Posted by Simon Sobo MD on December 12, 2002, at 9:44:50
In reply to Re: Well, whatever.... » Simon Sobo MD, posted by Dinah on December 12, 2002, at 8:07:56
Dinah, I'm not sure I would describe SSRI's as always causing apathy. That is pretty extreme, but I do think they cause emotional blunting (a term used in an earlier thread) The key point I was trying to make is that meds would be best used if they would be considered in terms of the psychological effect they have (which cuts across DSM IV diagnoses). Indeed like alcohol, Ritaline, morphine etc, SSRIs, for better or worse, cause a similar effect with or without a DSM IV diagnosis. Please see my article regarding my use for "thin-skinned" teen-agers and the like.
My main arguments is with the belief that the various disorders described in DSM IV are due to a "chemical imbalance" specific to them in the same way that say, tuberculosis is caused by a specific germ. Despite the impression of most people no chemical imbalance has been found for any disorder. The isn't to say that we don't have different genetic dispositions, possibly even differences in our brain chemicals and wiring. But we are centuries away from making sense of all of this, and we have no way of measuring it
As for your question about "anti-psychotics" Their actual history is that they began as a pre-anesthetic sedating agent and were tried out on Schizophrenics. They worked quite well. They also worked for anxiety and panic and all kinds of conditions. When I was in training they were called "major tranquilizers" and benzodiazepines (like Xanax and Valium and Ativan) were called "minor tranquilizers" The problem with drugs like Thorazine was that they had many side effects and finally when it was discovered that tardive dyskinesia was a common result they were pretty much reserved for psychotic conditions. Pretty soon they were being called "anti-psychotics" as if they were only effective in psychosis. Atypical neuroleptics, the new generation of anti-psychotics have been found to not be as likely to cause tardive dyskinesia so now they are being used for all kind of syndromes. They are also being touted as "mood stabilzers" a confusing, lousy term. You can find a link to at article about that whole mess at bipolarworld.net. Or it is linked to my article.
Hope this hasn't been too confusing. The fact is that we have a lot of great new effective drugs, which is reason for optimism. We also have a lot of gaps in our knowledge and I am not sure the current official wisdom is the best way to arrange what we know and don't know.
poster:Simon Sobo MD
thread:123623
URL: http://www.dr-bob.org/babble/20021210/msgs/131465.html