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Old 08-11-11, 02:09 PM
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Sci Am article on fewer psychiatric drugs in the future

http://www.scientificamerican.com/ar...AT_MB_20110810

A Dearth of New Meds: Drugs to treat neuropsychiatric disorders have become too risky for Big Pharma

Very interesting article. Thought it might be worthwhile to post.

Dizfriz
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Old 08-12-11, 08:22 AM
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Re: Sci Am article on fewer psychiatric drugs in the future

Quote:
Originally Posted by Dizfriz View Post
http://www.scientificamerican.com/ar...AT_MB_20110810

A Dearth of New Meds: Drugs to treat neuropsychiatric disorders have become too risky for Big Pharma

Very interesting article. Thought it might be worthwhile to post.

Dizfriz
Thanks Dizfriz.
I have read this.

I am not surprised- but not because of the risk thing- but because I think the idea of neurotransmitter based treatments has always been based upon an over simplistic view of neurophysiology.

I will take you back to 1988- when I was doing a term as "Senior Resident Medical Offecer" at one of our psych institutions in Melbourne ( Larundel- a scary place- since shut down).

The academic psychiatrists were out every few weeks explaining to us how all these wonderful new drugs ( that didn't even have proper names- just research codes) were going to come out and change everything. The academics could tell us exactly which receptors and which neurotransmitters would be affected.

What went through my mind at the time was "this looks really good on paper- but the problem is there is not a one to one mapping between neurotransmitters and functionality". The simplistic view being pudhed by the pharmacuetical- academic network was that we could just throw in an SSRI for instance and count on that drug acting just on the serotonin pathways we wanted to influence.

Well- nowadays we know that is not the case, and we know that that is why these drugs have so many side effects.

ADHD is a little different- in that ADHD drugs are generally very "clean" targeting only dopamine- so there is less chance for random mischief and vast arrays of side effects. However there are plenty of stimulant side effects involving unwanted activation of pathways not directly relevant to
ADHD.

That is why I like mindfulness- we focus on specific skills and train in them- activating and developing only the pathways involved in those skills.

Given a few years I am sure that mindfulness will be the "Gold Standard".
I know others remain to be convinced- but I am happy to be an early adopter in this field.
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Old 08-20-11, 06:35 PM
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Re: Sci Am article on fewer psychiatric drugs in the future

Quote:
Originally Posted by Barliman View Post
Thanks Dizfriz.

ADHD is a little different- in that ADHD drugs are generally very "clean" targeting only dopamine- so there is less chance for random mischief and vast arrays of side effects. However there are plenty of stimulant side effects involving unwanted activation of pathways not directly relevant to
ADHD.
My understanding was that CNS stimulants stimulated a lot of things, not just dopamine. Norepinephrine too, maybe some serotonin ... and this is the reason for the "paradoxical" effect of the meds, that they increase both excitatory and inhibitory chemicals. Am I wrong about this?

Quote:
Originally Posted by Barliman View Post
That is why I like mindfulness- we focus on specific skills and train in them- activating and developing only the pathways involved in those skills.

Given a few years I am sure that mindfulness will be the "Gold Standard".
I know others remain to be convinced- but I am happy to be an early adopter in this field.
I also like mindfulness. I've been taking an MCBT class this summer and I've got a lot out of it. I wish it were taught in school; I think everyone can benefit from it, and it might go a long way towards preventing mental illness from manifesting in those people who are presdisposed.

However, people who live with complicated psychiatric conditions can never rely on one single tool, whether that be meditation or medication. Some people need medication in order to function, but are noncompliant due to terrible side effects; others are in and out of hospitals because their meds simply don't do the job. Yes, neurotransmitters are not the whole story, and the monoamine hypothesis is pretty much dead -- but it still seems to me that there's good reason to look for "smarter" medications.

I'm concerned about this because I have a complicated illness that seems to change its face from time to time. Meds are a linchpin of treating that illness. So is my diet, exercise, sleep, CBT, other therapy I've done, and yes, mindfulness. But even though I attend to all of these, they are not enough to keep me healthy.
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Old 08-20-11, 09:45 PM
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Re: Sci Am article on fewer psychiatric drugs in the future

Quote:
Originally Posted by AddaptAbilities View Post
My understanding was that CNS stimulants stimulated a lot of things, not just dopamine. Norepinephrine too, maybe some serotonin ... and this is the reason for the "paradoxical" effect of the meds, that they increase both excitatory and inhibitory chemicals. Am I wrong about this?
Strictly speaking you are correct that an absolute pure single neurotransmitter drug probably does not exist.
However the predominant effect of stimulants is on dopamine pathways.
In terms of targetted effects they are "clean drugs' as compared to "dirty" or "scattergun" drugs like many antidepressants or antipsychotics.

The common side effects of stimulants are related to sympathetic overstimulation. ( raised heart rate, increased blood pressure, tremor, dry mouth, loss of appetite, tendency to anger & paranoia)

I think there is a very good argument to be made that one of the problems in ADHD is that we have become conditioned to get stressed every time we try to concentrate- and that these effects are NOT due to direct neurotransmitter effects, but due to mind body interactions.

Whatever the mechanism though- it is clear that the relaxation response is trainable. ( I have got to the point where all I need to do quickly stretch my sore low back and neck (arthritis) is sit up straight, take a few deep breaths and mentally think of relaxation and love- and my whole body will feel warmer and looser and my BP will drop.I used to be a slave to my stress).

The relevance of this is that I got to see for my own purposes that it was possible to use the focus of stimulants as a tool to enhance my earning of relaxation- so that the end result of taking stimulants for me was pure clean focus- with no jitteriness. ( The precision onset and short duration of short acting stimulants was immensely helpful in this task.)


In fact- one thing that I would argue that we should do with stimulants is when we start on them- for the first week- do a relaxation exercise 15 minutes after taking the tablet- then spend a few minutes doing something pleasurable before we roll up our sleeves and get to work).
Then we would condition ourselves to assocaite the stimulants with relaxation.

Quote:
I also like mindfulness. I've been taking an MCBT class this summer and I've got a lot out of it. I wish it were taught in school; I think everyone can benefit from it, and it might go a long way towards preventing mental illness from manifesting in those people who are presdisposed.
I fully agree- and I think it will become core to school curricula in time.

Quote:
However, people who live with complicated psychiatric conditions can never rely on one single tool, whether that be meditation or medication.
Once again I fully agree. The more tools we can bring to bear on our problem the better- that is what I have done. Remember I started with meds, and have done lots of diet, exercise, coaching, and a great deal of time on understanding the processes that kept me entangled in self defeating behavior.

As a doctor though_ I see lots of problems with psychiatric medications. First choices of medication fail more often than they work - and finding a successful medication is often hit and miss, and a very drawn out and difficult process.

Quote:
I'm concerned about this because I have a complicated illness that seems to change its face from time to time. Meds are a linchpin of treating that illness. So is my diet, exercise, sleep, CBT, other therapy I've done, and yes, mindfulness. But even though I attend to all of these, they are not enough to keep me healthy.
What I found was that I had to work my way through a range of approaches- what worked at one point was a hindrance at another stage.
One of the great virtues of mindfulness though is that it deepens my perceptiveness. The more I do it- the more subtle my ability to detect what is working and what is not becomes.

This is expected - mindfulness is a path- not a static tool.

The difficult thing is getting a start on it, and appreciating just how much can be done with it.
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Whenever you see a crowd all rushing in the same direction on any one issue, run in the opposite direction.

There is neither fun nor profit to be had in polishing the brass knobs on a bandwagon.
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Old 08-21-11, 12:16 AM
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Re: Sci Am article on fewer psychiatric drugs in the future

I find it hard to believe big pharma would give up on pysche meds when more and more people are being dxed for mental health issues.Big pharma makes big money off its bread and butter stuff.If anything I believe microchips will play a big part in everything from blindness,adhd and paralysis,it'll directly connect the defective neurtransmitters w out the side effects like barliman stated above w ssri drugs.I could be wrong and technology that helps people can be exploited to control people too.its a double edge sword that needs to be approached very carefully.
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Old 08-21-11, 05:19 PM
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Re: Sci Am article on fewer psychiatric drugs in the future

Quote:
Originally Posted by Barliman View Post
Thanks Dizfriz.
I have read this.

I am not surprised- but not because of the risk thing- but because I think the idea of neurotransmitter based treatments has always been based upon an over simplistic view of neurophysiology.

I will take you back to 1988- when I was doing a term as "Senior Resident Medical Offecer" at one of our psych institutions in Melbourne ( Larundel- a scary place- since shut down).

The academic psychiatrists were out every few weeks explaining to us how all these wonderful new drugs ( that didn't even have proper names- just research codes) were going to come out and change everything. The academics could tell us exactly which receptors and which neurotransmitters would be affected.

What went through my mind at the time was "this looks really good on paper- but the problem is there is not a one to one mapping between neurotransmitters and functionality". The simplistic view being pudhed by the pharmacuetical- academic network was that we could just throw in an SSRI for instance and count on that drug acting just on the serotonin pathways we wanted to influence.

Well- nowadays we know that is not the case, and we know that that is why these drugs have so many side effects.

ADHD is a little different- in that ADHD drugs are generally very "clean" targeting only dopamine- so there is less chance for random mischief and vast arrays of side effects. However there are plenty of stimulant side effects involving unwanted activation of pathways not directly relevant to
ADHD.

That is why I like mindfulness- we focus on specific skills and train in them- activating and developing only the pathways involved in those skills.

Given a few years I am sure that mindfulness will be the "Gold Standard".
I know others remain to be convinced- but I am happy to be an early adopter in this field.

Neurotransmitters have different effects on different pathways. This is a big issue because current psychiatric meds affect pathways in the brain that aren't related to the condition that is being treated.

Also, I read somewhere that there are hundreds of neurotransmitters whose function is still completely unknown to scientists. If this is indeed true then it's definitely a road block to better psychiatric meds. Current medications focus on only a handful of neurotransmitters. It seems to me like we are blindly stabbing at treating certain mental conditions since we don't know how these conditions are affected by the other neurotransmitters that are sort of being ignored.

Last edited by Alex9; 08-21-11 at 05:31 PM.. Reason: removed a smilie that didn't work
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