God I wish you were still accepting new patients, the doctor i currently have is so under educated on this topic, thank you so much for this videos and for being such an effective communicator and educator.
@@DrJohnKruse I've struggled with Adhd and motivation/organization my entire life, thankfully my witt and charm has brought me enough success in life. Its a miracle I'm still employed, thanks in most part to my incredibly understanding boss. If you could do a video on how one should go about talking to their doctor about adhd, and the medications used to treat it, I know it would be a great help to me and many others. My psychiatrist did the Adhd test with me again recently, but for some reason is still opposed to treating it with medication, and wants me to simply continue with the Cognitive Behavioral therapy, which certainly helps... but I feel powerless in changing the chemical imbalance in my brain. I keep notes, have a calendar, set alarm reminders, and work out 2-3 times a week, and yet I still feel powerless and unmotivated to accomplish anything meaningful in life.
From someone who has never formally studied these topics outside of the minuscule amounts from high school, these are super helpful explanations of brain systems and its role in ADHD. Im starting to grasp the details a lot better from your videos. I like how the video has a fair amount of technical and mechanistic details and I appreciate that you break down the technical words and make it easier to digest / understand. Without simplifying it, I probably would not have followed most of it, so thanks for that.
Thank you for the Medium article! It was very informative and clarifying. Dopamine is a hot topic on social media, I hope you make more videos about this!!
Thank-you again for making these! As a layman with some rudimentary neurological and biochemical knowledge: these videos are phenomenally instructive, I hesitate to say, "autopsies," of what's going on in my own prefrontal cortex (or rather isn't). What a phenomenally energetic man Stahl is! Yes, the signal/noise analogy, among others, certainly rings true.
Throughout your career as a psychiatrist treating ADHD, what would you say is the chance of someone not responding well to stimulant medication? And do you have any theories to why methylphenidate work better for some, while for others amphetamines work better?
I would say that upwards of 85% of people I have worked with have had at least some positive response to stimulants, but the number who take them regularly is substantially lower. I've worked with people who had adverse effects from amphetamines, or who were worried about the risks of them, and so they opted for methylphenidate, but in terms of benefits/efficacy, I see many more people who prefer amphetamine to methylphenidate. On a simplistic level, amphetamine is doing more -causing more dopamine / and or norepinephrine to be released.
@@1dayx Dr.Kruse would you think someone who's worried about the vasoconstriction should talk to their doctor about Methylphenidate vs Dextroamphetamine/Vyvanse? I hear the D isomers of amphetamines cause less peripheral side effects. And is Dexmethylphenidate (Focalin) something thats still prescribed? I was on Vyvanse and later Ritalin during my late teens in high-school and Community College.
Have you had clients that tried all of the major 3 (methylphenidate, amphetamine/vyvanse, atomoxetine) and eventually chose atomoxetine as their superior med (+small stimulant dose), not because they did not tolerate stimulants at higher doses, but for them it was actually the better drug. Can you cluster the patients within a certain subtype of adhd/add or do they have something in common? Is it possible to say for what type of patient atomoxetine is the better drug (apart from the obvious drug abuse answer...).
I'm not a big fan of atomoxetine (ua-cam.com/video/xsUYWBZcK9k/v-deo.html) and I wouldn't call it one of the major 3. I do have a few individuals who preferred either bupropion or duloxetine to the stimulants, feeling that it was optimal for them, but not large numbers. I can't discern clear patterns in terms of demographics or symptom profiles for those experiencing better effects from a "non-stimulant"
@@DrJohnKruse Ok, I see that your scepticism mainly derives from the fact that it is somewhat poorly tolerated and that therapeutic doses are >=80 whereas often times these doses are not reached due to tolerability issues... At the same time: If you do tolerate it, then you would consider it a good drug? What do you think of it as an addon like a baseline dose (10,18 or 25mg) of atomoxetine together with a combination of amphetamine+methylphenidate? Have you seen that and if so how did that turn out in long term?
@@digxx Yes, when tolerated it often works well, and I have worked with many people who used it alone or in combination with methylphenidate or amphetamine products. I haven't seen that many people who took that low a dose of atomoxetine with other agents.
@@digxx I'm not sure I've met too many "typical" people in the world, so I'll speak more in terms of ranges. Those who I've worked with who are on a combination of these two drugs are usually taking 60-100 mg atomoxetine and anywhere from 10-60 mg methyphenidate. Worry less about what others are taking, and focus more on what the medications are doing for you - both in terms of benefits and side effects.
God I wish you were still accepting new patients, the doctor i currently have is so under educated on this topic, thank you so much for this videos and for being such an effective communicator and educator.
You're welcome!
@@DrJohnKruse I've struggled with Adhd and motivation/organization my entire life, thankfully my witt and charm has brought me enough success in life.
Its a miracle I'm still employed, thanks in most part to my incredibly understanding boss.
If you could do a video on how one should go about talking to their doctor about adhd, and the medications used to treat it, I know it would be a great help to me and many others.
My psychiatrist did the Adhd test with me again recently, but for some reason is still opposed to treating it with medication, and wants me to simply continue with the Cognitive Behavioral therapy, which certainly helps... but I feel powerless in changing the chemical imbalance in my brain. I keep notes, have a calendar, set alarm reminders, and work out 2-3 times a week, and yet I still feel powerless and unmotivated to accomplish anything meaningful in life.
From someone who has never formally studied these topics outside of the minuscule amounts from high school, these are super helpful explanations of brain systems and its role in ADHD. Im starting to grasp the details a lot better from your videos. I like how the video has a fair amount of technical and mechanistic details and I appreciate that you break down the technical words and make it easier to digest / understand. Without simplifying it, I probably would not have followed most of it, so thanks for that.
I'm glad that it helps and I appreciate you taking the time to let me know that.
Thank you. All of the effort you give towards enhancing collective understanding is appreciated.
Thank you once again Dr K
Thank you for the Medium article! It was very informative and clarifying. Dopamine is a hot topic on social media, I hope you make more videos about this!!
Thank-you again for making these! As a layman with some rudimentary neurological and biochemical knowledge: these videos are phenomenally instructive, I hesitate to say, "autopsies," of what's going on in my own prefrontal cortex (or rather isn't). What a phenomenally energetic man Stahl is! Yes, the signal/noise analogy, among others, certainly rings true.
Throughout your career as a psychiatrist treating ADHD, what would you say is the chance of someone not responding well to stimulant medication? And do you have any theories to why methylphenidate work better for some, while for others amphetamines work better?
I would say that upwards of 85% of people I have worked with have had at least some positive response to stimulants, but the number who take them regularly is substantially lower. I've worked with people who had adverse effects from amphetamines, or who were worried about the risks of them, and so they opted for methylphenidate, but in terms of benefits/efficacy, I see many more people who prefer amphetamine to methylphenidate. On a simplistic level, amphetamine is doing more -causing more dopamine / and or norepinephrine to be released.
@@1dayx Dr.Kruse would you think someone who's worried about the vasoconstriction should talk to their doctor about Methylphenidate vs Dextroamphetamine/Vyvanse?
I hear the D isomers of amphetamines cause less peripheral side effects. And is Dexmethylphenidate (Focalin) something thats still prescribed?
I was on Vyvanse and later Ritalin during my late teens in high-school and Community College.
Such an interesting topic!
Have you had clients that tried all of the major 3 (methylphenidate, amphetamine/vyvanse, atomoxetine) and eventually chose atomoxetine as their superior med (+small stimulant dose), not because they did not tolerate stimulants at higher doses, but for them it was actually the better drug. Can you cluster the patients within a certain subtype of adhd/add or do they have something in common? Is it possible to say for what type of patient atomoxetine is the better drug (apart from the obvious drug abuse answer...).
I'm not a big fan of atomoxetine (ua-cam.com/video/xsUYWBZcK9k/v-deo.html) and I wouldn't call it one of the major 3. I do have a few individuals who preferred either bupropion or duloxetine to the stimulants, feeling that it was optimal for them, but not large numbers. I can't discern clear patterns in terms of demographics or symptom profiles for those experiencing better effects from a "non-stimulant"
@@DrJohnKruse Ok, I see that your scepticism mainly derives from the fact that it is somewhat poorly tolerated and that therapeutic doses are >=80 whereas often times these doses are not reached due to tolerability issues... At the same time: If you do tolerate it, then you would consider it a good drug?
What do you think of it as an addon like a baseline dose (10,18 or 25mg) of atomoxetine together with a combination of amphetamine+methylphenidate? Have you seen that and if so how did that turn out in long term?
@@digxx Yes, when tolerated it often works well, and I have worked with many people who used it alone or in combination with methylphenidate or amphetamine products. I haven't seen that many people who took that low a dose of atomoxetine with other agents.
@@DrJohnKruse What is the typical dose of atomoxetine + methylphenidate you have seen? 60mg + 40mg?
@@digxx I'm not sure I've met too many "typical" people in the world, so I'll speak more in terms of ranges. Those who I've worked with who are on a combination of these two drugs are usually taking 60-100 mg atomoxetine and anywhere from 10-60 mg methyphenidate.
Worry less about what others are taking, and focus more on what the medications are doing for you - both in terms of benefits and side effects.
Did they try l-dopa only in adhd to differentiate between noradrenaline und dopamine?
Two small, old studies on L-DOPA and ADHD found no effect in children, and just a transient effect in adults. But I wouldn't call that definitive.
@DrJohnKruse thank you sir!