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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 22 to 46 of 70. Go back in thread:
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
Posted by bassman on September 17, 2006, at 13:38:31
In reply to Re: the brain, posted by linkadge on September 17, 2006, at 12:24:18
That's really interesting. But maybe the average person that kills themselves is now happier. Maybe some one can do research on that.
You don't have much use for psychoactive meds, I take it (?).
Posted by WeeWilly on September 17, 2006, at 14:18:41
In reply to Re: the brain » bassman, posted by Squiggles on September 17, 2006, at 12:34:06
Clearly our minds are an orchestra of numerous elements. Any of of these elements not " playing" properly spoils the music(optimum mental function). I will be 47 soon. Over 30 years ago I felt my mood and mental difficulties were caused by a dyregulation in my HPG axis. To this day I still do. A scientist in 1898 proposed a theory and treatment for HPG dysregulation. It pertaind to mood and cognitive problems in cases of menopause. In the 1920's estrogen compounds became available. Now in 2006 the HPG axis is still not understood. It's encouraging to see the increasing focus on HPG dysregulation as the key to understanding cognitive problems in a number of disorders. A study in Feb of 2005 proposed that supplementing with Inhibin would be a prudent course to take in the future in an attempt to reregulate HPG axi's. Evidence in my own case back in 1987 led me to suspect I may not produce enough Inhibin.
Through the years knowledge of Inhibin its subunits, Activin, Follistatin,FSH,LH,testosterone,estrogen, etc., and the HPG axis overall has grown more and more complex. In time many of us will be treated to correct our HPG axis. Like I stated earlier estrogen treatment started in the 1920's, but the mode of action is still is not known. Research is vigorously looking for alternatives to this intervention in the HPG axis because of studies completed in 2004 found estrogen treatments to cause much higher rates of various health problems.
I keep trying AD's(Emsam now), with very little success. My HPG axis is dysregulated also my HPA axis(Dex. non-supressor), so it is not likely I will find a effective treatment until these are addressed.
We sure are in a bizzar situation. Best wishes.
Posted by Squiggles on September 17, 2006, at 14:59:54
In reply to Re: the brain, posted by WeeWilly on September 17, 2006, at 14:18:41
I had to look up HPG - ok, this is
a possible endocrinological problem;
you say you "felt" that was the cause--
what do you mean by that?Squiggles
Posted by WeeWilly on September 17, 2006, at 15:30:52
In reply to Re: the brain » WeeWilly, posted by Squiggles on September 17, 2006, at 14:59:54
> I had to look up HPG - ok, this is
> a possible endocrinological problem;
> you say you "felt" that was the cause--
> what do you mean by that?
>
> SquigglesI thought or suspected over 30 years ago. Now I am close to 100% certain.
About the analogy of our minds being like an orchestra. Your trombone players would have to reach over and assist with the piano playing, the flutists pluck the harps, etc.. Many if not most of the factors that are involved with cognition are multifunctional. Inhibins and Activins, early on were thought to only regulate FSH. Now with identified receptor sites in the adrenal cortex, hippocampus and many othe places, its clear they have wide rangeing roles.
Posted by Squiggles on September 17, 2006, at 17:25:12
In reply to Re: the brain » Squiggles, posted by WeeWilly on September 17, 2006, at 15:30:52
> > I had to look up HPG - ok, this is
> > a possible endocrinological problem;
> > you say you "felt" that was the cause--
> > what do you mean by that?
> >
> > Squiggles
>
> I thought or suspected over 30 years ago. Now I am close to 100% certain.
> About the analogy of our minds being like an orchestra. Your trombone players would have to reach over and assist with the piano playing, the flutists pluck the harps, etc.. Many if not most of the factors that are involved with cognition are multifunctional. Inhibins and Activins, early on were thought to only regulate FSH. Now with identified receptor sites in the adrenal cortex, hippocampus and many othe places, its clear they have wide rangeing roles.
I suppose we all march to a different drummer,
follow the Pied Piper, call the tune, blow
your our own horn, fiddle while Rome burns, etc.
But when the piece is off key, you don't have
to be a neurosurgeon to recognize it.Nice analogy, but complicates matters when
you present a further challenge of correspondence in biological psychiatry. I'm quite content
with feeling "well" rather than depressed,
whatever the music.Squiggles
Posted by WeeWilly on September 17, 2006, at 18:34:08
In reply to Re: the brain » WeeWilly, posted by Squiggles on September 17, 2006, at 17:25:12
> > > I had to look up HPG - ok, this is
> > > a possible endocrinological problem;
> > > you say you "felt" that was the cause--
> > > what do you mean by that?
> > >
> > > Squiggles
> >
> > I thought or suspected over 30 years ago. Now I am close to 100% certain.
> > About the analogy of our minds being like an orchestra. Your trombone players would have to reach over and assist with the piano playing, the flutists pluck the harps, etc.. Many if not most of the factors that are involved with cognition are multifunctional. Inhibins and Activins, early on were thought to only regulate FSH. Now with identified receptor sites in the adrenal cortex, hippocampus and many othe places, its clear they have wide rangeing roles.
>
>
> I suppose we all march to a different drummer,
> follow the Pied Piper, call the tune, blow
> your our own horn, fiddle while Rome burns, etc.
> But when the piece is off key, you don't have
> to be a neurosurgeon to recognize it.
>
> Nice analogy, but complicates matters when
> you present a further challenge of correspondence in biological psychiatry. I'm quite content
> with feeling "well" rather than depressed,
> whatever the music.
>
> Squiggles
>
>
"But complicates matters when you present a further challenge of correspondence in biological psychiatry"? Not sure what you are saying Squiggles.
I sense that maybe I am not expressing myself well to you. In a nutshell, tests to diagnose and treatments to correct HPG and HPA axis dysregulation is on the horizon. It will be the the appropriate treatment that many of us have been looking for. What percentage of present sufferers that this is the key to their disorder I would speculate as high as 60%. Best wishes
Posted by Squiggles on September 17, 2006, at 18:53:50
In reply to Re: the brain, posted by WeeWilly on September 17, 2006, at 18:34:08
I think i misunderstood -- that there are
tests for this, makes the dx possible. What
i meant was that it's hard to correlate
with neurological states. Were you tested,
diagnosed and treated, successfully?Squiggles
Posted by WeeWilly on September 17, 2006, at 19:54:38
In reply to Re: the brain » WeeWilly, posted by Squiggles on September 17, 2006, at 18:53:50
> I think i misunderstood -- that there are
> tests for this, makes the dx possible. What
> i meant was that it's hard to correlate
> with neurological states. Were you tested,
> diagnosed and treated, successfully?
>
> SquigglesThere are tests for most of the known hormonal proteins,peptides,and various other elements that constitute the HPG and HPA axi's. There are treatments to elevate or lower some of them if appropriate but not all. It's the peptides like Activin, Inhibin, etc that are'nt here yet for clinical use. Correlating with neurological states? Well like with the Hypothyroid condition if your thyroid tests out of range the neurological state you will likely represent mirrors that of types of depression. Likewise with dysregulation the HPG and HPA axi's. Best wishes
Posted by Squiggles on September 18, 2006, at 8:39:49
In reply to Re: the brain, posted by WeeWilly on September 17, 2006, at 19:54:38
I don't know if i was tested for
peptides, etc. Depression and manic-depression
can be caused by so many different things.
In a state of crisis, such as psychosis,
or mania, they have to give the drugs that
work no matter whether they are the best drugs.
I think that our health system has to rely
on external signs for economic reasons.
You sound like you have access to private health care, and the privilege of getting many tests.
If they got that right, good for you.Squiggles
Posted by alexandra_k on September 19, 2006, at 5:04:17
In reply to Re: the brain » WeeWilly, posted by Squiggles on September 18, 2006, at 8:39:49
I should read the meds board more :-)
An analogy.
Lets suppose I'm trying to write this computer program and the program isn't working. I take the back off my computer looking for something to fix. I mean... Computers are physical systems aren't they? If the program isn't working then shouldn't I tinker around with the hardware in order to fix the program?
'Psychotherapy is none other than delicate psychosurgery and psychosurgery is none other than crude psychotherapy'
"The Philosophical Defence of Psychiatry" p. 156
Posted by SLS on September 19, 2006, at 5:20:00
In reply to Re: the brain, posted by alexandra_k on September 19, 2006, at 5:04:17
> I should read the meds board more :-)
>
> An analogy.
>
> Lets suppose I'm trying to write this computer program and the program isn't working.So, it was concluded that the program was faulty?
> I take the back off my computer looking for something to fix.
Someone's program was truly faulty.
> I mean... Computers are physical systems aren't they? If the program isn't working then shouldn't I tinker around with the hardware in order to fix the program?
Not getting it, Alex. I wouldn't have opened up the box. If I had my doubts, I would have tested the program on another computer.
> 'Psychotherapy is none other than delicate psychosurgery and psychosurgery is none other than crude psychotherapy'
Now that, I get.
:-)
(Just busting them)
- Scott
Posted by Tomatheus on September 19, 2006, at 23:00:03
In reply to Re: the brain, posted by alexandra_k on September 19, 2006, at 5:04:17
> Lets suppose I'm trying to write this computer program and the program isn't working. I take the back off my computer looking for something to fix. I mean... Computers are physical systems aren't they? If the program isn't working then shouldn't I tinker around with the hardware in order to fix the program?
Of course not. But if the hard drive is malfunctioning, adding new software or removing potentially problematic software won't get to the root of the problem. In the case that I described, no competent computer engineer would say that attempting to repair the malfunction in the hard drive is just "masking the real problem" or like providing the computer with a "crutch."
Obviously, problems with both the hardware and the software of a computer can occur. And the two types of problems need to be addressed in different ways. It's also conceivable that problems with both a computer's hardware and its software could interfere with its ability to function optimally, in which case both problems would need to be addressed appropriately.
Because we created computers, we obviously understand how they work and what causes them to stop functioning properly better than we understand how we "work" and what causes us to function less than optimally. Just because we don't fully all of the processes that contribute to the way we function mentally doesn't mean that we should dismiss the things that we do know as being pseudoscientific or that we shouldn't keep trying to improve our understanding of these processes (I'm not saying that you've suggested these things, but there are a lot of people out there who have).
I'd like to think that we'd want to put our own well-being over that of our computers, but it seems from the rhetoric of some groups and individuals that there is not universal agreement that humans should be a priority.
Tomatheus
Posted by alexandra_k on September 20, 2006, at 6:03:30
In reply to Re: the brain » alexandra_k, posted by Tomatheus on September 19, 2006, at 23:00:03
:-)
With mental illnesses what is problematic are behaviours (including verbal behaviours).
We then infer that there is a malfunction within the individual that is causing the problematic behaviours.
Sometimes it isn't about an illness within the person, however, sometimes it can be an illness with society. For example, political dissentors in Russia used to be diagnosed with 'sluggish schizophrenia'. They were involountarily committed and drugged. There wasn't a problem within the individual so much as a problem with society. As another example, if you are living in poverty with substandard living conditions and you present with depression then there isn't a problem within the individual so much as a problem with the individuals greater social environment. There is still a tendency for society to think it better to drug such individuals rather than spending the money that goes to the pharmacutical industry on improving their living conditions.
Usually it is assumed that there is a malfunction on the level of hardware (neuro-physiology).
But there could be nothing wrong with the hardware, the malfunction could have to do with the level of software (psychology).
As an example of the latter, mental mechanisms have evolved to function within a certain range of environmental conditions. When the environmental conditions are outside the range (if you are raised persistently told you are good for nothing, for example) then the problem can be the content of the information that is being processed rather than a problem with neuro-physiological malfunction.
Drugging a person to deal with those conditions would be inappropriate. It would be a cover up strategy and would fail to deal with the cause of the problem.
> But if the hard drive is malfunctioning, adding new software or removing potentially problematic software won't get to the root of the problem.
That seems correct for the computer case. People are a little different, however. With people it seems that the only way you can change the software is to change the hardware. Does that mean that therapy is a waste of time? Not at all. Therapy works by effecting neuro-physiological changes in the hardware and there is evidence that therapy can lead to lasting neuro-physiological changes.
Hence... The biopsychosocial model of mental illness. There are two motivations behind the biopsychosocial model (best I can figure).
1) Instead of assessing behaviour and prescribing medications clinicians need to take adequate assessments of the persons overall functioning in each of those areas. This is supposed to lead to a more humanistic / humane psychiatry.
2) Neuro-physiological, psychological, and social factors can be causes of mental illness. In fact it can be hard to seperate them out. The social facts are represented in the individuals psychology (if you are living in a crap environment and you move to a nice environment then depression can lift). Psychological facts are realised in the individuals neurobiology (changing the psychology is realised as a change in neurobiology). And of course what people have faith in on the meds board, changing neurobiology can lead to changes in psychology too (though not necessarily).One could try and interveane at one point...
Or one could try and interveane at as many places as possible...Research has shown that a conjunction of medication and therapy works better than either one of those on their own. I don't know whether they have been able to compare with alterations in social environment (both individually and in conjunction) but if the biopsychosocial model is correct then it would seem likely that interventions targeted to all three would be more effective than interventions targeted at any one or combination of two.
Of course it might be the case that the causal relationships that hold for individuals are different from the causal relationships that hold for models of kinds of illnesses...
But I still think that for a very long time yet...
If you want to teach someone to cook you are better off showing them how than trying to manipulate their brain directly...
And if you want to teach someone to manage anxiety / depression etc therapy does something that direct manipulation of their brain is unable to do at present.
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Dr. Bob is Robert Hsiung, MD,
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