a few cultural differences

[polystyle]

ach man, that's horrible to hear. i'm sorry

isn't it the case (please stop me if i'm crossing over into some mythic line the outside world gets wrong about Japan) that you do get plenty of office joes offing themselves for (the ostensible 'reason', anyway) some minor professional infringement?

Thanks Scott, it was a tough ( for the family ) , baffling ( for me ) time and not so very long ago.
In that case, a tri fecta of 'reason's' ; this person didn't want to move up from his position in his music pub. company, had begun taking 'med's' prescribed to him and didn't see why to 'keep going on'.

 

[grizzleb]

Basically, there has been a problem with over-prescription of some psychiatric medications due to misdiagnosis. But this 'problem' is far less wide-spread and far less of a gravely serious issue than a lot of people would have you believe.

People reeeeally, reeeally need to get over the 'commonsense' notion that chemicals are somehow going to disrupt the precious sanctity of the magical noumenal entity that is the "mind". The "mind" IS chemicals, and the only way to make a "mind" better will always be to alter its biochemical balance. Whether this is achieved by pharmaceutical modalities, or electrical stimulation, or brain surgery, or any number of things, will be the real issue in the future.

Another thing people need to get over, because it's ridiculous: the idea that people are more depressed now than they ever were. CITATIONS PLEASE on that one... it's one of those ridiculous conservative nostalgic-for-and-imaginary-past canards that I absolutely hate to see "leftists" parroting.

Molecular genetics has been and will be winning the argument against "over-medicalization" for years to come. This sort of argument tends to come from places and people who simply don't know the science. More and more, America is losing it's scientific edge over other countries; it's no longer just Americans who understand neurochemistry anymore.

I'm not worried; Chinese and other researchers are poised to take the lead on a lot of this stuff. You *will* see an increase in effective treatments for mental illness, and you *will* see increasingly better trained physicians who make good diagnostic decisions. It has nothing to do with America and everything to do with the fact that certain key discoveries have been made- to go into it all here would take too long, but I'll try looking up some decent reading for people who are interested.

How do you account for improvements in a persons mental health that occurs without prescription of medication? I remember a few years ago I spent a good portion of my time in my bed, crying, wondering about how to kill myself, waking up after a night of intense insane dreams covered in cold sweat, etc. Basically losing my mind. The last few years I've attempted to improve my outlook and attempt to become less depressed, get out more, whatever, basically because I thought it would be a waste of time going to a doctor (rightly or wrongly).

I generally feel pretty good, and on an even keel now, no crazy ups and downs anymore. The problem with your view of the brain and mental illness, seems to be that chemistry is the only thing which matters, and that the way in which chemistry must be altered through direct physical intervention into the mind, the way in which you live your life can't change that chemistry. Also thoughts about the changing of what is normal human experience (me not being in a good situation so feeling shitty for the best part of year) turns into 'depression' which is an 'illness' rather than a legitimate response to whatever situation one finds oneself in...

 

[nomadthethird]

How do you account for improvements in a persons mental health that occurs without prescription of medication? I remember a few years ago I spent a good portion of my time in my bed, crying, wondering about how to kill myself, waking up after a night of intense insane dreams covered in cold sweat, etc. Basically losing my mind. The last few years I've attempted to improve my outlook and attempt to become less depressed, get out more, whatever, basically because I thought it would be a waste of time going to a doctor (rightly or wrongly).

I generally feel pretty good, and on an even keel now, no crazy ups and downs anymore. The problem with your view of the brain and mental illness, seems to be that chemistry is the only thing which matters, and that the way in which chemistry must be altered through direct physical intervention into the mind, the way in which you live your life can't change that chemistry. Also thoughts about the changing of what is normal human experience (me not being in a good situation so feeling shitty for the best part of year) turns into 'depression' which is an 'illness' rather than a legitimate response to whatever situation one finds oneself in...

I can explain that extremely easily. Not everyone who experiences periodic mild to moderate depression has a genetically based depressive disorder. There are very strict, extensively studied diagnostic criteria for diagnosing someone with a depressive disorder or other mental illness.

Another thing people reeeeeally, reeeeally need to get over is the idea that medication is a "quick fix" that somehow negates the need to change one's outlook and dispenses with any need for the pt to work hard at their own recovery.

It isn't. Very far from it. Medication is one small piece of a person's individual recovery puzzle. It alone can't do everything, but it can help even out the hard biological substrate of mental illlness, which is neutrotransmitter based.

 

[nomadthethird]

I never said a person can't change their brain chemistry without drugs. But they're certainly not going to get their DNA to start transcribing RNA, then translating RNA into proteins, that ARE NOT CODED FOR in the DNA.

Some people have DNA that doesn't properly code for certain proteins-- just one that leaps to mind is p11-- which are directly implicated in depression.

The results are in. The mountains of scientific evidence and consensus are overwhelming, and they all point to the same thing: mental illnesses are multifactorial diseases that are genetically based. At this point, to try to deny that is as foolish as denying evolution or climate change.

But the oldest superstitions always die the hardest.

 

[nomadthethird]

Case study: me

My DNA codes for a brain that misregulates glutamate, a synapse excitatory neurotransmitter. I produce far too much of it, and my receptors don't properly uptake it. This leads to seizures, chronic migraines, and, mostly likely, bipolar disorder. My medication is well-known for very effectively inhibiting glutamate receptors. This has some terrible side effects: short-term memory loss being the worst. It also tends to cause metabolic acidosis-- the thing arsenic poisoning causes-- which makes my hair fall out fast, and gives me kidney stones.

(Oh yes, being on medication is just a paradise on earth that makes my comfortable capitalist pig lifestyle easier to justify... not. Well, the opiate maintenance is nice but that's another story.)

Crazily enough, there are people with lives that were much tougher than mine who experience none of these symptoms. If mental illness is environment-based, how do you explain this? How do explain that all the twin studies that established a strong genetic component to most common neurological illnesses?

MSG is a dietary form of glutamate that, if I so much as look at it, makes me have a week's worth of migraines and seizures. I realized the other day that I had eaten chinese food a couple of times two weeks ago, and, though they claimed it had no MSG, it must have. Because I spent about a week miserable afterward.

So the environment can definitely contribute to neurological illness, but it alone cannot *cause* it. See the distinction there?

 

[muser]

^jumping in here about something that I have a limited knowledge about tbh but its interesting you say that as people say exactly the same thing about psychoactive drugs.

What about PTSD, soldiers suffering from shellshock etc, surely that is purely caused by the environment?

 

[nomadthethird]

^jumping in here about something that I have a limited knowledge about tbh but its interesting you say that as people say exactly the same thing about psychoactive drugs.

What about PTSD, soldiers suffering from shellshock etc, surely that is purely caused by the environment?

In concert with genetics. Otherwise, how do yo explain the fact that not every soldier suffers from PTSD, and some suffer far more than others?

Anxiety, like any other emotional response, is regulated by hormones and neurotransmitters. Some peoples' systems bounce back more easily than others after traumatic events.

Some women get raped and don't get PTSD, some get raped and it precipitates anxiety disorder, insomnia, eating disorders, Borderline Personality Disorder, PTSD, etc.

P.S. What is it that people say about psychoactive drugs? Not sure what you're referring to...

 

[nomadthethird]

Personally, I'd wager that TV and new media are more responsible for peoples' complacency than SSRIs could ever be. Several times over.

But admitting that would be too much like taking personal responsibility...

 

[muser]

P.S. What is it that people say about psychoactive drugs? Not sure what you're referring to...

as in drugs can be a contributor to mental illness but not a cause.

 

[nomadthethird]

as in drugs can be a contributor to mental illness but not a cause.

Ah... yeah, that's true. A drug can cause a temporary psychosis in someone who has no history or genetic predisposition toward neurological illness. But in that case, when the drug is out of the person's system, the symptoms dissipate/disappear. Or, as is often seen with LSD or hallucinogens, drug use can coincide with/speed up the onset and progression of schizophrenia.

 

[padraig (u.s.)]

But this 'problem' is far less wide-spread and far less of a gravely serious issue than a lot of people would have you believe.

this, I dunno about. obviously the neurochemistry of SSRIs is valid insofar as the mechanisms by which they act are understood, but what you might the call the emergent properties of the mind - i.e. the sum greater than the parts of the whole - are AFAIK, not, or poorly understood. and to say the mind is merely a collection of chemicals is, while technically true, reductionary and, I think, misleading. as with many things in biology - of which I'm sure you are aware - its the kind of thing where the direct, individual effect of one miscoded or missing protein may be known but how that might fit into the larger picture is not. this is not to argue against medication so much as to say that the various neurosciences are still - as you recently said about molecular genetics - in their infancy, comparatively crude, & that various problems are bound to arise as a result, including overprescription and misprescription. I don't know exactly how "widespread" those problems are, or not, but I don't think you (or anyone else) really does either.

there's also the problem of defining "better" or improved when it comes to the mind. which is perhaps more of a philosophical question, but still an important one to ask. you have to know where you're trying to go before you set out to get there, if you see what I mean. I don't doubt that a lot of v. smart people devote a fair amount of their time to thinking about this, anyway.

but this

Medication is one small piece of a person's individual recovery puzzle. It alone can't do everything, but it can help even out the hard biological substrate of mental illlness, which is neutrotransmitter based.

and this

mental illnesses are multifactorial diseases that are genetically based.

we can wholeheartedly agree on. although I would change "genetically based" to "influenced by genetics". as in genetics is one factor among several but only sometimes - rather than always - the leading factor.

came across it accidentally when searching for board mentions of Sasha Grey

scott, you never fail to warm my heart.

 

[padraig (u.s.)]

also in re: miscoding proteins etc, this is where epigenetics & gene therapy are headed. obviously if you don't have the code for a protein in your DNA - if there was an alteration in your chromosomes during meiosis, or a mutation or something - you're kinda screwed, & will be reliant on artificial substitute (i.e. a drug). but if the gene that codes for that protein is just silenced, then you might be able to develop drugs - likely w/less side effects - to turn it on (i.e. via demethylation or acetylation, or some other mechanism, depending on the specific case). that's not really feasible now, but I think it will be in the relatively near future. my knowledge of it is more in terms of cancers but I don't see why it couldn't also be applied to psychiatric disorders, or at least the genetic elements thereof.

 

[nomadthethird]

Well, I think it's overstated when people say "nobody knows how anti-depressants work"-- plenty of people have really strong, robust results that paint a pretty clear picture. It's just that tge devil's often in the details, which are still being worked out in some cases.

You're right when you say that, as of now, nobody knows exactly where to draw the line between cause and effect in every individual case of illness-- not with neuro-illness, or any other kind for that matter. But the vast majority of the evidence favors an approach that looks like this: neurological illness of the type that is seriously debilitating and causes dysfunction is very rare in humans who have no genetic predisposition toward it.

I'm all for criticizing Big Pharma, as I've said before: the problem is, most of the critiques you hear are ineffectual because they aren't based on good information. What I'm objecting to here and elsewhere is, basically, the "special pleading" fallacy that gets whipped out with regard to neuro-illness. For cultural reasons-- partly because, for so long, what the mind is was a total mystery--people want to think neurological problems obey special rules, basically break the laws of physics, while other illnesses don't. They want to level criticisms at neurological and psychiatric treatments that they'd never level at other medical treatments. (For example, a lot of doctors will tell you that X-rays are seriously over-used and that this is in fact contributing to the rise in cancer. But no lay people talk about that...they're the ones lining up letting some 30-year-old resident order a whole bunch of X-rays for a chest cold.)

It just annoys the hell out of me that people will go on and on about the fact that maybe some moderately depressed people were given SSRIs when they could have scraped by without them while ignoring other much more serious problems of overprescription/overmedication. For example, it bothers me that the average person has no idea that hormonal birth control poses much more serious health risks to women than SSRIs, even when misprescribed, do to depressed people. It bothers me that people don't realize that radical hysterectomies are almost never necessary. It bothers me that people who don't need it are taking Crestor, then later dying when their kidneys fail. It bothers me that the alterna-health crowd is pushing hormone therapy on post-menopausal women as if it's candy, and calling it "bioidentical" hormones when it's really just the same old synthetic chemicals.

SSRIs are small potatoes when it comes to medical risk. And they just aren't the quick and easy fix people want them to be-- a lot of people who went to the doctor who weren't mentally ill, thinking Prozac would fix everything, learned the hard way that this wasn't the case. It's really these types of middle class people who are now braying loudest about the "overmedicalization" of mental illness. And they don't seem to understand that they aren't the center of the psychiatric universe.

also in re: miscoding proteins etc, this is where epigenetics & gene therapy are headed. obviously if you don't have the code for a protein in your DNA - if there was an alteration in your chromosomes during meiosis, or a mutation or something - you're kinda screwed, & will be reliant on artificial substitute (i.e. a drug). but if the gene that codes for that protein is just silenced, then you might be able to develop drugs - likely w/less side effects - to turn it on (i.e. via demethylation or acetylation, or some other mechanism, depending on the specific case). that's not really feasible now, but I think it will be in the relatively near future. my knowledge of it is more in terms of cancers but I don't see why it couldn't also be applied to psychiatric disorders, or at least the genetic elements thereof.

Yeah, this is the type of thing I was meaning to suggest when I said that, in the future, the question won't be "do we treat mental illness medically?", it'll be what kinds of radical new treatments exist. It's looking like we may be able to forego pills and get right down to the molecular nitty gritty without so many chemical middlemen with annoying side-effects.

 

[padraig (u.s.)]

I have to run, but I just want to say - nomad is 100% right that these kinds of problems are hardly unique to psychiatry, & can be found in every area of medicinal practice. that's just the nature of medicine itself.

 

[nomadthethird]

For those interested...

There's a PBS special called This Emotional Life that's simple but has a lot of good info about new research into the connection between the brain and emotions. The second episode (called "Facing our Fears") focuses on depression and how clinical depression is an illness like any other.

 

[grizzleb]

I never said a person can't change their brain chemistry without drugs. But they're certainly not going to get their DNA to start transcribing RNA, then translating RNA into proteins, that ARE NOT CODED FOR in the DNA.

Some people have DNA that doesn't properly code for certain proteins-- just one that leaps to mind is p11-- which are directly implicated in depression.

The results are in. The mountains of scientific evidence and consensus are overwhelming, and they all point to the same thing: mental illnesses are multifactorial diseases that are genetically based. At this point, to try to deny that is as foolish as denying evolution or climate change.

But the oldest superstitions always die the hardest.

I really agree broadly with what you're saying - I'm sure that there are loads of mental health problems which emerge from genetics, etc, lack of genes that codes for certain proteins or whatnot, just as there is in other non-mental illnesses, it stands to reason. A few things I'm wondering about:

How do you make 'stringent' diagnoses of mental health problems to ensure that those that are prescribed for do have a genetic basis? I'm sure that they aren't giving out DNA tests willy nilly. The symptoms are going to be really similar in people who are and are not depressed (or whatever) due to genetic factors...It's something that's so subjective I don't see how the accuracy rate could ever be that high.

Are all mental health medications intended soley for use on people who don't code for particular proteins?

Just to pick up your point on 'quick fixes' - I guess that's part of the problem I have with peoples attitudes towards such mental health problems, and prescription of drugs for then. From the experience of various people I've known over the years, at least in the UK, the help given to people with depression and other mental health problems is weak. Drugs are basically given out with no other advice, with the implication basically that drugs will fix things automatically. It's this kind of thing that leads people to just become passive, to feel like they don't have any control over their life. I wonder about the way in which drugs are changing the way we view ourselves emotionally and the way in which we view how much control over ourselves we have.

And all that stuff about overprescription of other stuff - well I'm only aware of what I'm aware. There's plenty stuff that doesn't get reported widely, you can't blame people for not knowing about x, y obscure medical scandal. Also, there's probably more interest in stuff that surrounds mental health, just because people find it an interesting topic.

Cheeze for the link. Hopefully I can get it here.

 

[nomadthethird]

How do you make 'stringent' diagnoses of mental health problems to ensure that those that are prescribed for do have a genetic basis? I'm sure that they aren't giving out DNA tests willy nilly. The symptoms are going to be really similar in people who are and are not depressed (or whatever) due to genetic factors...It's something that's so subjective I don't see how the accuracy rate could ever be that high.

Are all mental health medications intended soley for use on people who don't code for particular proteins?

Aye aye aye.

In order to be diagnosed with major depressive disorder, you have to meet certain criteria. This process includes taking a battery of tests that indicate the patient has a whole bevy of symptoms (it's often necessary to have 10 out of 15, or something like 2/3 of the total), which have to persist for an extraordinary length of time to qualify. Also, being a differential diagnosis, no call is made until just about every other possible physical cause is ruled out. Just feeling ineffably icky or sad for a few weeks does not qualify. All of these guildlines are based on very careful research into the difference between debilitating, life threatening depressive disorders versus mild to moderate clinical depression. Even then, mild to moderate clinical depression *can be treated* with anti-depressants-- they just aren't quite as effective in mild depression as they are in MDD. Which is basically a no-brainer: someone with less of a problem regulating neurotransmitters is not going to benefit quantitatively as much as someone with a huge problem from a drug that stimulates neurogenesis.

The *symptoms* of depression in very general sense may be similar in everyone, but the duration, severity, and the etiology are not similar in normal people versus those with MDD or other neuro-illnesses. You'd be amazed at how differently different genetic disorders manifest phenotypically in different individuals.

I think the problem people have understanding the fact that spectrums exist is based on what Dawkins called the "discontinuous" mind. Seems to be a pretty common cognitive style.

 

[four_five_one]

Interesting that this discussion has come up again now. Haven't been able to read the thread properly as I'm still shaking and anxious, I've just had a terrible experience with an SSRI after going to the doctor asking for help with anxiety and OCD. She prescribed fluoxetine 20mg (which is the generic version of Prozac). Could feel it doing something on the first day, and it didn't feel good. Continued for three days and side effects got much worse, nausea, tiredness, confusion, whole body began to itch & some involuntary tremors. Anxiety was ramped up tenfold. But stupidly thought that these were just normal side effects so continued for four days more... at which point I couldn't get out of bed, too sick to walk or eat and feeling very dizzy and poisoned. I assume it was some form of serotonin syndrome: http://en.wikipedia.org/wiki/Serotonin_syndrome

Now it's been five days since I stopped and I've been in bed on average 18 hours per day. Unable to do anything but sleep. Weird dreams, nightmares & the whole bit. I'm feeling a bit more awake today, but the tremor & anxiety have increased. I assume this is an effect the serotonin draining from the body. Hopefully I'll be back to my "normal" (not very good) state in the next two weeks. Keep thinking I've been permanently damaged but I know that feeling of 'dread' is probably down to the dysphoria the drugs induced.

So all in all a disastrous experiment. I should've known I had problems tolerating serotonin, I had similar problems (tho nowhere near as bad) with St John's Wort which is pretty mild as far as SSRI's go. I assume my body just can't process serotonin effectively. Seems like I've got too much or I'm not getting rid of it fast enough if anything.

The whole process of me being diagnosed and getting prescribed fluoxetine took less than five minutes. My GP diagnosed me and chose the treatment by looking in a book, which had a small passage about each SSRI. No further explanation apart from: 'this will help you. give it three weeks, if it doesn't work, come back in a month'.

Also, the notion that antidepressants work by (just by) increasing serotonin is highly speculative. There are case studies of people with no serotonin at all that aren't depressed: http://neuroskeptic.blogspot.com/2010/03/life-without-serotonin.html -- prozac increases serotonin from day one, but the antidepressant effect usually take around a month to work, which is about the time it takes for neurogenesis to kick in: http://neurologicalcorrelates.com/wordpress/2009/02/24/stoned-and-stupid-blame-your-microtubules/ -- it's possible the increased brain plasticity allows you to see life differently and change your negative thought patterns.

There are other ways to promote neurogenesis including exercise, bright light, learning & certain foods/supplements (i.e. circumin from turmeric) may also help. This makes sense, many people report feeling better after increasing exercise, exposure to sunlight and so forth. Exercise immediately releases dopamine/serotonin, but the culminative effect on wellbeing many experience may be due to neurogenesis.

So I suppose I'll be focusing on 'natural' ways to change my thought patterns, which I was doing anyway, but now it's the only game in town for me, unless anyone knows of an anti-depressant that doesn't increase serotonin?

Also, agree depression is caused by genes x environment. But environment can generally override genetics. (Switch off genes etc, correct me if I'm wrong). A study I saw recently shows that East Asians are probably more likely genetically predisposed to depression, but the incidence of depression is in fact much less than in the U.S, probably due to the increased social support and sense of belonging people have. I'm too jumpy to find this study now but hopefully continue discussion when i feel better.

 

[four_five_one]

This antidepressant: http://en.wikipedia.org/wiki/Tianeptine works by lowering serotonin, but doesn't look like it's available in the UK, unfortunately.

 

[four_five_one]

Anyway, seems like there's little chance of effective treatment (if SSRIs don't work for you) unless you see a proper psychiatrist, preferably one that keeps up to date with the latest research.