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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 70. Go back in thread:
Posted by linkadge on September 16, 2006, at 20:30:27
In reply to Re: the brain » Squiggles, posted by yxibow on September 16, 2006, at 19:35:38
Many of the hypothesis that depression is *due* to a biochemical imbalance have been speculative. Antidepressants were discovered to have effect before their actions on monoamines were realized. The existence of medications that provide symptomatic relief of certain sympoms is not evidence of the origins of the underlying issues.
Despite how the knowledge of what antidepressants do, there exists no conclusive evidence that such dysfunctions are responsable for the illnes.
Like yxibow, I am not saying that such abnormalities don't exist, I am just saying there doesn't exist much solid proof of such theories.
Linkadge
Posted by linkadge on September 16, 2006, at 20:34:21
In reply to Re: the brain » yxibow, posted by Squiggles on September 16, 2006, at 20:00:02
We still have not proven that depression is due to biochemical imballance, and not that biochemical imballance is due to depression.
It is true that neurons may be firing more slowly etc, but is that the cause of the disorder or a consequence?
Linkadge
Posted by Squiggles on September 16, 2006, at 20:42:01
In reply to Re: the brain, posted by linkadge on September 16, 2006, at 20:34:21
> We still have not proven that depression is due to biochemical imballance, and not that biochemical imballance is due to depression.
>
> It is true that neurons may be firing more slowly etc, but is that the cause of the disorder or a consequence?
>
> Linkadge
"Biochemical imbalance" is a loaded term, almost
emotionally loaded, and hence a provocation to the
anti-psychiatry camp. What must exist is a change
between the chemical state of the brain under depression or mania or stupor or motor imbalance, etc. and the reversal of that due to drugs.Words are loaded weapons in psychiatry, but
facts are facts. Perhaps a different language
is needed.Squiggles
Posted by Phillipa on September 16, 2006, at 22:25:30
In reply to Re: the brain » linkadge, posted by Squiggles on September 16, 2006, at 20:42:01
I'm getting off the ad's for now as I can finally cry. Love Phillipa
Posted by willyee on September 16, 2006, at 23:08:53
In reply to Re: the brain, posted by linkadge on September 16, 2006, at 20:30:27
> Many of the hypothesis that depression is *due* to a biochemical imbalance have been speculative. Antidepressants were discovered to have effect before their actions on monoamines were realized. The existence of medications that provide symptomatic relief of certain sympoms is not evidence of the origins of the underlying issues.
>
> Despite how the knowledge of what antidepressants do, there exists no conclusive evidence that such dysfunctions are responsable for the illnes.
>
> Like yxibow, I am not saying that such abnormalities don't exist, I am just saying there doesn't exist much solid proof of such theories.
>
>
> LinkadgeHow can we have solid proof on something we are still at a stand still on understanding.
One could say we dont have solid proof on the latter either,that depression is a emotional disturbance that leads to a brai imbalance.
I agree and dont go for the whole "IMABLANCE CRAP" nor do i believe just about any of the drugs are "treating" anything.
They might however be possably masking,and in some cases masking as in tape just how to do.People have to live,and if a drug is needed to mask symptoms that normaly would keep people from doing these things.....work,family,social,etc.....then peoples decision to use them would i imagine be valid.
Going out,being more social,feeling simply OK,like myself,not feeling like my brain is on fire,etc,these are not options,they are goals,and its clear to me who is in my realm when people offer these as solutions,as if i never thought about opting not to go on the net,come here,and instead go out and party,these are the goals i want to reach,but forcing myself to do this and other things im only kidding myself,when i have short remission periods and do them,i feel content,but i loathe being forced to go "out more" and the like as if i never thought of these options.Im not gonna tell micheal j fox,hey stop shaking,i understand the man is having a malfunction causing this,and with the body suspect in every single area from toe up,i dont understand this stigma to where people dont feel the brain,the most used and complex part,can like the rest of the body,simply have various problems that can occur.
Even a jaquar can break down cant it?
Posted by linkadge on September 17, 2006, at 9:03:28
In reply to Re: the brain » linkadge, posted by Squiggles on September 16, 2006, at 20:42:01
Well what is fact? Cocaine can make a person happy, but that does not proove the existence of a cocaine deficiancy, or an imballance of any of the neurotransmitters that cocaine affects.
Linkadge
Posted by Squiggles on September 17, 2006, at 9:09:34
In reply to Re: the brain » Squiggles, posted by linkadge on September 17, 2006, at 9:03:28
> Well what is fact? Cocaine can make a person happy, but that does not proove the existence of a cocaine deficiancy, or an imballance of any of the neurotransmitters that cocaine affects.
>
> LinkadgeIn this context, if a person in a state of
suicidal depression is given drug X, and
the heavy mood of depression and despondence
lifts, and he/she feels at peace again, THEN
it is a fact that he was depressed before
drug X and not depressed after taking it.Squiggles
Posted by linkadge on September 17, 2006, at 9:19:47
In reply to Re: the brain, posted by willyee on September 16, 2006, at 23:08:53
I'm not saying that certain depression might not be due to a chemical imballance, but there is a bit of a difference between parkinsons and depression.
You don't see drug companies come on television to push their parkinsons drugs, cause they know that either you have it or you don't. With depression, a drug company knows that it can push an antidepressants on people who are depressed for normal reasons.
Nowadays everbody is on an antidepressant. There was an anonymous poll done on my psychology class which found that almost 1/2 of the class was on an antidepressat. Now do I believe that they all have genuine chemical imballances? No. I think that school can be tough, and that stess causes a lot of people to become very depressed.
Stress doesn't cause parkinsons, and you can't get parkinsons by loosing a loved one.
Thats not to say that some forms of depression don't have biochemical underpinnings, its just that there are too many factors to chalk it all up to "brain chemsitry"
Linkadge
Posted by bassman on September 17, 2006, at 9:58:50
In reply to Re: the brain » willyee, posted by linkadge on September 17, 2006, at 9:19:47
For my 2 cents, certainly there is such a thing as depression (if not, please tell me, so I can stop being depressed); and certainly some people respond to medication, for whatever reason. The real question is, "is the neurotransmitter theory correct', that is, are neurotransmitters primarily involved in anxiety and depression? The main problem is that no matter how much we find out about what happens to neurotransmitter levels during mental disturbance, we can't say that they are the cause-they could just co-exist with the "real" cause. Sort of like when people take TCA's; no one assumes that because their pulse rate goes up that having a faster heart rate is what is causing the person to be less depressed.
An interesting idea that I've seen is that in fact depression (at least "severe" depression, by which I mean a disturbance that causes someone to lose some important functionality) is actually an as yet undiscovered organic disease which has as its SYMPTOMS the manifestations we perceive when we are depressed, and refer to as “depression”. Who know if that is right, but it emphasizes the idea that we might be way off base with what causes depression.
BTW, I agree completely with the comment about as many as 50% of people taking AD's; I'm closer to retirement age than college age, but I've found that LOTS of people confide in me that they take AD's (I'm "out of the closet" on depression and anxiety because I facilitate an anxiety/depression support group-and so I’m viewed as safe, I think). Which leaves the question, “are lots of people taking AD’s that probably don’t need them; or, is there really an epidemic of sorts going on?” Fits nicely with the disease model, no?
Posted by Squiggles on September 17, 2006, at 10:16:22
In reply to Re: the brain, posted by bassman on September 17, 2006, at 9:58:50
When i look at articles on PubMed and
read books on the theories about causes
of mental illness, i am always impressed
by the variety of biochemical models
presented to explain what is going on.
The serotonin theory is one prevalent
today, but not the only one. Also, the
actual causes that lead to mental illness
are variable. Whether they all target the
same neurotransmitters, regardless of their
origin, or not, in order to make a person
depressed or happy, or forgetful, is
a difficult question. I think it is still
a huge field under investigation.But for practical purposes, what is important
to people now, is that they have something to
take to prevent them from becoming seriously
ill, as that can lead to suffering and tragedies
in their life and the life of others.So, as a layman, i can only appreciate
psychiatry and psychopharmacology from
an empirical point of view. The rest, you
really have to have a medical degree, and
a lot of insight and imagination. And yes,
i agree, the drug companies do not aspire
to scientific discovery as their ideal,
unfortunately.Squiggles
Posted by linkadge on September 17, 2006, at 10:18:41
In reply to Re: the brain » linkadge, posted by Squiggles on September 17, 2006, at 9:09:34
>In this context, if a person in a state of
>suicidal depression is given drug X, and
>the heavy mood of depression and despondence
>lifts, and he/she feels at peace again, THEN
>it is a fact that he was depressed before
>drug X and not depressed after taking it.But, that doens't say a whole lot about the validity of assumtpion that a biochemical imballance is the cause of depression and not a conseqence.
Lets say you've got your hand on a hot burner. An opiate might releive the pain, but you can't jump to the assumption that one now has an opiate deficiancy.
Linkadge
Posted by Squiggles on September 17, 2006, at 10:28:17
In reply to Re: the brain, posted by linkadge on September 17, 2006, at 10:18:41
> >In this context, if a person in a state of
> >suicidal depression is given drug X, and
> >the heavy mood of depression and despondence
> >lifts, and he/she feels at peace again, THEN
> >it is a fact that he was depressed before
> >drug X and not depressed after taking it.
>
> But, that doens't say a whole lot about the validity of assumtpion that a biochemical imballance is the cause of depression and not a conseqence.
>
> Lets say you've got your hand on a hot burner. An opiate might releive the pain, but you can't jump to the assumption that one now has an opiate deficiancy.
>
> LinkadgeIt seems to me self-evident, that there MUST
be a biochemical change in the brain, in the
examples you give. To put it bluntly, if
you do not have a brain, then neither an opiate
nor a drug, nor a stimulus in the environment
will have an effect on consciousness and
behaviour.Squiggles
Posted by SLS on September 17, 2006, at 10:29:19
In reply to Re: the brain, posted by bassman on September 17, 2006, at 9:58:50
> or, is there really an epidemic of sorts going on?”
Is there more psychosocial stress in our society to precipitate affective disorders or is there just more recognition and announcement of them, even though their proportion remains stable? Remember, our population has increased over the years. Even if all else were to remain status quo, reported cases would increase.
- Scott
Posted by linkadge on September 17, 2006, at 10:34:25
In reply to Re: the brain, posted by bassman on September 17, 2006, at 9:58:50
I think its more that we've discovered a group of drugs that has a desired effect.
There is a lot of trust out there that these are safe drugs, and without potential long term consequence.
As such, they are used for lesser and lesser problems.
The fact that they have some sort of positive effect for so many people who take them, kind of detracts from the notion that they are some magic chemical entities desined to target the exact biochemical abnormalities that exist in endogenious depression. The fact is that drugs like prozac are used recreationally (sometimes). They're just pep pills.
Cocaine was used for depression 100 years ago, but was it fixing anything? Were people better off because of it? Did it get to the underlying issue?
I just don't think we're at the stage where we can say, depression is due to such and such biochemical imballance.Linkadge
Posted by SLS on September 17, 2006, at 10:39:53
In reply to Re: the brain, posted by SLS on September 17, 2006, at 10:29:19
Look at the severe psychotic mania of bipolar disorder. At this point in time, who would imagine that to be a psychological deviation rather than a biological one. Now, consider that depression is a phase of that same disorder. How can one then argue that at least some presentations of depression are not biological too.
Let that be the thought experiment of the day.
- Scott
Posted by bassman on September 17, 2006, at 10:53:02
In reply to Re: the brain, posted by linkadge on September 17, 2006, at 10:34:25
I agree completely-empirically, some drugs just help some symptoms. Does that mean we know the mechanism? No. Does it mean we should stop taking them? No. I like the comment about, e.g. SSRI's, being such very safe drugs that the benefit/risk ratio is pretty high even for sub-clinical depression, for example. If I feel lousy all day, drag myself through the day, but am generally functional, it really becomes an issue of "happiness" (whatever than means). If I now take 20 mg Prozac or whatever and life takes on a new brightness, it may well be worth it. So now I take the AD and increase the percentage of people that are taking AD's, but that doesn't mean that there are more depressed people-back to empiricism-the only thing we know for sure is more people are taking AD's. Thanks Scott and Linkadge, I always learn something by reading your posts!
Posted by TJO on September 17, 2006, at 11:02:38
In reply to Re: the brain, posted by SLS on September 17, 2006, at 10:39:53
Hi,
Well if it is NOT a biological illness, then WHY do antidepressants work (for some people)?? There must be something that is being corrected and I think the percentages are too high for it to just be the placebo effect.Tammy
Posted by bassman on September 17, 2006, at 11:19:32
In reply to Re: the brain, posted by TJO on September 17, 2006, at 11:02:38
I don't think there is any question that depression/anxiety is ultimately a biological affliction that involves biochemical changes in the brain (?)...the only thing I think we're discussing is the mechanism. Put differently-what does (for example) Wellbutrin really do? Is it just a CNS stimulant and I could get the same effect with lots of coffee, etc. or does it really inhibit dopamine and norepinephrine reuptake in the neural synapse? Or does it suppress the symptoms of some as yet undiscovered organic illness, as I mentioned before? Recall that they used to send diabetics to the crazy house because they acted strangely...now someone gives them insulin and poof! they are abnormal in the same ways as the rest of us.:>} Clearly, insulin would be considered a powerful anti-depressant/anxiety drug, and the "proof" would seem to be indisputable. It all comes down to what Lou Duva (trainer for Mohammed Ali) said, "you can summarize it all in TWO words: you never know". :>}
Posted by Squiggles on September 17, 2006, at 11:31:11
In reply to Re: the brain, posted by bassman on September 17, 2006, at 11:19:32
I agree with bassman on this. But for me
at least, it is a question beyond my knowledge.
The troubling aspect of neurology and psychopharmacology, may be that the method
of research is troubled by biases. Biases,
such as marketing priorities in the drug
companies, academic politics, "glory" science,
lack of interdisciplinary research, just bad
research methods.. who knows.In the past 50 yrs. i am not sure that there have been great advances in the quality of psychiatric
drugs. I am taking a 60 year old drug, for
example. I wonder what people who take SSRIs
feel like - is their depression treated entirely,
a little bit, very well but with some undesirable effects, with terrible effects; is their mental state "clear as un unmuddied lake"?A friend of mine says "Psychiatry has yet to find its Newton" or something like that. Still, mental illness exists and has to be treated.
Posted by bassman on September 17, 2006, at 11:47:12
In reply to Re: the brain » bassman, posted by Squiggles on September 17, 2006, at 11:31:11
Forget Newton-when it comes to mental health, I think we are in the Old Stone Age, when we'd be the smartest human alive if we could figure out that a sharp stick might be useful for something. BTW, Newton said, when asked in his old age what his greatest accomplishment was (Laws of Motion, gravitational theory, helping Kepler, etc. etc.)-"lifelong celibacy".
Posted by linkadge on September 17, 2006, at 12:05:39
In reply to Re: the brain, posted by TJO on September 17, 2006, at 11:02:38
You can reduce symptoms of depression, or mask symptoms of depression without actually fixing anything. Same thing goes with physical pain. You could get relief from angina by taking morhphine, but that does not mean you are getting to the root of the angina. Infact, by not feeling the angina pain, you are more likely to suffer from an adverse cardiac event.
The same could be said for emotional disorders. You can blunt the preception of the problems with drugs, but that does not mean you become any smarter, faster, better looking. It doesn't make your job any more fufilling, nor does it make you earn more money. Drugs don't clean up the environment, nor do they remove the pesticides from your foods. Drugs don't clean the house for you. Drugs may take away the feeling having wasted your life, but they don't achieve your dreams for you. Drugs may remove the fear of contracting a deadly disease, but they won't reduce your chances of getting one. Drugs don't feed the kids in 3'rd world countries, but they may reduce the guilt over not helping. Drugs won't make friends for you, but they may reduce sensitivity to rejection. Drugs won't reduce your workload, but they may drone you through it.
Linkadge
Posted by bassman on September 17, 2006, at 12:11:14
In reply to Re: the brain, posted by linkadge on September 17, 2006, at 12:05:39
"...but that does not mean (drugs make)you become any smarter, faster, better looking"
Oh, no! I was sure Prozac made me better looking! :>}
Posted by linkadge on September 17, 2006, at 12:20:12
In reply to Re: the brain, posted by bassman on September 17, 2006, at 11:19:32
>biological affliction that involves biochemical >changes in the brain (?)...the only thing I >think we're discussing is the mechanism.
If you subject an animal to chronic mild stressors (p.s. life is a chronic mild stressor), they develop the whole list of symptoms of depression, including REM sleep abnormalities, reduced hednoic capacity, increased anxiety and HPA axis dysregulation, psychomotor retardation, the list goes on. You can reverse a lot of these changes with antidepressant treatment. So what does the mouse think, "oh well I was just chemically imballanced thats why I felt so crappy"?>or does it really inhibit dopamine and >norepinephrine reuptake in the neural synapse?
Repeated studies have shown that there is nothing wrong with the dopamine, norepinephrine reptuake mechanisms in people with depression. Actually the only known genetic group of people with lower levels of the norepinephrine transporter was some family that had (no suprise) chronic tacycardia, and high blood pressure.
The amphetamines act in a similar way, by inhibiting the reuptake of these catecholamines, but in the end are we just artificially boosting the level of certain areas of the brain. What is the long term conseqence? Probably that after drug discontinuation, those parts of the brain have a very hard time activating themselves on their own.
Antidepressants are like mental steroids. After you stop them, your brain just shrivels up, and doesn't work well on its own anymore. For each of the positive benifits you attain, you will experience the equal but opposite effect upon drug withdrawl. Not only that, you will grow tollerant to their effects over time.
Linkadge
Posted by linkadge on September 17, 2006, at 12:24:18
In reply to Re: the brain, posted by bassman on September 17, 2006, at 11:47:12
Antidepressants have not significantly altered the rates of suicide.
Linkadge
Posted by Squiggles on September 17, 2006, at 12:34:06
In reply to Re: the brain, posted by bassman on September 17, 2006, at 11:47:12
> Forget Newton-when it comes to mental health, I think we are in the Old Stone Age, when we'd be the smartest human alive if we could figure out that a sharp stick might be useful for something. BTW, Newton said, when asked in his old age what his greatest accomplishment was (Laws of Motion, gravitational theory, helping Kepler, etc. etc.)-"lifelong celibacy".
I've read that he was a real
curmudgeon, possibly insane himself,
and very mean-- not a babe magnet despite
his theory of gravitation.Squiggles
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