I recently responded to a psychiatric colleague asking a group of us a question like this:
I have a patient in recovery. She’s on several meds and doing well. But her AA group challenges her that she is only doing well because she is “high” on a stimulant. How might you respond?
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Now, I know the answer most psychiatrists will give, because they do not know about the power of Neurofeedback (brain training) for attention and impulse control issues like substance relapse prevention. And most psychiatrists and physicians in general are not thinking about the needs of women across their life cycle —needs for non-medication options in addition to psychotherapy, or the need for de-prescribing in the elderly.
So, I answered the way some psychiatrists might, then I addressed…..the rest of the story, from my perspective as a psychiatrist who also has these tools to offer.
I encourage — whenever I can — other clinicians to consider the specific contributions that Neurofeedback and biofeedback modalities bring to the successful treatment of chronic stress- related conditions. And the added benefits over medications to optimum performance and prevention.
This was my reply:
I’ve heard Daniel Amen (a psychiatric specialist in SPECT imaging and patient education) he has excellent presentations. (Regardless of widely divergent opinions re use if SPECT SCANS in psychiatry).
His video presentations may be available now via YouTube or his website. And his books. He described withholding stimulants as like denying prescription glasses to people with nearsightedness.
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On the other hand, I don’t know how you feel about Neurofeedback options, If interested, here are my thoughts. Feel free to share them.
Informed consent about alternatives — for this woman with clear preference for non-addictive or non-medication options —might include pirHEG Neurofeedback as a reasonable non-medication alternative. An alternative she may want to try, but needs your help considering and accessing. She may be motivated and not from you an interest in her preference for a non-stimulant or non-medicinal approach. You can de-toxify the “judgement or perceived prohibition” from her AA comrades but honor her interest and reasonable need to consider alternatives.
In a person with sluggish ability to activate the prefrontal cortex (in which I’d expect a positive response to a stimulant) I’d hope to reduce or replace the stimulant using brain training with Neurofeedback.
(If she were to get weekly pirHEG Neurofeedback, and show good tolerance/ benefit, you would need to anticipate a need to initiate taper, because you would at some point start to see increased side effects (tension or sleep issues, feeling “wired” for which she should be prepared to watch and to inform you, and not misinterpret it as negative side effects of the training). And even before increased side effect of stimulant, she might notice less daily “drop off” of the beneficial effects of the stimulant. As if the stimulant is “working longer”.
You would help her track the changes, noting the stronger, longer benefit of the weekly NF and helping her identify when her improvement from the Neurofeedback has plateaus and trainings should be spaced further apart or discontinued, or if needed, how often refresher sessions should be scheduled. You would also lead/check with decisions about lowering or skipping the stimulant. (Collaborating if you don’t learn to give the pirHEG yourself— pirHEG is easy for a physician to learn and deliver.)
Neurofeedback can sometimes provide an elegant alternative, by training her to achieve prefrontal inhibition. Like having a stimulant without taking one.
I’d think she’d be at less risk from her ADD during those times (evenings) when stimulants wear off. (More impulse control to help with stress triggers, relationships, relapse urges in evenings)
I believe this should be considered and offered as informed consent and preventive planning for all young women with ADD well ahead of planning pregnancy. (Starting with initial sessions.)
She may have other benefits in mood regulation, improvement in reactivity, anxiety and relationships, executive function, accident prevention, optimizing educational and occupational performance.
And could result in her stated preference of not needing any addictive medication.
And she may be more prepared for the de-prescribing needed as she ages.
Just food for thought.
I think all patients with attention or substance use issues deserve this information in the informed consent process. That information would include that this form of neurofeedback is provided with a very safe wellness device.
If her attention disorders are connected with bipolar disorder, I’d also consider eegNF, which is another discussion.
For more information check out the webpage on pirHEG from my website
I hope this is helpful!
Hogan Pesaniello, MD
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