Posted by linkadge on July 4, 2009, at 7:42:42
In reply to Re: Going back to old-school - lithium., posted by SLS on July 4, 2009, at 3:32:15
>Yeah. Those with occult bipolar spectrum >disorders.
Well if your definition of bipolar is an individual who has a manic epsode in response to an antidepressant then yes. Otherwise its just a drug reaction.
>Even depression can be parsed using the
>body's reaction or non-reaction to the >administration of the drug, dexamethasone.This is rarely used for diagnostic purposes. Even such, a certain response to dexamethasone does not conclusively indicate depression. The patient could have cushings disease for instance and react to dexamethasone in a similar manner to depression. Do they necessarily have depression? No. That is the danger in trying to classify drug reactions as diseases.
>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.
Who knows peoples motives. Have you ever noticed that ever since drugs like seroquel have been approved for bipolar depression, there is this big push on internet banners for patients to consider whether they might have bipolar depression. The drug de jour defines how we classify mental illnesses. We are in a perod of AD backlash. Everyone's got bipolar depression now because a) their SSRI pooped out or b) they had a manic response to an antdidepressant. Keep in mind the SSRI's can cause extreme akathesia for some patients. Many of the symptoms of extreme akathesia overlap well with mania - namely irritability, psychomotor agiation, insomnia, etc. etc.
>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.
This is exaclty what I am saying though. If the patient was bipolar already, one would expect the mood elevation itself to accelerate the cycle.
>I have never heard that. Stimulating, yes. It >might be closer in effect to methylphenidate
>(Ritalin) or amphetamine (Dexedrine).Exaclty, drugs which people abuse to get high. People high on stimulants have symtpoms identical to manic episodes.
>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.
Anyone who abuses amphetamine is more or less having a manic episode. Elevated mood, increased energy, goal directed behaviors, increased hedonic capacity, less need for sleep, pressure of speech, grandiose ideas, you name it - its all the same thing.
>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?
He has done losts of work in rats and what he notices is that high dose amphetamines do cause behavior which is used as a model for amphetamines. How do you think all of these bipolar and schizophrenic drugs are identified? By they activity in reducing the manic like excitement caused by stimulants. Stimulants cause a more rapid elevation in signal transduction systems than antidepressants do. Lithium and valproate direclty block the transducton wherase the AP's block the receptor induced transduction.
Antidepressants also elevate protein kinase C. Actually, the SSRI's have more potent effects on PKC than bupropion does.If you could relieve depression without causing mania then do you really have bipolar?
Take yourself for instance, what if you initially took (and got well on) bupropion and not nortriptyline. If you never had a manic response to this drug and remained well, would you still be bipolar????
What about agomelatine? I personally think this drug will have an extrelly low propensity to cause mania. No monoamine reuptake. 5-ht receptor blockade. Completely different profile. I think if drugs like this were used more often for depression we'd have fewer manic reactions and ultimately fewer bipolar diagnosis.
Linkadge
poster:linkadge
thread:904699
URL: http://www.dr-bob.org/babble/20090630/msgs/904900.html