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Friday, June 17, 2011

Do You Have a Chemical Imbalance?

First of all, let me say that I have battled clinical depression and obsessive-compulsive disorder for well over twenty-five years. I know firsthand the devastating effects of these mental illnesses. I would not wish the conditions upon anyone. They have taken a toll on my health and on my life in general as they have interfered with my ability to work, sleep, eat, and enjoy once pleasurable activities.I continue to deal with these disorders and their impact today.

Mental disorders are widely misunderstood. The prevailing attitude toward depression is "Keep a stiff upper lip, have a drink, maybe it will go away." Of course, this advice is ludicrous. People suffering from severe depression need profession psychiatric evaluation and good medical treatment including psychotherapy.

Many doctors have helped me with my illnesses. They have prescribed me many different medications to help me deal with my problems. All the meds have risks and some unwanted side effects. I have weened my way off prescriptions at various times during my decades of dealing with depression and OCD. I am most happy when I feel good without the aid of medications. But, I have suffered relapses, and I have had to resort going back on drugs to maintain mental health.

My doctors have told me that my mental disorders are most likely caused by a combination of inherited and environmental factors that affect brain chemicals called neurotransmitters.These doctors said that my mental disorders result from a chemical imbalance in my brain. I have accepted the doctors' diagnosis and prognosis of my diseases. This post will put a shocking twist on what, for me, has been a might struggle.

I Am Not Alone

Want a startling fact? Mental illness is now the leading cause of disability in children, well ahead of physical disabilities like cerebral palsy or Down syndrome, for which the federal programs were created.

How about this finding? A large survey of randomly selected adults, sponsored by the National Institute of Mental Health (NIMH) and conducted between 2001 and 2003, found that an astonishing 46 percent met criteria established by the American Psychiatric Association (APA) for having had at least one mental illness within four broad categories at some time in their lives. The four categories are anxiety disorders, mood disorders, impulse-control disorders, and substance-use disorders.

Speaking of Chemicals and Mental Illness

Three new books reviewed in an article by Dr. Marcia Angell titled "The Epidemic of Mental Illness: Why?" in The New York Times Review of Books (Angell was the first woman to ever be editor-in-chief of the prestigious New England Journal of Medicine) raise startling possibilities about the truth behind the explosion of prescriptions of pharmaceutical treatments for mental illness.

All of the authors of the new books agree on two thought-provoking viewpoints:

"1. Our understanding of categories of mental illness and their treatments has been influenced by drug companies, through both legal and illegal marketing.

"2. Mental illness is not caused by chemical imbalances in the brain." 

(Elizabeth Landau, "Are Antidepressants Glorified Placebos?, June 16 2011)

These views, however controversial, are documented well, Angell says.

For instance, even though the goal of psychoactive drugs is to alter levels of neurotransmitters - brain chemicals - which affect mood, scientists have not found good evidence that it's the chemicals themselves that cause the mental illness. Before treatment, neurotransmitter function seems to be normal, they say.

Here are the books that were reviewed by Dr. Angell.

The Emperor's New Drugs: Exploding the Antidepressant Myth
 by Irving Kirsch                                                  
Basic Books, 226 pp., $15.99 (paper)

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America
by Robert Whitaker                                                  
Crown, 404 pp., $26.00

Unhinged: The Trouble With Psychiatry--A Doctor's Revelations About a Profession in Crisis 
by Daniel Carlat                                                  
Free Press, 256 pp., $25.00

Irving Kirsch, a psychologist at the University of Hull in the UK, found that placebos were three times as effective as no treatment. That didn’t particularly surprise him. What did surprise him was the fact that antidepressants were only marginally better than placebos. As judged by scales used to measure depression, placebos were 75 percent as effective as antidepressants.

Kirsch was also struck by another unexpected finding. In his earlier study and in work by others, he observed that even treatments that were not considered to be antidepressants—such as synthetic thyroid hormone, opiates, sedatives, stimulants, and some herbal remedies—were as effective as antidepressants in alleviating the symptoms of depression. Kirsch writes, “When administered as antidepressants, drugs that increase, decrease or have no effect on serotonin all relieve depression to about the same degree.” (Marcia Angell, "The Epidemic of Mental Illness: Why?" The New York Review of Books)

Robert Whitaker, a journalist and previously the author of a history of the treatment of mental illness called Mad in America, concludes that antidepressants and most of the other psychoactive drugs are not only ineffective but harmful. He begins by observing that even as drug treatment for mental illness has skyrocketed, so has the prevalence of the conditions treated:
"The number of disabled mentally ill has risen dramatically since 1955, and during the past two decades, a period when the prescribing of psychiatric medications has exploded, the number of adults and children disabled by mental illness has risen at a mind-boggling rate. Thus we arrive at an obvious question, even though it is heretical in kind: Could our drug-based paradigm of care, in some unforeseen way, be fueling this modern-day plague?" (Marcia Angell, "The Epidemic of Mental Illness: Why?" The New York Review of Books)
What Does the Future Hold?

National Institute of Mental Health (NIMH) Director Thomas Insel, M.D., recently said it's time to fundamentally rethink mental illness. A surprising finding from genomic research is that mental illnesses appear to be related to extremely rare but potent genetic mutations that are not associated with any specific disorder but with a variety of phenotypes categorized as mental illness. (Mark Moran, "Brain, Gene Discoveries Drive New Concept of Mental Illness," American Psychiatric News Volume 46, June 17 2011)

Perhaps new research will find new and better treatments. For example, studies show that a combination of therapy and medication usually works better than using either one alone. Some studies claim a new treatment is zapping the problem away without the nasty side effects of drugs. Transcranial Magnetic Stimulation (TMS) activates certain parts of the brain by using electrical energy passed through a coil of wires to create a powerful magnetic field. (Maureen McFadden, "New Treatment Offers Hope For Those With Major Depression,", June 1 2011) 

James Hunter ("Research On Depression," National Institute of Mental Health,, 2010) offers some insight on the future of work on depression. 

Hunter says research on the causes, treatment, and prevention of all forms of depression will remain a high NIMH priority for the foreseeable future. Areas of interest and opportunity include the following:
  • NIMH researchers will seek to identify distinct subtypes of depression characterized by various features including genetic risk, course of illness, and clinical symptoms. The aims of this research will be to enhance clinical prediction of onset, recurrence, and co-occurring illness; to identify the influence of environmental stressors in people with genetic vulnerability for major depression; and to prevent the development of co-occurring physical illnesses and substance use disorders in people with primary recurrent depression.
  • Because many adult mental disorders originate in childhood, studies of development over time that uncover the complex interactions among psychological, social, and biological events are needed to track the persistence, chronicity, and pathways into and out of disorders in childhood and adolescence. Information about behavioral continuities that may exist between specific dimensions of child temperament and child mental disorder, including depression, may make it possible to ward off adult psychiatric disorders.
  • Recent research on thought processes that has provided insights into the nature and causes of mental illness creates opportunities for improving prevention and treatment. Among the important findings of this research is evidence that points to the role of negative attentional and memory biases -- selective attention to and memory of negative information -- in producing and sustaining depression and anxiety. Future studies are needed to obtain a more precise account of the content and life course development of these biases, including their interaction with social and emotional processes, and their neural influences and effects.
  • Advances in neurobiology and brain imaging technology now make it possible to see clearer linkages between research findings from different domains of emotion and mood. Such "maps" of depression will inform understanding of brain development, effective treatments, and the basis for depression in children and adults. In adult populations, charting physiological changes involved in emotion during aging will shed light on mood disorders in the elderly, as well as the psychological and physiological effects of bereavement.
  • An important long-term goal of NIMH depression research is to identify simple biological markers of depression that, for example, could be detected in blood or with brain imaging. In theory, biological markers would reveal the specific depression profile of each patient and would allow psychiatrists to select treatments known to be most effective for each profile. Although such data-driven interventions can only be imagined today, NIMH already is investing in multiple research strategies to lay the groundwork for tomorrow's discoveries.
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