Augmentation of Methylphenidate with Piracetam for Residual Executive Dysfunction and "Brain Fog": A Naturalistic Case Report

Adults with attention-deficit/hyperactivity disorder often continue to battle mental "fog," emotional lability and low drive even after guideline treatments have been optimised. Mounting evidence from mood-disorder research indicates that shifting glutamatergic traffic toward AMPA-receptor throughput can trigger rapid plastic changes, yet this principle has seldom been explored in ADHD.A 28-year-old woman who remained inattentive and anxious on atomoxetine was switched, in routine outpatient practice, to a low-dose extended-release methylphenidate formulation (18 mg) augmented with piracetam 1 200 mg daily. Within days she reported markedly sharper concentration, steadier mood and a new capacity to sustain purposeful activity without the late-day "flattening" she had experienced on stimulants alone. When piracetam was paused for three days the improvements evaporated, only to return on re-initiation, creating a clear temporal association.The observation supports the idea that a safe, inexpensive AMPA modulator can amplify the modest glutamate rise produced by methylphenidate and translate it into meaningful clinical gains. Although limited to a single case, the result invites systematic study of piracetam as an adjunct for adults whose ADHD symptoms have proven only partially responsive to standard pharmacotherapy.