Posted by BrittPark on December 12, 2002, at 15:23:53
In reply to Re: Drunk on Zoloft?, posted by Simon Sobo MD on December 12, 2002, at 6:44:03
I enjoyed reading your article, but must say that I don't entirely agree with you. First there are few psychiatrists who believe that simple chemical imbalances like too much or too little of specific neurotransmitters explain mental illnesses. They know that nobody knows how ADs work. Good psychiatrists work phenomenologically, using their experience and data from colleagues and the scientific literature. I don't see anything wrong with this approach. In fact I don't think there is any other rational approach.
Scientifically I don't think you'd find any researcher who believes he/she understands the mechanisms of mental illness and its treatment.
There is in fact much promissing research. In particular tomagraphic imaging of the brain, though in its infancy, has usually found that there are significant chemical and anatomical differences between "normal" and "mentally ill" people. In the future we can hope that such imaging will be used clinically as a diagnostic tool.
Finally psychodynamic and cognitive behavioral approaches to therapy can be very useful. However for people who are severely ill (let's say depressed to the point of suicidality) talk therapy isn't possible until some kind of pharmacological intervention works well enough for the patient to work with a talk therapist.
If I were a psychiatrist (I'm a biologist by training) I would use as my model: medication first and talk therapy as soon as the patient can reason clearly enough. If the patient is cogent enough (perhaps mild depression following loss) drugs might be unnecessary.
Let me just say that the drug companies are doing a terrible job of finding new and better treatments for mental illness. Since the discovery of antidepressants in the 50s there has not been a single new antidepressant shown to be more effective than any other. The opioid system and the dopamine system, to a lesser degree, are ignored in drug research even though they may well be excellent targets for ADs. I could go on but I've babbled too much already.
Britt (Piled higher and Deeper)
P.S. Please continue to post. It's very helpful to have bona fide physicians post to this board.