вторник, 8 мая 2018 г.

PSYCHOPHARMACOLOGY

VENN-DIAGRAM OF PSYCHOACTIVE DRUGS


Psychopharmacology a term first coined in the early 20th century is the term used to describe the science of psychiatric medications.
The timeline for psychopharmacology and its antidepressant/antipsychotic drugs are as follows:[1] For completeness I have added in a few key items in brackets.
The 1950’s
  1. Development of phenothiazines [E.g., Thorazine]
  2. Discovery of iproniazid’s and Monoamine oxidase inhibitors (MAOIs’) antidepressant effects in tuberculosis patients
  3. Synthesis and beginning use of  Tricyclic antidepressants (TCAs), like imipramine, for depression
The 1960’s
  1. Beginnings of broad clinical use of TCAs, like amitriptyline-Elavil, now preferred over MAOIs
  2. [Ritalin approved for kids]
  3. Catecholamine hypothesis of depression widely discussed and investigated
Up to the early1990’s
  1. Development and clinical use of SSRIs, like fluoxetine, citalopram, and sertraline
  2. Broadening use of antidepressants for other conditions like anxiety disorders and painful conditions
  3. More common prescribing of antidepressant agents by primary care physicians
Up to the present day
  1. Synthesis and clinical use of dual-acting norepinephrine and serotonin (NE and 5-HT) antidepressants, with fewer TCA-like side effects, including SNRIs (venlafaxine- Effexor, duloxetine-Cymbalta), mirtazapine-Remeron, bupropion, and nefazodone
  2. More rigorous investigation of the analgesic properties of newer antidepressant agents
  3. [The widespread use of the atypical antipsychotics characterized by their dual action of blocking both dopamine and serotonin receptors (D2, 5HT2) such as Seroquel]  
Below is a listing of all the currently available atypicals (AAP’s) on the market.
I listed many of the atypicals along with their names off Wikipedia. Several of the atypicals are worse for causing weight gain.[2] W+ indicates those associated with the greatest risk of clinically significant weight gain. ὡ indicates moderate risk of weight gain. π indicates lowest risk of weight gain. D indicates the greatest risk of diabetes and dyslipidemia (increase in triglycerides and a decrease in HDL).
From the data in this study the largest weight gain also poses the greatest risk for diabetes which makes sense. In fact, the two are associated, it’s called diabesity as I’ve mentioned in the chapter on obesity. Many other drugs in this list cause big gains in weight-ones that are not supposed to make you fat. If you happen to get really fat on another drug generally thought to be less risky, all of the other risk factors come with it such as increased chance of developing diabetes, hypertension, dyslipidemia and heart disease. With that comes heart attack and stroke the natural sequelae from inflammation which is what the metabolic syndrome is-an inflammatory disease. In other words AAP’s (and the SSRI’s) are very pro-inflammatory affecting your endothelium in a severe way.
Anywhere from 70 to over 90 patients die per year from AAP overdose and toxicity. They are not just bad for you they are bad to you. Let’s look at the Black Box warnings for Clozaril the first AAP to hit the market:
Clozapine also carries eleven black box warnings for agranulocytosis, CNS depression, leukopenia, neutropenia, seizure disorder, bone marrow suppression, dementia, hypotension, myocarditis, orthostatic hypotension (with or without syncope) and seizures.[3]
If you must take an atypical (a small percentage may need to only if exercise 7 days a week and/or therapy fails first) then at least ask your doctor if you can get on metformin as well. Metformin has been shown to help prevent metabolic complications in patients taking an atypical.[4]These data are provided because I want you to know the risks in taking an AAP. If you are taking one get to the bottom of why are you on it. Most indications are weak, written by primary care doctors not psychiatrists. You need to get off of it before it harms or even kills you. Below I outline the simple yet reliable technique I use to wean patients off of these dreadful drugs.
As you can see from the timeline the newer materials started becoming popular in the 90’s. They replaced the older tricyclic antidepressants (TCA’s) because they weren’t as sedating or drying. Anyone who takes Elavil (a TCA) knows how dry your mouth can get or worse. These are called the anticholinergic side effects which are generally dry mouth, blurry vision, difficulty urinating, and sexual dysfunction. The sedation is from theantihistamine side effect. Think of Benadryl as the quintessential antihistamine-very sedating but it also has a powerful anticholinergic profile so you see dry mouth and urinary retention. Taking high-dose Benadryl is not unlike a dose of Elavil.
In addition it was found that the SSRI’s could treat anxiety quite well and were able to be used instead of addicting drugs like Valium. Valium is fine for very short periods of time say 1-2 weeks. After that a tolerance quickly mounts and soon an addiction can develop. Furthermore, Valium has a very long half life leading to a pretty powerful hangover the next day and it can interfere with work. If you become addicted stopping Valium at this point produces the exact effects you were being treated for, only stronger. So you see enhanced insomnia, profound anxiety and so forth. Not a great deal for the one stuck taking Valium (or any other in the benzodiazepine class) chronically. When that’s all over you still have anxiety and insomnia because you never addressed the root cause(s).
That’s why the SSRI’s were so acceptable. You could now treat anxiety and depression with one pill and leave them on it basically forever. At the time, they felt it was completely safe and non-addicting. They also found that some-the ones that also blocked reuptake of norepinephrine-could treat pain. So you have a drug with fewer side effects, especially the ones that really bother people like dry mouth and sedation, “non-addicting”, with anxiolytic and anti-depressive effects, and it’s dosed once per day. While some types can replace Elavil for the treatment of chronic pain like peripheral neuropathy (from diabetes) or post-herpetic neuralgia without the patient being knocked out and given cotton mouth.
That was how it all got started. I read how meperidine got going as well. Meperidine or Demerol® was the first synthetic narcotic hailed as non habit forming at the time it was introduced back in the 30’s. Well it didn’t take long before half the surgeons in the country were addicted to it. That’s how well we know if a new drug is addicting. Likewise we now know that for about half the population taking an SSRI it is next to impossible to withdraw from acutely without as Ann Blake Tracy would say going postal-wanting to jump out of a car at 80 mph.
THE LOW SEROTONIN & CHEMICAL IMBALANCE THEORIES OF DEPRESSION
Because psychiatry deals with the mind and they wish to remain in the reductionist camp, they are constantly looking for a “physical” explanation for “mental” disease. After decades of research they are not much closer to providing a failsafe theory for depression or any other mental illness. Years ago the prevailing wisdom was that depressed patients had a chemical imbalance in their brain that led to depression. This was first thought to be a catecholamine imbalance, a decrease in the level of neurotransmitters in the brain like norepinephrine or dopamine. Neurotransmitters are chemicals that allow communication from brain cell to brain cell as part of an electrochemical signaling system. Later the theory was amended to single out low brain serotonin as the cause of depression. Serotonin is one of the neurotransmitters found in the brain. However, the vast majority of serotonin is located outside the brain in the gut and mesentery. The low serotonin idea was the prevailing theory when I was in medical school. It’s not surprising that the SSRI’s would be prescribed for this condition since they dovetail nicely with theory. SSRI’s increase the available serotonin within the depleted brain of the depressed patient. Once the serotonin level becomes normalized the patient no longer is depressed. Nice and neat.
Unfortunately both the chemical imbalance and the low serotonin theories are incorrect. As early as 1983 while I was being taught the low serotonin theory the National Institutes of Mental Health (NIMH) concluded that there is no evidence that anything is wrong with the serotonergic system in depressed patients.
Later in 2009 at the Neuroscience conference in Chicago Illinois, Dr Eva Redei, a long time researcher in depression, found strong indications that depression is the result of some sort of dysfunction of your neurons (brain cells), that stress does not cause depression and that decreased levels of neurotransmitters-a popular press belief-are not involved in depression. Moreover the medications are focusing on the effect, not the cause, of depression which is why more than half the patients prescribed antidepressants for depression never get relief.[5]
NOW YOU KNOW THAT THE THEORIES OF DEPRESSION ARE WRONG. DRUGS THAT INCREASE SEROTONIN TO TREAT DEPRESSION HAVE NO THEORY TO SUPPORT THEIR USE. WE ALSO SEE FROM ABOVE THAT THE NEWER AAP’S HAVE A PORTFOLIO OF COMPLICATIONS SUCH AS MASSIVE WEIGHT GAIN, DIABETES, HEART ATTACK AND STROKE. IN THE NEXT PUBLICATION WE’LL REVIEW DR IRVING KIRSCH’S  NEW BOOK THE EMPEROR’S NEW DRUG WHERE HE SHOCKED THE COUNTRY WHEN HE FOUND OUT THAT ALL OF THESE NEWER DRUGS-THE SSRI’S-WORK NO BETTER THAN PLACEBO-A SUGAR PILL. WE’LL ALSO GO OVER EVEN MORE SHOCKING NEWS THAT THESE DRUGS DO IN FACT INDUCE MURDER, MAYHEM, AND SUICIDES.

[1] Joseph A. Lieberman III, M.D., M.P.H. History of the Use of Antidepressants in Primary Care. (http://www.psychiatrist.com/pcc/pccpdf/v05s07/v05s0702.pdf)
[2] Nasrallah HA, Newcomer JW  Atypical antipsychotics and metabolic dysregulation: evaluating the risk/benefit equation and improving the standard of care. (J Clin Psychopharmacol. 2004 Oct;24(5 Suppl 1):S7-14) 04/26/2012
[4] Pramyothin P, Khaodhiar L. Metabolic syndrome with the atypical antipsychotics.(Curr Opin Endocrinol Diabetes Obes. 2010 Oct;17(5):460-6) 04/26/2012
[5] The Dangers of Taking Antidepressants with Aspirin (http://articles.mercola.com/sites/articles/archive/2011/11/04/antidepressants)



Автор: на
Ярлыки: , , , , ,

Комментариев нет:

Отправить комментарий

Подписаться на: Комментарии к сообщению (Atom)