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First Start, Fresh Start: Solving a Crushing Dilemma from a New Perspective

Volume 1 No. 1 |


Man with active brain lighting up

You cannot be a practicing primary care or psychiatric provider without being keenly aware of the current, growing, and overwhelming demand for medications such as Adderall and Ritalin coupled with a continuing lack of reliable availability. A PBS News Hour report on July 18, 2023, provided explanations for what has led to this “perfect storm” of need and unmet demand.


They list several reasons:


  • The large number of children diagnosed with ADHD. Based on CDC statistics, 6 million children in ages 3-17 in the U.S. have been diagnosed with ADHD. 60% of them were being treated with medication, primarily stimulants.


  • The large and growing number of adults with ADHD. The CDC reports that 4.4% of adults above age 18 have been diagnosed with ADHD and that 93% of them are being treated with medication. The demand for ADHD medications has been increasing for over a decade, but based on insurance claims data, the demand exploded during the pandemic. From 2020-2021, the number of stimulant prescriptions filled rose by more than 10% among females ages 15-44 and males ages 25-44. Among women ages 20-24, there was a nearly 20% increase.


  • As Schedule II controlled medications, the amount that manufacturers are allowed to produce is tightly regulated. In addition, prescriptions can only be filled with 30-day supplies and those are closely monitored by DEA units across the U.S. in an attempt to prevent illegal diversion.


  • Because of widely recognized severe shortages, desperate patients and parents have unleashed a torrent of phone calls to pharmacies seeking these drugs. Pharmacists are not allowed to transfer these controlled prescriptions to different pharmacies, and phone calls have swamped pharmacies already stretched beyond capacity.


 

So, what solutions might help you, your patients, and over-stretched pharmacists at this critical time of crisis? Here is a three-part possible solution that you should consider.


  1. View the diagnosis and treatment of this condition from a new neurobiological framework.

  2. Consider a potential solution from this new neurobiological framework.

  3. Apply this solution and its amazingly simple application from the perspective of "First Start, Fresh Start".


The new neurobiological framework:


In 2022, Dr. Christopher Palmer, a highly regarded Harvard psychiatrist, published a book which is touted as a “Revolutionary Breakthrough in Understanding Mental Health”. The book, Brain Energy, explains why there is so much overlap and co-morbidity between psychiatric diagnoses, and why current treatments are often disappointing. The book states in the introductory overview (which is extensively explained and documented in the rest of the book), “mental disorders are metabolic disorders of the brain”, and “tiny things called mitochondria are the key”. This changes everything and should change the way we approach neurodevelopmental disorders including attentional ones like ADHD.


A potential solution considering this new framework.

Dr. Palmer’s book explains the necessity of improving mitochondrial function. He fails to discuss potential treatments for dysfunctional mitochondria.



I think a very safe and simple option that can enhance and boost mitochondrial function for long-term use is a medicine known for almost 125 years. It is generic, inexpensive, and available without prescription. It is listed by the World Health Organization as one of its 100 “Essential Medicines”. An extensive scientific literature establishes that MB is protective and therapeutic for dysfunctional brain- cell mitochondria.


It is methylene blue (MB), an amazing agent that simultaneously increases energy (ATP) production and reduces reactive oxygen species and inflammation. While it is not FDA approved for ADHD, there is a substantial scientific literature that documents that attentional problems such as ADHD are often a result of dysregulated mitochondria in the brain and that MB enhances and stabilizes mitochondrial function. Because most chronic medical conditions also have known mitochondrial dysfunction. Instead of increasing medical risks, it simultaneously has significant potential to reduce them. While it has some MAOI inhibition (and there are warnings regarding use with serotonergic antidepressants), those warnings are based on high dose usage via IV at doses above 4 mg/kg body weight. The low oral doses used daily for psychiatric concerns are well below the NIH statement that it is safe below 2 mg/kg. I am using it and recommending it at doses around 0.25 mg/kg (equal to 15-30 mg of NeuroPro Plus) or even less. At these doses there are essentially no side effects except blue urine, and that serves as proof of adherence!


From now on, consider MB for the first treatment. Start first and start smart by treating the precious mitochondria.


If a patient is already diagnosed and treated with stimulants but is unhappy with results or inaccessibility, think fresh start by treating those precious mitochondria with MB. I think your patients, your staff, and your pharmacist will thank you!


Noel Gardner M.D., M.Div.







 

Morella I, et. al., 2022. Emerging roles of brain metabolism in cognitive impairment and neuropsychiatric disorders. Neuroscience and Biobehavioral Reviews. https//doi.org./10.1016.neurobiorev.2022.104892.

Verma P, et. al, 2016. Attention-deficit hyperactivity disorder suffers from mitochondrial dysfunction. BBA Clinical 6.(2016)153-158.

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