes for now.

ToDo:

Electronics
Read up on radio wave transmission, and electromagnetic phenomenon. Specifically google: copper shielding, or something.
Factor out how much

Biology
Read up on how DNA / RNA can be artificially encoded and then how proteins can be generated from these artificial codes.
Read up on protein structure Vs. protein RNA.
Devise a method of turning copper into microscopic strips accessible to the protein.
Devise a way to make the protein “grab on” to these copper strips.
Work out the binding site of the protein.
Work out the mechanical movement of the protein when a dopamine is bound, I'd need some kind of energy source... don't know if ATP is in this environment.
Figure out how to make the enzyme not respond to dopamine activation, until half an hour or so after the first bind to the active site is detected.
Figure out how make this thing decay without damaging any tissue.
Figure out how to get the protien where inside the body I want it in the first place.

Statistics
Figure out how to correlate the change in radio wave transmission to amount of dopamine. (the easy part, Imo, assuming you can find sensitive enough equipment to pick up the delta signal)

…Anyway, back to what I was doing… If anyone has any comments on it I’d love to hear them. I’m not very up to date with the current development of micro biology so I’d be interested to hear in what’s possible now, what’s not possible yet, and what’s fundamentally impossible. I just read the post about the gene-map. This is most definitely the best way to go about it, when the technology arrives (and it would seem to me that the strategy I posed could develop only after said technology is here).