Posted by SLS on July 4, 2009, at 3:32:15
In reply to Re: Going back to old-school - lithium., posted by linkadge on July 3, 2009, at 18:11:33
> >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.
Yeah. Those with occult bipolar spectrum disorders.
> Biology is way too complex to classify a disorder based on a reaction to a drug IMHO.
It is done all the time for diagnostic purposes in many different fields of medicine. I can't give you an example right off the top of my head. Even depression can be parsed using the body's reaction or non-reaction to the administration of the drug, dexamethasone.
> If it is the patient and not the drug, there is no fault with psychiatry.
I just don't think that this kind of mentality went into the decision reached by William Potter (NIH) in 1992 to understand my illness as being a variety of bipolar disorder.
> > 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.
I would have no expectation of this. I don't find any logic in extrapolating to every antidepressant the same clinical properties, whether they be therapeutic or adverse.
> 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.
Perhaps. The question is whether or not it is downstream from the pharmacological actions of the drug. Wellbutrin and Prozac hit different targets even though many downstream effects are the same.
> 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 have never heard that. Stimulating, yes. It might be closer in effect to methylphenidate (Ritalin) or amphetamine (Dexedrine).
> I think there are separate processes for affect and reward.
I think so too.
> Some of the AD's (notably parnate) have effects on affect and reward.
Its all about the brain region that the drug hits.
You are preaching to the choir, my friend.
> If it hits the right (or wrong) brain region, it can be like cocaine - able to give anyone a buzz.
You see, this is where I don't see the execution of the concept. Nice on paper, but show me. I do understand where you are coming from with all of this. If you really want to do some digging, you might want to try some empirical research. For example, at what rate does the general population respond to amphetamine with a manic episode versus people who seek treatment for depression.
If Manji can make rats "depressed", I guess he can make them "manic". How would he go about making a person manic? Where on the Net can I find the Manji quote you cited?
I still believe that if you are treating someone for a depressive disorder, and a drug brings out a manic reaction, the odds are that they are displaying a phenotype that lies somewhere along the bipolar spectrum. These people are not representative of the general population, and I am betting that manic reactions to antidepressants are more likely an indicator of bipolarity than a simple side-effect.
Soon, our debate here will be moot, as functional imaging studies will be able to identify bipolar brains. They already do, but it might be awhile before they see general clinical application.
Oh, well. For now, I guess we must continue to disagree on this one.
- Scott
poster:SLS
thread:904699
URL: http://www.dr-bob.org/babble/20090630/msgs/904881.html