diagnosingadhd

[it seems that people have just started using raclopride (another dopamine analog) and PET scan for just this thing; close but no cigar. I still believe the model toward the bottom is how my version of ADHD plays out]

Adhd is currently diagnosed by self-reporting, which is questionable at best. We need real-world diagnostic tests based on imaging and monitoring.

fMRI is ok but has its limitations since the thing we want to track is a molecule in the synapse; it is too small to register. Endocrine monitoring is downstream of dopamine in the brain, and we are unable to monitor phasic dopamine in a living person.

This leaves us with secondhand information about what adhd is, and the deductions of the scientific method seem conservative and incorrect based on what I experienced.

So I propose a new, simple imaging solution which would enable us to accurately track dopamine in the adhd brain vs a ‘normal’ brain and approach accurate diagnosis and new treatments.

• aripirazole is a exogenous dopamine analog

• we tag this analog, or another, with a radioactive isotope

• we monitor where it sits and how it behaves in the brain

Simple.

Why don’t people do this already? Surely there’s a reason. Is it because you couldn’t get your grant money? Then find some investors instead; they are far more open to moonshots.

And make no mistake - this is a multi-billion-dollar moonshot. This would not just stop at full-blown adhd but it would enable you to diagnose and treat all kinds of addiction before they even occurred.

While I was messed up I viewed the human brain as a planet, with the topography making up the neuronal landscape, weather making up the endocrine system, and ‘silken sand’ being dopamine. I could feel the aripiprazole moving in my brain; you’ll just have to believe me there.

My planet was full of deep valleys and bottomless holes gouged out through a life of over-exertion, over-consumption, and general addictive behaviour. The pit of alcohol is still there, for example, but it is consciously sealed off.

With this imaging technique you could monitor how aripiprazole (and hence dopamine) moves within the brain of a living subject. You could say ‘you have too much in blah blah and too little in blah blah’ and then go from there.

The mechanism for adhd, I am pretty sure, is accelerated receptor degradation due to higher phasic dopamine. I do not believe it is ‘lower tonic dopamine’ or anything so simple. This is based on post-mortem analyses and observed responses to stimulants and is just… wrong.

What happens is this:

• I am born with high phasic dopamine. My thrills and spills are bigger.

• my receptors are more flooded with bursts of dopamine than most.

• this means that the natural wear and tear of receptors is accelerated.

• my natural response is to seek bigger thrills to counteract the spills.

• and on it goes, until there is no joy in my life.

In my case it was extreme because of childhood trauma, also common in adhd, and this fits the pattern:

• childhood trauma, particularly the violent and repeated type, results in extreme levels of phasic dopamine.

• these people are primed for substance abuse, overtraining, high-pressure jobs, abusive relationships, etc, which worsen the cycle.

• and then they die, either as a byproduct of thrill-seeking or by their own hand.

• or they survive and become the grumpy old man / woman nobody likes and who lives alone.

The winter before my breakdown I was trying to map out our entire mountain range, in the backcountry snow, alone, while I built a bike and snowboarding shop, trained for ironman world championships, consumed copious amounts of cannabis and did art obsessively for 6-hour bouts. The following winter I had ptsd and nearly killed myself.

This is why the suicide spike after people start treatment - you are throwing more water at the broken sieve and breaking it further. You are eroding the land of their person. Stimulants are a quick-fix, same as any other substance use would be. In my model, they make thing worse at a fundamental level despite appearing to make them better for a while.

So we need imaging. We need to identify the *cause* of a person’s individual adhd and then we can begin to create real, long-term solutions. 

Right now ‘adhd’ is just a lazy catch-all for scientists who can’t get the funding to do real research. Stimulants get these people back in the game and feeding the machine. Job done.

Actual care for the individual and how their quality of life deteriorates is quite low, on a systemic level. The doctors care but they have no real tools for diagnostics or treatment so they just give you some meth and say ‘good luck’ and hope you don’t go down as a suicide or car crash.

This is such an easy hypothesis to test: can we tag aripiprazole, a cheap 50 year old generic drug, with a radioactive isotope and then observe how it behaves in a brain?

I think we can.

/jb202508171252