An Interview with Dr. Charles Parker
By Rheba Estante
Dr. Parker is a Child and Adult psychiatrist board certified in Adult and Forensic psychiatry. He specializes in diagnostic and medical services for troubled children, adolescents and adults. His broad range of clinical experience, from psychoanalysis to substance abuse, to psychopharmacology and SPECT neuroimaging, and his experience with systems/functional medicine and neurofeedback provide a comprehensive foundation for treatment interventions and recommendations.
Dr. Parker is the author of Predictable Solutions For ADHD Medications, a report on the misdiagnosis and improper treatment of ADHD. He treats patients utilizing neuroscience research on the connections between communication networks between the brain, the endocrine system and the immune system. His websites are: http://parkerschlichterandassociates.com/dr-charles-parker and http://www.corepsychblog.com .
In this interview with Rheba Estante, the ADDA e-News Neuroscience Editor, Dr. Parker answered a few questions on medication management and solutions to common issues faced by ADHD patients in getting the right dosage to manage their condition.
Q: Why do people say their medications stop working or that they have to keep switching dosages and types of prescriptions to manage ADHD?
There are many layers to the issue. We know a tremendous amount about immunity but it is not communicated effectively to people prescribing medication. That's why my work is focused on sharing this information. It has significant implications in how psychotropic medications work for ADHD. If we know about these other parameters, maybe we won't think so superficially. The brain is linked to the body on many levels, such as immunity and digestion. There is an entire hormone system that impacts absorption of medication.
The medical community is trying to decide what is right and what is wrong, while the academic community is stuck on old labels and ways of thinking about synaptic psychopharmacology. I am not condemning my colleagues in this regard, but we are keeping blinders on when we really need to look at the entire picture. I am looking at the big picture, and I am especially interested in the pre- and extra-synaptic, and all the things that affect dopamine and serotonin.
Immune function affects receptors and their ability to convey messages across the brain. What we know now about modifying receptors, neurotransmitters and immunity will only affect psychiatry in 10 years. We're looking at the precursors to neurons and what feeds into them before they become neurotransmitters. How do they progress from food intake to brain synapse? People need to know much more about this.
I described Taxilaxis - the need to keep increasing the dosage of medication for it to be effective - on my blog in the fall of 2011. The medical community is aware of this with addictive medications. Benozos (Xanax), for example, requires an increasing dose and can become addictive, so the medical community watches for it. However, the effect can be similar with stimulants.
In our office, we use a narrow and roving therapeutic window. Predominantly, stimulants have a half-life less than 24-hours (between 4 and 12 hours). ADHD medication is typically taken in the morning and we need to know how long it will remain effective. Immediate release has a 4-hour burn rate, and if you try to make it last longer, you risk overdosing to extend duration because you're messing with the therapeutic window. Extended release Adderall (8 to 12 hours) taken at 8 am will work until about 3 to 5 pm. Once you're outside that window, you're pushing it to do more than it can do, which is ineffective. You have to find the sweet spot.
Understanding a person's metabolic background, and awareness of such things as taysine and gluten allergies is helpful. Milk and wheat allergies are common. By dealing with allergies and accounting for them, we can increase a medication's effectiveness. When practitioners find they are chasing the sweet spot to get the right dosage, there likely metabolic and immune issues involved. I wrote about it in my fact sheet "Predictable Solutions ."
Q: How does immune and digestive function affect a medication's effectiveness?
Messenger proteins affect our bodies, and several of these proteins arise in allergic conditions to signal body changes. It's not surprising to find a relationship between ADHD and immune system deregulation. The immune system is the only system in the body that has the memory of the brain and nervous system. If you experienced an event perceived by your mother's system as an attack and experienced an immune reaction in utero, your immune function would remember it. We conduct tests to determine what's causing a person to have a food problem. Bottom line; with accurate testing, medications work better. My perspective is a scientific one - I'm a traditional psychiatrist with an interest in molecular physiology taking a comprehensive approach that combines traditional psychopharmacology with biomedical testing.
Q: What is the connection between the body and the brain that can disrupt medication? Are patients sentenced to just changing medications over and over again?
I use what is called a Neuro-Endo-Immune (NEI) approach. Neurological, Endocrine, and Immune are the three main systems that can imbalance function.
Neurotransmitters can be too high or too low. We've seen people experience years of unsuccessful psychotherapy and psychopharmacological attempts when the focus is on synapses and dopamine receptors, without sufficient neurological examinations. Neurotransmitter levels are highly representational as they are biomarkers for regular medical activity. Current diagnostic codes are not connected to biology. Depression is a diagnosis based on appearances, how a person looks, rather than how the brain functions.
The endocrine system presents similar challenges. Women can experience estrogen dominance related to Premenstrual Syndrome (PMS) and Polycystic Ovary Syndrome (PCOS), and all the associated sleep and migraine related problems. We can't ignore that when we're treating someone with psychiatric medication. And when people return from war, we're overlooking adrenal function except for one cortisol test, and we don't measure adrenal fatigue. But in all these cases, the endocrine system's behavior is very relevant to brain function.
The immune system can have a dramatic effect as well. I had a patient who was hallucinating. She was sensitive to wheat, but there was something more wrong. We discovered, through heavy metal testing, that she was significantly toxic with bismuth. In chelating it from her bloodstream, her hallucinations went away. The toxicity resulting from the foods she was eating had caused deregulation. Her body had an immune reaction that affected both her neurology and her hormones.
All three systems have receptors, and they are all talking to each other constantly. We've been treating the brain in isolation for years, but the brain is connected to and affected by all these systems.
Q: Do you have any advice for parents or patients?
Patients need to be informed consumers. Read the available literature on these issues, and start conversations with your doctors about what they're doing to look at brain function explicitly. My book, ADHD Medication Rules: Paying Attention To The Meds For Paying Attention is an attempt to move in that direction. The entire family needs to understand intervention, eating protein for breakfast, proper sleep, and other factors people are not thinking about when they put together a treatment program. ADHD is a contextual diagnosis.
Q: Why is ADHD still such a controversial diagnosis and why are women with ADHD sometimes missed?
It has to do with recognition of the problem. Based on the current diagnostic manual, impulsive and hyperactive people get more attention because of the trouble they cause for themselves and others. Our current criteria do not identify daydreamers or those who seem still. They're also affected but are often missed. We need to ask questions that delineate brain functions instead of appearances. The current diagnostic codes don't allow for that. They have no real merit in identifying the problem, and so lead people to misunderstand the condition. If we understood the brain functions that are affected, we'd be more able to see deterioration in executive function or de-synchronization of thoughts and actions. Procrastination is often missed as a symptom because we fail to connect the cause of poor brain function with timing problems.
Q: What is more effective for combined-inattention ADHD, Ritalin or Adderall?
Studies show that amphetamine (Adderall) works better but methylphenidate (Ritalin) is more forgiving. When you're using Adderall, you have to know what you're doing and you'll need more scientific care. Dosage has a direct relationship to metabolic variables.