akathisia- Marianco

[DAVID]

Marianco I've just reading your nice board about akathisia- You speak about high serotonin and low dopamine.

I have no difficulty to fall asleep very quickly the night. My brain say : I think it's a good night. But one hour after my eyes is open. I feel agited, I turning MY leg in bed for falling a sleep. Do this problem is akathisia ?

What the best strategy to increase the ratio dopamine/serotonin. I read that the best way is to take testosterone. But I take the HRT but this problem is here depiste testsoterone

When you have this problem is look like ADD in the day. What do you think about ritalin for akathisia ? Do you think is ritalin is a dangerous drug ?

Many physicians said that is bad for the brain but when you read Dr Amen, this good physician is good for ADD. What your idea about that ?

Thank you for your time and help

[HeadDoc]

just in case he doesn't show today, let me take a shot at this. You are probably suffering restless leg syndrome It, like ADHD, is associated with too low levels of dopamine. However, the dopaminerigic drugs for the two disorders are different as the receptor sites for the two are different--or at least, I think that's how they differ. Hope this helps and perhaps Marianco will show and to clarify this further.

I would be interested in knowing Marianco's site address. Thanks.

here's a site for information on RLS.

http://www.ninds.nih.gov/disorders/r...tless_legs.htm

[1cc]

Check this thread. They are treating ADHD using hormones, specifically pregnenolone.

ADHD, Social Anxiety disorder treated with hormones

[marianco]

Originally Posted by DAVID

Marianco I've just reading your nice board about akathisia- You speak about high serotonin and low dopamine.

I have no difficulty to fall asleep very quickly the night. My brain say : I think it's a good night. But one hour after my eyes is open. I feel agited, I turning MY leg in bed for falling a sleep. Do this problem is akathisia ?

What the best strategy to increase the ratio dopamine/serotonin. I read that the best way is to take testosterone. But I take the HRT but this problem is here depiste testsoterone

When you have this problem is look like ADD in the day. What do you think about ritalin for akathisia ? Do you think is ritalin is a dangerous drug ?

Many physicians said that is bad for the brain but when you read Dr Amen, this good physician is good for ADD. What your idea about that ?

Thank you for your time and help

I have observed that akithisia most commonly is a side effect of serotonergic medications or dopamine antagonists when the medication reduces the activity of dopamine so much that restlessness or agitation occurs. This may impair one's ability to fall asleep. The actual pathophysiology causing akathisia is not entirely known. Norepinephrine, histamine, and glutamate excesses may also be involved. This may be why Beta-blockers (blocking norepinephrine receptors), sedatives, and anticonvulsants may be also useful in treating akathisia. Dopamine mimic medications or medications that increase dopamine release can reduce symptoms of akathisia.

When a person is able to fall asleep, but later wakes up and feels agitated or restless, the question I would have is why? It is less likely akathisia since akathisia is usually a constant condition. From my observations, waking up agitated or anxious may occur as a result of a surge in norepinephrine or glutamate or histamine production in response to lower glucose production than the brain desires, resulting from tiring of the adrenal glands.

There is a separate condition called restless legs syndrome. It is unclear what causes it. However, since dopamine mimicking medications help reduce symptoms, perhaps it is caused by lower dopamine levels. But I think the actual situation is more complex. It appears to be a separate syndrome from akathisia since dopamine mimicking medications (which are agonists at D3 receptors) reliably reduce symptoms, whereas I have not found them useful in treating akathisia.

Ritalin and the amphetamines increase both dopamine and norepinephrine release. The dopamine component may help reduce akathisia, but the norepinephrine component may worsen it - both directly in the brain itself (contributing to agitation or anxiety) or by contributing to adrenal fatigue (and its consequences). I haven't found it useful for treating akathisia.

In the wrong hands, Ritalin, any other medications or substance (including water), is dangerous. There is always a risk in taking anything. Even eating food can potentially be lethal if certain e coli bacteria have contaminated it. Just driving a car, for example, kills more people in the USA each year than the number of American soldiers killed in Vietnam. The key is understanding the risks and making an informed risk assessment so one can make the best decision about treatment or non-treatment.

When testosterone level is at least 650 ng/dl with therapy yet problems remain, the other hormones, neurotransmitters, and/or immune system cytokines are involved.

Dr. Amen has defined subtypes of ADHD such as ADHD bipolar type, ADHD depressive type, etc. I don't agree with these distinctions. I would rather call "ADHD bipolar type" as simply "bipolar disorder", for example.

There is ADHD which is caused by dopamine resistance. In such a person, there is high dopamine production to compensate for dopamine resistance. This may be THE true ADHD as an illness.

ADHD-like symptoms can occur with many other conditions where there may be lower dopamine production relative to other stimulant neurotransmitter production (e.g. norepinephrine, glutamate, histamine). This includes depression, anxiety, hypothyroidism, adrenal fatigue, hypogonadism, diabetes, etc.

Treatment with Ritalin may help ADHD symptoms by increasing dopamine levels, but the tendency for Ritalin to increase norepinephrine may in the long-run worsen the condition, unless this is also taken into account in the treatment - e.g. by instituting an adrenal treatment.

Currently, the best way to increase the dopamine to serotonin ratio is to use a stimulant such as methylphenidate or amphetamine or to use an anabolic hormone such as testosterone or DHEA. However, each method does have its risks (such as excessive norephenrine with stimulants).

I usually do not encounter people with high serotonin levels. Rather, serotonin is usually low in people with mood disorders such as bipolar disorder, depression, or anxiety disorders; or endocrine problems such as hypothyroidism and adrenal fatigue. Thus, I would want to increase both dopamine and serotonin.

[marianco]

Originally Posted by HeadDoc

just in case he doesn't show today, let me take a shot at this. You are probably suffering restless leg syndrome It, like ADHD, is associated with too low levels of dopamine. However, the dopaminerigic drugs for the two disorders are different as the receptor sites for the two are different--or at least, I think that's how they differ. Hope this helps and perhaps Marianco will show and to clarify this further.

I would be interested in knowing Marianco's site address. Thanks.

here's a site for information on RLS.

http://www.ninds.nih.gov/disorders/r...tless_legs.htm

I don't have a web site yet.

However, the AMA does allow me to put up a web page on its site. I may soon put one there.

[marianco]

Originally Posted by 1cc

Check this thread. They are treating ADHD using hormones, specifically pregnenolone.

ADHD, Social Anxiety disorder treated with hormones

This is the original article at LEF.org: http://www.lef.org/magazine/mag2006/feb2006_ch_01.htm

The article is poorly written.

The person was thought to have ADHD and lacked energy. Testing revealed low pregnenolone, low DHEA, good testosterone, and good cholesterol levels.

The person improved on a treatment including pregnenolone, DHEA, magnesium, zinc, androstendione, Vitamin C, and other substances (including unnecessary substances such as Tribulus terrestris). Later, it was reduced to pregnenolone and DHEA alone.

It seems to me that the person clearly had adrenal fatigue, which causes an ADHD-like syndrome. The treatment for the most part was an adrenal fatigue treatment (with pregnenolone serving as a precursor for cortisol).

However, since the author was primarily focused on psychiatry and did not show knowledge of neuroendocrinology, the lab testing was incomplete and interpretation was incorrect.

Fortunately, despite the wrong interpretation, the patient improved.

[1cc]

Originally Posted by marianco

It seems to me that the person clearly had adrenal fatigue, which causes an ADHD-like syndrome. The treatment for the most part was an adrenal fatigue treatment (with pregnenolone serving as a precursor for cortisol).

However, since the author was primarily focused on psychiatry and did not show knowledge of neuroendocrinology, the lab testing was incomplete and interpretation was incorrect.

Yes, the main point I was trying to make was that many conditions are being described as psycological even though they are hormonal in origin. Such may be the case with a number of guys here on the board that described themselves as having ADHD.

[marianco]

Originally Posted by 1cc

Yes, the main point I was trying to make was that many conditions are being described as psycological even though they are hormonal in origin. Such may be the case with a number of guys here on the board that described themselves as having ADHD.

Your point is well made.

From my point of view, the mind is the sum of the functions of the nervous system, endocrine system, and immune system. These three systems are actually one single system. As such, there is very little separation if at all between psychological, neurological, endocrine and immune system problems. They are all part of one system - the mind.

A problem occurs when we look at a problem as being only due to one of these systems. For example, if we consider ADHD as only a nervous system problem or worse, as only a "psychological problem" - which means there is no physical component to the illness, no nervous system component to the illness. When looked at from only one point of view, the physician or other practitioner will totally miss the other components that contribute to the problem. Further, as a result of missing the other contributing components to an illness, more effective treatments may be missed.

Adrenal fatigue is not exactly only a hormone problem. It is an mind problem. The adrenal glands are part of the sympathetic nervous system. And they play a large role in the immune system.

When I see adrenal fatigue, I may see multiple areas of impairment. There often is relatively reduced serotonin, reduced dopamine, reduced GABA, high norepinephrine, and possibly high glutamate, and high histamine levels. There is reduced production of cortisol, DHEA, progesterone. Further, there may be increases in pro-inflammatory immune system chemical messengers (cytokines) such as IL-6 and IL-12. These cytokines may in turn influence the production of serotonin and other neurotransmitters, and influence the hypothalamic-pituitary-adrenal system. Thus adrenal fatigue is a much more complex condition than just cortisol, DHEA, or progesterone deficiency. It is not just a hormonal problem.

Treatment of adrenal fatigue can be as simple as a behavioral modification - thus treating the nervous system component only, or as complex as a total mind treatment involving behavior, nervous system, endocrine system, and immune systems.

Years ago, as a psychiatrist, we use to be able to hospitalize a person for two years and give them only psychotherapy. This treatment relieved the person of external stresses (including responsibilities). Usually, such a person came out psychologically much more healthy. Essentially, their adrenal fatigue was essentially totally treated by psychological means.

Without such an extreme intervention to reduce external stresses (essentially a 2 year vacation with a large staff to take care of one), treatment of adrenal fatigue may have to involve the other systems. Treating it with psychiatric medications alone may not be then enough. Adding endocrine and immune system treatments may then result in a stronger regimen - which is missed if the condition is only considered a nervous system/psychological problem.

[DAVID]

Thank you so much for all answers.

Marianco, I've learning more from you than Wilson (adrenal fatigue) or Jefferies (safe use of cortisol) about adrenal fatigue.

May be because I've adrenal fatigue and your answer in the board about adrenal is integrated with all the hormones/neurotransmetteurs/cytokines.

Dr Amen or Dr Braverman never speak about adrenal fatigue that is very important about brain chemistry.

Do you write a book about adrenal or article ? Do you known another book that it's different that Jefferies or Wilson or Herthoghe for understanding the cause and the physiology of adrenal fatigue ? When you look at PubMed there are not so much informations about that.

Why the "dogmatic medecine " never speak about this important problem ?

[marianco]

Originally Posted by DAVID

Thank you so much for all answers.

Marianco, I've learning more from you than Wilson (adrenal fatigue) or Jefferies (safe use of cortisol) about adrenal fatigue.

May be because I've adrenal fatigue and your answer in the board about adrenal is integrated with all the hormones/neurotransmetteurs/cytokines.

Dr Amen or Dr Braverman never speak about adrenal fatigue that is very important about brain chemistry.

Do you write a book about adrenal or article ? Do you known another book that it's different that Jefferies or Wilson or Herthoghe for understanding the cause and the physiology of adrenal fatigue ? When you look at PubMed there are not so much informations about that.

Why the "dogmatic medecine " never speak about this important problem ?

All those mentioned provide pieces of the puzzle the results in a fuller understanding of mental and physical health.

Thierry Hertoghe comes closest. He focuses primarily, though, on specific hormone deficiencies and nutrition, not linking them to whole organ systems nor to nervous system and immune function. When he talks about cortisol, aldosterone, DHEA, progesterone deficiency, in a way, he is talking about adrenal fatigue. He does use the strongest tools - hormone therapies and nutritional interventions - though some patients with severe problems (particularly those with mental illnesses) may need the psychiatric and immune system treatments also - a coordinated treatment.

[The_Skeptic]

Originally Posted by marianco

Your point is well made.

From my point of view, the mind is the sum of the functions of the nervous system, endocrine system, and immune system. These three systems are actually one single system. As such, there is very little separation if at all between psychological, neurological, endocrine and immune system problems. They are all part of one system - the mind.

A problem occurs when we look at a problem as being only due to one of these systems. For example, if we consider ADHD as only a nervous system problem or worse, as only a "psychological problem" - which means there is no physical component to the illness, no nervous system component to the illness. When looked at from only one point of view, the physician or other practitioner will totally miss the other components that contribute to the problem. Further, as a result of missing the other contributing components to an illness, more effective treatments may be missed.

Adrenal fatigue is not exactly only a hormone problem. It is an mind problem. The adrenal glands are part of the sympathetic nervous system. And they play a large role in the immune system.

When I see adrenal fatigue, I may see multiple areas of impairment. There often is relatively reduced serotonin, reduced dopamine, reduced GABA, high norepinephrine, and possibly high glutamate, and high histamine levels. There is reduced production of cortisol, DHEA, progesterone. Further, there may be increases in pro-inflammatory immune system chemical messengers (cytokines) such as IL-6 and IL-12. These cytokines may in turn influence the production of serotonin and other neurotransmitters, and influence the hypothalamic-pituitary-adrenal system. Thus adrenal fatigue is a much more complex condition than just cortisol, DHEA, or progesterone deficiency. It is not just a hormonal problem.

Treatment of adrenal fatigue can be as simple as a behavioral modification - thus treating the nervous system component only, or as complex as a total mind treatment involving behavior, nervous system, endocrine system, and immune systems.

Years ago, as a psychiatrist, we use to be able to hospitalize a person for two years and give them only psychotherapy. This treatment relieved the person of external stresses (including responsibilities). Usually, such a person came out psychologically much more healthy. Essentially, their adrenal fatigue was essentially totally treated by psychological means.

Without such an extreme intervention to reduce external stresses (essentially a 2 year vacation with a large staff to take care of one), treatment of adrenal fatigue may have to involve the other systems. Treating it with psychiatric medications alone may not be then enough. Adding endocrine and immune system treatments may then result in a stronger regimen - which is missed if the condition is only considered a nervous system/psychological problem.

As a man who is severe ADHD and secondary hypogonadic, I totally agree with your assumption that these conditions are all related. Unfortunately, none of the many psychiatrists and endos I've known over the years acknowledge this.

Many times the brain fog I experience with ADHD is most likely a result of elevated E2 levels because these are the times the Adderall doesn't help. And many times when I am depressed, it is most likely a result of low Test rather or in addition to low dopamine.

One day when I get some extra cash, I will fly out and visit you as a patient.

[DAVID]

Originally Posted by The_Skeptic

As a man who is severe ADHD and secondary hypogonadic, I totally agree with your assumption that these conditions are all related. Unfortunately, none of the many psychiatrists and endos I've known over the years acknowledge this.

Many times the brain fog I experience with ADHD is most likely a result of elevated E2 levels because these are the times the Adderall doesn't help. And many times when I am depressed, it is most likely a result of low Test rather or in addition to low dopamine.

One day when I get some extra cash, I will fly out and visit you as a patient.

Yes, it's strange since I take femara 1/4 of each every 5 days my brain fog is gone. May be you can explain the physiology of high brain estrogen on brain fog ?