Posted by linkadge on February 25, 2007, at 10:57:43
In reply to Re: opiates for depression, posted by Quintal on February 22, 2007, at 20:15:34
>Caffeine seems to mostly increase alertness and >still isn't as effective as amphetamines though >and it is less well tolerated at doses needed to >have the desired effects; most people with ADHD >seem to prefer amphetamines. Caffeine doesn't >seem to be an impressive treatment for ADHD in >spiders(!):
It simply has not been tested alongside traditional stimulants, so I don't think we can comment on its efficacy, although it has been helping people get their work done for the last...ever.
>That is the point I'm getting at link. This drug >does make sense in theory because there have >also been a number of studies that indicate a >deficit in the nordrenergic systems of people >with ADHD. Just as with dopamine, according to >my textbook, there has been a noradrenaline >deficit hypothesis in ADHD (it seems) whenever >it has been convenient to market a new drug that >operates via that mechanism.But, what I am saying is that you cannot say this drug is inneffecive simply because it fails to elevate dopamine in the neucleus accumbens. This drug doesn't work for other reasons.
>That's the whole point I'm getting at link; you >can increase attention span with drugs that act >on neurotransmitters other than dopamine, yet >they don't seem to be as good for treating the >overall problem.No, thats not what I mean, at all. It is possable to increase dopamine in areas of attention without increasing dopamine in areas of reward. That, in my opinion would be just as effective as a drug that happens to target the reward centres as well. Like I said before, there are drugs that enhance dopamine release in the neucleus accumbens which are not effective for ADHD.
>You can say the same thing about benzos and >point to people who have been taking them for >decades and feel they are helping their anxiety >long after the initial sedation and euphoria >have faded. That might be true for some, but as >studies suggest (in benzos for example), most >are receiving little real benefit from the drugs >at that point (hard though it is for them to >believe). They have little more than placebo >brought on by conditioning. I think a lot >depends on the rate at which each person >develops tolerance. For some it's rapid and the >anxiety slaps them in the face and they have no >choice but to admit the drug is no longer >working. For others I suspect it's more >insidious, creeping up over the years so >gradually that they have time to adjust and >develop coping mechanisms. In effect they've >gradually withdrawn from the drug in the >therapeutic sense, in that it is doing little to >help the original problem, yet they are still >dependent on it, but mostly to maintain >equilibrium.
>You seem to be suggesting that the only way to >help all mental illness is to activate the >pleasure centres of the brain. I would think you >are mistaken if you suggest that every >psychiatric drug we have works solely through >this mechanism.>Why would such drugs be any less effective for >ADHD if the reward systems played no part in the >therapeutic response?
Becuase, we know from repeated studies that long term early use of methyphenidate makes the reward centres permanantly dependant on the molecule for proper function. So, when you switch somebody off methylphenidate onto a nonrewarding drug, you've introduced a new problem, depression. Yes, depression can cause attention problems on its own, but without clear evidence of depressive symptoms in the first place you're only changing the intial problem. If the lack of attention was purely due to reward dysfunction, then you'd be dealing with a different issue, ie depression. It a patient comes in saying that they can't concentrate *because* they feel worthless, and life isn't worth living, then this would be depression and not ADHD.
>I was hoping to add some perspective on flmm's >comments about opiates by highlighting the fact >that some people here have been prescribed >amphetamines for this purpose and no such >objections are raised to this as they are with >opiates. I've also noticed some people with >chronic depression deciding that because they >have poor concentration and trouble organising >themselves they must have ADHD, and therefore >need stims to treat this newly discovered co->morbid disorder. That seems a little dubious to >me, hence my comments.I agree with you. My original point was that opiates may be treating depression in some yet undiscovered way, which may indeed have nothing to do with being euphoriants. I merely brougt in stimulants as a example of drugs which while are euphoriants, are not working solely because they are euphoriants.
Linkadge
poster:linkadge
thread:734151
URL: http://www.dr-bob.org/babble/20070224/msgs/736005.html