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CFS: 3 Cases and a Discussion of the Natural History of ADHD

Discussion in 'Latest ME/CFS Research' started by Firestormm, Feb 12, 2013.

  1. Firestormm

    Firestormm Senior Member

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    I haven't read or tried to access the full paper. A possible sub-category of patients who are unresponsive to whatever 'treatment' this paper has employed for CFS might have ADHD. Only 3 cases. Pretty small to build a model upon. Still, who knows what is in the 'pot' and how many people might benefit from a better examination and more appropriate diagnosis and treatment?

    SaraM likes this.
  2. Valentijn

    Valentijn Activity Level: 3

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    Yeah, let's ignore that symptoms are completely different. If a CFS patient responds to a stimulant instead of a typical anti-depressant, ADHD must be the answer! Just because two disorders have some response to the same drug, does need mean they are the same disorder.

    I have never had ADHD symptoms, yet an "ADHD drug" helps me. And not with symptoms related to ADHD, but with orthostatic hypotension. I think the researcher is having trouble realizing that a drug approved for a particular use does not make that drug only useful for that one use.

    He also badly misunderstands ME/CFS if he thinks it's all about "chronic fatigue and pain".
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  3. Valentijn

    Valentijn Activity Level: 3

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    Right. The author runs a behavioral clinic staffed with psychologists and psychiatrists.

    Thus anything he observes that isn't solely psychological will still be interpreted as psychiatric.
  4. Firestormm

    Firestormm Senior Member

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    Is is a free access essay, Val? Thanks.
  5. Valentijn

    Valentijn Activity Level: 3

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    Nah, have to subscribe/create a logon/whatever. The clinic website just has a list of publications, no links.

    And it looks like typical psychobabble, in addition to being on a very small scale, so I'm not really interested enough to look for the full paper. I mean "stimulants make fatigue patients less fatigued" is probably as good as it gets, since there was no reference to specific improvements, etc, in the abstract. Based on that abstract, it sounds like one guy pulling random theories out of various body parts based on his unscientific observations of three undefined patients. Not an actual study or anything.
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  6. Firestormm

    Firestormm Senior Member

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    I see from another thread Val, you appear to be taking ADHD medication - Strattera? I know this paper is based on a very small sample, but I wonder if this med was one that they used and if in fact by your own experimentation there is perhaps some link - maybe based solely on symptom relief and some mechanism in the body that produces similar symptoms.

    I couldn't see any reference in the FDA information relating to Orthostatic Intolerance (which are the symptoms you appear to suggest have been aided by taking Strattera) - perhaps the attributed symptoms are blurred. Was this a drug you stumbled across yourself - I see you are playing with the doses - or something prescribed for OI?

    I'd be interested to learn more about Strattera and OI and if indeed ADHD does have a cross-over with CFS/ME. Will have a search on-line and see if any other papers have suggested a link - even if only as a subset. Might try and read the above paper in full.
  7. adreno

    adreno 3% neanderthal

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    I doubt they used strattera in the study, it isn't a psychostimulant. A psychostimulant would be either amphetamine or methylphenidate.
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  8. Valentijn

    Valentijn Activity Level: 3

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    The website for the clinic involved lists Strattera as a non-stimulant ADHD drug, so the current paper would not have included it.

    Another forum member with identical OI symptoms had tried it and found it very effective. On that basis I researched it some more, and since it is an NRI, and norepinephrine controls blood pressure, and my norepinephrine levels were quite low, trying it was sensible. Of the NRI's listed, it is also the only one which does not list "hypotension" as a potential side effect - I have enough of that already and hardly want more of it!
  9. Firestormm

    Firestormm Senior Member

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    Thanks Adreno. I will try and get hold of the full paper and do a search for others I think.

    I did notice in the FDA Strattera information it in fact warned that Orthostatic Hypotension was a possible side-effect although it appears to only have occurred in very few instances:

    There is a trial that is still recruiting in the USA and is in Phase II that looks at OI and will be using Strattera that I have just come across: http://clinicaltrials.gov/ct2/show/NCT00262470

    Seems to have been taking a long while to get this Trial going. Began in 2003.
  10. Valentijn

    Valentijn Activity Level: 3

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    To clarify, this is manufacturer information, and not FDA information or an FDA warning. Also, as you quoted, that information is based solely on studies of children.
  11. Firestormm

    Firestormm Senior Member

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    There is information pertaining to adults throughout that information Val, and all of it has been approved by the FDA - whether it originated with the manufacturer or not.

    I came across two sites that are basically reviews from people with CFS who are claiming to have taken Strattera, but nothing thus far from an official source.

    The previous link to the Phase II Trial might yield further information - in respect of a treatment for OI - and I'll maybe have a word with Prof. Newton to see if she is aware of this Trial and of these drugs.

    It would be interesting to learn how they arrived at all those drugs they are trialling as experimental possible treatments for OI. I will continue looking for any papers published on this one. It would be very good for a drug to be made available to those in our community who experience and are diagnosed with POTS for example.
  12. adreno

    adreno 3% neanderthal

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    Right, and this is hardly surprising. When you take an NRI you're messing with the ANS. This can cause all sorts of changes in blood pressure etc. Be aware that an NRI will improve some forms of OI, but worsen others. Beta-blockers, which has an opposite effect of NRIs, are also used in treating POTS. POTS is very complex, and there is no uniform treatment. Also, POTS and orthostatic hypotension isn't the same thing. In any case, why are we shifting the focus to OI and strattera? It really has got nothing to do with the subject of this thread.
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  13. Firestormm

    Firestormm Senior Member

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    Because Strattera is a treatment for ADHD - which is the topic of this thread - and Val was on another thread - as a patient with CFS - finding that Stattera has helped with her OI symptoms.

    I'd be interested to learn if any other studies have been found that attempt to link ADHD with CFS (as subsets thereof), and to pursue these kind of treatments in terms of OI.

    I'd also like to learn what the treatments were within the paper at the top of this thread.
  14. adreno

    adreno 3% neanderthal

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    Well, for instance methylphenidate has been used as a treatment:

    Use of methylphenidate in the treatment of patients suffering from refractory postural tachycardia syndrome.

    I do not really see the link with ADHD, however. ADHD is a central disorder (hypoactive PFC), whereas POTS seems to be a peripheral problem. The stimulants and NRIs work for (some types of) POTS because they increase vasoconstriction and pressor response, not because of any central effects on the PFC. The central effects of stimulants would affect fatigue and pain though.

    In other words, the article seems to suggest that CFS is a central disorder, similar to ADHD, and as such it is dissimilar to OI. Though OI may cause brainfog, it is not the same disorder as ADHD, not even close. Anyway, none of this is news. We need to see the exact mechanism described in the paper, otherwise it is worthless.
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  15. adreno

    adreno 3% neanderthal

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    As I said, this line of thought has been pursued before:
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  16. Valentijn

    Valentijn Activity Level: 3

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    I've never really delved into the central versus peripheral aspects of disorders and the effects of drugs, and I think you've provided a very nice and concise explanation here. It could also explain the confusion of the therapist who wrote the paper ... he's primarily focused on psychiatric treatment, so his understanding of some of the more subtle aspects of the human nervous system (especially central versus peripheral) is probably understandably limited.
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  17. adreno

    adreno 3% neanderthal

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    Also, for ADHD the D-isomer variant of stimulants (dexamphetamine, dexmethylphendate) is often used, because it has far less peripheral effects than the racemic drugs, but is still very effective for ADHD. In cases of ADHD, you are not interested in peripheral effects, such as vasocontriction. These peripheral effects have even lead to Raynauds in some cases, and are generally unwanted. For OI however, you would of course choose the racemic version.
  18. Firestormm

    Firestormm Senior Member

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    To my naive way of thinking, ADHD is about a state of hyperactivity, mental and physical. It is the cognitive aspect of this that interests me the most. If these drugs given as 'stimulants' it would seem contra to any attempt to 'calm' the patient and enable better engagement.

    If the symptoms of ADHD might be said to be similar in some aspects to CFS i.e. the lack of ability to concentrate, process information, constant state of 'arousal' at least mentally and an inability to 'calm' - then treatments for ADHD might have some similar effect on these aspects of CFS.

    However, as with all attempts to 'calm' and enable improved concentration etc. there is a risk of further 'fatigue'. This drug Strattera is however a stimulant and this is where I get lost. What is it stimulating? Better concentration etc.? How does that work exactly, as I would have thought you'd want to 'calm' this state of over-arousal.

    I will take a closer - layman's - look at this when I get back.

    Thanks.
  19. Valentijn

    Valentijn Activity Level: 3

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    So it sounds like an adult-onset ADHD would necessarily be a contradiction in terms. Maybe one of those things people like to use to explain why they aren't paying attention to what other people say ... and useful for therapists that want to broaden their customer base.

    Bah, you'd think with it being preferred for comorbid psychiatric disorders, the nasty neurologist I saw would've thought it was a great idea for an ME patient :rolleyes:

    I don't know about tics and spasms, but muscle twitches seem pretty common for ME patients.

    I've never tried stimulants (barely even get caffeine), so no idea what effect they'd have on me. I'm also a bit leery of the possibility of a "stimulate you now, PEM you later" effect.
  20. adreno

    adreno 3% neanderthal

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    ADHD is not a state of hyperarousal. It is hypothesized that the dopaminergic connections from the perfrontal cortex to the more primitive sites in the midbrain are hypoactive. This means ADHD patients have less impulse control. You cannot think of the brain as a uniform whole, different regions have different functions, and you can have hypoactivity in some areas and hyperactivity in others. The regions that control wakefulness and pain are also in the midbrain, not the PFC, again this has nothing to do with ADHD. The use of stimulants in ADHD is really not counterintuitive, because they strengthen the dopaminergic connections coming from the PFC, allowing the patients to apply impulse control and concentrate.
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