This intrigued me for two reasons:

One, because this means that hyperactivity is probably inherited genetically, for the most part, and perhaps is somewhat independent from other aspects of ADHD (inattention, impulsivity, etc). This could lead to more refined subcategories of ADHD, and hopefully to more individualized pharmacotherapy if Big Pharma ever gets around to updating their hopelessly antiquated stimulant formulations (this shit’s been around since 1937, we’re ready for version 2.0).

Two, because this suggests that ADHD arises from dysfunctional DRD4 receptors in SUBcortical areas (lizard brain areas) rather than in the prefrontal cortex (associated with planning, working memory, impulse control, sustained attention, etc). Non-stimulant medications such as Strattera and Intuniv primarily target the prefrontal cortex and exhibit little to no effects in the subcortical areas, whereas stimulants target both the PFC and aforementioned “lizard brain parts” — and as we all know, stimulant medications are far more effective than any other available treatment.

Moral of the story: the ADHD kid’s lizard brain is tragically messed up, and apparently we all need a properly functioning lizard in our brains in order to sit still and be boring. Damn lizards.

Oh you know, just… half my college career’s worth of garbage.. no big deal.

It’s pretty long, and the quality isn’t great — but take a look at it and tell me if you don’t answer yes (or perhaps HOLY FUCK THIS GUY HAS BEEN FOLLOWING ME, HOW DOES HE KNOW THIS) to an overwhelming majority of the questions. I answered “no” to about 5 or 6 out of about 128 questions. I love when people with ADHD write books for other people with ADHD… it’s amazing how similar we all are, despite how heterogeneous ADD can be.

Sample questions:

55. Do you find driving a car fast to be a soothing experience?
…
49. Are you a dreamer?
…
3. Are you more generous than most people?
…
8. Do you tend to solve problems intuitively rather than logically and methodically?
…
9. Do words like logically and methodically bring back bad memories?

ADD quiz

In any case, I found an article that discusses the cross-potentiation effects of nicotine and psychostimulants like methylphendiate (Ritalin) and amphetamine (Adderall, Dexedrine). Well, it primarily focuses on amphetamines, but I imagine the same holds true for Ritalin to at least a small degree. Here are the bullet points:

• Psychostimulants are often used in close tempo- ral proximity to nicotine and have been reported to enhance acutely nicotine’s desirability in humans.
• When administered simultaneously, nicotine and amphetamine produced a predominantly additive effect on locomotor behavior.
• However amphetamine, when given 2– 4 h before nicotine, strongly potentiated nicotine-induced locomotor activity.
• Correspondingly, nicotine given 1–4 h before amphetamine robustly enhanced amphetamine- stimulated locomotor activity even when the effects of the nicotine pretreatment dissipated.
• Overall, the present data demonstrate that acute interactions of nicotine and other psychomotor stimulants produce potentiative effects and that these transient inter- actions may play a role in the frequent co-use and abuse of nicotine and other stimulants.

The article itself is a bit technical (sorry!) but the bullet points are pretty clear: nicotine before amphetamine, never been… more stimulated? amphetamine before nicotine… still more stimulated? I came, I tried to rhyme, I failed. I apologize for my poetic shortcomings. Anyway, please leave comments of your experiences on the matter! I’d love to know I’m not alone in my stimulant co-use and abuse, to quote the article (and I suspect I’m not!)!

ADHD song of the year. Believe it or not, I was obsessed with this song before I even listened to the (eerily appropriate) lyrics — which are incredible.

“Blame it on my ADD, baby!”

I copied and pasted the main bullet points:

• Poor oral health Yep, we tend to have bad teeth. Do we forget to buy toothpaste? Forget to brush and floss? Forget to make dental appointments or forget to go when we do make them? Or can we just not afford to go to the dentist? All good questions.
• Poor financial organization We are more likely to have a financial plan for the weekend than for our retirement. Our idea of planning for the future is a more short term thing. Many of us are just trying to remember that we have the rent or mortgage to pay on the first.
• Hoarding and clutter Which came first, the chicken or the egg? These two siblings of a disorganized life are hallmarks of our disorder. Like our symptoms though, not all ADHDers suffer from them, in fact the randomly chosen ADHDer may be insufferably organized, if that’s something they hyper-focus on.
• Dysgraphia Dysgraphia is poor penmanship turned up to ten. I have to print if I want to have a hope of others being able to read what I have written. I can decipher it, but even I have trouble.
• Skin hypersensitivity Itchy material, scratchy tags, clothing that is too tight or too loose, all these can prove to be irritating. My three big ones are collars that are too tight, long sleeves, and labels on the back of my neck.
• Lateness Being late or missing appointments all together isn’t cool, I try hard not to do that, but I don’t always succeed. I’m better at it than many of our tribe, but there is still room for improvement.
• Undone taxes Yes, the reason my road is in such great need of repair is because I’m two years behind on my taxes. I think it may be time to find someone who will do my taxes for me … or at least with me.

Oh, the joys and perils of the ADHD mind (and body).

Don’t get me wrong, ADD sucks and makes everything I do ten times harder than it is for everyone else. But I’m not looking forward to experiencing for the first time the unsettling tranquility of being, not bored, but boring.

I’m starting to worry that in suppressing my ADD symptoms, I’m erasing the only part of me that feels alive, alive and a part of the world.

The other funny thing about ADD is that the feeling will pass just as quickly as it came, probably before I even finish editing this posting.

And now, all I’m thinking about is pumpkin log and sticky buns and those ridiculous Pillsbury sugar cookies with the reindeer on them and for the love of Christ, there had better be Dram Buie. Maybe Christmas break won’t be so bad after all.

When a bottle of shampoo runs out in my apartment, generally it remains in the shower for any number of weeks or months until it has multiplied and taken over the sacred altar of cleansing, until it becomes hazardous for an ADD kid to step into the tub (without looking or remembering that he himself had neglected to take every single one of those shampoo bottles out).

So, still writhing in pain and crying out with rage at my most recent Tony Hawk Dove-boarding Extreme incident, I hurled the culprits over the shower curtain onto the bathroom floor. And as you can imagine, I’m now faced with a choice…

Either I let shampoo bottles accumulate to dangerous levels, or I hurl them over the shower curtain as soon as I run out. Granted, later on I generally put the bottles in the recycling — the trash turnaround rate of floor-dwelling Dove bottles is astonishingly speedy. So my question is this: am I alone in chucking my empty Lethal Luges out of the shower? Or are there fellow irrational beings who face this same problem?

I also compulsively go to Public Library booksales and buy inordinate amounts of the shittiest books imaginable, especially on $5-box Sunday (A WHOLE BOX OF BOOKS — ANY BOOKS!! — FOR $5!). It’s just so cheap… and there are so many books… but after four years of hoarding all the novels based on movies and all the novels with pictures of women in rural areas sitting in pity-evoking but somehow “self-reliant” poses. Or at least that’s what I think when I look at Stony Hollow Here My Woman Cry or whatever the hell that weird book is called.

And, in all honesty, I haven’t read a single one of those damn books. It’s embarrassing.

All right! Now that I’ve satisfied my Catholic urge to confess my sins from behind a veil of anonymity (internet = confessional? that’s gotta be a sacrilege right there), the post comes to a close. And anyway — the empty soda bottles in my car which I have intentionally avoided mentioning until just now are FAR more shameful and overwhelming than a shampoo bottle on the floor or an extra bookshelf. I hope that one day I can stage some sort of ADHD-exclusive messiest car contest. Everyone would have to take pictures or video or whatever of their cars (and obviously, our cars are never clean) and everyone would have to identify where the shit came from, maybe depict scenes where people yells at them to throw some piece of garbage away and they refuse.. or perhaps in some sort of semi-serious emergency, an acquaintance (like a professor or a colleague, but one you don’t know well or one that is your superior somehow) has to sit in the backseat or something on top of the massive conglomerate of the majority of your belongings that maintains a permanent residence in your backseats. OH MY GOD and bonus points if they’re germophobes or OCD or something like that.

…Wow, that was an elaborate plan. I hope this really pans out someday. Competitive ADD-ing..? Eh. I’ll find a better name for it.

Parting words: books are heavy as shit to box up and move EVERY SINGLE YEAR, and if you have any weird ADD stuff that you do (like my shampoo shot-put or my Dewey Decimal fetish) feel free to share it in a comment or something. Your insanity would offer me MUCH consolation. Ha.

But let’s start with our current standard: fluoxetine. Also known as Prozac, it is perhaps one of the most well known pharmaceuticals on the market, and is currently the most prescribed medication in the US. It’s prescribed for a variety of conditions, including Generalized Anxiety Disorder and Major Depressive Disorder (or, Clinical Depression). What is less widely known, however, is that neither doctor nor pharmacological engineer truly understands how or why it works – and doesn’t work – and, in fact, a large body of evidence indicates that it is no more effective than placebo. This isn’t a vendetta against Prozac, mind you — most of the newer antidepressants, particularly those in the class of drugs to which Prozac belongs — Selective Seretonin Reuptake Inhibitors, or SSRIs — have been proven no more effective than placebo time and again in various clinical trials. Clinical trials that produce unfavorable results or that are inconclusive often go unpublished, while one or two trials with positive results ensure Big Pharma turns a profit on their (multi-billion dollar) investment. It all sounds a bit suspect, but considering the astronomical risks they’re taking… I can almost look past it.

In any case, Prozac and other antidepressants are used primarily to treat Major Depressive Disorder (MDD), a psychiatric illness afflicting millions of Americans. MDD is characterized by: a loss of interest or pleasure in activities that used to be enjoyable, insomnia and/or sleeping excessive amounts, fatigue, lethargy, feelings of worthlessness or inappropriate guilt, poor concentration or difficulty making decisions, and thoughts of suicide or death. These symptoms must persist for at least 2 weeks in order to be diagnosed as MDD.

Now, although Prozac is often helpful, it carries quite a side effect profile with it. Compare the symptoms of depression to the adverse effects associated with Prozac:

aggressiveness, impulsiveness, irritability, restlessness, or inability to sit still; severe or persistent anxiety, trouble sleeping, or weakness; suicidal thoughts or attempts; tremor; unusual or severe mental or mood changes; unusual weakness; and worsening of depression (among others

Interestingly, the side effects of Prozac seem to coincide for the most part with the symptoms of MDD itself. Though it is unlikely that a patient would experience even a small proportion of the potential side effects, it is nonetheless a peculiar similarity. Although Prozac may often prove effective, most studies indicate it’s no more effective than placebo — and its side effect profile suggests we have no idea how it’s producing the positive outcomes that we do see.

All right – it’s starting to sound like I’m on a soapbox, so I’ll step down from my unintentional tirade. I won’t deny that SSRIs DO help a lot of people, even if we don’t know why, even if we have to deal with a number (WITH A SHITTON) of unpleasant side effects. The plot really started to thicken for me when (flashback to the beginning of the post — remember the link to that article about ketamine? Here I come, making a point at last) I read a new study which examined the antidepressant effects of a SINGLE dose of ketamine — administered intravenously – effects which caused total remission of symptoms in a majority of cases and which lasted a full seven days post administration. Additionally, these antidepressant effects were determined to be independent of any euphoria or intoxication related to the ketamine state. Again, ketamine is an NMDA-receptor antagonist, and it produces dissociative effects much like PCP or dangerously high doses of cough syrup (Robo-trippin!). It’s used as an anesthetic and a horse tranquillizer, and apparently it cures even the bluest of blues (at least until the clock strikes twelve and Depressed Dave turns back into a pumpkin, er, I mean a psychiatric patient).

WHAT. THE. HELL. I don’t know about you, but that blows my mind.

There are numerous advantages to a basically instantaneous reversal of depressive symptoms. Most importantly, this eliminates the risk of suicidal ideation and self-harm that many patients experience when their depression does not improve or worsens; furthermore, SSRIs carry a risk of actually inducing suicidal thoughts or actions — a side effect clinicians must watch out for. Ketamine, on the other hand, produces instant results with no risk of treatment-induced suicidal tendencies. What’s more, the patient won’t have to wait the typical 6-8 weeks for treatment to begin improving their quality of life. They’ll feel better before the doctor sends them home, even. Granted, the relief is short-lived, and ketamine is known to have addiction potential. But the mechanisms at work here, as well as the warp-speed recovery, are the keys to newer, more effective drugs and better treatment outcomes (happier patients! happier golden retrievers from those Cymbalta commercials! … who does depression hurt? …EVERYONE).

But unfortunately, we’re stuck with Prozac for the time being. All in all, it’s clear that we know very little about how these compounds produce the results they do, and even less about what causes the imbalances causing depression in the first place. Though I am certainly not one to discourage the use of pharmaceuticals, I do think it’s time we exercise more caution in clinical practice, as these drugs – which are prescribed more and more every day – may permanently alter your brain in ways we don’t yet understand. While it may still be a worthwhile option in the more severe cases (though not the mild to moderate cases of depression — read more here), a Lexapro a day won’t keep the weepies away for long for Joe Six-Pack and his Hockey Mom wife suffering from a touch of Seasonal Affective Disorder (or worse – suburban psychosis).

Parting words: depression is very real, and it’s not something you wear on your sleeve. If you think you’re depressed, talk to someone; and, if need be, talk to your doctor about medication. It’s still the best shot we have — just don’t make the decision to commit to pharmacotherapy lightly.

And for the FINAL parting words, a little dark humor (or at least, it’s humorous for me): I never could take those Zoloft commercials from like 2004 seriously. I’m pretty sure the Zoloft lump is a character out of a Shel Silverstein book… The Missing Piece Meets the Big O, I think? Come on, Pfizer. Don’t exploit my childhood like that.