• CIG CIG
    February 13, 2011
    in the brain
    CIG CIG
    February 13, 2011

FROM OUR EXPERTS

  • Judy
    Health Guide
    February 13, 2011
    Judy
    Health Guide
    February 13, 2011

    I don't think that depression is a simple matter of chemical imbalance in the brain and that's why it isn't so simple to fix.  I think that sometimes it can be brought about by the coping behaviors we might have developed as children - or even as adults - in order to survive unbearable things such as poverty, abuse or neglect, to name a few.  Our brains create new pathways through repetition until our response becomes automatic and unconscious when triggered by stress.  We are all unique in how we do this, I think, because our bodies and brains are unique in various ways and it would explain why one medication might work wonders for one person and cause nothing but horrible side effects in another.  I think there are ways of measuring brain activity in response to particular stimuli, but no doubt the technology is cost prohibitive, for one thing.  I'm not a scientist, I don't know anything for sure.

    • CIG
      CIG
      February 13, 2011
      CIG
      CIG
      February 13, 2011

      Hi Judy...

       

      Thank you, for the response. In my experience, being a scientist isn't indicative of certain knowledge and you seem to have some good insights.

       

      Depression, almost certainly, results from a genetic predisposition with environmental "triggers"; stressors and is simple enough to "fix", with gene therapy. The primary reasons it hasn't are more political and economic than anything else. 

       

      Brain activity, in response to particular stimuli, can be measured with positron emmission tomography but brain activity isn't what I was referring to. While there's a correlation between "brain activity" and "chemicals in the brain", this would vary, widely, among individuals so results would be of dubious value, for the purpose I was referring to.

       

      Magnetic resonance spectroscopy can "measure" the "chemicals in the brain", the imbalace of which, supposedly, causes depression.

       

      Neither positron emmission tomography nor magnetic resonance spectroscopy are "inexpensive" but both are a long way from "cost prohibitive". Any "cost/benefit analysis", of a treatment for depression, should take into account the costs of, currently, ineffective treatments; more than ten billion dollars, per year, just on drugs as well as the astronomical and rising, direct and indirect, losses, experienced by individuals and society, which result from depression. Pretty much, anything is "cheap", in comparison, I think.

       

       

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  • John Folk-Williams
    Health Guide
    February 13, 2011
    John Folk-Williams
    Health Guide
    February 13, 2011

    Hi, CIG -

     

    Thanks for the information in your follow-up responses. As a layman, I'm not nearly as knowledgeable as you are about the methods available for measuring the activity and levels of specific chemicals in the brain. I've never heard of - and have never had myself - any effort to measure chemicals in the brain in patients/clients and prescribe medications to match the deficiency/excess.

    One reason is that no one is sure of the precise imbalance. It's not just the chemical level either - medications seem to have different levels of effectiveness according to the specific targeted mechanism by which the neurotransmitters are circulated in the brain. As near as I can tell, researchers have based their theories of the effect of various neurotransmitters on depression on experiments done on mice and other animals. It's only in their brains that they can remove parts, deprive them of specific chemicals, etc. to isolate the effect of specific neurotransmitters.

    The human trials are based on comparisons with placebo or other drugs to measure comparative effectiveness in relieving symptoms - not on brain measurements of any type. Some researchers focus on measuring levels of "activity" and size/shape of specific brain areas of depressed persons. Blood samples are necessarily indicative of an imbalance, in my humble opinion, because there are so many other body systems where they play a role (as serotonin does in the vascular system, among others.)

     But you're right, trial and error is what every patient goes through to find one that works. That in itself should show how imperfectly the chemical imbalance theory works in practice. As I understand it, psychiatrists cover the general confusion over causes by emphasizing the biopsychosocial model (not sure I've arranged the syllables properly) - i.e. pretty much the kitchen sink.

     John

    You might find this article especially interesting:

    The Chemical Imbalance Myth of Depression - Here are Some Better Explanations

    Or this:  Repost - Ten Depression Myths Busted

    • CIG
      CIG
      February 14, 2011
      CIG
      CIG
      February 14, 2011

      Hi John...

      Thank you, for the response.

      I'd have been surprised if you had heard or had yourself any effort to measure chemicals in the brain and medications prescribed to match the deficiency/excess. As I said: "I'm not aware of any instances, in clinical practice, where the levels of the chemicals, in the brain, (have been) measured and, targeted, medications used." I expect there'd be more certainty, "of the precise imbalance", if the levels were measured.

      I'm not sure I understand what you mean by: "medications seem to have different levels of effectiveness according to the specific targeted mechanism by which the neurotransmitters are circulated in the brain". Please explain and are you suggesting a medication, which acts on a particular "mechanism", may be more "effective" than a medication, which acts on another "mechanism", regardless of the effect of the medications on the levels of the "chemicals in the brain"?

      "Theories" is the correct word and the majority have developed from animal models, which, as you're likely aware, aren't, necessarily, representative of the human. Human trials were "based on comparisons with placebo or other drugs to measure comparative effectiveness in relieving symptoms - not on brain measurements of any type", which, again, as you're likely aware, is problematic in that the same drug may have, widely, varying effects, in any given demographic, and many effects are self-reported, so, subjective.

      "Measuring levels of 'activity' and size/shape of specific brain areas of depressed persons" may, very well, be useful but are, I think, unlikely, to lead to a "cure", for depression, or even a, comprehensive, treatment.

      I assume you meant to say: "blood samples AREN'T necessarily indicative of an imbalance (in the brain)". There's no correlation between brain and blood cortisol levels but the reason, for this, is the "blood-brain barrier".

      Currently, there are several hundred studies and trials, utilizing magnetic resonance spectroscopy, in progress; several dozen related to depression. Unfortunately, the majority of these are, extremely, limited in scope and the use of MRS has become prevalent only in the past two or three years.

      Yes, the "trial and error (that) every patient goes through to find one that works...should show how imperfectly the chemical imbalance theory works in practice". "Peter Pan Syndrome" was taken so I ascribe the fact that it, generally, doesn't to what I'm calling the "Wendy Syndrome"; "I believe, I believe, I believe"...in spite of clear evidence to the contrary.

      You "arranged the syllables properly" and, yes, psychiatrists use it to cover <del>their asses</del>...sorry, I meant to say: "the general confusion over causes", rather than to explain the causes, thus, increasing the confusion and extending their, perceived, usefulness.

      Pretty simple, though:
      biological - genetic pre-disposition; vulnerability to depression
      psychological - perceived stressors, processing of stress
      social - "triggers", socialization increasing vulnerability, lack of support

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FROM OUR COMMUNITY

  • Donna-1 February 13, 2011
    Donna-1
    February 13, 2011

    Have you checked out the work of Daniel Amen, MD?  He has some ideas about brain functionality and the type of treatment(s) needed to restore function.  You might want to look at the SPECT brain imaging of the schizohrenic brain on and off medication.  Just seems like something you might find interesting.

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    • CIG
      CIG
      February 14, 2011
      CIG
      CIG
      February 14, 2011

      I have a general interest in imaging and psychiatric disorders; more specifically, in MRI and depression. SPECT is non-specific, so, of less value, for the purpose of treatment, than MRI. I believe schizophrenia and other psychiatric disorders are more closely related to depression than is, generally, thought but, as I said, my specific interest is in depression.

       

      Yes, I've "checked out the work of Daniel Amen". In my opinion, his "work" amounts to taking advantage of vulnerable, desperate people. There are a number of reasons his "ideas" and "treatment(s)" wouldn't be effective. The only evidence they are is his claim that "85% of our patients report a high degree of satisfaction with our services", which may or may not be true and, if true, may be "placebo effect".

       

      I'd wager any, perceived, benefit, from his "treatment(s)", is illusory and temporary. You can feel better, temporarily, and get screwed, for a lot less than the several thousand dollars he charges, by engaging the services of an escort.

       

      His book, "Change Your Brain Change Your Life", which he claims is a "breakthrough", is actually a mash-up of every half-baked idea to come down the pipe in the past two millennia (see CBT, NLP, Dare To Be Great, etc.) and amounts to an affirmation that you can "conquer" depression by "pulling yourself up, by your bootstraps".

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  • Donna-1 February 13, 2011
    Donna-1
    February 13, 2011

    Well, actually, I think this is precisely what is being done.  But still, different medications may restore the "balance" in different ways and be more or less effective in each individual.  Targeting specific neurochemicals continues to be an exciting field of study for the drug companies.  For instance, Zyprexa, which is an antipsychotic, also worked on my depression.  Something it was not initially intended to do, but is a desired side effect.  Sometimes it takes a combination of antidepressants, or pairing an antidepressant with an antipsychotic or other med in order to promote recovery from depression.  If you are talking about looking at the specific individual and measuring exactly what dose of which medication is needed for him or her, that is also being studied.  The field of epigenetics and stem cell research and who knows what else are all being looked at as areas of interest.  The field of medicine is always expanding and drug companies would love to be able to do what you sugest.  Maybe it will be possible in the next 10-20 yrs to hit that chemical imbalance target in the individual with medication and/or other therapies.  I hope so!

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    • CIG
      CIG
      February 13, 2011
      CIG
      CIG
      February 13, 2011

      Thank you, for the response. I don't understand some of your comments, though.

      Why do you "think this is precisely what is being done"? I'm not aware of any instances, in clinical practice, where "the levels of the chemicals, in the brain, (have been) measured and, targeted, medications used". As far as I know, pharma therapy continues to rely on the "algorithm", which consists of a "spin of the wheel", to choose a starting anti-depressant, and working your way through the list, in the hope of finding something that works.

      Off label use, adjunctive therapies and pleiotropic effects are all interesting and some may even be beneficial but aren't really relevant, to my question.

      I'm "talking about looking at the specific individual" but measuring exactly what "chemicals in the brain" are out of balance, in order to determine "which medication is needed for him or her".

      While "epigenetics and stem cell research" are, also, interesting and gene therapy will, eventually, be found to be the "cure" for depression, they, also, aren't really relevant, to my question.

      Call me cynical but I doubt the "drug companies would love to be able to do what (I) sugest (sic)". I suspect they'd rather numerous ineffective medications continue to be bought and paid for rather than an effective medication being prescribed, initially. Treating depression is profitable; curing depression isn't.

      I'll be dead "in the next 10-20 yrs" so your suggestion that "maybe it will be possible...to hit that chemical imbalance target" doesn't give me much comfort. What's really depressing, though, is that it's been "possible...to hit that chemical imbalance target in the individual with medication..." for the past twenty years. The "chemicals in the brain" are the 5-HT neurotransmitters and neuromodulators. Drugs, to modify the level of these chemicals,  were first developed in 1970. Magnetic resonance spectroscopy was first used, to measure concentration of neurotransmitters, in 1990. What's even worse is that, while an "imbalance the chemicals, in the brain" is associated with depression, it isn't the "cause" and the drug companies know this. Look at any of their literature, referring to the cause of depression, and you'll see "MAY be caused"; not "IS caused". Hell, depression "MAY be caused" by Jupiter being out of alignment with Mars.

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