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mental health mondays :: oops

thanks very much to dom for alerting me to this fascinating article from salon/ scientific american. for those of you pressed for time, here's a tl;dr version:

"we may have been wrong about that whole lack of serotonin causing depression thing. oops. love, science"

for many years now, psychiatric medicine has relied on the model of the neurochemical imbalance to understand and treat depression and anxiety disorders. and while this particular article only relates to the insufficiency of serotonin reuptake inhibitors as treatment, it's pretty clear that the same thing would apply to drugs that regulate the amount of norepinephrine and/ or dopamine in the brain as well.

the short, over-simplified version is that while drugs that help delay the reuptake of neurotransmitters associated with pleasure and reward do indeed make depressed people feel better, they aren't actually treating depression, at least not its cause. because it turns out that depleted serotonin in the corridors of your noggin is an effect of the fact that your brain is producing fewer neurons and nerve contacts. and that, my friends, is the real reason you're depressed.

it is not uncommon for medicine to start out treating the symptoms of a disease and to gradually move onward to the cause. in fact, it would be anomalous for it to happen the other way. as we observe a disease for longer and understand its progression better, the drugs developed to combat the disease come closer to the epicentre of the death star. most times, we start out just trying to stop the symptoms we see on the surface.

what is surprising is how long its taken for this research to take place. development of drugs to treat major depression, anxiety and other mental disorders has been more or less at a standstill for decades, with "advances" chiefly comprised of tweaks on previous formulas, especially providing long-release versions of existing drugs. to put that in perspective, aids has been identified, grown to an epidemic, its symptoms treated with a variety of harsh drugs, triggered a massive shift in attitudes towards safe sex, had its spread curtailed in the western world and come to be a manageable condition at various stages, all in the time we've been tinkering with prozac. [note :: i am not saying that all aids victims have access to proper treatment or education, only that the potential to eliminate the virus if caught early enough or mitigate its damage to a great degree exists.]

i'm not claiming to know why this is the case. the brain is an unfathomably complicated piece of machinery, as is evidenced by the fact that we discover entirely new things about it virtually every time we attempt to validate anything we actually think we know. check the prescribing information sheet on any psychiatric drug and you'll find a line that says something like "the mechanism of action is thought to be..." science isn't even trying to convince you that it knows how this thing really works. and while testing out the efficacy of a new sinus medication is likely only to result in a more snot/ less snot check sheet, playing around with the inner workings of your brain requires a little more in the way of due diligence. no one wants this stuff rushed to market.

and you certainly can't argue that there's no money in it. the amount of money in psychiatric drugs is staggering. so unless someone offers some pretty convincing proof that cauliflower cures depression, there is probably more than enough financial incentive to do this sort of work.

i am interested to see how long it takes for this research to spur the development of a newer class of drugs, to see if getting our slacking neuron-producers off their butts represents a great leap forward.

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