![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 58. This is the beginning of the thread.
Posted by Racer on July 8, 2005, at 19:26:04
This is prompted by a thread above, which really bothered me. In that thread, several links were posted to a series of websites that are biased against the theory of chemical imbalances as the cause of mental illness, and are oriented away from medications as treatments for mental illness, including depression. I really want to say a few things about web sites like those, and to offer a few pieces of advice about reading such sights.
First of all, because the web sites in question have a very strong anti-medication/anti-"chemical imbalance" theory viewpoint, whatever they write on those sites will support that stance. They are only choosing to write what supports their stance -- or seems to support it. Here's a little secret: much of the information such sites publish is offering half-truths, rather than giving you the full story. Read this sort of thing critically, and you can see that they leave out hard facts and figures, and they also leave out anything that might possibly support other views.
For example, the first site posted above spent several paragraphs expressing the idea that no one can offer up the idea chemical levels of the MAOs in the brain. OK. That's true, the only way to check the levels directly is to slice up the brain in question, which will only show the levels at the time of death.
That site did not mention that you can get a pretty good estimate of those levels by metabolites in the blood stream, or from a spinal tap, etc. And it also neglected another little bit of information: the drugs that are known to raise the levels of the monoaminic neurotransmitters in the brain ACTUALLY WORK! They relieve depression. They don't do much of anything for normal people, but for people with depression, they make a difference!
I didn't look at the date of that site, but I'll be generous and assume that when it says that there is absolutely no evidence for a genetic or inheritible cause of any mental illness, it's because they did not see the article from New Zealand that showed exactly that: an allele directly passed on in a Mendelian pattern that causes vulnerability to depression.
I'm also betting, though, that they're unwilling to recognize family studies that show relationships between family members with related disorders. After all, that's only anecdotal, when you come right down to it, right? There's no hard science there, right?
Weeeellll....
Actually, that is still science, and the studies taht have been done really do show that there's a genetic trait involved in most of these disorders. They just haven't got a specific gene -- or even a specific chromosome -- to point to for it. What's more, it's likely that many of these disorders are multi-genetic, or are caused by a number of related genetic patterns. And most everyone says that having the genes will make you vulnerable to an affective disorder -- NOT that the genes will cause it directly. Environment plays a key role, as does support structures in that environment. If a child suffers a major stressor, but has adequate social and familial support, that child may develop resistance to depression -- no matter what his or her genetic heritage.
So, please, when you read what's written on the web, or in magazines or newspapers, or anyplace -- please question what is written. Many times there is a bias, and many times that bias will affect what information is offered. Don't just read and believe. Use your mind. As well as reading what is said, try to read what isn't said: are they offering hard facts? Numbers are great, although often the percentages that are offered only tell part of the story. Is there a clear bias? That needs to tell you something.
In the case of the web site offered above, the sneering tone in which several paragraphs were written would have tipped me off to a problem -- why sneer, unless you're sure you're making your point? And in science, you're just not supposed to start out with a point in mind.
Besides, this is the medication related board, so I'm guessing most of us here haven't given up on finding a medication that helps us, right? That doesn't mean that we won't also be giving therapy a go, which has been shown to be optimal in most studies -- combination of medications and psychotherapy -- it just means that we're taking a medication. I guess I think it's a bit thoughtless -- at best -- to post links to the scare-mongering anti-medication sites on this board.
OK. I'm done ranting now. Please forgive me for muddying up the board.
Posted by linkadge on July 8, 2005, at 21:26:13
In reply to Regarding the whole Chemical Imbalance thing, posted by Racer on July 8, 2005, at 19:26:04
I have some things to say. I'll try to keep it short. I think there is evidence of certain chemical imballences, but there is also a lot of information that does not seem to fit the model, a lot of inconsistancies.
Here are some things that weigh on my mind.
Tryptophan depletion does not relyably make normal people depressed. Even if it is followed for several weeks. It does not make depressed people worse unless they are on serotogenic antidepressants.
Monaminergic antidepressants *can* make some people feel better. This is especially true with the MAOIs. Infact, if they didn't make normal people better, they would never have been discovered in the first place. They were discovered when they were given to patients for TB, and doctors noticed an unusual elation. This is when they were recomended to be tested in depression. These patients were not suffering from depression. Prozac has been known to be abused by commedians and salespersons trying to
gain a different prespective on their coureers.
These drugs are also found by tests on animals. By repeatedly stressing normal animals, they can induce helplessness, any drug which reverses this behavior can go on to the next round. These animals are *not* chosen because of specific serotogenic, noradrenic abnormalities, but yet the antidepressants still reverse the behavior.Antidepressants are effective for chemotherapy induced depression. Did the chemothereapy cause a chemical imballence, then not genetics.
My friends refer to paxil as a "chill pill", and will use it for various reasons for which it was never prescribed or intended.
The so called serotonin gene that has been discovered (short-short varient) which purportedly increases the risk of depression, actually codes for a *slower reputake* of serotonin, than those with other variants.
This is counterintuitive to why SSRIs would help at all.A few studies showed that antidepressants protected the brain from stress induced atrophy of hippocampal neurons, the study failed to point out that only tianeptine had this effect, and that prozac offered no such protection.
Some of the studies that showed that fluoxetine increased BDNF levels, failed to report that BDNF was increased in any animal that was "handled"
Tianeptine is an effective antidepressant, and clinically it does the opposite to what SSRI's do, it increases the uptake of serotonin.
The below statement was taken from
http://biopsychiatry.com/antidepskep.htm
Two of the largest and most reputable trials found only negligible differences between tricyclic antidepressants and placebo.
Some people noted that 5-ht2a receptors were downregulated by antidepressants, this was one purported mechanism. But ECT actually upregulates 5-ht2a receptors.
Most surprisinly, antidepressants have not been shown conclusivly to reduce suicide rates. That is a fact. The only two pharmacudicals that have, are lithium, and clozapine, but not the antidepressants.
The more I read, the more hazy the picture looks.Linkadge
Yes, monaminergic antidepressants do work for some people, but they don't work for everbody.
Posted by linkadge on July 8, 2005, at 21:57:36
In reply to Re: Regarding the whole Chemical Imbalance thing, posted by linkadge on July 8, 2005, at 21:26:13
Also, there are drugs that increase serotogenic, and/or noradrenic function but fail to be active antidepressants.
Linkadge
Posted by linkadge on July 8, 2005, at 22:30:29
In reply to Re: Regarding the whole Chemical Imbalance thing, posted by linkadge on July 8, 2005, at 21:57:36
Taken from:
http://biopsychiatry.com/serotonin/gene-brain.html
The gene codes for the serotonin transporter, the protein in brain cells that recycles the chemical messenger after it's been secreted into the synapse, the gulf between cells. Since the most widely prescribed class of antidepressants act by blocking this protein, researchers have focused on possible functional consequences of a slight variation in its DNA sequence across individuals. Everyone inherits two copies of the gene, one from each parent, which comes in two common versions: short and long. The short version makes less protein, resulting in less recycling, increased levels of serotonin in the synapse, and more serotonin-triggered cellular activity. Previous NIMH-supported studies had shown that inheriting the short variant more than doubles risk of depression following life stresses,** boosts amygdala activity while viewing scary faces,*** and has been linked to anxious temperament. Yet, how it works at the level of brain circuitry remained a mystery.
---------------------------------------
This is the exact opposite to what you'd expect.
They don't comment on that though.Linkadge
Posted by Phillipa on July 8, 2005, at 23:34:39
In reply to Re: Regarding the whole Chemical Imbalance thing, posted by linkadge on July 8, 2005, at 22:30:29
Very simply everyone in my family has anxiety and panic attacks. There is a hx of diabetes, arthritis, osteoporosis, heart disease. So why wouldn't the anxiety/depression be genetic too? Everyone in my family has been on a benzo and AD. And on my ex-husbands side alchoholism is rampant in all of the males plus bipolar. Fondly, Phillipa
Posted by SLS on July 8, 2005, at 23:45:35
In reply to Re: Regarding the whole Chemical Imbalance thing, posted by linkadge on July 8, 2005, at 22:30:29
I think the term "chemical imbalance" is used more often in layman's explanations than it is in scientific literature. It is an easier concept to grasp as opposed to things like "trans-synaptic receptor dysregulation" or "second-messenger cascade gene transcription events" or "white matter hyperintensities" or "hypothalamo-pituitary-adrenal axis dysregulation" or many of the other more specific descriptions portrayed in current models of depression. The key issue here is not whether the pathology of depression includes variable concentrations of neurotransmitters, but rather that it have any biological component at all. It does.
- Scott
Posted by linkadge on July 8, 2005, at 23:49:48
In reply to Re: Regarding the whole Chemical Imbalance thing, posted by Phillipa on July 8, 2005, at 23:34:39
So why wouldn't the anxiety/depression be genetic too?
-----------------------------------------------Not saying there may not be a genetic component but just saying that what this gene does doesn't fit the theory of why SSRI's should have any effect at all.
Linkadge
Posted by linkadge on July 9, 2005, at 0:11:03
In reply to Re: Regarding the whole Chemical Imbalance thing, posted by linkadge on July 8, 2005, at 23:49:48
Am also saying that there are a lot of unanswered questions as to how they work, when they work, when they fail, why they fail etc.
It was only 25 years ago that norepinephrine deficiancy was assumed to be the primary cause of depression. Much of the theory comes secondary to the clinical results of the drugs.
Like, I'll sit here and defend it all too, but I'd just like to offer some reasons why it might be advendagious to curb your enthusiasm.
Linkadge
Posted by ed_uk on July 9, 2005, at 8:06:22
In reply to Re: Regarding the whole Chemical Imbalance thing, posted by linkadge on July 9, 2005, at 0:11:03
>Am also saying that there are a lot of unanswered questions as to how they work, when they work, when they fail, why they fail etc.
Now that's true!
~Ed
Posted by Racer on July 9, 2005, at 13:20:53
In reply to Re: Regarding the whole Chemical Imbalance thing, posted by linkadge on July 9, 2005, at 0:11:03
Maybe I shouldn't have posted this. I got set off, big time, by a post above that cited a bunch of alarmist articles about how this whole concept of "chemical imbalance" was utterly wrong, that it had no scientific basis, etc -- and that the antidepressant medications of the world were some sort of evil plot against us. That sort of thing does set me off.
I guess what I was trying to say, really, is that it's good to read things like that skeptically, and that whether or not anyone knows the exact mechanism of action, these drugs do work.
Now, you want the qualifiers? Fine. They work for some people, some time. I know that as well as you do, since I've tried so many of them over the years. For a lot of people, though, they work well enough. Just some of us, like you, me, Scott, etc -- well, we're special. How's that? We're special, so we have to try more meds.
Now I'm done with this topic. Mostly because I'm over being worked up about having those other sites cited on this board...
Posted by Lou Pilder on July 9, 2005, at 15:03:45
In reply to Regarding the whole Chemical Imbalance thing, posted by Racer on July 8, 2005, at 19:26:04
> This is prompted by a thread above, which really bothered me. In that thread, several links were posted to a series of websites that are biased against the theory of chemical imbalances as the cause of mental illness, and are oriented away from medications as treatments for mental illness, including depression. I really want to say a few things about web sites like those, and to offer a few pieces of advice about reading such sights.
>
> First of all, because the web sites in question have a very strong anti-medication/anti-"chemical imbalance" theory viewpoint, whatever they write on those sites will support that stance. They are only choosing to write what supports their stance -- or seems to support it. Here's a little secret: much of the information such sites publish is offering half-truths, rather than giving you the full story. Read this sort of thing critically, and you can see that they leave out hard facts and figures, and they also leave out anything that might possibly support other views.
>
> For example, the first site posted above spent several paragraphs expressing the idea that no one can offer up the idea chemical levels of the MAOs in the brain. OK. That's true, the only way to check the levels directly is to slice up the brain in question, which will only show the levels at the time of death.
>
> That site did not mention that you can get a pretty good estimate of those levels by metabolites in the blood stream, or from a spinal tap, etc. And it also neglected another little bit of information: the drugs that are known to raise the levels of the monoaminic neurotransmitters in the brain ACTUALLY WORK! They relieve depression. They don't do much of anything for normal people, but for people with depression, they make a difference!
>
> I didn't look at the date of that site, but I'll be generous and assume that when it says that there is absolutely no evidence for a genetic or inheritible cause of any mental illness, it's because they did not see the article from New Zealand that showed exactly that: an allele directly passed on in a Mendelian pattern that causes vulnerability to depression.
>
> I'm also betting, though, that they're unwilling to recognize family studies that show relationships between family members with related disorders. After all, that's only anecdotal, when you come right down to it, right? There's no hard science there, right?
>
> Weeeellll....
>
> Actually, that is still science, and the studies taht have been done really do show that there's a genetic trait involved in most of these disorders. They just haven't got a specific gene -- or even a specific chromosome -- to point to for it. What's more, it's likely that many of these disorders are multi-genetic, or are caused by a number of related genetic patterns. And most everyone says that having the genes will make you vulnerable to an affective disorder -- NOT that the genes will cause it directly. Environment plays a key role, as does support structures in that environment. If a child suffers a major stressor, but has adequate social and familial support, that child may develop resistance to depression -- no matter what his or her genetic heritage.
>
> So, please, when you read what's written on the web, or in magazines or newspapers, or anyplace -- please question what is written. Many times there is a bias, and many times that bias will affect what information is offered. Don't just read and believe. Use your mind. As well as reading what is said, try to read what isn't said: are they offering hard facts? Numbers are great, although often the percentages that are offered only tell part of the story. Is there a clear bias? That needs to tell you something.
>
> In the case of the web site offered above, the sneering tone in which several paragraphs were written would have tipped me off to a problem -- why sneer, unless you're sure you're making your point? And in science, you're just not supposed to start out with a point in mind.
>
> Besides, this is the medication related board, so I'm guessing most of us here haven't given up on finding a medication that helps us, right? That doesn't mean that we won't also be giving therapy a go, which has been shown to be optimal in most studies -- combination of medications and psychotherapy -- it just means that we're taking a medication. I guess I think it's a bit thoughtless -- at best -- to post links to the scare-mongering anti-medication sites on this board.
>
> OK. I'm done ranting now. Please forgive me for muddying up the board.Friends,
I am requesting that you consider the following if you are going to post to this thread.
A. My posts of links concerning the chemical imbalance theory of psychiatry are just the start of what I would like to post about here.
You see, if the thread here is innitiated about the post in the thread that I posted the links in question, I am in the other thread mentioned responding to Dr. Hsiung's offer to show:
A. That it may not be exaggerating that psychotropic drugs could shorten one's life or cause harm to those that take them.
B. I also would like to show that the "chemical imbalance theory of psychiatry" is not accepted as fact by many in the psychiatric and psychology fields.
C. Other aspects relevant to this.
Lou
Posted by linkadge on July 9, 2005, at 15:35:34
In reply to Lou's response to aspect of this thread-hrmtolif?, posted by Lou Pilder on July 9, 2005, at 15:03:45
I think most of us know that the chemical imballance theory is not a "fact". Though, I don't understand what you're trying to say.
There are many things in life that we do dispite not haveing a full insight into the apparent workings. I guess it comes down to weather you want to suffer or not, there's not much beyond that.
Linkadge
Posted by linkadge on July 9, 2005, at 15:54:50
In reply to Lou's response to aspect of this thread-hrmtolif?, posted by Lou Pilder on July 9, 2005, at 15:03:45
There are many people who come on this board and think that they can disuade me from using psychiatric medications.
I have my reserves about psychatric medications, as do many people on this board.
I think there is some sort of false idea, that everyone who uses them is narrow-minded, looking for the quick and easy route out, and that we have no idea about the side effects etc.
We know the side effects.
We know what they can do.
We are able to distinguish between true side effects, and those proposed by anti-psychiatry sensationalists.
Many people come on the board claiming to have some new information about why they should not be used.
I admit I *used* to get offended. But then I said to myself. I know the pros and cons. I know fully what they can, and cannot do. I am prepared to face the consequences. Some people think that I don't have a head on my shoulders, and cannot think for myself.
I think that some people find their own way out, and they *assume* that their coping mechanisms will work for everbody.
If you want to post some new information go right ahead. But, will tell you this. The information had better be scientifically based, or I will brush it off.
Even though I am not on anything right now, I will sit here and stand behind my right to take psychiatric meds.
Understanding this, be my guest.
Linkadge
Posted by Lou Pilder on July 9, 2005, at 17:22:11
In reply to Re: Lou's response to aspect of this thread-hrmtolif? » Lou Pilder, posted by linkadge on July 9, 2005, at 15:35:34
Friends,
If you are going to post to this thread, I am requesting that you consider the following before you post.
A. A poster writes here something like,[...there are many things we do in life despite not having a full insight...]. The poster does not give examples of such
B. A poster writes,[...it comes down to weather you want to suffer or not...]. The poster does not write an explanation of what that could mean. Could it mean that if you take psychotropic drugs that you will suffer? Could it mean that unless you take psychotroic drugs that you will suffer? Could it mean that only those that take psychotropic drugs do not suffer?Could it mean that you {must} take psychotropic drugs or you will suffer?
C. A poster writes,[...there is not much beyond that...]. Is that a conclusion based on fact? Is the poster saying that there is no hope to overcome unless you take psychotropic drugs?
Lou
Posted by linkadge on July 9, 2005, at 17:39:16
In reply to Lou's response to aspect of this thread-nohop, posted by Lou Pilder on July 9, 2005, at 17:22:11
I'll post the way I choose to post thank you very much. Take it for what it is.
Linkadge
Posted by SLS on July 9, 2005, at 19:53:41
In reply to Lou's response to aspect of this thread-hrmtolif?, posted by Lou Pilder on July 9, 2005, at 15:03:45
Anyone who is a bipolar ultra-rapid cycler will argue passionately that what they suffer from must be some biological illness beyond their control to modify.
You should only know.
I pray for you that you never shall.
I know.
- Scott
Posted by SLS on July 9, 2005, at 20:10:19
In reply to Lou's response to aspect of this thread-hrmtolif?, posted by Lou Pilder on July 9, 2005, at 15:03:45
:-(
Posted by Phillipa on July 9, 2005, at 20:17:06
In reply to The world is still flat., posted by SLS on July 9, 2005, at 20:10:19
I'm sooooo sorry Scott. Fondly, Phillipa
Posted by linkadge on July 9, 2005, at 20:47:46
In reply to Re: The world is still flat. » SLS, posted by Phillipa on July 9, 2005, at 20:17:06
You mean that the world is still flat in that our acceptance is still narrow.
Linkadge
Posted by SLS on July 9, 2005, at 21:31:09
In reply to Maybe I shouldn't have posted... » linkadge, posted by Racer on July 9, 2005, at 13:20:53
> Maybe I shouldn't have posted this.
Why not?
Unfortunately, what you have drawn attention to is a ubiquitous topic of debate and contention. There should be none at this point in human history, but there is. To some, the world is still flat. For them, anything that upsets this notion often brings about defensiveness and a panicked attempt at expousing a liturgy without the enlightenment that humanity's objecive investigation into mental illness has demonstrated.
I think you are in agreement with most others along this thread that abnormal biological function contributes to most cases of Major Depressive Disorder (MDD) and Bipolar Disorder (BD). I see that there is some confusion here as to semantics and the descriptions of the details of the varying models of the etiologies of these disorders.
I think there is some confusion as to what a theory is.
Evolution is still a theory. We here this expression used all the time by those who would have us believe that evolution has not been proven. It has. It is a fact that it occurs. However, there are varying theories as to how it occurs. Likewise, it is now a fact that MDD and BD are illnesses involving brain function. However, there are varying theories as to how this occurs. One theory is that there is a chemical imbalance within the synapse between neurons. Other theories try to incorporate recent observations involving the abnormal structure and function of the brain.
Is depression the result of a chemical imbalance?
I don't know. However, I am sure that depression can be a disorder of the brain.
From the NIMH, NIH:
http://www.nimh.nih.gov/publicat/depresfact.cfm
"Evidence from neuroscience, genetics, and clinical investigation demonstrate that depression is a disorder of the brain. Modern brain imaging technologies are revealing that in depression, neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly, and that critical neurotransmitters—chemicals used by nerve cells to communicate—are out of balance. Genetics research indicates that vulnerability to depression results from the influence of multiple genes acting together with environmental factors. Studies of brain chemistry and of mechanisms of action of antidepressant medications continue to inform the development of new and better treatments."
- Scott
Posted by Phillipa on July 9, 2005, at 22:33:11
In reply to Re: The world is still flat., posted by linkadge on July 9, 2005, at 20:47:46
Again I'm simplistic. Just go to a psych hospital and watch what happens to a schizophrenic or Bipolar once their meds are adjusted. But there is abuse of the system too. Fondly, Phillipa
Posted by Sarah T. on July 9, 2005, at 22:37:13
In reply to Lou's response to aspect of this thread-hrmtolif?, posted by Lou Pilder on July 9, 2005, at 15:03:45
Psychotic people should be on medication. They should also be in therapy. Psychotic people with OCD should be on medication. They should also be in therapy. Psychiatry and psychotropic drugs are still deeply flawed, but it is painfully clear that, for some people, the alternative is far worse.
Posted by Racer on July 9, 2005, at 23:30:55
In reply to Racer, I understand what you're trying to say, posted by linkadge on July 9, 2005, at 15:54:50
I was certainly *not* suggesting that people avoid psychotropic drugs, Link. I was writing about this because I think there are a lot of people -- especially in the depths of depression -- who might read those pages and get freaked out. You said that you had gotten a bit freaked out once or twice yourself, right? Imagine being a newbie to depression, etc, and coming across those pages that say ADs are terrible and dangerous?
I doubt anyone still remembers when I first posted here -- maybe SLS? -- but I had just been prescribed Serzone, and was too worried to take it. (As it turned out, I was right to be concerned, but that's another topic...) I wanted more information about whether or not it would be safe for me before I took it. If I had been greeted by something that told me that psychiatric medications were dangerous, would shorten my life, were the wrong way to go, etc, well, I would have taken the acepromazine cocktail that I was already considering.
And you're right: too many people assume that those of us who choose to take psychiatric medications are doing it as a shortcut. They don't realize how many of us either are in therapy, or would like to be in therapy as well.
We're on the same team, Link. And I owe you a long email, but have gotten smashed lately with a couple of things...
Posted by linkadge on July 9, 2005, at 23:57:10
In reply to Not sure... » linkadge, posted by Racer on July 9, 2005, at 23:30:55
I definately agree with you and see where you're coming from.
I throw out a lot of ideas, essentially to learn more. But by no means am I condeming psychiatric meds as a whole.
Linkadge
Posted by gardenergirl on July 9, 2005, at 23:57:29
In reply to Regarding the whole Chemical Imbalance thing, posted by Racer on July 8, 2005, at 19:26:04
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Dr. Bob is Robert Hsiung, MD,
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