![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 259 to 283 of 297. Go back in thread:
Posted by linkadge on March 6, 2006, at 16:33:31
In reply to Re: SSRIs and the heart » linkadge, posted by Larry Hoover on March 6, 2006, at 10:54:26
Well, first of all, the cocoa has been a very positive experience. I have a few of my own gold standards; omega 3 is probably at the top followed closely by cocoa.
As far as antidepressants on cardiac function I am not suggesting that I know the answer. We do know that a few studies have linked the TCA's to increased mortality esp. in patients with pre-existing arythmia.
I think it is necessary to keep an open mind to all possabilities. For instance, SSRI's are sometimes used in IBS, but they can also cause increased rates of GI bleeding etc.
Like I mentioned above, SSRI's will eventually lead to an increased release of serotonin. The 5-ht2b receptors have been implicated in fenfluramine induced cardiac events (a metabolite is actualy a 5-ht2b agonist).
Nevertheless, an SSRI increasing agonism at all serotonin receptors, can induce an array of side effects including sexual function (overactivation of 5-ht2c) psychic anxiety (overactivation of 5-ht2a), may indeed increase the likelyhood of cardiac problems (overactivation of 5-ht2b).
http://www.nature.com/cgi-taf/DynaPage.taf?file=/nm/journal/v8/n10/full/nm764.html
As a side note...
Yes, I know. Chocolate may increase PEA, and increased PEA may lead to paranoid psychosis. :)Linkadge
Posted by linkadge on March 6, 2006, at 16:36:38
In reply to To Linkadge, posted by deniseuk on March 6, 2006, at 11:05:27
I think it is probably a combination of things. Life events, drug effects, placebo effect, and dozens of other factors probably come together to determine the likelyhood of response.
Linkadge
Posted by linkadge on March 6, 2006, at 16:54:14
In reply to Re: suggestability » deniseuk, posted by Larry Hoover on March 6, 2006, at 11:39:24
The thing is that if you have a highly suggestble person, it may only requre a very weak drug effect for your mind to create the remainder of the AD effect. Sometimes if the drug just does *something* that is enough to make the paitent believe in the whole system of treatment.
As one progresses in the course of their illness. Suggestability may decrease, in which case a stronger drug effect is acutally required.So, some people may indeed need the active drug insomuch as it creates enough of a biochemical shift for the brain to initiate a psychological shift.
P.S.I've always found that my search for the cure, was the best cure I had. Accordingly, I could never find "the right pill" because that would mean the search was over.
Linkadge
Posted by yxibow on March 6, 2006, at 19:54:12
In reply to Re: Why did Yxi's post just disappear? » yxibow, posted by ed_uk on March 6, 2006, at 13:32:26
Hi Eddy (do you mind this -- I can call you Ed, it just seemed to rhyme with Yxi :)
>
> >I've seen this happen.
>
> I see your post got redirected to p-babble withdrawal. Funny, since we were no longer discussing withdrawal!I know... and as I said, I've rarely gotten any notice. I shall bite my tongue now on a certain individual who is in charge here.
>
> >Any way my point was that diphenyhdramine shouldn't be taken long term particularly for depressed patients because at least by my experience it creates a depressive hangover the next day.
>
> Perhaps your reaction was unusual?
>
> Ed xIt could be... thats why I always say your miles may vary, and by my experience. I'm usually fairly careful not to say absolutes on here. If I were stuck on a desert island with my usual insomnia I suppose I would take it, but its a crude sleep agent and I believe it offers little REM. But it might calm my slightly shaking hands and whatever other EPS.
Posted by sdb on March 6, 2006, at 19:59:33
In reply to Re: NASA's , SSRI, SNRI, etc.}} SLS » sdb, posted by SLS on March 6, 2006, at 8:11:43
Thanks for warming up and your comments to my questions :-)
ah yes, the Phen-Fen problem. I get it.
~sdb
Posted by musky on March 6, 2006, at 22:26:17
In reply to Re: NASA's , SSRI, SNRI, etc. » musky, posted by Phillipa on March 4, 2006, at 16:50:52
> Right , which is exactly my point.. If they cant measure how much you have in your system , then they cant possibly know if you are lacking in this .. also it has never been proven that low levels of serotonin or even the serontonin reuptake inhibitors are directly responsible for mood, or if this is a downstream effect..
this is why I am very skeptical if these drugs do what they do or what people feel is the SECONDARY effect of excess epinephrine that the body will produce to counteract the antidepressant that is screwing up the serotonin in the brain./body.
Im trying to simplify things here... antidepressants block the natural uptake of serotonin supposedly., this then causes and over abundance(which cant possibly be healthy) of serotonin to be available in the system. The brains neuro receptors shut down because they are over loaded with serotonin . That is why we get side effects because once receptors are not functioning, everything else in the body starts to be affected... scary stuff.. sorry to ramble. thanks for the clarification.. but this is curious what you say that serotonin isnt in the blood??musky
Serotonin can't be messured by a blood test. At least the serotonin in your brain. You can test for some TCA's but no blocd test of SSRI ,SNRI. If there were they would know how much and which drug to give you. Correct me if I'm wrong. Fondly, Phillipa
Posted by musky on March 6, 2006, at 22:31:37
In reply to Re: NASA's , SSRI, SNRI, etc. » Phillipa, posted by yxibow on March 4, 2006, at 17:23:02
> >
that is very interesting you say that the receptors are in the gut... If you read the literature on how neurorecptors work, they are the ones that signal across the synaptic junction and the antidepressants either affect the signal before or after the synapse..In other words you would first absorb the drug yes in;your gut, but the end effect is in the brain...the neuro transmitter cells. The SNRI's Etc all block the receptors from reabsorbing the serontonin like it should , thereby creating an excess...
muskySerotonin can't be messured by a blood test. At least the serotonin in your brain. You can test for some TCA's but no blocd test of SSRI ,SNRI. If there were they would know how much and which drug to give you. Correct me if I'm wrong. Fondly, Phillipa
>
>
> There is a test for serotonin serum levels. You may be right that it doesn't allow for blood-brain level testing, although of course more than 90% of the serotonin receptors are -not- in your brain, they are in your gut.
>
> http://www.nlm.nih.gov/medlineplus/ency/article/003562.htm
>
>
>
Posted by musky on March 6, 2006, at 22:36:58
In reply to Re: NASA's , SSRI, SNRI, etc. » yxibow, posted by Larry Hoover on March 4, 2006, at 19:20:21
i agree larry... there is no proof that serontonin is directly effect the mood or that snri, snras etc. directly affect the mood..
Remember this is all just a theory,, tested in a lab on RATS!!!! pharamaceutacal companies make billions on these drugs that are so called selective .. yet they prescribe them for everything under the sun... figure that one out.. what is supposedly SELECTIVE is now widespreadmusky
Posted by musky on March 6, 2006, at 22:44:45
In reply to Re: NASA's , SSRI, SNRI, etc. » Larry Hoover, posted by yxibow on March 5, 2006, at 17:04:04
sorry i hope Im doing this right.. ha, ha
I just joined this thread and not sure if I am sending the posts to the right people..or getting all the messages screwed up
please be patient with me.. still learning this system
I am struggling to get off this stupid Remeron and I am very shocked at how many people are on some drug or another/.
My acupuncturist told me that i had more chance of crashing if I stayed ON the antidepressant than if I came off of it and let my body heal and balance itself out.. and you know I Believe him
the drs. (not all) but alot scare the patient into believing that they need the drug to function..not true.
I work in a research lab and even the drs here wouldnt touch this stuff!!Good luck to all who are trying to wean off
take your time and be careful and believe in yourself.. PUsh negative thoughts aside..they cannot hurt you.. they are just thoughts.musky
Posted by musky on March 6, 2006, at 22:52:36
In reply to Re: NASA's , SSRI, SNRI, etc.}} SLS, posted by SLS on March 5, 2006, at 19:28:52
> > sheesh after reading this message I really am wondering more about these SNRI's etc!!! which gives me more reason to get off of it(ha, ha). Then again so many things are dangerous.. one must keep this in perspective.. but when it comes to fooling with the neuro receptors in the brain, I would caution anyone to think twice before going on any SNRI, SSRI, etc, etc..
Majority of people are depressed cause of life issues and how they deal with them and think about them.
I believe that the cognitive therapy approach is THE way to go here...no drugs..just use your mind .
Ive been off of ativan for 2yrs now because I learned to manage my anxiety other ways.. and IT works.. no drugs just mind control.. and practice. and Im glad that I have the power to control my anxiety, not have to run around will a pill in my purse or panic to have one on memusky
Then there is the alternate possability that SSRI's are dammaging the heart in a manner similar to certain serotonergic weight loss drugs, but I won't go there.
>
> There's no reason not to go there. You make a very important observation. Of course the main difference between SSRIs and the diet drugs Pondamin and Redux is that the latter two are serotonin releasers and seem to act very differently in the body. I have never seen any evidence for SSRIs producing the same heart valvular pathologies as are seen with the serotonin releasers. However, this possibility should not be overlooked.
>
> Good call.
>
>
> - Scott
>
>
Posted by musky on March 6, 2006, at 23:00:14
In reply to Re: NASA's , SSRI, SNRI, etc. » SLS, posted by TylerJ on March 5, 2006, at 22:43:26
> > oops me again! I think I am responsible for that one the NASA , I was thinking of the drug im on which is both a norepinephrine and serotonin Reuptake antagonists.. I think.. sorry, It affects both chemicals..
Ithink it may be an SNRI but i was sure I saw NASA somewhere in my readings(ha, ha).
sorry
musky
> Scott,
> > > What the Heck is an NASA?
> > >
> >
> > lol
> >
> > I haven't a clue! I was hoping you might tell me!
> >
> > lol
> >
> > Occasionally, you will see the acronym "NARI". It stands for noradrenaline reuptake inhibitor. Noradrenaline is another term for norepinephrine.
> >
> > I guess I'll have to go another sleepless night wondering about "NASA". :-)
> >
> > I'm sure it has a very legitimate meaning that I will come to know with some measure of embarassment.
> >
> >
> > - Scott
>
>
> LOL...Thanks Scott, Let me know when you figure it out please :) Also Scott, I'm doing very well on Parnate, however I'm trying to learn as much as possible in case a problem occurs. What augmentation strategies do you recommend for Parnate, of course, only if needed? Thanks.
>
> Tyler
Posted by linkadge on March 7, 2006, at 9:39:07
In reply to Re: NASA's , SSRI, SNRI, etc., posted by musky on March 6, 2006, at 23:00:14
That being said, I do agree that certain forms of depressive illness are a result of certain brain abnormalities.
People with severe parkinsons disease can't always just get away with mind over matter.
I do agree with you that most peoples depression is a result of life stress, but there are many other factors such as why two people subjected to the same amount of stress can react very differently.
FOr most people the best solution is probably just talk therapy, exercise etc. but I personally would not extend those treatments to suggest they are everyone's answer, becuase I do believe that brain abnormalities can lead to depression.
Linkadge
Posted by Chairman_MAO on March 7, 2006, at 11:10:57
In reply to Re: oh » Chairman_MAO, posted by linkadge on March 4, 2006, at 9:27:34
You are being duped by purposefully biased science. The reality is much more complex.
I would administer crack cocaine until I died if I were locked in dank cage for life as well. What else is there to do? Self-actualize?
Posted by linkadge on March 7, 2006, at 11:36:28
In reply to Re: oh » linkadge, posted by Chairman_MAO on March 7, 2006, at 11:10:57
I am sitting on the fence on this issue. I know that crappy life circumstances can bring just about anybody down.
But for me, it doesn't take much looking to see that all man was not created equally.
Me an my brother were both raised in the same environment, and had acess to the same diet. He always weighted about twice as much as I did. It is as hard for me to gain weight as it is for him to loose.
Duped, is a pretty strong word. This, too is a fairly unbiased opinion since I have been off drugs for over a year.
I am suprised I am hearing this from somebody who claims to have been depressed from birth. Were you locked in a cage as a child ?
Linkadge
Posted by Chairman_MAO on March 7, 2006, at 11:58:32
In reply to Re: oh » Chairman_MAO, posted by linkadge on March 7, 2006, at 11:36:28
I am not talking about depression; I am talking about the assertion that rats--and humans--will undoubtedly self-administer crack cocaine until death.
Posted by Chairman_MAO on March 7, 2006, at 12:11:42
In reply to Re: oh » Chairman_MAO, posted by linkadge on March 4, 2006, at 9:27:34
Specifically, I am in agreement with the Rat Park investigator, who said:
" The disease model has been "embellished in the news media", to the point, he writes, "where the belief in drug-induced addiction has acquired the status of an obvious truth that requires no further testing." The widespread acceptance of this belief "is a better demonstration of the power of repetition than of the influence of empirical research ..." [9]
See also: http://www.szasz.com/addiction.pdf
and various works by Stanton Peele.Mental illness CANNOT be a medical illness per se because physiological pathologies of the brain are the domain of neurology. A pathology is nothing except that which is identifiable post-mortem. My suffering of depression is irrelevant to this. The suffering in mental illness is real, and there certainly may be undetected abnormalities on a psychobiological level. However, until what such a problem is can even be defined--which it is has not, otherwise antidepressant monographs would not claim that the mechanism of action is unknown--there is no such thing as mental illness as defined by most psychiatrists and other professionals in the field. If you know of an argument to the contrary (especially in a peer-reviewed publication or other scholarly work) I am always interested in hearing it. Despite what you may think I have a very open mind about this, and have never heard anything that vitiates the Szasz argument.
Posted by linkadge on March 7, 2006, at 13:04:26
In reply to Re: oh » linkadge, posted by Chairman_MAO on March 7, 2006, at 11:58:32
"am talking about the assertion that rats--and humans--will undoubtedly self-administer crack cocaine until death."
No arguments.
Linkadge
Posted by linkadge on March 7, 2006, at 13:16:40
In reply to Re: oh » linkadge, posted by Chairman_MAO on March 7, 2006, at 12:11:42
I fully agree with you that mental illness is not something that has ever been made concrete in terms of its underlying malfunctioning or lack thereof.
But, simply because we lack the scientific language to fully describe or understand an abnormality does not mean that the abnormality is fabricated or nonexistant.
Dr. Peter Kramer argued two ways. While he made the point clear that the mechanisms of depression have never been fully elucidated, he also argued that this lack of knowledge is not proof, in any way that depression is not, in some cases, an entirely biological condition.
For instance, low thyroid can cause depression, thats biological. Many people on AD's could similarly have some sort of real, yet unidentified, biochemical abnormality. Its not inconcievable.
Sorry, I am a little unclear of what you are getting at, but thats o.k. I'm slow.
Linkadge
Posted by Chairman_MAO on March 7, 2006, at 14:40:46
In reply to Re: oh, posted by linkadge on March 7, 2006, at 13:16:40
Dr. Kramer is not familiar with basic scientific epistemology, then. One is only allowed to make a positive scientific knowledge-claim regarding causal relations insofar as one is able to reason deductively from empirically validated propositions. Deductive reasoning entails making the claim that the conclusion could not be satisfied without the premeses being true. This is the spirit in which double-blind, placebo controlled studies are held as the most valuable evidence. Without a control group one can only reason inductively at best, and there are no firm rules for inductive reasoning. Dr. Kramer is conflating correlation with causation.
There has not been one cause of end-stage syphilis that does not feature a certain anatomical lesion detectable upon post-mortem examination. Indeed, a pathologist has no greater certainty that an individual's _behavior_ was due to syphilis than the presence of that lesion. The behavior is a symptom, not a cause. In the case of depression, Kramer is begging the question by treating the behavior as a symptom and then pointing to something which is merely a correlate with the symptom as a cause, e.g. low 5-HIAA levels. There are no data that I am aware of which shows that low 5-HIAA levels are anything but a CORRELATE of being depressed. That is, every conscious state has a complex neurobiological substrate; some folks who displayed depressive behavior turn out to have low 5-HIAA levels, some don't. In "real diseases", there is always an underlying set of pathologies without which the disease is not present. It would be absurd to say that someone who has low 5-HIAA levels and never claimed to be depressed nor acted depressed was depressed. There is no identified sine qua non of any mental illness; otherwise--as in neurosyphilis, Alzheimer's dementia, etc.--the behavior would be reclassified as symptoms of a neurological disorder. The psychiatric slight-of-hand involves taking what is considered to be the de facto pathology--such as drug addiction or depression-- and ascribing it to an underlying cause (it used to be demons, then humours, now it's biological, in keeping with the popular ideology of the time) which in reality is not a cause at all, but simply a correlate of the beahvior which is deemed pathological.Below a certain density of dopaminergic neurons in the substantia nigra (MNs) WILL PRODUCE Parkinson's disease symptomology. There is no case in which there is 90% loss of MNs does not exhibit Parkinsonism that I am aware of. The link between hypothyroidism and mood is a CORRELATE; supraphysiological doses of T4 have an antidepressant effect in many people with "normal" levels. This does not indicate a pathology per se, only a hormonal influence on one's affective state.
I will agree with Kramer only insofar as there is no evidence that rules out psychobiological pathology. Certainly it is likely that some people diagnosed with many different mental illnesses have some heretofore unrecognized neurobiological abberation. However, many people without so-called "mental illnesses" do as well. The problem with psychiatric reasoning is that the beahvior is used to infer the abberation, which the psychiatrist in turn appeals to when asked about the cause of the disorder. This is called begging the question, and it is the antithesis of sound scientific reasoning.
This problem is further confounded by the entire medical notion of the norm. What is "normal"? The "normal" range of testosterone concentration, for instance, is so broad that many men who screen as normal exhibit symptoms of hypogonadism. Surely this is in part because of receptor insensitivity as well as things we have yet to or--here's the rub--never will be able to quantify. Despite the claims made to the contrary, there is no notion in neuroscience of what a "chemical imbalance" would even look like.
That does not mean such a thing does not exist. However, most people choose scientific theories based upon a synergy of two fundamental principles: (1) (Bayes' Theorem) which involves evaluating the likelihood of hypotheses given the weight of various pieces of evidence. (2) Occam's Razor, which states that the simplest plausible explanation of a phenomenon is likely to be the correct one. Biopsychiatric sophistry violates both of these principles some if not most (or all) of the time.See:
http://www.szasz.com/manifesto.html
http://en.wikipedia.org/wiki/Bayesianism
http://www.peele.net/lib/blues.html
http://www.eliofrattaroli.com/main.asp
Posted by linkadge on March 7, 2006, at 15:51:26
In reply to Re: oh » linkadge, posted by Chairman_MAO on March 7, 2006, at 14:40:46
"Certainly it is likely that some people diagnosed with many different mental illnesses have some heretofore unrecognized neurobiological abberation"
Thats all I am asserting. As far as seeking "treatment", or rather, "relief" goes, I don't really see it as being a prerequisite that one indeed has a firm grasp on the exact causes of their suffering.
So you have a problem with concentration. You take a stimulant. You have absolutely no conclusive evidence that your lack of concentration has anything do do with the biochemical mechanisms which the stimulant is purported to alter, but that doesn't factor much into your decision, because you know it can help - at least for now.
The same with MAO inhibitors. I realize that no conclusive evidence has linked overactive MAO to depression, but the medicine works for you.
So I guess what I am saying is, "so what" ?
I guess the, "so what" is in the possability that the medicines could make things worse long term.
Thats why my paranoid self got off everything.
Linkadge
Posted by Chairman_MAO on March 7, 2006, at 16:28:25
In reply to Re: oh, posted by linkadge on March 7, 2006, at 15:51:26
There is a lot behind the "so what".
--Justification for involuntary mental hospitalization on the grounds that one has a "mental disease or defect" that renders them "dangerous". This is a way of incarcerating people who threaten those in power (politicians or a jury) but have committed no over crime. This is determined based upon expert testimony, considered scientific because it wears the mantle of neurobiology.
--Justification for the insanity defense, which provides for a "not guilty" verdict in case a person has a "mental disease or defect". This is a way of letting off those people who those in power (politicians or a jury) feel should not be punished though the law prescribes otherwise.
--Justification for forced drugging to protect people from themselves.
--Justification for government control over the administration of psychoactive drugs via psychiatrist proxy, e.g. it is OK to compel children to take Ritalin to eliminate behaviors considered undesirable in school, but an adult taking Ritalin of his own free will can be prosecuted and jailed for 10+yrs.
--Justification for arbitrary social norms disguised as scientific fact; the modern equivalent of religious people calling behavior that offends them "unnatural" or "unholy".
--Justification for state-mandated 12-step addiction treatment which somehow gets accepted as medical despite being anything but.
--Justification for the draconian drug policy that has created a veritable gulag of non-violent offenders in US Prisons (and around the world). Fifty percent of all US prisoners are non-violent drug offenders.I'm sure there's more.
Posted by Chairman_MAO on March 7, 2006, at 16:34:01
In reply to Re: oh, posted by linkadge on March 7, 2006, at 15:51:26
It is the notion of mental illness as a medical disease that makes it so a doctor can tell responsible adults which drugs he is entitled to in the pursuit of "life, liberty...and happiness". It is OK to take amphetamine, but only if a doctor deems it "medically necessary". I have languished for years waiting to have access to a doctor that was enlightened enough to see that I needed more than an SSRI+antipsychotic (as if more than a minority optimally benefit from that stuff).
Social control masquerading as medicine. This is the point that Thomas Szazs has been making for, oh, nearly fifty years now to no avail.
Posted by linkadge on March 7, 2006, at 21:30:33
In reply to Re: oh » linkadge, posted by Chairman_MAO on March 7, 2006, at 16:28:25
I don't see how my statement of "some people may have a genuine biochemical driven mental illness" gets extended to the notion that we should allow people be to invaulentarily hospitalized on the basis of a jury's assumption of mental illness.
Please keep in mind that my statement was intended to be narrow, short reaching, and not terrably indicative of anything global. I know where you stand on certain issues, and it is obviously a very complex and multifaceted issue. I don't stand for the concept of "mental illness" projected at large, if that is what you are assuming.
Linkadge
Posted by linkadge on March 7, 2006, at 21:59:04
In reply to Re: oh » linkadge, posted by Chairman_MAO on March 7, 2006, at 16:34:01
Although we may be misguided about the safety of SSRI's, they do offer the benifit, that for some individuals their mood improving effects can last longer than those of a stimulant.
So, I cannot say a whole lot about your choice to medicate with a MAOI and a stimulant. If you believe that this will lead to unprecidented, and long lasting improvement in mood, then I can only wish you the best.
There are reasons beyond those which you have mentioned, why doctors tend to lean away from the use of stimulants and opioids to treat depression. I'm not going to venture to argue against your opinions on the use of stimulants and opioids to treat depression. If that is the path you wish to take, all of the best luck to you.
I *could* list a number of reasons why it might not be good idea, but I know you are familiar with all of those arguements, and would undoubtedly have a counterargument that would be feasable on at least some level. However, time will tell. Only time will tell if these drugs will actually make the cut for you.
One of the smartest men I know "Dr. Manji" said something allong these lines: 'The brain works to achieve homeostasis. Whenever you take a stimulant, or an antidepressant, you inevitably activate the systems which work to drive the brain into depression.'
The brain is infintely smarter than we are. It is *always* one step above.
Linkadge
Posted by Chairman_MAO on March 7, 2006, at 23:49:17
In reply to Re: oh, posted by linkadge on March 7, 2006, at 21:59:04
Good luck driving the brain into depression at 80% MAO inhibition with modest doses of a catecholamine releaser! If this maxim really held true (I will pretend it does for the sake of argument, but my conclusion will show why it cannot), then psychostimulant+MAOI would not be one of the last bastions of antidepressant pharmacotherapy.
I know phenelzine brings about an unprecendented, long-lasting improvement in mood. The amphetamine helps out my concentration problems and gives me more energy to carry out tasks. I also know that the benefit of it does not build much tolerance, either. While there are of course some exceptions, those using psychostimulants for ADHD do not build tolerance to the therapeutic effect. The initial EUPHORIA fades as homeostasis sets in, but it is possible to have a new homeostasis that allows for better functioning than the old one. The increased focus/energy sticks around. Thus, I am combining the two drugs. I respond well to both for distinctly different purposes; why not put them together?
It is absurd to think that ABSOLUTE tolerance builds to a psychostimulant such that what once was an effective dose no longer has any effect whatsoever. There is no reason to believe that the new homeostasis created after administration of modest doses of d-amphetamine is inherently depressive. One could apply this logic to MAOIs (or SSRIs) as well; take away the MAOI too abruptly, and you could well have a rebound depression that is greater than what existed before. Furthermore, there are is actually SENSITIZATION to some amphetamine effects over time while others build tachyphylaxis (I LOVE THAT WORD).
Also, for his statement to have its implied theoretical import, one must assume that the mechanisms involved in psychostimulant action are the ones involved in the neurobiological substrate of the depression. In reality, the brain is far too complex for this to be the whole situation. I see his point, but it seems as if it could be expressed as "what goes up must come down". How far back down relative to the original level, though?
Ultimately, all this theoretical posturing is not worth much, as the problem actually lies in the mind, about which none of these hypotheses even apply.
Dr. Manji's statement, while obviously of value at least as a thought experiment, cannot be true because the mind is driven into depression, not the brain. And now we're back to square one: the impossibility of mental illness as a medical disease. For if the brain were the diseased entity, there would be some observed structural pathology indicating as such. However, depression is never diagnosed by observing the brain with diagnostic instruments alone. Rather, the patient's MIND is depressed--assume he's not faking it--not his brain. Minds can only be at most metaphorically sick, as they are metaphysicial entities which defy direct examination. Therefore, although use of certain drugs may activate certain mechanisms which could in theory lead to excacerbated depression, the important effect to evalute is "how do you feel", asked many times over the course of the therapeutic engagement.There were many users of drugs such as Dexamyl (amobarbital/d-amphetamine) who used 3 caps regularly for 10+ years who did not build tolerance and attained a consistent therapeutic effect. Did it feel like the first day on the drug? I doubt it...but that doesn't mean Happy Hoover Lady (the Dexamyl 'mascot') didn't feel better than her default state most of the time while on the drug.
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Dr. Bob is Robert Hsiung, MD,
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