Mar 23, 2018 | Research Updates
Beth Krone, Ph.D.
Icahn School of Medicine at Mount Sinai
In March 2017, a group of young adults emailed me a link to a crowd-funding website to ask my thoughts on a new, direct to consumer health drink being marketed as a cognition boosting, anxiolytic, nutritional supplement. The makers were a group of neuroscience students without clinical licensure. Their all natural product was listed as being a mixture of antioxidants, b-vitamins, and Phenibut.
So what is Phenibut?
Phenibut is a Latvian produced, Soviet developed pharmaceutical that has not been licensed in the United States. In 2018, Australia joined several European nations in regulating Phenibut. Since it has not been licensed in the U.S., it remains unregulated. This means that a quick Google search will lead to a variety of Phenibut products for sale from U.S. based internet merchants or health food stores, since it is not illegal to buy, sell, or possess it.
Phenibut is a gabapentinoid, β-phenyl-γ-aminobutyric acid (β-phenyl-GABA), or a GABA analogue. Known to cross the blood–brain barrier, it is dopamine enhancing in the striatum, has some effects similar to benzodiazepines, may induce euphoria, and there is mixed information about its potential for inducing seizure activity based on its effects on calcium channel activity. There is also mixed information regarding the addiction potential of Phenibut, with at least one published case study supporting many anecdotal reports of it being highly addictive with quick tolerance and intense withdrawal symptoms. When overdosed, Phenibut has also been implicated in Eosinophilia and some fairly severe kidney and liver problems.
With its known side effect profile and abuse potential, Phenibut is a fairly potent psychotropic with pharmalogical properties that require dosing by age and health status. Certainly a health professional would expect this to preferably be done by a competent clinician with prescription privileges and with some type of compliance monitoring for safety.
Bulletin boards and a self-medication community
A quick review of some of the most often used bulletin board sites like Reddit and drugs-forum.com, though clearly shows that young adults do not necessarily share this perspective. Although some users name their preferred formulations, these sites do not advertise a particular drug, company, or formulation. People form communities in support of self-medication on these sites. Lacking resources or unhappy with the care they have received for their ADHD and comorbidities, they share information about unregulated psychotropics. They recount personal experiences of their trials. They freely discuss tweaking their medication regimens with various combinations of prescribed drugs, unregulated supplements, and illicit drugs.
Their discussions are, from a clinical management perspective, very educational. From a developmental or social psychological perspective, it is not surprising that young adults would accept prescribing information from peers without clinical degrees (or names), who often provide quite sophisticated scientific sounding information without references. From a systems or health literacy perspective, though, this highlights the enormity of the clinician’s task in building trust, reaching, and successfully serving the unserved or underserved who cannot find relief through safer channels. This task may be increasingly difficult in context of the larger social conflicts between the medical imperative to prescribe approved and well validated treatments, and the perspectives of a vocal and growing population of people outside the medical community.
To see what some of your patients are reading, check out:
https://www.reddit.com/r/phenibut/comments/4kvbq3/the_beginners_guide_to_phenibut/
https://drugs-forum.com/threads/pharmaceutical-phenibut-physician-patient-instructions-translated-from-russian.221041/
https://nootropicuniverse.com/phenibut-legal-status/
Mar 5, 2018 | Conference Blog
Luke Norman, Ph.D. Postdoctoral Research Fellow University of Michigan
I am very grateful for the opportunity to attend the APSARD conference, and have now become a committed APSARD member! A clear advantage of this conference over other psychiatry conferences is its focus on ADHD, although the broad scope of ideas presented from within the field of ADHD research was equally impressive. A theme underlying sessions at the conference was the extent to which ADHD is a ‘brain disorder’. In the first plenary session, talks by Professor Philip Asherson and Professor Trevor Robbins outlined theoretical models of how brain networks may be dysfunctional in ADHD. Professor Asherson suggested a plausible theory that ADHD may be a disorder of default mode and task positive brain network interplay, with alterations in the interactions of these brain networks underlying dysregulated mind wandering in the disorder, while Professor Robbins presented data suggesting that numerous potentially dissociable fronto-striatal brain networks underlying executive functions may be impacted in ADHD and improved by ADHD medications. However, while these data and theoretical models were plausible and stimulating, presented data from recent large consortium efforts in genetics and structural brain imaging were more humbling. GWAS work presented by Professor Anita Thapar further invalidated previous narratives resulting from candidate gene studies of ADHD, with the influence of each individual genomic hit in the presented work being very small and composite polygenic risk scores having quite a modest predictive power. In a presentation of the recent ENIGMA mega-analysis of gray matter abnormalities in ADHD, Professor Barbara Franke showed that previously reported deficits in striato-limbic gray matter were significant in the large mega-analytic sample, but differences between ADHD and control groups had small effect sizes and there was a substantial overlap between patients and controls and no significant differences at all between adult patients and controls. These findings indicate that biological mechanisms in ADHD may be more diffuse and subtle than anticipated by earlier theorizing, and suggest the need for further large-scale collaborative studies to investigate more sophisticated models of brain alterations in ADHD, which may also include the potential for heterogeneous neuropathophysiology in ADHD as well as greater considerations of neurodevelopment. At times, the questions and answers sessions were even more stimulating than the talks themselves and I enjoyed the discussions of these topics. I look forward to next year’s APSARD!
Mar 1, 2018 | Events and Announcements, Research Updates
Here is an interview by APSARD board members Sandra Kooij, M.D., Ph.D. and Vatsal Thakkar, M.D. on sleep and health issues related to living with ADHD.
http://mediatracks.com/shows/RHJ_18-08.mp3
Feb 19, 2018 | Conference Blog
Natalie Miller, Ph.D. Post Doctoral Fellow University of Maryland – College Park
This was my first APSARD conference and I was not sure what to expect. I knew APSARD as a psychiatry conference and assumed many presentations would focus on medication management of ADHD symptoms. Although some symposia addressed medication issues, symposia topics covered the waterfront, from etiological models involving genetics and neuroscience to clinically-oriented sessions about assessment and treatment to big data epidemiological approaches. A resounding theme across many symposia was our struggle to understand how and why ADHD symptoms develop. The causal role of environmental factors in the pathogenesis of ADHD were considered in several symposia. During the Sunday morning plenary session, Drs. Edmund Sonuga-Barke and Anita Thapar addressed the shifting conceptualization of ADHD from a biologically-based disorder to a transactional disorder involving a complex interplay between genetic predisposition and environmental processes. Dr. Sonuga-Barke discussed results from the English and Romanian Adoptee Study, which demonstrated that severe environmental deprivation early in life can cause ADHD symptoms. Dr. Thapar outlined the complexities in parsing genetic from environmental risk given that shared genetic liability for ADHD may be driving maladaptive features of parenting as well as child symptoms. She discussed how longitudinal adoption design studies can isolate genetic from environmental risk and add specificity to how environmental processes contribute to ADHD symptoms (and how ADHD symptoms contribute to environmental processes). These talks, along with many others, highlighted how our conceptualization of ADHD is in flux. There are many unanswered etiological questions and future research is needed to better understand how environmental processes intersect with biological vulnerability. Although I left the conference feeling less certain about what I thought I knew, I also left feeling energized to keep up the search for the how and why of ADHD.
Jan 4, 2018 | Uncategorized
J. Russell Ramsay, Ph.D.
Associate Professor of Clinical Psychology
University of Pennsylvania, Perelman School of Medicine
The upcoming special issue of the Journal of Attention Disorders highlights research on the prevalence of ADHD around the world as well as throughout the lifespan. These articles are important, not only further documenting the global reach of ADHD, but also shedding light on heretofore under recognized populations of children, adolescents, and adults who may benefit from various supports and treatments — many of which will be reviewed at the APSARD conference next week in Washington, D.C. A benefit of an APSARD membership is access to this important and informative journal.
Click HERE to Access the January Table of Contents.
