Tuesday, April 01, 2008

the usual,"i'm up really late after a craptacular day" post about brain issues.....

ha, actually, read an interesting article in Wilson Quarterly (Winter 2008) last night entitled, "The Brain: A Mindless Obsession" by Charles Barber. It's adapted from his recent book Comfortably Numb: How Psychiatry Is Medicating a Nation. in the essay, he gives a brief history of mental health treatment in the U.S. before focusing on current trends with medication and brain imaging.

so...the bit I found interesting, and poorly tried to explain to RTO last night:

To this day, no one knows exactly how psychoactive drugs work. The etiology of depression remains an enduring scientific mystery, with entirely new ways of understanding the disease - or diseases, since what we think of as "depression" now is probably dozens of discrete disease entities - constantly emerging. Indeed, the basic tenet of biological psychiatry, that depression is a result of a deficit in serotonin, has proven to be one that was too eagerly embraced. When this "monoamine" theory of depression emerged in the 1960s, it gave the biologically minded practitioners of psychiatry what they had long been craving - a clean, decisive scientific theory to help bring the field in line with the rest of medicine. For patients, too the serotonin hypothesis was enormously appealing. it not only provided the soothing clarity of a physical explanation for their maladies, it absolved them of responsibility for their illness, and to some degree, their behavior. Because, after all, who's responsible for a chemical imbalance?

Unfortunately, from the very start there was a massive contradiction at the heart of the monoamine theory. Whatever it is that Prozac and the other members of the widely used class of drugs called selective serotonin reuptake inhibitors (SSRIs) do to change brain chemistry, it happens almost immediately after they are ingested. The neurochemical changes are quick. However, SSRIs typically take weeks, even months, to have any therapeutic influence. Why the delay? No one had any explanation until the late 1990s, when Ronald Duman, a researcher at Yale, showed that antidepressants actually grow brain cells in the hippocampus, a part of the brain associated with memory and mood regulation. Such a finding would have been viewed as preposterous even a decade earlier; one of the central dogmas of brain science for more than a century has been that the adult brain is incapable of producing new neurons. Duman showed that the dogma is false. He believes that the therapeutic effects of SSRIs are delayed because it takes weeks or months to build up a critical mass of the new brain cells sufficient to initiate a healing process in the brain.

While Duman's explanation for the mechanism of action of the SSRIs remains controversial, a consensus is building that SSRIs most likely initiate a series of complex changes, involving many neurotransmitters, that alter the functioning of the brain at the cellular and molecular levels. It appears that SSRIs may only be the necessary first step of a "cascade" of brain changes that occur long after and well "downstream" of serotonin alterations. The frustrating truth is that depression, like all mental ilnesses, is an incredibly complicated and poorly understood disease, involving many neurotransmitters, many genes, and an intricate, infinite, dialectical dance between experience and biology. One of the leading serotonin researchers, Jeffrey Meyer of the University of Toronto, summed up the misplaced logic of the monoamine hypothesis: "There is a common misunderstanding that serotonin is low during clinical depression. It mostly comes from the fact that many antidepressants raise serotonin. This is a bit like saying pneumonia is an illness of low antibiotics because we treat pneumonia with antibiotics."

he goes on to wrap up and briefly mentions some newer psychotherapy methods that he thinks are being overshadowed by drugs (for less severe cases at least). I'm a bit intrigued by the thought of being able to "rewire" my own brain with help from the therapist. had an interesting visit a few weeks ago where we tried some eye-movement thing and it was... something for another post, probably. I'll do some research, maybe ,when i'm feeling more motivated.