CHAPTER 10
Type 5: Limbic ADD
Type 5: Limbic ADD is where ADD and depression intersect each other. The ADD core symptoms are present in addition to negativity, moodiness, sadness, low energy, and decreased interest in life. On SPECT we see decreased prefrontal cortex activity both at rest and during a concentration task and we see too much activity in the deep limbic or emotional center of the brain. Depression on SPECT is similar. There is decreased activity in the prefrontal cortex (especially on the left side) at rest, but it improves with concentration. Understanding the deep limbic system is important to understanding Limbic ADD.
THE DEEP LIMBIC SYSTEM
The deep limbic system lies near the center of the brain. Considering its size—about that of a walnut—it is power-packed with functions, all of which are critical for human behavior and survival. From an evolutionary standpoint, this is an older part of the mammalian brain that enabled animals to experience and express emotions. It freed them from the stereotypical behavior and actions dictated by the brain stem, found in the older reptilian brain. The subsequent evolution of the surrounding cerebral cortex in higher animals, especially humans, gave the capacity for problem solving, planning, organization, and rational thought. Yet, in order for these functions to occur, one must have passion, emotion, and desire to make it happen. The deep limbic system adds the emotional spice, if you will, in both positive and negative ways.
3-D underside active view
This part of the brain is involved in setting a person’s emotional tone. When the deep limbic system is less active, there is generally a positive, more hopeful state of mind. When it is heated up, or overactive, negativity can take over. This finding actually surprised us at first. We thought that excessive activity in the part of the brain that controlled emotion might correlate with enhanced feelings, not necessarily negative feelings. Yet, we noticed, again and again, when this area was overactive on SPECT, it correlated with depression and negativity. It seems when the deep limbic system is inflamed, painful emotional shading results. New research on depression from other laboratories around the world has borne this out.
Due to this emotional shading, the deep limbic system provides the filter through which you interpret the events of the day. It tags or colors events depending on the emotional state of mind. When you are sad (with an overactive deep limbic system), you are likely to interpret neutral events through a negative lens. For example, if you have a neutral or even positive conversation with someone whose deep limbic structure is overactive or “negatively set” he or she is likely to interpret the conversation in a negative way. When this part of the brain is “cool” or functions properly, a neutral or positive interpretation of events is more likely to occur. Emotional tagging of events is critical to survival. The valence or charge we give to certain events in our lives drives us to action (such as approaching a desired mate) or causes avoidance behavior (withdrawing from someone who has hurt you in the past).
The deep limbic system, along with the deep temporal lobes, has also been reported to store highly charged emotional memories, both positive and negative. If you have been traumatized by a dramatic event, such as being in a car accident or watching your house burn down, or if you have been abused by a parent or a spouse, the emotional component of the memory is stored in the deep limbic system of the brain. On the other hand, if you have won the lottery, graduated magna cum laude, or watched your child’s birth, those emotional memories are stored here as well. The total experience of our emotional memories is responsible, in part, for the emotional tone of our mind. The more stable, positive experiences we have, the more positive we are likely to feel. The more trauma in our lives, the more emotionally set we become in a negative way. These emotional memories are intimately involved in the emotional tagging that occurs.
The deep limbic system also affects motivation and drive. Hyperactivity in this area, in our experience, is associated with lowered motivation and decreased drive, which is often seen in depression. The deep limbic system, especially the hypothalamus, controls the sleep and appetite cycles of the body. Healthy sleep and appetite is essential to maintaining a proper internal milieu. Both of these components are often a problem with limbic abnormalities.
The deep limbic structures are also intimately involved with bonding and social connectedness. When the deep limbic system of animals is damaged, they do not properly bond with their young. In one study of rats, when the deep limbic structures were damaged mothers would drag their offspring around the cage as if they were inanimate objects. They would not feed and nurture the young as they would normally do. In people, this system affects the bonding mechanism that enables you to connect with other people on a social level; your ability to do this successfully in turn influences your moods. Humans are not like polar bears, wandering the tundra alone eleven months out of the year. We are social animals. When we are bonded to people in a positive way we feel better about our lives and ourselves. This capacity to bond, then, plays a significant role in the tone and quality of our moods.
The deep limbic system directly processes the sense of smell, the only sense that has so direct a connection. (The messages from all the other senses are sent to a “relay station,” the thalamus, before they are sent to their final destination in different parts of the brain.) Considering this, it is easy to see why smells can have such a powerful impact on our feeling states. The multibillion-dollar perfume and deodorant industries count on this fact: beautiful smells evoke pleasant feelings and draw people toward you, whereas unpleasant smells cause people to withdraw. Expensive perfumes and colognes can make you beautiful, sexy, and attractive to others, whereas a disagreeable body odor can make the other person want to rush to the far side of the room.
Research has demonstrated that females, on average, have a larger deep limbic system than males. This gives females several advantages and disadvantages. Due to the larger deep limbic brain, women are more in touch with their feelings and are generally better able to express their feelings than men. They have an increased ability to bond and be connected to others (which is why women are the primary caretakers for children: There is no society on earth where men are primary caretakers for children). Females have a more acute sense of smell, which is likely to have developed from an evolutionary need for the mother to recognize her young. Having a larger deep limbic system leaves a female somewhat more susceptible to depression, especially at times of significant hormonal changes such as the onset of puberty, before menses, after the birth of a child, and at menopause.
The deep limbic system, especially the hypothalamus at the base of the brain, is responsible for translating our emotional state into physical feelings of relaxation or tension. The front half of the hypothalamus sends calming signals to the body through the parasympathetic nervous system. The back half of the hypothalamus sends stimulating or fear signals to the body through the sympathetic nervous system. The back half of the hypothalamus, when stimulated, is responsible for the fight or flight response, a primitive state that gets us ready to fight or flee when we are threatened or scared. This “hardwired response” happens immediately upon activation, such as seeing or experiencing an emotional or physical threat. In this response, the heart beats faster, breathing rate and blood pressure increases, the hands and feet become cooler to shunt blood from the extremities to the big muscles (to fight or run away), and the pupils dilate (to see better). This “deep limbic” translation of emotion is powerful and immediate. It happens with overt physical threats and also with more covert emotional threats. This part of the brain is intimately connected with the prefrontal cortex and seems to acts as a switching station between running on emotion (the deep limbic system) and rational thought and problem solving with our cortex. When the limbic system is turned on, emotions tend to take over. When it is cooled down, more activation is possible in the cortex. Current research on depression indicates increased deep limbic system activity and shutdown in the prefrontal cortex, especially on the left side.
The problems in the deep limbic system often look like depression. Do you know people who see every situation in a bad light? That actually could be a deep limbic system problem. As mentioned, this system tends to set our emotional filter, and when it is working too hard, the filter is colored with negativity. One person could walk away from an interaction that ten others would have labeled as positive, but which he or she considers negative. And since the deep limbic system affects motivation, people sometimes develop an “I don’t care” attitude about life and work; they don’t have the energy to care. Because they feel hopeless about the outcome, they have little willpower to follow through with tasks.
Since the sleep and appetite centers are in the deep limbic system, disruption can lead to changes, which may mean an inclination one way or the other, too much or too little of either. For example, in typical depressive episodes people have been known to lose their appetites and to have trouble sleeping despite being chronically tired, and yet in atypical depression they will sleep and eat excessively.
DEPRESSION VERSUS LIMBIC ADD
Due to the similarities between the two conditions, it can be hard to distinguish between depression and Limbic ADD: After all, both diseases demonstrate similar symptoms and even somewhat similar SPECT results. Developmental history seems to be the most helpful tool in helping clinicians decide. Depression tends to be a cyclic illness. It may be associated with some of the core symptoms of ADD, but not in a developmental pattern. The cognitive symptoms are only present when the depression is present. By contrast, in ADD, one can see symptoms for a prolonged period of time, usually back to childhood.
In addition, there are subtle SPECT differences. Research has shown that depression is seen on SPECT as decreased activity in the left prefrontal cortex at rest with increased limbic activity. When a depressed person tries to concentrate there is usually increased activity in the prefrontal cortex. Limbic ADD, on the other hand, tends to show decreased prefrontal cortex activity during concentration in conjunction with increased limbic activity.
Barry
Barry, seventy, came to my clinic for help with a short attention span, poor memory, decreased energy, terrible disorganization, and trouble finishing projects. Barry also complained of problems sleeping, frequent negative thoughts, excessive guilt, and a tendency to isolate himself. His doctor felt that he was depressed, but the antidepressants Prozac and Zoloft made him feel worse. His great-grandson had just been diagnosed with attention deficit disorder and got significant benefit from treatment. He reminded Barry of himself when he was a little boy. Maybe there was still time for him to get help.
Barry had symptoms consistent with Limbic ADD or ADD that also has many depressive symptoms. Hallmark symptoms of Limbic ADD include the typical ADD symptoms (short attention span, distractibility, etc.) plus negativity, sadness, poor energy, social isolation, and feelings of guilt, hopelessness, or helplessness. His brain SPECT study showed decreased activity in the prefrontal cortex plus increased activity in the limbic system (which is the mood control center of the brain). Barry was placed on DL-phenylalanine and L-tyrosine, the amino acid building blocks for norepinephrine and dopamine, the two neurotransmitters implicated in this type of ADD. Within two weeks Barry noticed a significant benefit. He felt more focused, better physical and mental energy, more positive, and more social.
Charity
Charity was thirty-seven when she first came to my clinic, brought in by her husband, a local minister. Both she and her husband wanted help with Charity’s negativity, low energy, poor organization, irritability, and short attention span. She also had a poor appetite and had trouble gaining weight. Charity was also very distractible and sensitive to touch. She cut tags out of her shirt and could only be touched by her husband when she was in the mood. Their sex life suffered. Her family physician tried Paxil and Celexa, but they seemed to make her symptoms worse.
Charity had struggles in school since she was a little girl. She was a quiet child who tended to be sad and negative. Her report cards had comments like “needs to try harder” and “needs to work on paying attention.” Her organization was a big problem and she remembered being in trouble for her messy room. She remembered that homework was torture and that she would frequently stay up late into the night working on it. Her long-standing symptoms of short attention span, distractibility, disorganization, and poor follow-through were consistent with an ADD diagnosis. In addition, the symptoms of negativity, social isolation, low libido, and poor energy put the ADD into Type 4. Initially Charity wanted to try a “more natural treatment” than prescription medication. I placed her on DL-phenylalanine and L-tyrosine along with The Zone Diet and intense aerobic exercise. Within several weeks Charity felt much improved. Her appetite was better, she was able to gain a few pounds, and she felt more focused and less distracted. Her husband said she was like a new person. Her libido also improved.
Doug
Seventeen-year-old Doug was brought to our clinic by his parents. He was failing in school, despite being tested as being very smart. He had started to talk about feeling hopeless and even suicidal. He was socially isolated, didn’t find pleasure in activities other teens enjoyed, and his thought patterns were negative. He smoked marijuana as a way to feel more relaxed and less depressed. He had always struggled in school with a short attention span and distractibility and he was “the master of procrastination” (as he put it). His school problems were worse after he started smoking pot. He had been seen in psychotherapy and had tutors through the years. These interventions did not make much difference. The family doctor put Doug on Prozac, but it only made him less motivated.
Seeing the situation as serious, I ordered a SPECT series. There were a number of findings: He had decreased prefrontal cortex activity at rest that worsened with concentration. He had increased deep limbic activity on both studies, and there was decreased activity in the back half of the temporal lobes (a finding common among marijuana users). I showed Doug his scan and encouraged him to stay away from the marijuana as it was probably damaging his brain. I told him the damage would probably get much better if he stopped. In addition, I put him on Wellbutrin to stabilize his mood and a small dose of Adderall to help him with energy and focus. I also encouraged him to change his diet and to get more exercise. Within two months Doug was feeling much better. He was more optimistic, less negative, more focused, and he was more positive about school. He decided to take the California High School Proficiency Examination to test out of high school and he went to the local junior college. By the age of twenty he earned his AA degree and is now attending a California university.
Doug’s case highlights that many people use illegal drugs as a form of self-medication. They have an underlying mood disorder, type of ADD, or anxiety disorder. They use drugs as a means to feel better, more normal. Without proper treatment it is very hard for them to give up the substance abuse.
Stacey’s Concentration SPECT Study (Underside Active View)
Stacey
At the age of fifteen, Stacey was failing school. She had two D’s, two F’s, and a C. She had been cutting classes, smoking cigarettes, and arguing with her parents. She had recently become sexually active and just had an abortion before she came for an evaluation at the clinic. Despite being a bright child, she had always struggled in school. Homework took forever to do and she frequently did not turn it in. She had poor handwriting and was easily distracted, very impulsive, and disorganized. She was becoming more negative, irritable, and isolated.
After a full evaluation, it was clear to me that she had Limbic ADD. A SPECT study confirmed the diagnosis. Initially, I tried her on DL-phenylalanine and L-tyrosine, but they were not effective. I then put her on Wellbutrin, a stimulating antidepressant. She had a very nice response to the medication. Within two weeks, her mood brightened, her attention span improved, and she even stopped smoking (Wellbutrin has been approved by the FDA to help people stop smoking).
Sonny
Thirty-eight-year-old Sonny was brought to see me by her husband. She was frequently overwhelmed, irritable, and negative. She had trouble keeping up with her work at home and she constantly complained of being tired. She had a very poor appetite and did not sleep well. She had little interest in sex and was feeling more and more distant from her husband and family. She barely graduated from high school and felt constantly behind in her work. She tended to fall asleep whenever she read. Her husband had read about ADD and found our clinic on the Web. She took our interactive ADD test and found it was likely that she had Limbic ADD. After evaluating her, I agreed. I gave her the options of antidepressant medication or the amino acid supplements. We started with the supplements, diet, and an exercise regimen. After three weeks she said that the combination was very helpful for her. She could tell within a half an hour if she cheated on the diet. She said, “It’s amazing to me that food is as powerful as a drug. When I eat right I feel good. When I don’t eat right I feel bad.” Her libido improved, as she felt better emotionally and physically.
Limbic ADD is often responsible for failed marriages. The low sexual interest, tiredness, feelings of being constantly overwhelmed, and lack of attention to detail often cause marital conflict. Treating Limbic ADD can literally save families and change a person’s life.