| T O P I C R E V I E W |
| pspa123 |
Posted - 08/03/2012 : 12:41:48
If chronic pain is a phenomenon of the mind without a physiological cause, do we also believe here that depression and anxiety are of similar origin and are not "caused" by neurotransmitter imbalances and/or deficiencies (as big pharma the supplement industry and psychiatrists would have us believe)? The logic seems the same to me, and there is a lot of writing recently suggesting the whole neurotransmitter thing is bogus. Is there a difference? |
| 5 L A T E S T R E P L I E S (Newest First) |
| pspa123 |
Posted - 08/04/2012 : 22:11:53
Oh and by the way, yes I have read that book by Dr. Breggin. I admire him a great deal, although he comes at it from the perspective not that drugs aren't efficacious, but that they work through means that ultimately are harmful. He sometimes calls these brain-disabling effects and more recently has referred to them as "medication spellbinding." He is pretty radical in his beliefs, but I think he does add to the picture. |
| pspa123 |
Posted - 08/04/2012 : 21:58:36
I don't recall if it is contained within the link or not, but I have read about one or more studies where researchers were able to lower serotonin as measured in the CSF and it didn't make people any more depressed. There is also an anti-depressant that works by INCREASING the reuptake of serotonin, I forget the name, it was developed in France I believe. And some of the antidepressants with the same efficacy rate (claimed rate anyhow) as SSRIs, as you know, work on other neurotransmitter sites in addition to or instead of serotonin. All this either argues that (as you say) it's much more complex than the theory we have been given and I have heard from many doctors, OR there is something altogether different going on, like BELIEF.
Oh and one more link, from the New England Journal of Medicine.
http://www.nejm.org/doi/full/10.1056/NEJMsa065779
I don't know the answer either.
But if you take a step back and look more broadly, just look at the incredible array of modalities that people say has worked for their depression: homeopathy, acupuncture, meds, supplements, exercise, diet, yoga, and on and on and on: could it be, maybe, that the common denominator is a BELIEF that they would work? To me, this is very consistent with TMS theory, that the mind is what's going on, not some biochemical thing. |
| Dr. Zafirides |
Posted - 08/04/2012 : 20:42:46
pspa,
Thanks for the link. I skimmed it this evening, but will definitely review the information in more detail. I greatly respect your point of view. There is, however, significant evidence that suggests antidepressants are more effective than placebo for moderate-to-severe depression. The bigger question is the efficacy of antidepressants for mild-to-moderate depression.
While the big pharmaceutical companies are no angels, I have seen these treatments improve the quality of life for the majority of my patients. For some, it has literally saved their lives. I think the issue of "chemical imbalance" is an unfortunate descriptor that stuck as it relates to the biology of mood disorders. I think there are complex interactions that occur when one increases the levels of these neurochemicals in the body. It may not even be the serotonin effect per se that improves mood, but it is part of the cascade of events that leads to the mood improving. The only real direct confirmation of serotonin levels being implicated in depression has been in the low levels of serotonin & serotonin metabolites in the spinal fluid of people who had ended their lives by suicide.
There is some fascinating work being done on the role of inflammation in depression. It may be that inflammation may be a cause of depression, which is a very consistent mechanism by which other diseases occur (heart disease, cancer, etc.). Serotonin is involved in the theory of how inflammation leads to depression.
A wonderful book that I am halfway though is Toxic Psychiatry, by Peter Breggin, MD. You may have already read it..
I don't have all the answers, pspa. I try to take in the evidence - pro and con - as objectively as I can. I just want to do right by my patients. We may have different points of view, but that is how we learn from one another.
Thank you again for that link.
Kindly,
Dr. Z
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| pspa123 |
Posted - 08/04/2012 : 18:50:42
Thank you for your thoughtful reply. The below link has a good compilation of some of the recent writings and evidence suggesting that the chemical imbalance theory of mood disorders is really a myth. I have read extensively on this subject and apparently even the chief FDA psychopharmacologist has acknowledged there is no evidence for the "low serotonin" story underlying the promotion of SSRIs.
http://www.anxietycentre.com/downloads/Chemical-Imbalance-Theory-is-False.pdf
Also, there is seemingly convincing research that when ALL the drug studies are analyzed, not just the ones big pharma cherry-picked to submit to the FDA, there is no evidence that antidepressants work any better than placebos. Fascinating, truly. Because it suggests that where the drugs do work, they work not by correcting chemical imbalances, but by somehow harnessing the patient's BELIEF system.
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| Dr. Zafirides |
Posted - 08/04/2012 : 18:15:25
pspa,
This is a phenomenal question.
The answer - I believe - also depends on who you are talking to. As a psychiatrist, we certainly have been trained to believe that neurotransmitters are the cause of depression and anxiety. But there are others (including a few psychiatrists) who completely reject the neurotransmitter hypothesis.
Personally, I do not believe this is a "black or white" issue. There are many shades of grey. While I believe in the neurotransmitter hypothesis, I believe more in the inherent strength of the individual. This is first and foremost. Validation, respect, empowerment and belief are critical aspects of all healing - both emotional and physical.
That does not mean I reject Western medicine approaches - I am a physician, after all! I believe psychotropic medications are critical (and for some patients, the ONLY way they get better), but meds are not the only answer. There is great healing power in the therapeutic relationship. Doctors take this for granted these days. Many have been reduced to feeling their only power is in the medications they prescribe or the procedures they perform. No wonder many doctors are so unhappy. We forget the position of trust we are given (rightly or wrongly) simply because we are physicians. I would argue that utilizing this trust - to empower an individual and make them believe in their strength - is a critical part of the healing process. If I tell you that I am fully confident we will resolve your emotional distress and give you REAL hope (not a patronizing sell-job), how much of your health is because of the medications vs. the belief you will get better? I truly believe one's belief is a critical part of the healing process.
But biology does matter. Anxiety and depression runs in families, suggesting a genetic component. The advancement in our understanding of depression and anxiety - over the last 5 years alone - have been incredible! There is a bigger urgency here as well, pspa. The effect of poor emotional states can devastate the physical body as well, just look at my latest - and perhaps most important - post on my website, The Healthy Mind:
http://www.thehealthymind.com/2012/08/04/study-even-mild-depression-and-anxiety-can-kill-you/
This study of almost 70,000 individuals found that even mild depression and anxiety significantly reduced your life expectancy. This is deadly serious. I think keeping an open mind about the full extent of treatment - including medications - is not only reasonable, but a refusal to do so may have deadly consequences.
In summary, I do not think there is one absolute answer to the question of the proper treatment of emotional disorders. I don't think it is wise to have an absolute position.
But the same can be said for TMS. There isn't a TMS clinician out there practicing today (at least that I am aware of) who would acknowledge that ALL physical pain is TMS. You simply cannot be that absolute. All of us here are fighting an opposite battle with TMS - having clinicians and patients begin to understand that not ALL pain can be explained by biology alone.
But we are starting to be heard. And we will continue to speak out until more and more people hear us. This forum and others like it are shining beacons of proof that pain is not explained by biology alone. It represents the very best in all of us and our absolute ability to be active participants in our healing process.
Never, ever doubt how truly powerful you are.
Kindly,
Dr. Zafirides |
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