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Re: Doctors underestimate our intelligence/knowledge ?

Posted by linkadge on November 18, 2006, at 8:52:18

In reply to Doctors underestimate our intelligence/knowledge ?, posted by ronaldo on November 18, 2006, at 7:58:00

The problem is that flimsy neurotransmitter knowledge such as ours has only a limited capacity to predict outcome of any of our drug trials.

People like myself have gone in with all sorts of crazy wacko ideas of why this drug or that drug needs to work, based on its activity at such and such a recptor but it really doesn't amount to anything. I'd urge you to find anybody who has found the right drug based on neurotransmitter theory.

I guess what I am saying is that how a drug is thought to work dosn't really mean much in the end. I'd say the experience that a psychiatrist has with what works and what doesn't is a much more valuable tool.

Even if a person correcly predicts what drug affects what neurotransmitters. That is a far strech from matching it with ones underlying biology. Many people for instance, incorrectly assume that if a SSRI doesn't work then they must have a dopamine problem. Other incorrect assumptions are that if unipolar drugs don't work, the person must be bipolar. Unfortunatley it doesn't work in such a binary manner.

Let me give another example. Many people think that Wellbutrin is working primarily via dopamine. People come on the board convinced that they have some sort of dopamine defiiciancy and that Wellbutrin is the answer.

The problem is that more recent and detailed invesitation into the workings of Wellbutrin reveal that it has only negligable affinity for the dopamine uptake pump. At maximal doses, a person might only achieve 20% inhibition of the uptake pump. Other findings about the drug have called for a reconsideration of its principle mechanisms.

Another example is straterrra/reboxetine. Both are potent inhibitors of noradrenaline uptake, yet on shows significantly more antidperessant potential than the other.

So, does a good doctor underestimate our "knowledge"? A good doctor doesn't and probably shouldn't (IMHO) care about our petty knowedge of the flimsy proposed mechanisms of a drug which in the end, only serve as weak guidposts to drug selection.


Just my 2 cents.


Linkadge


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poster:linkadge thread:704811
URL: http://www.dr-bob.org/babble/20061117/msgs/704815.html