Posted by undopaminergic on June 3, 2008, at 3:43:30
In reply to Re: Clonidine Contributing to Depression? » SLS, posted by ace on May 29, 2008, at 1:43:35
> > > > What was the case profile of these folks. Does anything stick out in your mind as a commonality among individuals with depression whom respond favorably to clonidine?
> > > Very much so- the vast majority were diagnosed with ADHD or ADHD type symptoms. Although I have seen anecdotes on 'normal' depression (without co-morbidity) responding to it favourably. I believe I have some on trials on it too- for OCD, ADHD- always with depression as a co-morbid problem.
> > The ADHD I knew about. Not the OCD. Interesting. I guess that makes sense if NE pathways to the frontal cortex are overactive.
Eur J Pharmacol. 1991 Feb 14;193(3):309-13. PMID 1675994
Clonidine causes antidepressant-like effects in rats by activating alpha 2-adrenoceptors outside the locus coeruleus.
"Clonidine, 0.05, 0.1 and 0.5 mg/kg administered i.p. as a three-injection course but not as single doses, significantly reduced the immobility of rats in the forced swimming test."
Eur J Pharmacol. 1990 Jan 17;175(3):301-7. PMID 1969801
Alpha 2-adrenoceptor blockade prevents the effect of desipramine in the forced swimming test.
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Personally, I like to maintain a suitable degree of alpha2-agonism through the use of guanfacine. I haven't noticed an antidepressant action, but it improves some facets of working memory and executive function. Bonus effects include a reduction of heart rate and blood pressure. The only drawback is an increased tendency to dry mouth. It should perhaps be noted that guanfacine is not equivalent to clonidine for all intents and purposes - it's better tolerated, and more suitable for cognitive enhancement, but may be less efficacious for some other uses.
> I understand, and I checked out the link- thanks for that. You must of heard that statement Jung made about a physician 'washing his hands first' (before treating others)
A physician should of course wash himself, and be free from contagious diseases, so as not to transfer these to his patients.
> Would you say, per se, it would be unethical for a psychiatrist to be on the very medications he prescribes?
Absolutely not. In the good old days, doctors often tested treatments and medications on themselves - for instance, the stethoscope, the hypodermic needle, opium preparations, and hypnotic agents. Freud familiarised himself with the effects and propertiess of cocaine by administering it to himself before venturing to use it on his patients. In this day and age, psychiatrists generally lack first hand experience with most of the treatments that they prescribe, often prolifically, to others. In my opinion, this is somewhat irresponsible.
It would, however, be unethical - and more importantly, unsuitable and inefficient - for a physician to be so enthusiastic and passionate about a particular medicine or other treatment that he presses it onto patients for whom it is not appropriate, or for whom alternative treatments would be more effective or suitable. Such enthusiasm may come from personal use of the treatment and a resulting amazement with its efficacy for treating a health condition, or any other agreeable effect of it.
As an example, if a physician used morphine on himself to treat chronic back aches, and found it not only to be remarkably effective for the pain, but also to induce a state of comfort and joy, it would not be appropriate to let such experience cloud his judgement so that he proceeds to prescribe morphine therapy for a patient presenting with migraine (except perhaps after trying other, more suitable treatments first and finding them ineffective).
As a particularly pertinent example, it would be inappropriate for you to let your personal success and satisfaction with Nardil lead you to prescribe it for patients for whom EMSAM or Parnate would have equal probability of success but less likelihood of adverse effects regarded by the patient as particularly undesirable.
> I do know many psychiatrists (on a personal level) (Also, my uncle is a psychiatrist) who certainly suffer mental illness, and a myriad of "Axis II" disorders. And I have noted (what I feel) is improper behaviour, due, to what I feel is their own psychiatric problems.
It is important to remember that psychiatrists are only human, and it is not reasonable to demand them to be perfect. Besides, the definitions of mental health and illness are subject to change - for example, homosexuality is a mental condition that is no longer regarded as an illness. Additionally, ideals are also subject to change - for instance, what may have been considered ideals for everyone to strive towards in ancient Greece may be regarded with ridicule or contempt in some other place and time.
> Maybe my whole anxiety about this is a manifestation of my own mental illness, I'm not sure?
It's quite possible that it's a manifestation of some underlying mental condition, such as a lack of confidence or self-esteem, or alternatively, exaggerated perfectionism or idealism.