Posted by DSCH on October 5, 2003, at 20:07:21
In reply to Help w/ daughter - atypical, anxiety, ADHD more, posted by Cairo on October 5, 2003, at 18:43:02
> 1. With so much going on, where is a good place to start? Treat the atypical depression or start with a drug for anxiety?
Tonight some of my confidence seems to have fled off somewhere, but something else must be egging me on to make a stab at this.
If there is an HPA axis problem I think that should be the first priority. Basically start at the most basic levels and then work on up to more recently acquirred functions (in the evolutionary sense) residing in the neocortex.
Does she not fell rested after sleep and have dark patches under her eyes and/or dark patches on the joints? Tea made from licorice root is actually suprisingly good for this sort of thing as it contains a cortisol-breakdown inhibitor.
> 2) What does the side effect of social withdrawal with psychostimulants and Strattera tell us about her neurotransmitter dysfunction? Did we give Strattera enough of a trial period or should we just forget it as it didn't help attention that much anyway?The decreased effectiveness of the older stim cocktail raises the possibility, as I see it, that the synthesis of neurotransmitters (particularly norepinepherine) is her current bottleneck. She might benefit from precursor loading (L-phenylalanine, DLPA, and/or L-tyrosine).
> 3) Given her attention difficulties and lack of motivation and anxiety/social phobia, what place do drugs that increase dopamine have other than the psychostims?
Not many drugs *other* than the pstims target dopamine very heavily. For example, there is, to my knowledge, no such thing as a selective dopamine reuptake inhibitor.
> 4) Because of the FMS symptoms (muscle aches and tightness, Raynaud's like symptoms, orthostatic intolerance, etc.) and the role of HPA axis hypofunction, would we be better off starting her off with a tricyclic, wait for aprepitant to be released later this month to give it a whirl, or try the Paxil? And if an SSRI, any suggestions as to which might be a better first choice? What about Effexor?
OK, I think I have exhausted my well on the previous questions! ;-)
> 5) Would ordering cortisol levels be indicated? Is salivary cortisol commonly done?
Pass. See above. ;-)
> I know that because of her complexity, I should just forget the questions and take her to an expert somewhere. Our local Pdocs don't seem to see the big picture and look at all her problems as being compartmentalized; one just wants to give her something for anxiety, another give her something for sleep. I mention CRH and HPA axis hypofunction and their eyes glaze over. WHAT ARE YOUR VOTES FOR THE BEST PLACE TO TAKE HER - any expert, any place? I would appreciate discussion regarding my questions, though.
OK, a wild stab here. Two unorthodox places would be the Amen Clinic where they would do SPECT imaging of your daughter's brain, and the Pfeiffer Treatment Center in Warrenville, IL where they take an orthomolecular approach (but the gears grind very, very slowly there). Some better university psych clinics may have SPECT, fMRI, MEG or QEEG capabilities and experts able to base treatment plans on the results of the imaging/mapping.
> I also have FMS/atypical, but that is another post. I just completed a sleep study which showed I have 200 arousals per night (and that's on a sleep med), so thank you for any help you can give this TIRED mom.
>
> Cairofemlite might be someone you'll want to talk to (she has fibro too). She's interested in xyrem for enhancing sleep.
poster:DSCH
thread:265767
URL: http://www.dr-bob.org/babble/20031004/msgs/265782.html