Gail Williams (gail) Tue 16 Mar 10 13:59
Gary, I happened upon an article today about Personality types and depression. It seems to muddy the distinctions even further. > The temperament harm avoidance (HA) has consistently demonstrated an association with major depressive disorder (MDD), serotonin functioning and reduction in depression symptoms in response to antidepressant medications targeting the serotonin system. ... > HA mediated the response to antidepressant treatment, such that any treatment effect of clomipramine occurred through HA reduction. ... http://www.medicalnewstoday.com/articles/181733.php Changing temperament? Is personal identity the next frontier for mind drugs -- "gimme a prescription for a new personality?" Or is that already part of what treating depression is about.
Gary Greenberg (gberg) Wed 17 Mar 10 08:15
>Or is that already part of what treating depression is about. That's an interesting way to pose the question. The quick answer is that this is not supposed to be what treating depression is about because depression is an illness that, at least theoretically, can strike anyone regardless of their personality type, just as diabetes is. (I use that comparison because it is the one that the depression industry uses; they'd be smarter to compare depression to heart disease, as that does have robust correlations with personality factors.) But studies, most of them recent, have shown that it is possible that the personality changes wrought by the drugs are prior to the changes in depressive symptoms, and maybe even cause them. The most impressive of these was in the Archives of General Psychiatry at the end of last year, and it purported to show that the personality changes actually caused the remission in depression, perhaps because people, once changed, liked themselves better. Personally, I'm skeptical of this work, much as it corresponds with what I believe, which is that depression, in many cases, and certainly in the less severe cases, is the expression of something essential (if not happy) about the person who is depressed. "Personality" itself is a highly problematic construct, and the dimensions along which it is measured tend to be oversimplified, reductionistic categories tailor made for the measurements. Nonetheless, I think this line of research is valuable, if only as a counterweight to the conventional wisdom about depression as a disease. An interesting implication here is that it reverses the main and side effects of the drugs. Peter Kramer. in Listening to Prozac, wrote about the personality changes in SSRI takers as if they were accidental outcomes of treating their depressions. But it's opssible that he had it backwards.
Gary Greenberg (gberg) Wed 17 Mar 10 08:17
>Changing temperament? Is personal identity the next frontier for mind drugs -- "gimme a prescription for a new personality?" Well, of course, we already have drugs explicitly for that purpose--psychedelics, entheogens, etc. That's why you're unlikely to see the drug companies pushing to evaluate the personality-changing dimensions of antidepressants. It would blur the line that they ahve painstakingly painted between "medicine" for "illness" and "drugs" for "enhancement."
Lisa Harris (lrph) Wed 17 Mar 10 10:14
Gary, I'd like to take this opportunity to thank you so very much for joining us in Inkwell.vue. We will be turning our focus to a new book today, but you are all welcome to stay here as long as you like.
Steven McGarity (sundog) Sun 21 Mar 10 21:36
Been a really great discussion. I'm glad you wrote that book.
Gary Greenberg (gberg) Mon 22 Mar 10 04:34
Thanks. This was lots of good,challenging fun.
paralyzed by a question like that (debunix) Mon 22 Mar 10 10:19
One of the most valuable classes I didn't take in medical school was a history of medicine course at Berkeley, and the discussions about well-accepted and frequently diagnosed diseases that went in and out of favor, really gave some good perspective on what we think we know vs what we really know. It's good to reexamine the roots of our current understanding again.
Mark McDonough (mcdee) Mon 22 Mar 10 11:00
I'd reexamine the roots of my current understanding, but my neurasthenia is acting up again. ;-)
Gary Greenberg (gberg) Mon 22 Mar 10 16:35
>One of the most valuable classes I didn't take in medical school >was a history of medicine course at Berkeley, and the discussions >about well-accepted and frequently diagnosed diseases that went in >and out of favor, really gave some good perspective on what we >think we know vs what we really know. For many docs, the specialization in science starts so early (sophomore year, maybe even freshman) that they don't get much exposure to history, let alone history of science, and only minimal coursework in literature. So they are not well-equipped to understand the context of their knowledge. And while much of science does seem to operate outside of history, on a sort of gradual climb through ignorance and error to the pinnacles of knowledge, in fact that history is really important to understanding what a doctor is doing. Especially what a psychiatrist is doing. Freud wrote an essay called The Question of Lay Analysis, in which he outlined why he was so vehemently opposed to the New YOrk Psychoanalytic Society's decision in 1926 to limit the practice of psychoanalysis to physicians. Medical training, Freud wrote, was exactly the wrong kind of education for being a psychotherapist. Without that grounding in history and literature, and the accompanying view that the life of the mind demanded its own kind of science, doctors would be prone to seeing our suffering as a disease and to seek cures. Freud lost that battle. And Psychologists suffer a similar version of this problem--their education is constrained by needing to get into ph.d. programs, which are in agggregate harder to get into than m.d. programs, and as a result tend also to miss out on the liberal arts. If nothing else, that kind of education can help to instill a kind of modesty, a sense of how much we just don't know and of how contingent the knowledge that we have is, that is a good counterbalance to the certainties and pieities of medicine.
paralyzed by a question like that (debunix) Mon 22 Mar 10 17:33
I was easily able to fit that course into my curriculum as a pre-med student, and so were a lot of my fellows.
Gary Greenberg (gberg) Tue 23 Mar 10 03:32
And many doctors start out as liberal arts students, changing in midstream, or even doing the science in a post-baccalaureate program. But it's pretty much left up to the student, unlike, say, organic chemistry, which is a requirement. I think this is changing at some medical schools, which are also trying to teach doctors about the intricacies and importance of patient communication. But at least when it comes to psychiatric training, I think a good grounding in history, religion, literature, etc., ought to be mandatory.
Velma J. Bowen (wren) Wed 24 Mar 10 08:24
As an idle data point, my partner checked himself into the psych ward of the hospital we use about a fortnight ago. The doctors prescribed him Prozac immediately; the first appointment with the therapist is mid-to-late April. I am exceedingly unthrilled by this. Unsurprised, mind you, particularly after reading your book, but unthrilled.
Gary Greenberg (gberg) Wed 24 Mar 10 08:29
Take two Prozac and call me in a month? That's pretty bad, even by current standards. I do hope they suggested you and he keep a close eye on his level of agitation, impulsiveness, and suicidal thoughts as he embarks on Prozac, and call in if you have any concerns. The first days are often the hardest days.
Velma J. Bowen (wren) Wed 24 Mar 10 08:34
Ha. They said nothing to either of us. I've been carefully reading all the documentation, going online to look at other effects (I refuse to call them "side-effects") and interactions with his other meds, and <scraps> and I have been talking about this daily. Thus far, he seems to be handling it well.
Peter Richardson (richardsonpete) Mon 16 Aug 10 16:05
Congrats on the Harper's cover story, Gary.
Gary Greenberg (gberg) Mon 16 Aug 10 21:33
Jay Marvin (punkblood) Fri 8 Oct 10 18:05
I've been in therapy 30 years. Giving someone Prozac, and then shoving them out the door is wrong. The person made need drugs and talking therapy. Prozac is a generic short half life drug. I'd look for a person who deals in both meds and talking. I know what I'm talking about been through it many times due to moving from state to state.
Idea Hamster On Speed (randomize27) Tue 12 Oct 10 11:01
I feel that most psych drugs today are like painting over rusty metal or rotting wood - covers up the problem, makes it look functional, but unless you deal with the problem, it will continue to rot away until not even the most powerful drugs/strongest paints will help.
uber-muso hipster hyperbole (pjm) Tue 12 Oct 10 11:10
Sometimes you have to put put in braces and scaffolding before you can fix the building.
Idea Hamster On Speed (randomize27) Tue 12 Oct 10 14:14
That's very true. And there are therapy methods to do that. But, just drug-and-go is only covering up the problem, not fixing it, or preparing to fix it. Had a girlfriend once, she started having panic attacks, went on Xanax and Prozac, changed her personality, killed her sex drive, and she was still having debilitating panic attacks four years later, before...well, I broke contacts with her 3 years after we broke up, though we'd been friends for those 3 years. Me, had a robbery a hair over 4 years ago that triggered debilitating panic attacks. Got therapy, didn't take any drug courses, dealt with it, and while I still have an occasional panic attack, haven't had a debilitating one in years. Where she painted it over, I immediately got to work on the scaffolding and braces. Still could throw on some paint, but it's good enough now, why bother?
uber-muso hipster hyperbole (pjm) Tue 12 Oct 10 14:53
Painting over is a real problem if we are to live authentic lives, I agree. A percentage of people, though, have genuine chemical imbalances in their brains that cannot be fully changed by therapy and action. Sometimes brain chemistry needs to be augmented on a long term basis.
paralyzed by a question like that (debunix) Tue 12 Oct 10 15:07
I recently had the mother of a patient get really angry with me that I would not give her a new prescription to continue a psychiatric med a psychiatrist started her on *without* arranging any ongoing followup/counseling with any sort of mental health practitioner. Always have to wonder if the family misunderstood, hard to believe a psychiatrist would start it without even the *intention* of followup, but still, all too common that patients get the drugs without counseling, even kids. Yikes.
Gary Greenberg (gberg) Tue 12 Oct 10 17:19
Around here (Eastern CT) that's pretty much par for the course. The only followup is the one to the psychiatrist to make sure the drugs are working. Fewer and fewer psychiatrists place much stock in therapy, except for the assembly line CBT version, and often that's just lip service.
Linda Castellani (castle) Tue 12 Oct 10 19:50
<scribbled by castle Tue 12 Oct 10 23:35>
Idea Hamster On Speed (randomize27) Tue 12 Oct 10 22:48
Oh, a permanent imbalance is a whole 'nother critter...but anything that can be dealt with by therapy instead of meds, I'll take the therapy, hard and fast, rather than drug myself into someone else.
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