ADHD, Depression & Anxiety Serotonin & Dopamine Tutorial

Welcome folks. Dr. Charles Parker. I’m here to tell you about one of the most important clinical problems that we see almost every day and my outpatient offices and I we’ve been seeing him since the early 90s and we’ve been talking about it for Many many years and it’s this following problem regarding missed diagnosis and miss treatments of comorbid Attention deficit disorder and depression. So I called the basal ganglion seesaw If a person has depression and a DD at the same time and one of those halves is missed It makes the whole problem much worse and the person feels Completely untreatable like a treatment failure, you know If you feel like you’re a treatment failure, you’ve been treated and treated and treated for depression, but it’s not getting better it could be that you have a Significant attention deficit disorder problem associated with it. So how does the Seesaw work. Well, it’s really simple on this side of the equation. The seesaw is a balance like a regular seesaw on you got Attention deficit disorder on this side and depression on this side. Okay. So attention deficit disorder has People have a problem with dopamine deficiency. I’m Oversimplifying it. But let’s just call it a dopamine relative dopamine deficiency, and we’re going to treat that dopamine deficiency with a Dopamine a dopaminergic an medication or something He’s going to affect the dopamine function on that side of the equation and a person who has depression many forms of depression predominantly Serotonergic li related so you’re going to use a serotonin medication for depression Now if you miss one of those halves here’s what happens So assume that a person has both problems going on but one half of its not recognized So what happens is a smart? Pediatrician comes in and sees this child with attention deficit disorder treats the dopamine side of the equation and pulls that dopamine up appropriately What happens to? the Serotonin, it actually goes that well what happens when serotonin which is already? Compromised goes down Well, the child feels like they’re completely depressed. They crash very hard in the afternoon vigorously and what happens then the individual most of the time the physician will try to change the dopamine product repeatedly and And miss this side of the equation Pediatricians are not trained on the depression side Some of them are not trained on the attention deficit disorder side But that’s how the oversight occurs now if you take the other side of the equation what happens frequently with adult psychiatrists? Not all of them But and this is not all pediatricians all but this is what happens an individual who sees only part of it Say an adult psychiatrist sees only the depression they get the serotonin, correct But they aren’t really trained to recognize attention deficits of problems In fact, many of them just don’t believe in attention deficit disorder, which is a whole nother thing So what happens is you get the serotonin treated you get the dopamine comedown? What happens when a person loses their? Executive function you tell me Bipolar illness. Yeah, it’s not bipolar It is a half of the half of the diagnosis is missed. You can’t treat a Serotonergic lis related problem a depression with the dopamine Nor can you treat a dopamine? Problem with serotonin serotonin doesn’t treat a dopamine problem Dopamine doesn’t treat a serotonin problem. So you have to treat both of the problems simultaneously It’s just like if you came in and you had heart disease and outra physician I said listen, I know you got heart disease But I’m going to try and treat it with Insulin, I’m going to give you some diabetic medication and imma cross my fingers and hope that it works for heart disease I don’t think so So what happens is we have two different relative two different Disease states really for one of a better expression one of the dopaminergic lis related one I’m serious, and article e related and we have to treat each one Simultaneously carefully with very clear ideas of what we’re doing on both sides of the equation very simple very quick Think about this don’t treat depression with a stimulant. Don’t treat a DD with a serotonergic Antidepressant it will not work. The person will get worse and will very likely be called you guessed it Bipolar illness and get a big dose of depakote, which they don’t deserve. So thanks for your attention Talk to you later. Have a good one

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