# Belated neuropharmacology links... # Fun (?) Google's been [serving AI-generated](https://www.404media.co/google-serves-ai-generated-images-of-mushrooms-putting-foragers-at-risk/) mushroom photos 🫠 # ADHD ## [Standard Treatment vs CAM for ADHD](https://psychopharmacologyinstitute.com/section/an-overview-of-standard-treatment-vs-cam-for-adhd-2689-5360) ![Possible Nutrient Deficiencies in Children with ADHD | Download Table](https://www.researchgate.net/publication/307728786/figure/tbl1/AS:613936768495652@1523385340923/Possible-Nutrient-Deficiencies-in-Children-with-ADHD.png align="left") * CAM stands for Complementary and Alternative Medical therapies, e.g. CBT, micronutrients, not getting vaccinated… * Approximately 70% respond to stimulants and/or CBT, yet the remaining 30% just call “hey it’s a multifaceted condition, my ass” * ADHD sufferers often have decreased magnesium, zinc and iron blood levels → it stands to reason that alleviating those deficiencies can help - at least temporarily. Et voila, [54% had experienced symptom relief](https://www.jaacap.org/article/S0890-8567\(21\)00473-1/fulltext)! * I’d still put in [memantine on my short-list](https://www.perplexity.ai/search/micronutrient-therapy-and-mema-vy6QYdaXQi.3nqc4ug1drQ) of “screenshot that, it’ll help” for ADH/D and ASD: IMO the *“*[*less pruning*](https://other-autism.com/2024/01/31/neural-pruning-synesthesia-and-autism/) *→ higher excitation and excitatory propagation probability →* [*symptoms depending*](https://www.newscientist.com/article/2370409-lack-of-neuron-pruning-may-be-behind-many-brain-related-conditions/) *on brain regions (*[*inattentiveness*](https://theneurodivergentbrain.org/synaptic-pruning-in-adhd/)*, special interests, meltdowns, mysophonia, hyperfocus, you name it…)”* hypothesis will hold at least partly true some day. * Surprise-surprise - methylphenidate doesn’t F up the sleep in ADHD any further, it even [seems to be able to improve it slightly](https://psychopharmacologyinstitute.com/section/long-term-effects-of-methylphenidate-on-sleep-in-children-and-adolescents-with-adhd-2789-5695) ## [ADHD algorithm](https://psychopharmacologyinstitute.com/section/treatment-algorithm-for-adult-adhd-2835-5765) * *Non-stimulants (clonidine, memantine, modafinil, guanfacine etc) > atomoxetine > methylphenidate > amphetamines* for the sake of safety ![](https://cdn.psychopharmacologyinstitute.com/transcripts/%5B8605%5D%20Treatment%20Algorithm%20for%20Adult%20ADHD/image7.jpeg align="left") * CBT for **executive function** deficits as you don’t want to prescribe adderal to anyone and everyone since childhood, pals * **Own note**: introduce bupropion **carefully** because of its [seizure threshold action](https://www.medicalnewstoday.com/articles/325791) * **Own note 2**: consider [lamotrigine](https://pubmed.ncbi.nlm.nih.gov/23784736/) for reasons similar to memantine (memantine may cause brain fog for some due to [alpha7 nAchR blocking action](https://pubmed.ncbi.nlm.nih.gov/15522999/)) * Comorbid **depression**: bupropion + SSRI/SNRI * Comorbid **anxiety**: atomoxetine + SSRI/SNRI The fun thing - *proposed* algorithm is precisely inverted: ![](https://cdn.psychopharmacologyinstitute.com/transcripts/%5B8605%5D%20Treatment%20Algorithm%20for%20Adult%20ADHD/image5.jpeg align="left") # Depression ## [Comorbid depression and diseases: antidepressants](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10483387/) ![An external file that holds a picture, illustration, etc. Object name is jamapsychiatry-e232983-g004.jpg](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10483387/bin/jamapsychiatry-e232983-g004.jpg align="left") Pretty much this - antidepressants can, at least partly and sometimes, decrease the risk of comorbid diseases worsening. Let’s theoritise why: * Decreasing [clotting/embolism risks](https://www.sciencedirect.com/science/article/abs/pii/S1043661816307769) (less platelet serotonin → less probability of platelet activation → huh) * Some [anti-inflammatory effects](https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2022.1039379/full) via ⬇️ TNF-a, ⬇️ IL-6: ![](https://www.frontiersin.org/files/Articles/1039379/fnins-16-1039379-HTML-r1/image_m/fnins-16-1039379-t002.jpg align="left") ## [Which Antidepressants Have the Highest Risk of Discontinuation Symptoms?](https://psychopharmacologyinstitute.com/section/which-antidepressants-have-the-highest-risk-of-discontinuation-symptoms-2830-5756) ![Relational psychiatry: More research required on withdrawal from antidepressants](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgM7K6pDZCa579mn_DXz4JUrhCANYW0I_JrgvZw3HKBZ6TfoPseor_esTV9-uL7YzYlNn5XIuTqp_m_lvfD9sFuLOrAW6CKBqyHcv7TswYjvEkC1ri7lJ4VaZ-Yu4P1WuW9jzm2lQ/s1600/Anti-depressant+Withdrawals.jpg align="left") * ~17% of those taking antidepressants suffer from withdrawal and discontinuation symptoms (note: yeah yeah [of course, just 17%](https://www.survivingantidepressants.org/)) * Higher **rates of symptoms emerging**: imipramine, desvenlafaxine, venlafaxine and escitalopram * More **severe symptoms:** imipramine, desvenlafaxine, venlafaxine and paroxetine (more mechanisms + shorter half-life) * **Lowest rates**: sertraline and fluoxetine. Fluoxetine is often used to taper off the more ‘notorious’ medications due to its half-life. *Like, after taking it for a month it’ll have inhibited P450 metabolising itself so you’ll be able to wait over for Half-Life 3* --- Welcome to **Teleogenic**❣️ Other places I cross-post (not always) to: * [**Hashnode**](https://posts.teleogenic.com) * [**Medium**](https://baldr.medium.com/) * [**Telegram**](https://t.me/ohmyboi) * [**Twitter**](https://twitter.com/ZakharKogan) * [**LinkedIn**](https://www.linkedin.com/in/zakhar-kogan/)