Posted by linkadge on July 3, 2009, at 18:11:33
In reply to Re: Going back to old-school - lithium., posted by SLS on July 3, 2009, at 17:28:37
>I don't understand. What exactly would upset the >integrity of psychiatry if it were found that >drug-induced manias were not necessarily the >result of an underlying bipolar disorder.
Then, it could be seen as (what I believe it is) a side effect of certain drugs in certain patients. Biology is way too complex to classify a disorder based on a reaction to a drug IMHO.
If it is the patient and not the drug, there is no fault with psychiatry.
>They are probably more heavily >catecholaminergic. Anyway, in what way is this >fact relevant to your beliefs regarding drug->induced manias?
Well, if all drugs are equally effective in elevating mood, you'd expect them to be equally likely to induce mania. That is, if the mania is the result of the drug acellerating a cycle.
Because some drugs are more likely to induce mania, suggests to me, that there is some biochemical target which is more fundimentally linked to the manic processes.
Some AD's like survector had to be pulled because it was too good an AD. Basically meaning that it must have induced euphoria as a side effect.
I think there are separate processes for affect and reward. Some of the AD's (notably parnate) have effects on affect and reward. Its all about the brain region that the drug hits. If it hits the right (or wrong) brain region, it can be like cocaine - able to give anyone a buzz.
For instance, the first MAOI's were noted to cause notably elevated mood in the TB patients they were first administered to - beyond what would be expected from TB symptom recovery. From the biological theory of depressive disorders, it is suprising that these patients experience any improvmente in mood (let alone to the point of hypomania).Nextly there is are the TCA's. The wikipedia article on imipramine suggessts that it has been known to cause a very high rate of manic reactions. The TCA's induce sensitization of limbic dopaminergic circuts faster and to a greater extent than the SSRI's. This is increasing reward sensitivity a core aspect of mania. In addition, anticholingerics (especially m1 antagonists) have been know to produce reinforcing effects in animal models. They have also been asocaited with manic and psychotic like effects in animals an humans.
I remember feeling better (very quickly) on TCA's - as in the next day. My mother too noted the effect. This was much unlike the SSRI's which took a month to produce a very modest apthetic improvement. My mother only had 1 manic epsiode which was on a high dose TCA. Never before, nor since.
>Even prednisone can produce psychosis. I have no >problem with the concept, just its execution.
Explain further.
Linkadge
poster:linkadge
thread:904699
URL: http://www.dr-bob.org/babble/20090630/msgs/904797.html