Posted by JohnL on October 30, 2000, at 5:12:39
In reply to Re: Cam - Peer reviewed vs non peer? Reliable? » JohnL, posted by Cam W. on October 29, 2000, at 10:55:56
Cam,
Thank you for the time you put into your response. I know how busy you are and I greatly appreciated the reading. Sometimes I look at my own posts and I think, "Darn, that's too long, nobody's going to read that", and then I edit the heck out of it just to make it shorter. I lose valuable points in the name of readability. But with your post, as long as it was, it wasn't long enough! Thoroughly enjoyed ll of it. I'm glad I caught you in a writing mood. Thank you.
As a general overall comment, I would say I now find it difficult to trust anyone in psychiatry. Geez. I mean, you're right, everyone is human, everyone has an agenda, and everyone has to pay their bills. As long as humans are involved, objectivity will always be questionable I guess. I still feel though that even though results of studies can be skewed in the whole process, the actual recorded events of the studies can't. Pertaining to this topic of rapid response, I think some can be explained by placebo, some by misinterpreted side effects, but some are authentic. Set clinical studies aside, I've just seen it in real life enough to take notice. That's all. The ones I witnessed, and the ones where witnesses here at this board came forth to describe, were not placebo or side effects.
I do believe many intricate changes in the brain take place after initiating medication. It's not as simple as saying someone's serotonin was low. But I also believe that sometimes the whole process does not have to occur for the patient to feel better. I believe increasing serotonin sets into motion a whole lot of chemical changes in the brain, in a chain reaction. I believe increasing dopamine does the same thing, except that it primarily affects a different set of pathways of chemical reactions, and may only slightly overlap into the serotonin one, and at a different point in that chain of reactions. Likewise, increasing norepinephrine will set into motion a distinctly different set of chain reacions, which at some point may also overlap into the same ones as serotonin and dopamine, but farther down the chain. Because I believe this, I also believe the choice of medication can and does influence the speed to response. For example, if some link in the serotonin chain is awry and is basically at fault for a person's symptoms, a serotonin medication will get around to correcting that problem sooner than a norepinephrine or dopamine medication. Simply because that link in the chain wasn't as far away as it was in the norepinephrine or dopamine chain. And thus a quicker response. In any random population of patients, there are always some who get better a lot faster than others. I think that is explained by the medication affecting the correct chain of reactions, and not having to wait for a longer domino effect that eventually gets around to the real culprit chain, if it ever does. Fewer dominos to knock down, so to speak. Not a scientific view, but that's my interpretation.
To further complicate the matter, each person has unique genes and unique wiring. Things in the brain might be intertwined and arranged differently than someone else's, amongst the millions of neurons and such. And to complicate it even more still, not all medications will have the same binding potential from one person to the next. Thus not only is choosing the correct medication for the correct chain of events important, but choosing one with the correct binding potential for that unique individual is also important. Whatever medication does all that is a superior match in my definition. Unfortunately the only way to find the medication that does all that is to try and compare different medicines. The superior match will make itself known, and there is no doubt when it's found. I've just seen it happen too many times to discount it as fluke.
I think we all tend to see what we want to see, or see only what we're looking for. That's natural for humans I think. Imagine you and me taking a hike through a densely wooded forest in Canada. You might take notice of the different types trees, because you just happen to be into trees and you've been thinking about firewood for the winter lately. Meanwhile, I didn't really notice one tree from another, they were all just trees to me. But I noticed the groundcover we were walking on. It was Brunswick blueberries which only grow several inches tall. I'm into fruit gardening, so I noticed these right away. Everything was there for both of us to see equally, but we each picked out different things depending on what our interests and desires were. And thus the subjectivity of humans you mentioned in your post. And thus in psychiatry, no matter what kind of evidence presents itself, you will see what fits your world and I will see what fits mine. In a perfect world, we would all have innocent eyes to see it all, and not just parts.
> 1) If it sounds to good to be true, it is.
....probably, but not always. (Reminds me of a certain psychiatry book. Test and compare medications for a week each to find a favorite, or to elimate a whole class. Not as good as it sounds. Ever tried taking ABC med for a week, stop, wait, then take XYZ med for a week, stop, wait, then the next? It sounds good, and it works, but believe me, it aint no picnic!) :-)> 2) Believe nothing of what you hear and only some of what you see.
....True, at least up to the point you have reason to believe one way or the other. I want evidence to support or refute what I see and hear before adopting a general conclusion. (Reminds me of how I was going to take such pleasure out of critiquing a certain psychiatry book because it sounded too good to be true. The only problem was, in all my years I couldn't find the faults I was sure existed. Damn.)> 3) Never believe that someone has "your" best interest in mind, particularily if it involves the output of money.
....Sometimes. (Reminds me of my local psychiatrist. He sincerely had my best interest in mind at all times. Only after I had received personal customized care did he send the bill. Pristine service, no hint of anything except my best interests. In contrast to an earlier local psychiatrist who seemed to care not at all that Serzone was making me more depressed as the weeks went by. She just wanted me to schedule yet another appointment and pay her yet another $80 for a worthless 15 minutes that had nothing to with my best interests, while the whole time I'm pondering how I wish I would be dead.)
>
> One of my longer rants - Cam
....Me too. :-) - John
poster:JohnL
thread:47596
URL: http://www.dr-bob.org/babble/20001022/msgs/47748.html