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Re: Larry, Re: about the chemical imbalance concept

Posted by Simon Sobo, M.D. on April 26, 2003, at 6:51:22

In reply to Re: Larry, Re: about the chemical imbalance concept » McPac, posted by Larry Hoover on April 25, 2003, at 9:56:30

It is interesting that almost all of the posts in reaction to my article have suggested still more medicines and herbs to try to treat "the chemical imbalances" they are dealing with. Actually my article is challenging the automatic assumption that the problem is necessarily chemical. It may be but it may not be. The fact is this. WE DON'T KNOW! I am not against using medications in my practice. They are often very helpful but I am claiming they exert their effect through the more general psychological effects that they have on a person and not through a specific correction of a specific chemical imbalance for a specific diagnosis. Many of you commented on the article that I cited about using amphetamines for OCD. I have never used them for OCD but I am surprised that no one mentioned the other article claiming morphine helps OCD. Actually what I was saying is that intoxicants of all varieties may help OCD symptoms. I am not advocating this as a treatment but many people with OCD lose their OCD when they get drunk (others get worse).
I became interested in the amphetamine article after one of my patients told me cocaine had helped his OCD. Here is the portion of the article that you have reacted to and then I have one further bit of clinical information,

"In Obsessive Compulsive Disorder (OCD) similar problems emerge. Originally, the fact that serotonin enhancing drugs were uniquely effective led to a belief that there was a causal connection, but as early as 1991 there was confounding evidence. Thirty mg. of dextroamphetamine was found to ameliorate OCD symptoms (Joffe 1991). Moreover, while I am not advocating this as treatment, I have had patients report to me that intoxicants such as marijuana, alcohol, and cocaine have given them temporary relief from OCD symptoms. Indeed, a recent study has shown that oral morphine is reasonably effective (Franz, 2001). Once again it is possible to speculate that there is a downstream effect on serotonin, but if we use this argument we have come full circle in a tautological trap. The original reason for the serotonin-OCD chemical imbalance model was that serotonergic agents were believed to be unique in their effectiveness"

Here is the other clinical tidbit. The patient who found cocaine helpful for his OCD lost his symptoms completely when he became a Jehovah's Witness. This cure disappeared after about 6 months when he became disillusioned with the cult but it is nevertheless fascinating. OCD has something to do with uncertainty. If you can take that away, give a feeling of completeness or innocence or something like that there will be improvement. I guess morphine, SSRI's, and many intoxicants can do that for certain people, but the primary problem is probably psychological not chemical.


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poster:Simon Sobo, M.D. thread:221657
URL: http://www.dr-bob.org/babble/20030423/msgs/222532.html