Is a thyroid-related issue a prerequisite for challenging perimenopause & menopause experiences?
Why are the symptoms of peri/menopause and thyroid-related issues near identical?
Is pregnenolone the ideal HRT due to it's various therapeutic qualities and role as a precursor for all other hormones?
The DSM questions it's own interpretation of ADHD, direct quote: >“[O]n the basis of patterns of symptoms, comorbidity, and shared risk factors, ADHD was placed with neurodevelopmental disorders, but the same data also supported strong arguments to place ADHD within disruptive, impulse-control, and conduct disorders”
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Psychiatrists critical perspective (dated 20 May):
there have been well-known cases of MDs having corrupt ties to Pharma, and the resulting bias from such relationships did in fact alter collective medical practices.
the DSM has always catered to the prevailing political demands of its time (even more so than catering to the commercial interests of Pharma). This is a bigger systemic problem than Pharma’s influence.
the DSM is not a medical document, though it pretends to be one. It has to balance the interests of many non-medical professionals and societal agencies, which happen to be the biggest consumers of the DSM (the insurers, the legal courts, the school system, the psychotherapy clinics…etc). The APA’s largest stream of income comes from selling the DSM. Again, that is a more problematic issue than Pharma funding.
many MD researchers currently producing quality “medical knowledge”, do have ties to, or are sponsored in some of their studies by, Pharma. Funding sources do create a known bias in the literature, this does not suffer from a hidden “cabal” effect, and to an extent, most funding bias can be managed and controlled for in the final analysis of data.
Most MD researchers do not work for Pharma. Psychiatry actually has less Pharma funding than many other fields of medicine.
Any experienced MD researcher knows how to study medicine/psychiatry without necessarily being forced to sacrifice data findings to commercial interests. When they actually do alter the fidelity of the data for commercial interests, it is a choice that the researchers are exercising. Some MDs are corruptible and do cause a lot of damage if they are not called out for their actions.
the extent of “negative” Pharma effect on medical data, and how generalizable/systemic it became, is a serious matter, and medicine should have its own system of correction.
Pharma ties to medical researchers are best balanced by advancing other forms of research backing (eg NIMH), where applicable. And by populating agencies with varied views on medical interventions based on the original source of funding. In psychiatry, there are many non-MDs who contribute to the science, more so than other fields of medicine.
the source of funding can always be problematic. Jeffrey Epstein managed to fund many researchers(mostly in social sciences)
the MDs/their representative national organizations should have the ultimate oversight over Pharma. But keep in mind that Pharma itself tries to undermine the authority of MDs specifically by advancing the expertise of non-MDs (as in these papers) and end up benefitting from the same article that putatively critiques its influence.
"Vitamin" D3 is a prototypical secosteroid which originates from cholesterol, as do all steroid hormones (including glucocorticoids, mineralocorticoids and neurosteroid hormones).
>Vitamin D is a secosteroid hormone exerting neurosteroid-like properties. Its well-known nuclear hormone receptor, and recently proposed as a mitochondrial transcription factor, vitamin D receptor, acts for its primary functions. The second receptor is an endoplasmic reticulum protein, protein disulfide isomerase A3 (PDIA3), suggested to act as a rapid response.
Half-life: >...the body stores vitamin D-hormones in adipose tissue with a half-life on the order of months...
>With a half-life on the order of months for both D2 and D3, summer sun exposure may provide enough supply to last through darker winter months, except in those living in places where sunlight is severely limited such as nursing homes or the arctic. For this reason, the use of the term “daily,” in the context of required or recommended allowances, warrants reconsideration. Otherwise, one is left with the impression that every cloudy day requires dietary supplements.
>It is little known that the metabolism, biodistribution, and effects of vitamin D-hormones likely depend on their source – from sunlight or diet. [...] When produced in the skin via sunlight, vitamin D-hormones are carried in the bloodstream by DBP. When derived from the diet, 90% of the dose is absorbed from the intestine within chylomicrons along with other fat and fat-soluble nutrients [...] chylomicrons, the fats and dietary vitamin D-hormones that they carry, avoid the portal circulation and first-pass metabolism in the liver. Instead, they are delivered to the peripheral circulation where endothelial lipoprotein lipase breaks down the triglycerides, delivering fats to the cells in adipose tissue and muscle.
5-HT: >The vitamin D–serotonin biochemical relationship derives from vitamin D’s influence on the tryptophan hydroxylase (TPH) transcription, as the hydroxylation of tryptophan is a limiting step in serotonin biosynthesis
>Further, according to preclinical data, 1,25 dihidroxyvitamin D significantly increases the expression of both TPH 1 and 2 and represses the expression of serotonin reuptake transporter (SERT) and monoamine oxidase A (MAO A), two major players in serotonin metabolic pathway, which may explain the observed increase in serotonin concentration in treated cells. [...] However, to date, only limited animal models have sought to clarify this phenomena...
(Thank you!)
Abstract: >The contemporary conceptualization of ADHD as a complex, multifactorial neurodevelopmental disorder cannot be understood as such without a complex assemblage of political, economic, and cultural processes that deem the conceptualization to be valuable and useful. In this article we use the notion of psychiatrization as a lens through which to see parts of these processes that make up ADHD what it is. In the first part of the article, we critically assess the scientific basis of the ADHD diagnosis via examining its diagnostic criteria as presented in the current fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM), the so called “Bible” of modern psychiatry. The second part of the article asks what is done with the ADHD diagnostic entity and with the idea that it represents a natural neurodevelopmental state within an individual—something an individual has—as represented in the DSM-5. Drawn from our previous research, we analyze how ADHD becomes real in discourse practice as a powerful semiotic mediator through analysis of the various functions and forms in which it takes shape in institutional, social, and individual levels.
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>Quasi-Scientific Basis of ADHD in DSM-5
>The DSM is regarded as western psychiatry's “bible” (Horwitz, 2021). From the publication of its third edition in 1980 and on, DSM committed to a “neo-Kraepelinian,” cause-effect biomedical framework (Jacobs and Cohen, 2012). This framework embraces the assumptions that “psychiatry is a branch of medicine and treats people who are sick, there is a boundary between the normal and the sick, there are discrete mental illnesses, psychiatrists should concentrate on biological aspects of mental illnesses, and diagnostic criteria should be codified” (Jacobs and Cohen, 2012, p. 88). The publication of the manual's fifth edition (DSM-5; American Psychiatric Association, 2013) immediately provoked an unprecedented—both in size and intensity—criticism from within and outside psychiatry (e.g., Frances, 2013; Kirk et al., 2013; Timimi, 2013; Wakefield, 2013; Gambrill, 2014; Lacasse, 2014).
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>Prescriptions of Normality
>Disorders cannot be defined in the absence of social values and notions of normality (Horwitz and Wakefield, 2012). As Bowden (2014, p. 434) points out in his paper on sociological accounts of disorder, “[i]t is not that objective physical states are identifiable as disorder, only then to provoke moral quandaries, or then translated into ‘lived experience.' Rather, any demarcation of behavior as disorder is meaningful only because of a normative context.” Hence, ascriptions of disorder essentially implicate value judgments about behaviors that are undesirable. Certain behaviors are regarded as rule-breaking and thus undesirable and deviant, and it is only through this devaluation that they can be characterized as symptoms of a disorder.
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>Inadequate Attention to Context and Agency
>DSM-5 portrays an ethnocentric (Bredström, 2019) and “an extraordinarily sanitized, asocial view of the human condition” (Jacobs and Cohen, 2012, p. 90). The diagnostic rationale of the DSM-5 for ADHD is subject to the fundamental attribution error. The fundamental attribution error suggests that observers attribute other people's behavior primarily to dispositional (internal) causes, rather than to situational (external) causes (Ross, 1977). As Kirk et al. (2013) explain, “descriptive psychiatry requires the implausible belief that the meaning and causes of observable behaviors can be understood and used as symptoms of mental disorder without paying attention to the social context of the behaviors themselves, and of course the meaning of the behaviors to the person and those who observe the person” (p. 168).
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>Description Is Not Explanation
>Descriptive diagnoses do not have any explanatory power. Instead, they are prone to the Begging the Question Fallacy, that is circular reasoning (Tait, 2009). Children have a disorder because they present the behaviors which define it: “The child often has difficulty sustaining attention in tasks or play activities because she has ADHD and she has ADHD because she does not sustain her attention in tasks or play activities.” As Pérez-Álvarez (2017, p. 2) notes “the symptoms are the guarantee of the diagnostic category, which in turn is invoked to explain the symptoms in an endless loop.”
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>How Does ADHD Become Real? Functions and Forms of the Diagnostic Entity
>Thus, no matter how influential the idea of ADHD as a natural state within an individual is (i.e., text), it only materializes if recognized as such in practices of institutions (e.g., law, healthcare, welfare, education, and parenting), pertinent professionals (clinicians, physicians, educators, social workers, etc.), or laypeople (e.g., family members, peers, or the one being diagnosed). The idea of ADHD as a complex, multifactorial neurodevelopmental disorder becomes real via performance or enaction in material interactions with ideological conventions and power relations, with agents empowered to push these ideologies to action (e.g., clinicians, teachers, parents, interest groups) and with the ones being diagnosed.
Abstract >To assess the extent and types of financial ties to industry of panel and task force members of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR), published in 2022.
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The DSM was written with the involvement of $14.2 million in undisclosed industry compensation. The full extent of this is outlined in this article.
The author outlined their report here.
>What should readers take away from your report?
>The DSM has been referred to as the "bible" of psychiatry and industry influence over the development of this diagnostic guideline can have a profound effect on public health (e.g., by broadening diagnostic categories and influencing what medications will be prescribed and covered by insurance). Thus, it is critical that this psychiatric taxonomy is free of industry influence, or even the appearance of such influence. There is an abundance of research documenting the impact of financial conflicts of interest on medical literature, including randomized clinical trials, meta-analyses, and clinical diagnostic and practice guidelines. Such research has consistently shown that conflicts of interest lead to subtle but impactful pro-industry thinking and conclusions.
A few days ago I made a post about the famous crash and why it happens. There is something else going on which I thought was worth highlighting.
We all know that vyvanse/adderall work via dopamine and noradrenaline. What isn't discussed is that they also work via triggering stress hormones. This causes a "fight-or-flight" state which is largely driven by adrenaline. The fight-or-flight mode is there to help you focus and deal with a threat (eg a tiger) by either fighting the tiger or running from the tiger (fight-or-flight). But in your town/city there is no tiger. The fight-or-flight mode is active but the focus is a job /school work /exam /interview /driving /shopping /laundry /dog walk /school run etc.
This is very helpful for focus but it can also affect things like mood. Adrenaline can contribute to anxiety, overstimulation, hyperactivity, impulsivity, scattered focus, overthinking and insomnia. It can sometimes paradoxically cause over-exhaustion which leads to a crash/sleepiness/fatigue/burnout (see here for more insight on this).
In the long-term vyvanse/adderall can also contribute to possible increased stress sensitivity. This might be helpful for some people but not necessarily helpful for others.
This can also explain some behavioural & emotional effects from vyvanse/adderall. The fight-or-flight mode is normally there to deal with a threat which influences how you perceive things going on around you (eg time, people, noise, temperature, weather, colour, fabric). This is reminiscent of PTSD which is a condition characterised by a dysregulated stress system. This ADHD site gives more detailed info on this, it's fairly easy to read.
Obviously for many people these medications have a welcome calming effect. Both dopamine and noradrenaline have indirect anti-stress qualities which tempers the fight-or-flight mode (drug pharmacology is not exactly straightforward). This article implies that, for some people at least, amphetamine can temporarily dampen the stress response. These medications are truly a "mixed bag" of different properties which can affect everyone differently. Stimulants aren't inherently bad, just misunderstood.
PS. The only medications which "stop" adrenaline are Guanfacine and Clonidine. They are sometimes used for ADHD which makes some sense when you understand the role of adrenaline.
It's usually just called a "crash" but it's more accurate to understand it as a "metabolic crash". This post is simply to present this notion in part by paraphrasing several biochemistry concepts (this post is a TLDR).
Vyvanse artificially pushes the metabolic system beyond it's current capacity ("limits") causing over exhaustion. Eventually after weeks/months/years you get a "metabolic crash" which looks like fatigue, sleepiness, mood issues (eg irritated, anxiety), brain fog etc. Some people tolerate it better than others.
>The metabolic system governs energy levels, mood, brain function and hormones...so when the metabolism crashes they all do. This ideally needs time to recover & recuperate (easier said than done?)...
This is very common, if you look at any ADHD group there's always people reporting issues with a crash (some more serious than others). The doctors tend to trivialise it and either prescribe more drugs or larger doses without disclosing any further information about the issue itself.
(This post applies to all amphetamine-type medications)
This post is about the consensual understanding of ADHD and it's various connotations (it's neurodevelopmental, it's hereditary etc). Some people accept the official explanation of ADHD without question while others consider the term "ADHD" as generic & inadequate since it encompasses so much.
This 2022 paper articulates certain aspects of this:
>The contemporary conceptualization of ADHD as a complex, multifactorial neurodevelopmental disorder cannot be understood as such without a complex assemblage of political, economic, and cultural processes that deem the conceptualization to be valuable and useful.
>The premise of this paper is that ADHD, as it is contemporarily conceptualized, exists in an abstract space of text and becomes real in the concrete space of practice through various functions. Text refers to semiotics occurring in different forms of communication and interactions. The DSM is an example of a powerful and influential text. The DSM—and essentially its creator the American Psychiatric Association—plays a key role in “the global spread of psychiatric ways of being a person and how we all come to understand ourselves within this register”.
So what is ADHD?
This is difficult to answer when you consider the diverse range of underlying issues which can manifest symptoms that doctors interpret as ADHD. This label seems like a catch-all term for symptoms of diverse origin with the most advanced "treatment" being amphetamine (which provides only symptomatic relief). Keeping an open mind, it seems plausible that natural human variation is one of many possible causes.