Posted by Simon Sobo MD on December 15, 2002, at 7:25:07
In reply to Re: Drunk on Zoloft? » Simon Sobo MD, posted by BrittPark on December 13, 2002, at 12:01:53
I have absolutely no doubt that physical changes occur in depression. The sodium content of a depressed person's saliva changes, not to mention sleep EEG patterns, the immune system and a thousand other things. Nor do I doubt that successful treatment changes these abnormalities. Actually I have a link on my site by Glen Gabbard where PRT and SPECT studies are one of the main focuses. Here is a sample:
" In one study of obsessive-compulsive disorder, Baxter et al. (1992) looked at local cerebral metabolic rates for glucose using positron emission tomography scan methodology. They found that both behavior therapy and fluoxetine (Prozac) produced similar decreases in cerebral metabolic rates in the head of the right caudate nucleus, suggesting (but not proving) that this form of psychotherapy and fluoxetine have similar physiological effects at the level of the brain.There is extensive evidence that cognitive-behavior therapy is an effective treatment for panic disorder. Panic attacks can be triggered by lactate infusion in those with panic disorder. At least one study (Shear et al., 1991) has demonstrated that lactate induction of panic can be effectively reversed through successful cognitive therapy. These findings suggest that psychological interventions can alter the response of the brain to biochemical factors. Psychiatric researchers in Finland recently published a report showing that psychodynamic therapy may have a significant impact on the neurotransmitter serotonin (Viinamäki et al., 1998). At the beginning of a one-year psychotherapy process, single photon emission computed tomography (SPECT) imaging was undertaken with a 25-year-old man suffering from personality disorder and depression. Another young man with similar problems also underwent imaging but did not receive psychotherapy or other treatment.
Initial SPECT imaging showed that both patients had markedly reduced serotonin uptake in the medial prefrontal area and the thalamus compared with 10 healthy control subjects. After one year of dynamic therapy, repeat SPECT imaging showed that the patient who received the psychotherapy had normal serotonin uptake while the control patient who did not receive psychotherapy continued to have markedly reduced serotonin uptake. This study suggests that dynamic psychotherapy may normalize serotonin metabolism."
There is absolutely no doubt that the mind effects the body and the body the mind. There is no doubt that meds work by having an effect on brain chemistry. So does alcohol, cocaine and opium. I am not trying to put meds down by this analogy simply stating the obvious. And there is no doubt that we are all wired differently from birth. We may be genetically predisposed to develop certain diseases. This has been clearly demonstrated in schizophrenia and bipolar disorder and it may be a factor in all of the DSM IV disorders.
But here is where the important distinctions have to be made. Nature-Nurture has been a controversy for hundreds of years and the pendulum keeps swinging. When Freud came along people thought everything was genetic. Certain families had a genetic taint, which was a stain on them which they couldn't erase. In Germanic countries especially, so did certain racial-religious groups and the like. (When the head of the NIMH went in this direction about 10 years ago regarding genetically determined criminality he was forced out of his post)
Anyway Freud was welcomed as a liberator when he argued that trauma was more important than genetics.
On the other hand when studies such as you are quoting on this board demonstrated for instance, that ADHD was "really" a brain disorder and therefore not the "fault" of the way they are being raised, parents of ADHD kids felt exonerated. I don't think there is any point blaming parents but I am convinced that many, perhaps most cases of ADHD (I am working on a paper on ADHD, hence I keep going back to it) have very much to do with the way they have been and are being raised. Certainly some kids with ADHD were born that way, but I think the vast majority have been raised in a way that favors their symptoms. So how we interpret differences in PET as documented by brain studies is crucial. I am claiming such studies are "phony" if they are used to "prove" the whole problem is biological and therefore a drug is the answer to the problem.
Furthermore, I believe genetic "wiring" kinds of explanations are devastating to the kids. They lower expectations from teachers (as in "they can't help themselves") and more ominously convince kids that they are doomed. So much of what kids accomplish has to do with overcoming their doubts about themselves, especially when something doesn't come easily. We have all been there, tasted failure and frustration and we have been lucky this has been answered by our parents or teachers belief in us (even when they might be secretly wondering whether we have it in us to do it). I can't imagine what it must be like to believe that you are wired wrong from an early age. PARTICULARLY WHEN THE EVIDENCE IS NOT THERE!The bottom line is that there are a lot of biological kinds of studies which have been amazingly misinterpreted to "prove" most psychiatric problems are "really" physical problems. This is not a coincidence. Many biological psychiatrists are true believers. Yes they mouth truisms about psychosocial factors but they basically believe therapy's purpose is to keep patients taking their medicine.
Having been in academia when biological psychiatrists took over most psych departments, and the major psych journals, I can tell you that these problems are not theoretical but real. One side of the truth is being presented to the public and to psychiatrists in training. It was no different when therapy oriented psychiatrists controlled academia. They were not very open to biological ideas and funding, but you should know that there are reasons for the overenthusiasm in interpreting biological phenomenon in a way that favors the reigning ideology.
As for your complaints about my lack of politeness what can I say. Sorry? Let me tell you something. My profession is very polite in its discourse. There is an amazing lack of public disagreements and controversy considering the amount of garbage being accepted as truth. There is a pack-man mentality in the field, a need to hide in conformity out of fear of law suits should they not comply with "expert consenus protocols" This would be fine if we had reached a point of expertise where controversy and uncertainly were issues of the past, if we had solid knowledge that would eliminate controversy. But we are not there.
Time magazine recently ran a cover story on bipolar kids that was astoundingly wrong headed or certainly worth an uproar considering that these poor kids are going to be zonked out of their minds. I see teenagers all the time misdiagnosed with bipolar disorder who have put on 30 pounds and sleep 14 hours a day and the doctors who made the diagnosis in the hospital saw them 20 minutes.
Anyway, that is enough for now. I don't want to frighten posters on this board. Many meds are very very helpful and most doctors are doing their best and are doing their job well. Indeed it is the effectiveness of many of our newer meds that have probably led to some complacency. Moreover, I have always been a doubter of official truth (even when Freud was the God) so my statements should be put in perspective. But I would say that a degree of independent thinking is always valuable even in patients.
poster:Simon Sobo MD
thread:123623
URL: http://www.dr-bob.org/babble/20021210/msgs/131888.html