A new era of rationally designed antipsychotics

Feb 28, 2018

By David R. Sibley & Lei Shi

Schizophrenia is a disorder that involves hallucinations, delusions and cognitive impairment, and that affects nearly 1% of the global population1. The mainstays of therapy have been drugs that block the activity of the D2 dopamine receptor (D2R), a member of the large G-protein-coupled receptor (GPCR) superfamily of membrane proteins. Unfortunately, most of these antipsychotic drugs come with a plethora of debilitating side effects, many of which are due to off-target interactions with other GPCRs. In a paper in Nature, Wang et al.2 now report the crystal structure of D2R in complex with the antipsychotic drug risperidone. The structure reveals features that might be useful for the design or discovery of drugs that have greater selectivity for D2R than existing therapeutics, and consequently have fewer side effects.

The naturally occurring ligand for D2R is a neurotransmitter called dopamine, which mediates various physiological functions, including the control of coordinated movement, cognition and the reinforcing properties of drugs of abuse. There are five receptors for dopamine, which fall into two subgroups on the basis of their associated intracellular signalling pathways and their affinities for various drugs3: D1-like receptors (D1R and D5R) and D2-like receptors (D2R, D3R and D4R). As early as the 1970s, it was hypothesized that the therapeutic effects of antipsychotic drugs were due to them blocking D2-like, rather than D1-like, receptors4,5, but the existence of multiple D2-like receptors was not discovered until they were cloned some 15 years later6.

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64 comments on “A new era of rationally designed antipsychotics

  • Numerous studies have shown that it is our experiences that bring about changes in brain chemicals and also result structural changes in the brain. For example, when mice are subjected to various psychological stresses (e.g. being restrained) their neurochemicals as well as the structure of their brains change and these changes are REVERSIBLE through psychological means (e.g. when stressed, restrained animals are released). If someone loses their job, all the rumination, worry, regrets, etc., will change their brain chemicals and when the person gets a job again (or if their life circumstances change), these chemicals return to normal again. Other research has shown jugglers gain more grey matter in certain areas as a result of engaging in juggling. Taxi drivers gain grey matter in other areas. Even attaching to different intentions is known to change the brain. Additionally, mindfulness practices result in measurable changes in the structure and function of the brain in positive ways (e.g. increases in gray matter and cortical thickness, etc.). So, stated differently, the organization of brain circuitry is constantly changing as a function of experience. This phenomenon is well known to neuroscience and is often listed as a key discovery of neuroscience, and yet, it is very much ignored.

    The brain is very complex organ with billions of neurons and trillions of synapses that connect and interact in complex ways – there is so much we do not know about this organ. So, introducing chemicals to it following someone’s idea of “treating” mental problems would only mess up the natural biochemical pathways, adversely affecting the functioning of the brain in the long-term.
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  • Dayane

    So, introducing chemicals to it following someone’s idea of “treating” mental problems would only mess up the natural biochemical pathways, adversely affecting the functioning of the brain in the long-term.

    Which mental problems are best treated with medication and which are best treated with mindfulness and other similar therapies?
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  • Dayane #1
    Mar 1, 2018 at 7:36 pm

    Numerous studies have shown that it is our experiences that bring about changes in brain chemicals and also result structural changes in the brain.

    That is so, but it has also been shown that drugs and drug abuse, also bring about changes in brain structure.

    For example, when mice are subjected to various psychological stresses (e.g. being restrained) their neurochemicals as well as the structure of their brains change and these changes are REVERSIBLE through psychological means

    Some changes are reversible, some involve the physical “wiring” of new circuits and are durable unless “rewired” by various means.

    So, introducing chemicals to it following someone’s idea of “treating” mental problems would only mess up the natural biochemical pathways, adversely affecting the functioning of the brain in the long-term.

    There have certainly been plenty of errors in the past, but there ARE treatments which are proved to provide relief from damaging conditions, so there is no merit in taking a fatalist approach and claiming nothing is understood, and can be done.

    Neurological pathways are not fixed!
    They are constantly being reworked, pruned out, or extended, so the question is one of guiding charges where nature left to itself is malfunctioning.
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  • Brains are indeed plastic. They grow and regrow and are pruned to meet new requirements. Much brain structure is formed by the nature of the data it is presented with. (This is the fairly new discipline of neuro-constructivism.)

    A child beaten, abused or starved will fail to grow in the first or second major periods of brain growth, 0-18 months and 12 to 25 years. Or end up over pruned in the period 18months to 25years, this thanks to the stress hormone cortisol.

    Evolution, trying to make the best of a bad job creates, literally, stunted humans with stunted brains, with much lower energy demands. Depending on timing it creates bullies and psychopaths to better survive the grim reality of the child’s world. Restoration outside of the main growth periods is painfully slow. Viral insults to the brain or inflicted damage with recreational drugs (cannabinoids and schizophrenia) are rarely much ameliorated.

    Mild autism is often much better handled as the child grows, but this is by the expedient of creating neural workarounds rather than fixing the initial problem. The reason for this is entirely the fact that our genes aren’t a map of what to build but instructions merely of sequenced building processes. There is no reference design to get back to. When the build process goes “wrong” because of unusual genes. Work arounds (to make better use of presented data to a plastic brain) may be too slow and inefficient to save a reproductive life.

    Drugs are often essential in cases of extreme distress and danger. They are sub optimum because of their wide effects when the “fault” may be very local.

    A new approach of neural pacemakers, delivering topical neural corrections seem to hold tremendous promise, being, well, topical and turn up and downable. The effect can be contingently optimisable by the user.
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  • [Since there isn’t a reply button to individually reply comments – I have included my replies to ‘LaurieB,’ ‘Alan4discussion’ and ‘phil rimmer’ below]:

    LaurieB: I don’t think any ‘mental issue’ should be treated with medication except in very rare occasions and only for an emergency (such as when posing a danger to others or if there is clear evidence of pathology that can be treated – such as an infection).

    Alan4discussion: Yes, drugs and drug abuse bring about changes, but we are talking about ‘healthy changes’ here not just ‘random changes.’ Also, physical “wiring” (i.e., changes in neurological pathways) happens as a result of psychological changes – for example, mindfulness practices increase white matter connectivity (as measured by diffusion tensor imaging) after only a few hours of training [see for example the following reference: “Mechanisms of white matter change induced by meditation training”. Frontiers in Psychology, 5 (2012): 297–302].

    phil rimmer: If a child is beaten and abused – it doesn’t mean that they need to be given a drug to cure it. I know many who have fully recovered though practices like mindfulness – when practicing mindfulness meditation, one can gradually train oneself to become aware of how stressful thoughts come and go, and train oneself to not ruminate on them (see for example the reference: Querstret, D., & Cropley, M. (2013). Assessing treatments used to reduce rumination and/or worry: A systematic review. Clinical Psychology Review, 33, 996–1009) – that itself makes those thoughts less powerful. Additionally, psychological stresses are known to bring about unfavorable changes in genetic expression [see for example the reference: Nestler, E. J. (2012), Epigenetics: Stress makes its molecular mark, Nature,171, 171–172]. On the other hand, mindfulness practices are known to bring about favorable changes in genetic expression. The following study showed that mindfulness practices bring about changes in objectively measurable biomarkers: Hoge, E. et al. (2017), The effect of mindfulness meditation training on biological acute stress responses in generalized anxiety disorder. Psychiatry Research.
    Yes, drugs are useful only for cases of extreme distress and danger.
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  • Dayane #5
    Mar 2, 2018 at 3:34 pm

    Alan4discussion: Yes, drugs and drug abuse bring about changes, but we are talking about ‘healthy changes’ here not just ‘random changes.’

    Surely the point of prescribed medicines, is that studies have been carried out to make outcomes measurable and to some extent predictable, as confirmed by tests. There is no reason to believe that malfunctions will simply self-correct despite the body’s considerable capacity for healing.
    Medicines can certainly suppress harmful distracting abnormal reactions which may otherwise dominate in the brain or cause malfunctions of the endocrine system.

    Also, physical “wiring” (i.e., changes in neurological pathways) happens as a result of psychological changes – for example, mindfulness practices increase white matter connectivity

    Physical brain-wiring develops because of many causes – including mental exercises, habits of thought, academic specialisms, and physical activities: – not to mention natural stages of development during gestation, childhood, adolescence, and early adulthood.
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  • @OP link – The ideal drugs for treating schizophrenia are postulated to selectively block the D2 dopamine receptor with optimum binding kinetics.

    This is effectively saying that the drugs selectively block the receptors which otherwise allow the operation of malfunctioning brain circuitry.

    The crucial issue is is to target the appropriate receptors accurately – which is where improvements are being suggested.

    For those wishing to understand the basic mechanisms of neurotransmitters here is a link with diagrams.

    http://faculty.washington.edu/chudler/synapse.html
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  • If a child is beaten and abused – it doesn’t mean that they need to be given a drug to cure it.

    My illustration was to show the limits of plasticity due to timing of the neural insult. The catastrophic outcomes of many of the Romanian Orphans (subject to prolonged high level stress when very young) remained substantially un-remediated. Talking therapies and CBT strategies to divert attention additionally help. But all this stuff is modest. Close experience with Risperidone has shown me that it can be a life saving drug for schizophrenia. But better, narrower acting drugs are always needed.
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  • Dayane

    it is our experiences that bring about changes in brain chemicals and also result structural changes in the brain.

    Mice under stress, person loses job, taxi driver, and juggler – all of the examples that you presented in your comment 1 above would be examples of individuals who are good candidates for mindfulness to improve their mental health. (Not sure how the mouse will fare…) but can you honestly say that it is our experiences that cause the major mental health disorders such as schizophrenia, bipolar disorder, dissociative disorders, ADD, Tourettes, OCD, psychopathy, etc.? Every one of these very serious conditions can be ameliorated at least somewhat with the use of medications. Actually I’m not sure about the psychopaths. Many of those conditions have a direct genetic cause and often run in families. This has nothing to do with “experience”.

    I wonder, Dayane, have you ever spent time with anyone who suffers from the conditions listed above? These people live lives of distress and torment and the suffering isn’t limited to the individual but has an extremely stressful effect on their families. What we have here is an ethical issue that I would like you to consider; If there is suffering (a type of harm) and there is a pill that can soften or eliminate that suffering/harm then is it ok to deny the individual (and the family) the relief that can be delivered by taking that pill?

    A basic principle of ethics says that if there is harm and we see that there is harm, then we are ethically obligated to help as long as the consequences to ourself is not too onerous.

    These harms (suffering) that people who have these conditions endure are so substantial that the very thought of telling them that they will not be offered pills but instead must practice mindfulness techniques seems to me to be the height of cruelty and absolutely unethical.
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  • So, introducing chemicals to it following someone’s idea of “treating” mental problems would only mess up the natural biochemical pathways, adversely affecting the functioning of the brain in the long-term.

    Dayne, I have had nightmares since I can remember. Sleepwalking, yelling in my sleep, night terrors.
    For about fifteen years, I was sweating so bad I had to take showers every few hours in the middle of the night.
    Saw lots of doctors.
    About ten years ago I was prescribed a common blood pressure med, Prososan.
    I now sleep a full nights sleep, on schedule. My heart took a beating however. For years I didn’t sleep more than three or four hours and it was debatable whether any rest took place.
    Some people need it and some don’t. In cases like mine, it was earthshaking. For the first time in years, I was able to sleep.
    It has been shown in studies, people who suffer from migraines are more likely to commit suicide. No proof of cause and effect but it doesn’t seem unlikely.
    So this is a hidden and long term danger that sometimes cannot be diagnosed quickly.
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  • These harms (suffering) that people who have these conditions endure are so substantial that the very thought of telling them that they will not be offered pills but instead must practice mindfulness techniques seems to me to be the height of cruelty and absolutely unethical.

    Laurie. We have seen enough studies to know what happens to a person health when they are exposed to noise for an extended time. (I was married once) Enough stress and the body shuts down eventually.
    Mental stress is no different. It takes a toll on the health.
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  • alf

    People who have a paranoia about medications or who take it upon themselves to criticize others for taking medications or giving them to their children display a sanctimony built on ignorance. If I only had a dime for every time someone has launched into the tired old topic that starts out with – “Can you believe all these parents just turning their kids into ritalin zombies? Just because they can’t deal with bad behavior! So they just drug them!” I get this a lot because the minute I disclose that I’m a psych major they must assume I’m one of those -turn them into zombies advocates.

    My responses include: Have you ever talked to a kid with ADD? Talked to their parents about what the family is going through? Watched a kid with attention deficit try to work through a night’s worth of homework? Talked to that kid about peers that don’t like them? Parents of those peers who don’t want their own kid hanging around with the ADD kid? Have you had a look at the consequences of untreated ADD? High School dropping out, drug use, trouble with police, difficult relationships and loss of friends? All of this and a damn pill can make much of this go away. Who is so cruel that they want their kid to go through life suffering over these problems? Stop worrying about everyone else’s kid and worry about your own!

    Do these medication rejection advocates belong to a cult along with the anti-vaccination bunch? They base no health decisions on a rational analysis of medical research as far as I can see.
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  • Laurie. Yes. A couple of years more and I probably would have had a stroke or heart attack.
    As it is now, I have an enlarged heart from years of lack of rest and sixty hours a week.
    How important is a regular schedule? I think we are starting to get the picture.
    I can’t set parameters on who should get them and who should not. That’s too complex a problem.
    If living is affected on a day to day basis that is going to cause long term harm, yes. Why wait until the damage is both psychological and physical?
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  • “….our experiences that cause the major mental health disorders such
    as schizophrenia, bipolar disorder, dissociative disorders, ADD,
    Tourettes, OCD, psychopathy, etc.”

    Yes, it is the human experiences – however, they don’t start off as ‘major disorders.’ Once a label is assigned to these people (note that these labels are given using checklists – there are no objective tests because decades of research have not found any brain differences between normal people and so-called “people with mental illness”), these issues only get worse. This is because labels not only increase stigma, but could also lead to further progression of these conditions through nocebo effects (i.e., negative expectations leading to negative outcomes: opposite of placebo effects).
    Research has also found that ALL symptoms listed in DSM (used in the labeling process) are normally distributed in the population – that is, they happen as a continuum in the population [reference: Understanding Psychosis and Schizophrenia (2017) by the British Psychological Society Division of Clinical Psychology]. It is just that as a result of specific life experiences, some people sometimes have extreme readings in some of the symptoms – these are the people who get labeled and are told that these are “brain disorder” – as a result these people only get worse.
    (I plan to read the other comments here some other time – shall reply later – in a hurry.)
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  • Dayane

    I read through the material on the link that you posted in comment 14. I’ve never seen such a whitewash of what are some very serious mental illnesses. Quite slick I must say. I’m sure there are plenty of people who under the effects of wishful thinking, are taken in by it. I certainly understand that medication-phobes who have never been in the presence of individuals afflicted by schizophrenia, bipolar disorder, and other conditions of serious nature, would like to believe statements such as, “Hearing voices or feeling paranoid are common experiences…” and “There is no clear dividing line between psychosis and other thoughts, feelings and beliefs” What?! Believe me Dayane, there is a very obvious difference!

    Hearing voices or feeling paranoid are common experiences which can often be a reaction to trauma, abuse or deprivation. Calling them symptoms of mental illness, psychosis or schizophrenia is only one way of thinking about them, with advantages and disadvantages.

    There is no clear dividing line between ‘psychosis’ and other thoughts, feelings and beliefs: psychosis can be understood and treated in the same way as other psychological problems such as anxiety or shyness. Significant progress has been made over the last twenty years both in understanding the psychology of these experiences and in finding ways to help.

    Anxiety and shyness are in no way similar to a full blown psychosis. People who suffer from moderate to severe anxiety benefit from medication in combination with therapy that delivers strategies for effective treatment.

    Some people find it useful to think of themselves as having an illness. Others prefer to think of their problems as, for example, an aspect of their personality which sometimes gets them into trouble but which they would not want to be without.

    There is an element of truth to this statement but much has been left out that is important. Individuals who have Tourettes, ADD and Bipolar disorder DO report that they would like to have some time to themselves off their medications but they do recognize their own dysfunction when off those meds. Some time off meds isn’t always a bad thing for those who want to engage in talents that they feel are blunted when under the effect of their meds. This needs to be managed and I don’t think it’s for everyone. Some people should never go off their meds. The consequences can be disastrous and far reaching. They aren’t the only ones who suffer. Families suffer too when one of their own goes off the rails.

    In some cultures, experiences such as hearing voices are highly valued.

    Mostly these are traditional cultures that believe their shaman is in touch with the Gods. Then again, just watch the televangelists in their American megachurches doing the same thing in front of their gullible deluded congregations. Hearing voices in dominant cultures of the West is a harbinger of a court order for observation in the local psych ward.

    Each individual’s experiences are unique – no one person’s problems, or ways of coping with them, are exactly the same as anyone else’s.

    Meaningless sentence.

    For many people the experiences are short-lived. Even people who continue to have them nevertheless often lead happy and successful lives.

    And…for many people the experiences (of psychosis) last for their whole lives with no escape.

    It is a myth that people who have these experiences are likely to be violent.

    Here is a link to a Scientific American article that discusses the relationship between mental illness and violence:

    https://www.scientificamerican.com/article/deranged-and-dangerous/

    Psychological therapies – talking treatments such as Cognitive Behaviour Therapy (CBT) – are very helpful for many people. In the UK, the National Institute for Health and Care Excellence recommends that everyone with a diagnosis of psychosis or schizophrenia should be offered talking therapy. However most people are currently unable to access it and we regard this situation as scandalous.

    Ok, it’s not scandalous. Freud would be the first to say that not everyone is suitable for talk therapy. An ability to engage in introspection is an obvious requirement! People who are psychotic are by definition -detached from reality. Not much introspection going on in those minds. The only way I can see that we could get reasonable talk therapy with these patients is to first deliver an antipsychotic medication and when we have the best results we can from that, then try the talking. Again, anyone who has interacted with a person in full blown psychotic break would know that it’s hopeless to reason with them.

    More generally, it is vital that services offer people the chance to talk in detail about their experiences and to make sense of what has happened to them. Surprisingly few currently do.

    Again – Because they can’t!

    Professionals should not insist that people accept any one particular framework of understanding, for example that their experiences are symptoms of an illness.

    Many people find that ‘antipsychotic’ medication helps to make the experiences less frequent, intense or distressing. However, there is no evidence that it corrects an underlying biological abnormality. Recent evidence also suggests that it carries significant risks, particularly if taken long term.

    There are unfortunate side effects for long term use of some of these medications. There are very dire risks for not taking meds too – Someone forgot to mention that.

    The British Psychological Society believes that services need to change radically, and that we need to invest in prevention by taking measures to reduce abuse, deprivation and inequality.

    I’m all for reducing abuse, deprivation and inequality but what would really make me feel better is if I didn’t have that 50% genetic relationship with my bipolar mom.
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  • Getting people to be more tolerant of their condition (I’m thinking of schizophrenia here), to develop more insight into their own unexpected cognitions and behaviours can be useful. It can alter the dosage level needed. Reducing the dosage can reduce the side effects, like weight gain and libido loss. It can allow more of the schizophrenic cognitive advantage that you might enjoy, often enhanced creativity. It can also make it easier for you to spot a downturn when you are med free and newly in need of them again. There is a huge problem of getting schizophrenics, relapsing into a deep episode, to take their anti-psychotics.

    Promoting ideas like this

    introducing chemicals to it following someone’s idea of “treating” mental problems would only mess up the natural biochemical pathways, adversely affecting the functioning of the brain in the long-term.

    especially with the false concept of a natural system correcting to a norm (for which there is no map) makes schizophrenics naturally rebel against taking their meds. I have/had three friends with serious schizophrenic problems. Two I count as the most interesting people I know and treasure their friendships, the other, untreated I lost sight of.

    One, tumbling for the third time into psychosis, refused to take his meds. An idiot (religious) doctor (GP) was persuaded that his problems were spiritual and wrote that as a diagnosis. My friend, delighted by his thrilling world where God spoke to nurses through sunlight explaining how they knew so much and flowers blooming though the soil in its pot was bone dry, (he had forgotten how succulents work), declined to take his meds unless it said “for spiritual complaints” on the side.

    Earlier episodes had their dangerous aspects and this occasion had kids out of the house and at one point out of the country.

    This love of the wild exciting creative condition/person and the passionate self defense of it when regained, is exactly captured in a story line of Homeland (season 4 if I recall correctly). It exactly mirrored my experience of events.

    It is hugely important, whilst not badly affected to get the idea across that this pill is the safety net, and this thrill may get quite out of your control with little enough warning.

    The safest mode in this instance was to always be taking antipsychotics at very low dosage levels, so habit and acceptance are retained, with an SSRI to lift the anxiety threshold. He now, is able to regulate his own dosage (in agreement with his doctor) to match his own cognitive needs (more creative, more stable) or respond the effects of stress and other health issues which can trigger “the glow”..

    There is a whole spectrum of schizophrenic experiences to be had. Hearing voices can be very common. Expecting to be called, it is very usual to falsely hear the call, and as Richard Gregory proposed, false experience is common because because all cognitions persist with your expectation for the cognition for as long as possible before the real data can re-establish the objective facts of the case.

    Knowing that, when hearing voices, these are just some of sub-conscious thoughts, falsely judged salient and worthy of conscious testing, can help you live with the condition. Indeed they may become a source of introspection denied others. Important though is that their appearance is stable and the correlates of any variability are understood. It is also important to know that you have an anti-psychotic safety net, even try it out, and decide when, how upset you need to be to use it
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  • alf1200 #11
    Mar 2, 2018 at 8:00 pm

    Laurie. We have seen enough studies to know what happens to a person health when they are exposed to noise for an extended time.

    We know that these anti-psychotics can give relief from the constant torment, sleeplessness, and distracting destruction of concentration, from internally generated “voices or noises, in the head”.

    Of course there are those, who wish to focus ON their voices in their heads, and claim that these provide “divine wisdom” which is of a superior nature to objective information.
    Some also have followers who proclaim such voices qualify them as “divine leaders” with supernatural “knowledge”.

    https://www.richarddawkins.net/2018/02/omarosa-on-mike-pence-he-thinks-jesus-tells-him-to-say-things/

    ( otherwise known as, “communications from a god delusion”!)
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  • Chatting to my daughter on this she points out the growing problem of Pill Shaming here and in the US that is spuriously putting people of seeking and accepting the most appropriate treatments for serious conditions. At the other end of the scale in the UK is the under-supervised use of SSRIs.
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  • LaurieB:

    “I’ve never seen such a whitewash of what are some very serious mental
    illnesses.”

    You say that because you are so ‘brainwashed’ into thinking that way about these conditions.

    “they do recognize their own dysfunction when off those meds.”

    This is due to withdrawal effects. This type of reasoning is also called ‘circular reasoning.’ I should be able to find a good reference article regarding this.

    “Some people should never go off their meds”

    This is what the pharmaceutical companies want people to “believe” – then they can make more money off the medicines by keeping them on the meds for life.

    By the way, you mention “detached from reality” as if you have figured out what reality is!

    Psychological treatments are not merely about clients talking about their problems – one can take steps to address them. This can be done in various ways including ways a client hadn’t thought about on their own. Also, numerous studies have shown that rumination, worry, etc., activate the default mode system of the brain and lead to various psychiatric problems. Mindfulness practices considerably reduce rumination, worry, etc., and also result in measurable changes in the structure and function of the brain in positive ways (such as increases in gray matter and cortical thickness, brain connectivity, etc).

    Also there is one BIG unanswered question: When decades of research have failed to find any structural or other brain differences between patients with ‘mental conditions’ and healthy individuals, how can one argue for administering medicines? It is the pharmaceutical companies that come up with various medicines using a hit-or-miss approach – after that, they use authentic sounding complicated neuro-jargon to justify how these pills work. So, innocent patients are deceived into thinking that they have some ‘problem in their brains,’ needing medicines.

    Additionally, medicines appear to work for some people (those who can tolerate their terrible side effects), only because of the “placebo effect.” Lots of studies have shown this. The recent study published in Lancet that states these ‘drugs do work’ have forgotten the fact that almost all of the existing drug trials (that they have reviewed) have been funded by large pharmaceutical companies. These trials are known to engage in a great deal of selective reporting, medical ghostwriting, data mischaracterisation and academic malfeasance. Some of the biases in these studies are exposed in the following article: Lancee, M., et al. (2017), Outcome reporting bias in randomized-controlled trials investigating antipsychotic drugs, Translational Psychiatry, 7, e1232.

    I hope you will see through your deep-rooted conditioning and reflect on the evidence rather than your gut reactions…
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  • phil rimmer: I think all the points I wrote to LaurieB above are relevant to your comment – especially the point: When decades of research have failed to find any structural or other brain differences between patients with ‘mental issues’ and healthy individuals, how can one argue for administering medicines?

    Also, in various organs of our body (such as the heart, liver, spleen, etc.), it is extremely rare that various problems spring up due to biological/physiological abnormalities that happen to suddenly arise from nowhere. But as soon as people display “mental illness,” a biological/physiological problem in the organ brain is presumed to cause it! Psychiatrists completely ignore neuroplasticity/epigenetics – i.e., how the activity of the mind (human experiences) brings about structural changes in the brain.
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  • Psychiatrists completely ignore neuroplasticity/epigenetics – i.e., how the activity of the mind (human experiences) brings about structural changes in the brain.

    Umm, No. They are well aware of the chemical changes that occurs when stress is high.

    Also, in various organs of our body (such as the heart, liver, spleen, etc.), it is extremely rare that various problems spring up due to biological/physiological abnormalities that happen to suddenly arise from nowhere.

    Wow. I can’t agree with that one either. Bad heart valve? Common. Cancer of the liver? Common.
    Heart defects in newborns? Every day of the week. Every minute one is born.
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  • When decades of research have failed to find any structural or other brain differences between patients with ‘mental issues’ and healthy individuals, how can one argue for administering medicines?

    Is this true for serial killers too?
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  • When decades of research have failed to find any structural or other brain differences between patients with ‘mental issues’ and healthy individuals, how can one argue for administering medicines?

    Can’t you argue for them on the basis of a measurable reduction of symptoms?

    Anyway, I don’t know much about it. I just thought the above claim was remarkable. So I did a little digging. I think it may be stretching things a bit. Some differences have definitely been found. But some of what I found suggested that it hasn’t been easy to find the differences, and exactly what is different hasn’t been teased out yet.

    Have you seen research like this? Widespread white matter microstructural differences in schizophrenia across 4322 individuals: results from the ENIGMA Schizophrenia DTI Working Group

    What do you think of it?
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  • Sean, there are well documented studies on serial killers that show a remarkable difference in brain activity
    when in an MRI. This is however somewhat misleading.
    It doesn’t show causation or effect.
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  • Dayane, #20

    When decades of research have failed to find any structural or other brain differences between patients with ‘mental issues’ and healthy individuals, how can one argue for administering medicines?

    As it stands this has no logical basis with regard to prescribing medicines. It is also false in its claim of apparent neural consistency.

    it is extremely rare that various problems spring up due to biological/physiological abnormalities that happen to suddenly arise from nowhere.

    This makes little sense to me, both as a statement and as a model for unwanted brain behaviours. The powerful brain forming period of brain pruning between 0 and 10 years (super intense from 1.5 to 5) creates almost forever-more-wiring that is indistinct in its robustness as most pre and perinatal wiring. The work of Dr Victoria Horner has shown human infants have evolved to believe what it is taught (skills, semantic knowledge) against the evidence of its own eyes and reason. This happens because of excellent copying devices (mirror neurons), grown numerous most probably to create a safety net for a spectacularly premature and incompetent ape infant. Humans are born with only 28% of its adult brain mass, because of the pelvic girdle bottleneck. (Chimps have 50% at birth.) We to a unique degree have our brains mostly formed whilst in a flux of cultural data. Much of the brain material developed in the first two years in the associative corteces is wired chaotically and is pruned into usefulness, especially in how we cognise.

    If we don’t have appropriate experiences our brains will never grow certain skills. A strabismus, uncorrected for twenty years will mean the subject will never be able to experience 3D vision. In hunting animals the visual cortex lays down strips of inferencing neurons, alternating left, right, left right, like, tiger stripes. These form when fed two data streams with small left right offsets. Too large offsets compromise primary coherent cognitions (what the hell is it) and the lesser depth discerning skill is sacrificed and one eye becomes strongly dominant. The stripes don’t form and relative motion skills develop in their place. All experience is brain structure forming, macrostructures early on, finessing later. No amount of talking or drug use will restore early deficits. Nor will it with the chronically abused Romanian orphans. It is expected that they will exhibit much increased connection (white matter) between amygdala and hypothalamus. The hypothalamus provides various tagging to memories for categorisation and retrieval. The amygdala identifies threats or unknown entities. The expectation is that memories in the abused those with PTSD are tagging memories more negatively…remember bad shit happens. For the early abused with such a legacy of negativity a whole life’s worth of defensive brain structuring, little ameliorates it except anxiety reduction drugs. For later PTSD victims talking therapies, CBT and distraction techniques using good memories work pretty well preventing the building of more memories of bad memories etc.

    Now schizophrenia may have arisen in this naked ape alone because of a recent evolutionary change in the GABA transport mechanisms in the prefrontal cortex our general purpose inferencing machine. This appears to have happened 2.5mya. Like many other propensities associated with mental illness it appears to work advantageously creating tribes of differently cognitively capable people. Creative, problem solving, people often have schizotypal members in their family history. Scientists with systemising brains may often display mild austistic spectrum behaviours. These individual genetic heritages seem to settle at stable levels of manifestation, like psychopaths, making good leaders, you don’t want societies of just scientists or just artists etc. As a genetic propensity operating at ten percent of the population this can work well for everyone…But for the ten percent who get a single dose of the creative disposition or the systemising one, there is one percent who get the double dose and potential misery ensues. This one percent cost appears to evolution to be bearable. Now, no single gene does all the work. Many many genes are involved in this making discovery really difficult and smearing the effects into a pretty smooth spectrum, albeit one with a nasty if narrow peak. The point is great minds known for this or that capacity sit on the mid slopes of these spectra. Tolerant and empathetic societies support such minds further up the slope, but at some point… these folk become a misery and danger to themselves and others or simply incapacitated. There is no normal, certainly no plan for our brain, only the current average. Cultivating our brain diversity is the secret of our success.

    I’ll stop now, but I simply don’t understand your claims in the light of current research. There are not enough written accounts for the general public, unfortunately, but I’m hoping to study neuro-constructivism the year after next which seeks a comprehensive account for neural structure formation from, genetic, epigenetic, cultural and biographical pressures.
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  • Dayane #20
    Mar 4, 2018 at 9:20 pm

    When decades of research have failed to find any structural or other brain differences between patients with ‘mental issues’ and healthy individuals, how can one argue for administering medicines?

    Repeatedly asserting this, does not make it so!

    But as soon as people display “mental illness,” a biological/physiological problem in the organ brain is presumed to cause it!

    This is nonsense!

    All mental brain functions are “biological”!
    The brain works on electro-biochemistry as my link @#7 clearly explains in simple terms.
    The issue is: “what particular (sensory, hormonal or chemical) inputs or malfunctions are causing abnormalities in mental processes?”

    Problems with the endocrine system are often identified and treated, as are the longer term problems cause by abuse with illegal drug use and physical damage.

    Psychiatrists completely ignore neuroplasticity/epigenetics – i.e., how the activity of the mind (human experiences) brings about structural changes in the brain.

    Again, – asserting this does not make it so!
    Neuroplasticity covers a much wider scope than this!

    The development of the brain throughout gestation, childhood, and on into later life, is also “biological” and is “epigenetic” development triggered by hormones interacting with hox genes!

    PNAS 2007 June – In mammals, including humans, female fetuses that are exposed to testosterone from adjacent male fetuses in utero can have masculinized anatomy and behavior.

    It is studied in detail by embryologists and neuroscientists, with various forms of scan increasingly used!

    There is also plenty of research where structural changes are identifiable in patients with mental issues – as with Alzheimer’s, strokes, brain-tumors, and boxers or accident victims, with brain damage.

    https://medlineplus.gov/magazine/issues/spring13/articles/spring13pg2-3.html

    The brain is more complex than any computer ever built, its computational energy and power just enormous. We are in the early stages of understanding—of mapping—what the different areas of the brain do and how they work together to enable complex functions, such as speaking or moving your fingers. Often, when one part of the brain dies, another part takes over its function. This is called neuroplasticity.
    In brain mapping, we are trying to understand how that plasticity happens. That’s the key to recovery.

    The system of using medications to block malfunctioning circuits, is based on the plasticity of the brain developing desirable alternative systems.
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  • Dayane #19
    Mar 4, 2018 at 9:16 pm

    So, innocent patients are deceived into thinking that they have some ‘problem in their brains,’ needing medicines.

    Well actually, some of them DO have problems with their brains, which give them some very unpleasant or dangerous symptoms which need treatment!

    Additionally, medicines appear to work for some people (those who can tolerate their terrible side effects),

    Which is why there is careful monitoring by medical staff, and medications or dosages are changed, if positive results are not produced, or unpleasant side effects arise.

    BTW: I would not describe some side-effects such as sleeping more, as “terrible”!

    only because of the “placebo effect.” Lots of studies have shown this.

    Err no! There are plenty of cases where significant improvements have been observed as a direct result of treatment with medications.

    The recent study published in Lancet that states these ‘drugs do work’ have forgotten the fact that almost all of the existing drug trials (that they have reviewed) have been funded by large pharmaceutical companies.

    While funding by big-phama may cause suspicions, there is no basis for dismissing research in peer-reviewed publications, simply because of it being sponsored by drug companies. – Especially when patients benefiting from medications or deteriorating when failing to take their doses, can be observed in the community.

    Only a few patients suffer side effects, and there are very clear details of these and the precautions and actions required if they are encountered.
    The level of detail indicates that these matters have been VERY thoroughly researched!

    https://patient.info/medicine/risperidone-risperdal
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  • Sean, #24

    Exceptionally interesting material.

    One critical point about research like this is just how expensive and difficult it is. Humans are not lab rats and cannot be culled for microscopic analysis (something about ethics, and the paperwork is horrendous…). Nor have we had until very recently the tools to resolve in sufficient detail live functioning brains. We have only just got tools (7Tesla fMRI scanners) that can resolve down to a millimetre sized voxel which would typically contain 80,000 neurons.

    Much of the earlier understanding of brains was based on hypotheses unsupported by evidence. The details supporting some of these hypotheses are only just coming to light. Much new also.

    Every brain state is physical from either as hard wiring to a more ephemeral, recent synaptic potentiation that may or may not become wiring. There is every chance we can be talked out of potentiation. We will not be talked out of wiring. Mitigations of the effects of wirings are drug softening of symptoms, neural pacemakers drowning out mistakes or filling in signalling deficits, and the slow addition through years of training of overlaid compensatory mechanisms.

    This latter is what brain evolution does. The amygdala was a simple minded fish/ reptile attempt at identifying the appropriate alternate strategies wired into the cerebellum, depending on friend, foe, don’t know. To develop a more social and cooperative response, we couldn’t un evolve such a safety feature without devastating risk. We had to overlay a clever inferential modeling system that contained a vetoing mechanism. Thumping the mother in law, on further consideration, for all its immediate merits will prove a bad idea.
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  • Wow. Brainwashed? That’s a first, but I must say, refreshing! Usually it’s accusations of being so skeptical of everything to the point of trust issues and excessive doubting to the point of character flaw. But brainwashed? That’s a new one!
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  • Laurie,

    Conspiracy theorists

    This is what the pharmaceutical companies want people to “believe” – then they can make more money off the medicines by keeping them on the meds for life.

    have such faith in the “revealed” power of a potential motive, they pretty much brainwash themselves.

    I am disappointed by this clumsy debate. I had hoped for more nuanced discussion on what goes right in treatments and is needful (e.g. with psychoses) and what goes wrong with undersupervised and ill considered prescribing of SSRIs (too often for unhappiness taken to be depression).

    q.

    Mother-in-Law jokes… I’m expecting to be shot down over that.

    Quite a meta concern. Perhaps I needed to think twice before posting…
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  • Dayane #20
    Mar 4, 2018 at 9:20 pm

    Also, in various organs of our body (such as the heart, liver, spleen, etc.), it is extremely rare that various problems spring up due to biological/physiological abnormalities that happen to suddenly arise from nowhere.

    While malfunctions or organ failures usually build over time, except in the case of physical accidents or serious infections, SYMPTOMS suddenly arising when the condition tips beyond some point of balance and the patient becomes aware of them – are quite common.

    Cancer cells for example, do “suddenly arise” following a mutation in a cell.
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  • Dayane,

    I’m going to utilize clear, direct communication with you now because I don’t want you to duck out of this conversation by using the excuse that I’m just brainwashed and can’t see the forest for the trees because I didn’t embrace your position on this right from the start.

    I want you to go out into real life and talk to people who are suffering from major psychological conditions and run this medication issue by them. Also ask their family members about how they’ve been affected by their mentally ill loved one and everything they’ve sacrificed and been through for the sake of that mentally ill person in their lives. How do they feel about the patient going off their meds and substituting mindfulness? Don’t say you can’t find anyone to ask this of – these families are all around you. If the thought of this task is already producing resistance in your mind – if you’re already composing your rebuttal to me with a hundred reasons on why you can’t/won’t do this simple research, then we need to rethink who’s the brainwashed person in this scenario that we find ourselves in.

    I see that you are very committed to your current position and you might think that I am in the position of a shill for big pharma but I am asking you to reconsider this assumption. I have no doubt that we could at least come close to agreement on this problem but no agreement ever happened when two people lose the middle ground and move out to the extremes, digging in their heels there.

    Dayane, I’m not a shrink but I do have a B.S. in experimental psych and some years in dealing with people who have serious mental illness and some who have neuroses and some with the basic trials and tribulations that are part of normal life. Do you think that I advocate drugging everyone up? No psych major worth their salt would think that!

    My view on drug therapy in the mental health field is that psychotics (detachment from reality, and let’s not get into a what is reality debate here, we are not in the fucking matrix.) need to be medicated with the drugs that achieve the best result at the correct dosage – not too much and not too little. This is extremely important! People’s lives are at stake here and our ethical responsibility to them is huge.

    Along with drug therapy, as soon as it is possible, behavioral therapy and talk therapy and yes, your favorite mindfulness techniques can be implemented and adjusted for efficacy just like the medications.

    I feel like this is a standard approach in the field. It’s an eclectic approach that can be tailor fit for individual needs.

    Now, are you going to remain out on your extreme or do you have the guts to pop your comfortable bubble and look deeper into the mental health field? I’m leaving this door open for you.

    Your turn.

    🙂
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  • alf1200:

    “They are well aware of the chemical changes that occurs when stress is
    high.”

    Yes, they seem to know, but still push for drugs – they just can’t get over their old conditioning.

    “Bad heart valve? Common. Cancer of the liver? Common.”

    Yes, however these conditions (cancer of the liver, heart valve, etc.) don’t happen in young people in very high numbers (percentages) compared to the currently diagnosed psychiatric problems. Also, unlike these conditions such as cancer, liver issues, etc., psychiatric problems are diagnosed merely using checklists – because there are no objective tests to diagnose these (there are no objective tests because as I said before, I will repeat: despite decades of research, scientists have not been able to find any structural or other brain differences between patients with ‘mental conditions’ and healthy individuals).

    Comment #25
    These are correlations. As I mentioned earlier, the organization of brain circuitry is constantly changing as a function of experience and learning. Additionally, studies have shown that impulsivity is associated in reductions in gray matter. Mindfulness practices (that reduce impulsivity) are known to increase gray matter.
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  • Sean_W

    “Can’t you argue for them on the basis of a measurable reduction of
    symptoms?”

    Sorry – no. Medicines appear to work for some people (those who can tolerate their terrible side effects), only because of the “placebo effect.” As I said earlier, I can provide references for this. Also, as I said earlier, these studies are funded by large pharmaceutical companies that appear to engage in a great deal of selective reporting, medical ghostwriting, data mischaracterisation and academic malfeasance – some of the biases in these studies are exposed in the following article: Lancee, M., et al. (2017), Outcome reporting bias in randomized-controlled trials investigating antipsychotic drugs, Translational Psychiatry, 7, e1232.

    Regarding the study you mention (Widespread white matter microstructural differences…) – you need to remember that psychiatric drugs change the brains of people in the long-term (I could provide evidence for this, citing references). Also, when people go through severe psychological stresses (note here that in addition to life stresses that made these people ‘mentally unwell’ in the first place, these individuals are told that they have such and such a “brain disorder” and that these are long-term conditions etc.,) all these stresses bring about structural changes in the brain. As I mentioned earlier, even animal studies have demonstrated that psychological stresses result in dendritic atrophy, etc.

    Also, if there are structural differences at the time of diagnosis of these so called “disorders,” why is it that there are no objective tests to detect these conditions?
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  • phil rimmer:
    comment #26

    “As it stands this has no logical basis with regard to prescribing
    medicines. It is also false in its claim of apparent neural
    consistency.”

    I don’t understand this comment – please explain further.

    “The powerful brain forming period of brain pruning between 0 and 10
    years (super intense from 1.5 to 5) creates…..”

    You are going off track – you are talking about what influences brain development in great length and I feel that you are doing that to evade and distract this conversation. I am talking about what is happening in psychiatry now – blaming the brain and medicating (using merely a hit-or-miss approach) in spite of there being no brain differences between normal people and people with so called “mental disorders.” Also, all what you say only further strengthen the evidence for brain plasticity.

    Regarding GABA transport mechanisms – studies have sown that acute psychological stresses bring about changes in GABA concentration – so this is the direction of causation. (see for example the reference: Hasler, Gregor et al. “Effect of Acute Psychological Stress on Prefrontal GABA Concentration Determined by Proton Magnetic Resonance Spectroscopy.The American journal of psychiatry 167.10 (2010): 1226–1231. PMC.).

    When talking about psychiatric diagnosis, we are not talking about individuals who were orphaned in childhood or individuals subjected to severe depravations. Many individuals who receive diagnostic labels these days are from good functioning families.

    “I’ll stop now, but I simply don’t understand your claims in the light
    of current research.”

    Please let me know what this “in the light of current research” means – please give actual citations where direct evidence of brain differences in “patients” that are given various psychiatric labels have at the time of diagnosis. These “patients” are given various medications with the assumption that they have brain abnormalities – but no brain abnormalities have been found.
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  • Alan4discussion – comment #27

    “Repeatedly asserting this, does not make it so!”

    That’s not a good argument – you are evading the question. Please answer the question directly.

    “All mental brain functions are “biological”!”

    I agree. However, biological organization of brain circuitry is constantly changing as a function of experience and learning.

    “what particular (sensory, hormonal or chemical) inputs or
    malfunctions are causing abnormalities in mental processes?”

    Even if you learn the processes – to reverse it, you need psychological interventions, then these “malfunctions” will change. For example, for someone, losing his/her job may create a great deal of stress and although you would interpret this as “malfunction of the brain” by looking at his brain – this “malfunction” is merely a correlate of this person’s experience at that time. When this person gets a job or his life circumstances change, then you will look at his brain and say “the malfunction is gone!” – but if you treat the brain with drugs thinking “lack of this neurotransmitter” and “too much of this other neurotransmitter” etc., the chances are this person will be mentally ill (and dependent on drugs) for life because you are more likely to mess up his brain than heal it.

    Regarding your PNAS 2007 article – no one is denying that hormones can bring about biological changes – I am talking about psychiatric drugs being given in the absence of any structural or other brain differences between patients with ‘mental conditions’ and healthy individuals and the fact that people come up with these medications using mere guess work – when you do this you are more likely to mess up someone’s brain than heal it.

    Regarding brain-tumors, accident victims, etc, – in this discussion I am NOT talking about physical conditions that have clear physical issues that can be treated. I am talking about psychiatric drugs and labels people are given – please read my comments above carefully.

    Comment #28

    “Well actually, some of them DO have problems with their brains”

    “The problems in their brains” are either caused by psychiatric drugs or severe psychological stresses as I described earlier. If they have any other physical problem (a tumour), then they can be treated with surgery, etc. We need to be careful about the ‘direction of causation.’

    “Which is why there is careful monitoring by medical staff”

    since these medicines work only due to the “placebo effect” (several studies have demonstrated this), why not give some placebos to begin with – then at least it wouldn’t result in long-term harm.

    “There are plenty of cases where significant improvements have been
    observed as a direct result of treatment with medications.”

    Please provide citations – again, I think I would have to repeat this although I know you don’t like it – these medications are given in the absence of any structural or other brain differences between patients with ‘mental conditions’ and healthy individuals and drug companies come up with these medications using mere guess work – they are more likely to mess up someone’s brain than heal it.

    “While funding by big-phama may cause suspicions, there is no basis
    for dismissing research”

    Please note that I am not dismissing without a basis – please read my comments above and also please read the following article: Lancee, M., et al. (2017), Outcome reporting bias in randomized-controlled trials investigating antipsychotic drugs, Translational Psychiatry, 7, e1232.

    Additionally, the following academic article talks about how psychiatric trainees and junior psychiatrists blindly accept the illusory underpinnings of psychiatry because they simply assume that much smarter people before them have sorted out all the details (of the theories underlying psychiatry). Here’s the reference: McLaren, N. (2016). Psychiatry as Bullshit. Ethical Human Psychology and Psychiatry, 18(1), 48-57.
    The article also says that the teachers who instruct psychiatry are not lying (i.e., are not “bad people”), but are merely repeating what they have learnt without questioning.

    Comment #33

    “Cancer cells for example, do “suddenly arise” following a mutation in
    a cell.”

    Please note that psychiatric drugs are given without any observable deficit or mutation – please read my earlier comments carefully.
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  • LaurieB:

    Comment #35: If you don’t like the word “brainwashed” I please substitute the word “deeply conditioned”…

    Comment #36: Sorry for the late reply. I have other things to attend to apart from constantly checking and answering this blog! (But you all seem to be at it 24/7! : )

    “…..talk to people who are suffering from major psychological
    conditions and run this medication issue by them….. How do they feel
    about the patient going off their meds and substituting
    mindfulness?…..”

    Unfortunately it is too late for most of them now – most of them are already damaged by the medicines and getting rid of their medicines would only result in withdrawal symptoms. So, they would not want to go off their meds.

    By the way, did you know that there has been a huge increase in prescribing of antidepressants over the last three decades and this has been accompanied by a substantial rise in the numbers of people who are in receipt of long-term disability benefits due to depression and related disorders? (Here’s the reference: Viola S and Moncrieff J. Claims for sickness and disability benefits owing to mental disorders in the UK: trends from 1995 to 2014. BJPsych Open 2016;2:18-24).

    “need to be medicated with the drugs that achieve the best result at
    the correct dosage – not too much and not too little.”

    So, you think the medicines that the drug companies come up with using guess work is going to work wonders on your patients! I consider this to be highly misguided thinking (it is much more than ‘misguided thinking’ when you consider that there are no structural or other brain differences between patients with ‘mental conditions’ and healthy individuals – not sure how many times I have to repeat this phrase!).

    Please also note that health conditions like infectious diseases, diabetes, blood pressure, etc., have well established causes (through lots and lots of research studies). For mental illnesses, what happens is, pharmaceutical companies come up with various drugs using a hit or miss approach (and these drugs do more harm than good to the brain.).

    If you really want to give psychiatric drugs, please give placebo pills – at least that won’t do the damage that the psychoactive drugs do. Meta analyses have shown that most active drugs and placebos have similar effect sizes. See the following: Howick J, et al. (2013) Are Treatments More Effective than Placebos? A Systematic Review and Meta-Analysis. PLoS ONE 8(5): e62599.
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  • Dayane, #39

    You are going off track – you are talking about what influences brain development in great length and I feel that you are doing that to evade and distract this conversation.

    I have no interest in ignoring anything. You may not have noticed that I agree with your point in specific areas but crucially not in others where I have (for some bizarre reason) a lot of personal experience. Nor is it going off track but an attempt to get you to understand the varieties and drivers for neural growth and change and its relative post hoc tractability.

    Regarding GABA transport mechanisms – studies have sown that acute psychological stresses bring about changes in GABA concentration – so this is the direction of causation.

    But stress produces all sorts of changes in all sorts of neurotransmitters. That is their job. You need to have said something like “so this is a direction of causation of X”.

    Many serious psychiatric problems like many psychoses, like autism, have strong genetic components. They run in families. Psychotic manifestations are episodic often with triggers like stress, but that is no reason whatsoever to conclude that an active schizophrenic can be substantially relieved of her distress and erroneous cognitions by talk. My two schizophrenic friends after the antipsychotics have brought them down and returned some internal stability, get talking therapy (including family) to help repair attitudes and remove some fear and better prepare to avoid triggers next time. The drugs are essential to begin that process.

    The way brains and neurons work there is no driver back to normal or even average, from an insult or unfortunate double dose genetic hit that creates wiring. There is no normal given 72% is configured in a flux of active and differented experience. Neurogenesis, apoptosis, and Hebbian learning still reconfigure brains through life, though the first falls off rapidly with age. There is no drive to reverse to a norm but only a drive to additionally configure what is there to achieve a better utility.

    I have no doubt that there are problems with over prescription of some drugs in some areas. But your blanket assertions are in my view wild and dangerous.

    Autism may not be an interest for you, but for me, a mild aspie, it is fascinating. Neurotribes by Steve Silberman is a comprehensive account of Autism. Psychiatry’s total failure to comprehend the phenomenon and and its resultant brutal and damaging treatments (talking therapies believing the cause was “refrigerator mothers” did untold damage to families) has now evolved into people (on the lower slopes of the spectrum at least) appreciating their different-ness, that they can be a power for useful change in society. Therapies to help people live with their mild symptoms in other areas like schizophrenia and educate them to look out for changes to worse, and what to do to get a safety net are wholly admirable, in my view.

    If you want to step back from your blanket assertions about drug effectiveness and topical suitability to discuss egregious issues of prescription creep, proper training for prescription, proper monitoring of patient progress, or drugs ending their profitable life (patents expiring) being replaced by “better” drugs with new patents that are really no better, then I’m your man. But note the problem is not so much the evil of drug companies (not legally obliged to be moral) but government institutional failures of care for appropriately defining requirements in the market and standards of approvability coupled to the processes of prescription and monitoring.
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  • Dayane #40
    Mar 5, 2018 at 9:32 pm

    Alan4discussion – comment #27 “Repeatedly asserting this, does not make it so!”

    That’s not a good argument –

    Indeed it is a very poor method of argument, which is why I pointed out your use of it has no merit!

    you are evading the question. Please answer the question directly.

    There is no “question” – just a repetitive assertion!

    “All mental brain functions are “biological!”

    I agree. However, biological organization of brain circuitry is constantly changing as a function of experience and learning.

    It is indeed, but you seem to ignore or deny the other factors I have listed which cause change.

    “Which is why there is careful monitoring by medical staff”

    since these medicines work only due to the “placebo effect” (several studies have demonstrated this), why not give some placebos to begin with –

    There may be instances of placebo effects being involved, but it simply an unsupported assertion, that “these medicines work only due to the “placebo effect”! Studies in reputable scientific and medical publications have confirmed that some treatments work. Anecdotally the fact that medical staff change prescriptions and some medications work for some patients when others don’t, would indicate that those medications are effective over the long term.

    then at least it wouldn’t result in long-term harm.

    All powerful medications, can have side effects, but monitoring can stop or reduce their use in affected patients.

    For example, for someone, losing his/her job may create a great deal of stress and although you would interpret this as “malfunction of the brain” by looking at his brain – this “malfunction” is merely a correlate of this person’s experience at that time.

    Of course it is! – and of course changing the circumstances to reduce the stress will bring improvement.

    When this person gets a job or his life circumstances change, then you will look at his brain and say “the malfunction is gone!” –

    That is not what the evidence shows. Post-traunatic stress is real and enduring – as treatment of military veterans shows!

    but if you treat the brain with drugs thinking “lack of this neurotransmitter” and “too much of this other neurotransmitter” etc.,

    That is not how synapses work! It is rogue or stress related neurotransmitters ( as with recreational drugs) REPLACING or blocking the normal ones, and establishing abnormal wiring, which is one of the problems.

    the chances are this person will be mentally ill (and dependent on drugs) for life because you are more likely to mess up his brain than heal it.

    This is just fanciful conspiracy theory, which projects the cause of the problem on to the treatment to mitigate it!

    Regarding your PNAS 2007 article – no one is denying that hormones can bring about biological changes

    Hormones can cause substitution of neurotransmitters or rogue links causing malfunctions, as can various other factors such as pollution and stress.

    these medications are given in the absence of any structural or other brain differences between patients with ‘mental conditions’ and healthy individuals

    As even modern scanning techniques do not get down to cellular level, HOW HAVE YOU OBTAINED THIS INFORMATION? – or has it just been made up? What can be asserted without evidence can be dismissed without evidence!

    #27 “Repeatedly asserting this, does not make it so!”

    or other brain differences

    Clearly blood tests used for diagnosis and monitoring, DO provide information on “other differences”!

    Additionally, the following academic article talks about how psychiatric trainees and junior psychiatrists blindly accept the illusory underpinnings of psychiatry because they simply assume that much smarter people before them have sorted out all the details

    There are indeed throughout medicine generally, examples of junior staff simply following instructions or directions without a detailed understanding of the more complex issues. This is the nature of the complexities involved.
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  • Dayane,

    Though written in response to Sean I hoped you might read #29 also. There is a horrible muddle in what you post to Sean in #38.

    Regarding the study you mention (Widespread white matter microstructural differences…) – you need to remember that psychiatric drugs change the brains of people in the long-term (I could provide evidence for this, citing references).

    No need for me. Continual baths of cortisol change brains and most particularly in the young as discussed. Given the new context the brain is in (a caring environment) its permanent wiring for a terrifying one might well be considered damaged.

    Also, when people go through severe psychological stresses (note here that in addition to life stresses that made these people ‘mentally unwell’ in the first place, these individuals are told that they have such and such a “brain disorder” and that these are long-term conditions etc.,) all these stresses bring about structural changes in the brain.

    For Romanian orphans this was true. Their brains are irretrievably wired to cope with a miserable world. Amygdalas are over wired to the hippocampus generating negative memories and triggering eternally defensive behaviours.

    As I mentioned earlier, even animal studies have demonstrated that psychological stresses result in dendritic atrophy, etc.

    Of course they do. Cortisol is, for instance, a powerful drug when not used in its daily set-you-up-for-the-day mode. Along with accentuating the negative with white matter (wiring!) as mentioned above it eliminates the positive if not directly then by Hebbian un-learning. Wiring unused loses synaptic coupling. With more negative memories those with positive associations will increasingly fade and die.

    Now here’s the point stress or inappropriate and excessive cortisol, whilst an underlying cause for Depression, PTSD and even a contributor to Psychopathy, is in no way a primary cause of Schizophrenia. Many factors including genetic heritage and misuse of recreational drugs are required for that. Stress is but one possible trigger to the onset of the condition. Viral infections even may trigger it.

    To make your case you have to join things up much more than you do. Folk who know some psychology, have degrees in it, experience with sufferers, or who know a fair bit about neuro-psychology are not convinced by noting that “stress” mentioned over here in this study has any causal relation to “stress” over there in that paper. More to the point the blanket assertion that all psychiatric things must be like thus or so simply because of these correlations of terms is nonsense on stilts.

    Pill shaming is dangerous. I am seriously thankful my friend in the depths of mania didn’t read you and only had the nonsense spiritual diagnosis to fend of the Risperidone. Having to stage an intervention (I was a lead in one involving nearly twenty people) is horrible and public often, greatly hampering the restoration of dignity later. But much worse, pill shaming undermines evidenced criticism of the system, diagnosis creep, under-supervision. Just like anti-vaxxers undermine the call for better drug trial reporting. (Another area we agree on.)
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  • phil rimmer #44
    Mar 6, 2018 at 7:56 am

    Pill shaming is dangerous.

    Indeed so!
    Stopping medication for no good reason, can have dire consequences – as can using under-qualified staff or understaffed wards, without adequate supervision!

    http://www.bbc.co.uk/news/uk-england-leeds-43303343

    Two men died after being attacked on a hospital ward by a fellow patient with paranoid schizophrenia whose drugs had been stopped, it has emerged.

    A report, leaked to the Health Service Journal (HSJ), found nurses on the ward had little mental health care training.

    Mr Bosomworth, who had previously been diagnosed with paranoid schizophrenia, was admitted to St James’s in January 2015 for cancer treatment and was receiving acute care on ward J19.

    The attacks happened on the morning of 28 February when he woke up after being sedated because of aggressive behaviour.

    Mr Bosomworth was then sectioned under the Mental Health Act before dying of cancer four months later.

    An internal report leaked to the HSJ found his anti-psychotic medication had been stopped by staff the month before the attack, despite warnings from his family.

    The independent review, commissioned in March 2016 by Leeds Teaching Hospitals Trust (LTHT) and Leeds and York Partnership Foundation Trust (LYPFT), said staff at the hospital failed to prioritise Mr Bosomworth’s mental health.

    It detailed how ward J19, a medical diabetes ward, was repeatedly used for patients with mental illness and dementia but found nurses had “little or no formal training” in mental health care.

    The report went on to state Mr Bosomworth had been seen by mental health staff working for LYPFT but they concentrated too much on his physical condition and information about his mental state had not been shared.

    For some time now, there have of course, been various criticisms of the UK government’s failure to provide and fund appropriate numbers of beds for mental health patients!

    No mention of placebos! 🙂
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  • phil rimmer, #42 and #44

    “But stress produces all sorts of changes in all sorts of
    neurotransmitters. That is their job. You need to have
    said something
    like “so this is a direction of causation of X”.”

    Of course psychological stresses can produce all types of neural changes – I mentioned GABA because you mentioned it within your comments. So, regarding that ‘causal’ sentence – here is a fuller sentence:
    Our experiences and learning constantly bring about changes in all sorts of neurotransmitters. The direction of causation is:
    Changes in our experiences and learning → changes in the activity of neurotransmitters and structural changes in neurons.
    (Note: for examples of ‘experiences and learning,’ please see my comment #1).

    Regarding the heritability of autism – I think this issue (not only for autism but for all psychiatric disorders) is highly controversial. The following study concluded that the risk genes for mental disorders number in the hundreds, each contributes perhaps 1%-2% to the overall risk, and the same genes confer risk for multiple DSM-5 categories of disorder – see: Ross, C. A. (2013). Biology and Genetics in DSM-5. Ethical Human Psychology and Psychiatry: An International Journal of Critical Inquiry, 15(3), 195-198.
    Also there appears to be articles that criticize assessment methods used in studies (that assess genes responsible for psychiatric issues).

    Also, don’t forget ‘genetic expression’ – even if one has a gene, it may not be expressed (as I stated in point#5 earlier). Additionally, as I explained earlier, psychological treatments are not merely about clients talking about their problems (please see my comment #19).

    Interestingly, regarding autism – the use of SSRI antidepressants during pregnancy has been found to increase the risk of autism spectrum disorder by 87-percent! (reference: Boukhris T, et al. (2015) Antidepressant use during pregnancy and the risk of autism spectrum disorder in children. JAMA Pediatrics: 1-8).

    “……back to normal or even average,……”

    Please let me know what is “normal”? What is your ‘bench mark’ for normal?

    “But your blanket assertions are in my view wild and dangerous.”

    Please let me know what psychiatric drugs actually work.

    Amygdalas are over wired to the hippocampus generating negative
    memories

    Do you think that giving psychiatric drugs would change their “brain wiring”? I doubt it very much. On the other hand, according to resent research mindfulness programs appear to show promise for individuals with autism (please see:
    Ridderinkhof, A., de Bruin, E. I., Blom, R., & Bogels, S. M. (2017). Mindfulness-Based Program for Children with Autism Spectrum Disorder and Their Parents: Direct and Long-Term Improvements. Mindfulness, 1-19.

    Also, as I mentioned in comment #5 when practicing mindfulness meditation, one can gradually train oneself to become aware of how stressful thoughts come and go, and train oneself to not ruminate on them – so there is very good ‘theoretical basis’ for using mindfulness as well.
    Just like physical activity brings about changes in muscle cells, the practice of mindfulness changes the brain wiring.

    You talk about Amygdalas and hippocampus, but did you know that before improved standards of antenatal care were available, Lorber (1981) had studied hundreds of patients who displayed normal and above normal IQ’s in spite of having severely reduced brain tissue? [Reference: Lorber J. Is your brain really necessary? Nurs Mirror. 1981 Apr 30;152(18):29-30.].
    There are a few other studies like this too.
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  • Alan4discussion, #43

    “There is no “question” – just a repetitive assertion!”

    You are simply playing with words – the question I am asking is a very valid question deserving an answer. For psychiatric disorders, there has never been any replicable study demonstrating identifiable pathology (comparable to conditions like diabetes or cancer).

    “other factors I have listed which cause change”

    Of course other factors (such as hormonal or chemical factors) can change our behaviour under artificial conditions, but administering these (or variants of these) are not going to magically cure mental problems – administering drugs can change the brain in various ways but not in ways we want (random changes are of no use), considering that these drugs are either administered on a hit or miss basis (i.e., drugs that pharmaceutical companies come up as trial and error), or based on someone’s idea (theory) on how these “disorders” need to be treated. Also, coming up with various drugs has not solved the problem of mental issues at all. If we just consider antidepressants – ‘real world’ studies of people treated with antidepressant medications show that the proportion of people who stick to recommended treatment, recover and don’t relapse within a year is staggeringly low (108 out of the 3110 people) – reference:
    Pigott HE, et al (2010). Efficacy and effectiveness of antidepressants: current status of research. Psychother Psychosom, 79(5):267-79.

    “these medicines work only due to the “placebo effect”! Studies in
    reputable scientific and medical publications have confirmed that some
    treatments work.”

    Please give me some examples of studies that have “confirmed that some treatments work.”

    The following studies show that these psychiatric drugs are merely placebos:

    Barbui, C., et al. (2011). Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis. The British Journal of Psychiatry, 198(1), 11-16.

    Howick J, et al. (2013) Are Treatments More Effective than Placebos? A Systematic Review and Meta-Analysis. PLoS ONE 8(5): e62599.

    Also, the two studies below show that people show the same changes in brain scans when they respond to a placebo as they do when they take an actual drug – this is further evidence that these drugs are placebos:

    Pecina, M., et al. (2015). Association between placebo-activated neural systems and antidepressant responses: neurochemistry of placebo effects in major depression. JAMA psychiatry, 72(11), 1087-1094.

    Fava, M. (2015). Implications of a biosignature study of the placebo response in major depressive disorder. JAMA psychiatry, 72(11), 1073-1074.

    Additionally, there is evidence that psychiatrists overestimate antidepressants, underestimate placebo – see for example the reference: Laferton, J. A., et al. (2015). Psychiatrists’ Attitudes Toward Non-Pharmacologic Factors Within the Context of Antidepressant Pharmacotherapy. Academic Psychiatry, 1-7.

    All powerful medications, can have side effects, but monitoring can
    stop or reduce their use in affected patients.

    Why bother when these drugs are merely placebos? (as I have stated above).

    “Post-traumatic stress is real and enduring”

    Mindfulness techniques appear to be promising for post-traumatic stresses – there are even changes in the brain as a result of mindfulness training – below is one recent example study specifically for post-traumatic stress:

    King, A. P., et al. (2016). Altered Default Mode Network (Dmn) Resting State Functional Connectivity Following A Mindfulness‐Based Exposure Therapy For Posttraumatic Stress Disorder (Ptsd) In Combat Veterans Of Afghanistan And Iraq. Depression and anxiety, 33(4), 289-299.

    “REPLACING or blocking the normal ones, and establishing abnormal
    wiring, which is one of the problems.”

    This is how one messes up the brain! This is your interpretation of what needs to be blocked! As I mentioned earlier – the brain is an extremely complex organ with billions of neurons and trillions of synapses that connect and interact in complex ways – there is so much we do not know about this organ. So, introducing chemicals to it following someone’s idea of “treating” mental problems would only mess up the natural biochemical pathways, adversely affecting the functioning of the brain in the long-term.

    Think of someone whose muscles are affected by lack of exercise (muscle atrophy) – in such a case, what you are doing is like studying the microstructure of muscle cells so that you can add some agent (drug) to react with the microfibrils so that they can be altered in some way. But the natural way would be for that person to gradually increase their physical activity levels. This is the same with the brain – here, it is mental changes.

    “This is just fanciful conspiracy theory”

    Sorry – no. There is strong evidence to back it – please check out the following articles (I should be able to find more references).

    Ronalds C, Creed F, Stone K, Webb S, Tomenson B. Outcome of anxiety and depressive disorders in primary care. Br J Psychiatry1997 Nov;171:427-33.

    Dewa CS, Hoch JS, Lin E, Paterson M, Goering P. Pattern of antidepressant use and duration of depression-related absence from work. Br J Psychiatry 2003 Dec;183:507-13.

    Brugha TS, Bebbington PE, MacCarthy B, Sturt E, Wykes T. Antidepressants may not assist recovery in practice: a naturalistic prospective survey. Acta Psychiatr Scand 1992 Jul;86(1):5-11.

    Pigott HE, et al (2010). Efficacy and effectiveness of antidepressants: current status of research. Psychother Psychosom, 79(5):267-79.

    Also, according the following study, there is a dose-response relationship between increased psychiatric treatment and completed suicide:

    Hjorthoj, C. R., et al. (2014). Risk of suicide according to level of psychiatric treatment: a nationwide nested case–control study. Social psychiatry and psychiatric epidemiology, 49(9), 1357-1365.

    As even modern scanning techniques do not get down to cellular level

    So, you are trying to treat ‘invisible’ disorders – doesn’t seem to work too well either.

    “Clearly blood tests used for diagnosis and monitoring, DO provide
    information on “other differences”!”

    Please let me know what these ‘blood tests’ are.

    Also, it is different for psychiatry – some honest psychiatrists have admitted these failures of psychiatry – I happened to come across the article titled “The Disillusioned Psychiatrist” by Dr. Eva A. Wood recently (you should be able to find it on google).

    Comment #45

    “Stopping medication for no good reason, can have dire consequences.”

    These are the withdrawal symptoms – another huge problem that psychiatric patients have to deal with.

    “No mention of placebos!”

    They should seriously consider giving placebos – I have heard that even open label placebos work.
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  • Dayane #46

    I thoroughly approve of mindfulness as a useful strategy to enhance abilities to cope, unpick errors of thought and bring negative thinking under better control. It does not remotely begin to fix psychoses.

    Here is a 2017 paper published by the AMA on the heritability of Autism Spectrum Disorders.

    https://jamanetwork.com/journals/jama/fullarticle/2654804

    Click the PDF

    Discussion | In a reanalysis of a previous study of the familial
    risk of ASD, the heritability was estimated to be 83%, suggesting
    that genetic factors may explain most of the risk for ASD.
    This estimate is slightly lower than the approximately 90% estimate
    reported in earlier twin studies1
    and higher than the 38%
    (95% CI, 14%-67%) estimate reported in a California twin
    study,4 but was estimated with higher precision. Like earlier
    twin studies, shared environmental factors contributed minimally
    to the risk of ASD.
    Twin and family methods for calculating heritability require
    several, often untestable assumptions.5,6 Because ASD
    is rare, estimates of heritability rely on few families with more
    than 1 affected child, and, coupled with the time trends in ASD
    prevalence, the heritability estimates are sensitive to the choice
    ofmethods. Themethod initially chosen in the previous study2
    led to a lower estimate of heritability of ASD. The current estimate,
    using traditional methods for defining ASD discordance
    and concordance, more accurately captures the role of
    the genetic factors in ASD.However, inboth analyses, the heritability
    of ASD was high and the risk of ASD increased with increasing
    genetic relatedness.

    By astonishing coincidence, around midnight last night, a women, outside, was screaming surrounded by five police officers several cars and two vans. She was in her dressing gown and deeply distressed. She fought them with no care for her own safety.

    Endlessly she wailed, “Help me. help me. They are going to drain all my blood.” She clearly was hurting herself by her efforts to escape.

    This is why you have not got all bases covered.
    Report abuse

  • Dayane #47
    Mar 6, 2018 at 9:23 pm

    Alan4discussion, #43 “other factors I have listed which cause change”

    Of course other factors (such as hormonal or chemical factors) can change our behaviour under artificial conditions,

    Who is restricting these to “artificial conditions”?
    The whole of the natural world is full of chemical factors, with biological warfare going on between competing plants and animals all the time!
    Human pollution is just one more factor added to this!
    Huge numbers of psychoactive and biologically active chemicals occur naturally in plants, or the venoms and poisons in animals!

    but administering these (or variants of these)
    are not going to magically cure mental problems –
    administering drugs can change the brain in various ways
    but not in ways we want (random changes are of no use),

    You seem to be missing the point, that drugs used in medical treatments have had “random effects” studied and catalogued in depth, at the testing stage.
    Only rogue herbalist quacks or or illegal drug smugglers, and their followers use untested “random” medications!

    considering that these drugs are either administered on a hit or miss basis

    Not really, – although a range of them may be offered in sequence, to see which have the most beneficial effects for individual patients.
    (Human beings do not come in standard forms! – Individual sensitivities and susceptibilities, vary!)

    (i.e., drugs that pharmaceutical companies come up as trial and error),

    That is at the experimental stage of testing before being adopted for general medical use.

    or based on someone’s idea (theory) on how these “disorders” need to be treated.

    I think the word you are missing is “diagnosis”.

    Also, coming up with various drugs has not solved the problem of mental issues at all.

    I don’t think they claim to “solve the problem of mental disorders”! They are prescribed to mitigate the distracting symptoms and allow the patient’s mind to move on to develop more constructive activities.

    “Post-traumatic stress is real and enduring”

    Mindfulness techniques appear to be promising for post-traumatic stresses –
    there are even changes in the brain as a result of mindfulness training –
    below is one recent example study specifically for post-traumatic stress:

    Various forms of counselling are used in conjunction with medications. It is your instance that this is the be-all and end-all of treatment to the exclusion of effective medications which I (and others) dispute.

    @#45 – “Stopping medication for no good reason, can have dire consequences.”

    These are the withdrawal symptoms –

    They may well be, but one of the withdrawal symptoms is likely to be the return of the previously treated suppressed symptoms!

    another huge problem that psychiatric patients have to deal with.

    IF they disregard the medical advice!

    Withdrawal Do not stop taking this drug abruptly as it may increase the intensity of withdrawal symptoms. Consult with your doctor before reducing or stopping this medication. You may reduce withdrawal symptoms by slowly tapering off of this medication. Possible symptoms of withdrawal include:

    Insomnia
    Irritability
    Delusions, hallucinations, or other psychotic symptoms
    Return of mania or symptoms of bipolar

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  • Dayane

    Just a thought.

    That poor woman possibly transferred or on her way to a secure psychiatric unit by now (Have you ever been inside one?) will be given at some point antipsychotic medication after which she will substantially come to her senses in all likelihood. But for paranoid schizophrenics the moment of medication will be the most terrifying part. Murder in progress, with no kind soul to help her. Any friends or relatives will be traitors of the scariest sort.

    They should seriously consider giving placebos – I have heard that even open label placebos work.

    Have you given any thought to how lethal that could be? Placebos most probably work by giving the brain permission to turn the immune system up to max. (In hunter gatherer times and before illness meant your calorific intake would plummet. Worse, the immune systems consume excess calories to do there job, raise body temp etc. If the immune system went up to max it could kill a hunter gatherer faster than the infection. We have evolved to hold back on this.)Being treated with concern, or chants or elaborate treatments signals that you are cared for, will most likely be fed and the immune system can be let rip.

    It is contingent most likely on feeling you are being cared for. Placebos highly correlate with psychological feelgood.

    “They are going to drain all my blood.” (My friend believed it was poison on two occasions.)

    Why might they not shut down the immune system more?

    Fortunately Risperidone works quickly to relieve the devastating symptons. The feelgood after a few days genuinely comes from actually getting better. My friend after a few days re-emerged from this scared animal. “I see I’m ill now. I can see what are delusions at least, though I still have them on occasions. I know they are delusions because they are illogical.” (Perhaps a re-connection with semantic knowledge, somehow previously blocked.) After that he could increasingly, actively participate in his own recovery and his world repopulated with friends.
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  • Phil

    When my mom has experienced psychotic breaks after a period of increasing mania I get her to the emergency room where they deliver a sedative and a shot of haldol. When I come back to get her the next morning she is sitting on edge of bed dressed for the day with her purse in hand, completely aware of surroundings like nothing ever happened. Once she expressed annoyance with me for being late to get her. It’s astounding to observe the healing power of these drugs. This has happened to her three or four times and after the fact she inquires as to what has happened to her and she describes her delusions and asks what was true and what was not true. It takes her some days to accept that her perceptions were false.

    The one she held onto the longest was when she was on the way home from Rome with my daughter who was 18 years old at the time. She was super stressed and sleep deprived and headed toward a manic phase that blew out full effect while they were in Rome. My daughter called frantic while in the Sistine saying that Grammy had disappeared from the main chapel. She had wandered off in search of the Pope’s apartments for a private chit chat about the art in that area, convinced that she had been summoned by the Pope to do so. My daughter managed to get her back to Boston without my having to fly over there and deal with the problem (my very resourceful resilient daughter!) but on the layover in Heathrow my mother was convinced that the children she saw there were actually marionettes. We laugh now but she is still not entirely convinced that they were real human children. When we got to Boston I delivered her straight to the emergency department for the usual shot of haldol. Problem solved.

    This is what we are up against and why I have no patience with pill paranoia. Walk a mile in my shoes.
    Report abuse

  • Yep, Laurie.

    Failing to understand the reality of severe mental health issues and not seeing the near miraculous release from them is dispiriting. What is needed is a general public that will push for these treatments wisely prescribed and carefully monitored. Conspiracy theories involving the hoodwinking of some of the smartest people in society (doctors) needs some pretty remarkable evidence to swing it and I’ve seen precious little so far. The crappy judgements of politicians in implementing policy is less to be trusted. To manage that we need to listen to our experts and support them.

    What further dismays me is the tendency to use stumble-across evidence with sounds-like and looks-like correlations, with no discernible understanding of underlying mechanisms.

    Dayane,

    I know you mean well and there are many issues on which we could agree and push for better. But you have been sold some half-baked stuff and extended it way beyond where it might have been half useful.
    Report abuse

  • phil rimmer #48

    “It does not remotely begin to fix psychoses.”

    It does. Please check out the following references:

    Potes, A., et al. (2018). Mindfulness in severe and persistent mental illness: a systematic review. International journal of psychiatry in clinical practice, 1-9.

    Aust, J; Bradshaw, T (2017). “Mindfulness interventions for psychosis: A systematic review of the literature”. Journal of Psychiatric and Mental Health Nursing. 24 (1): 69–83.

    Holger, C., et al. (2017). Mindfulness- and Acceptance-based Interventions for Psychosis: A Systematic Review and Meta-analysis”. Global Advances in Health and Medicine. 5 (1): 30–43.

    Khoury B, et al. (2015). Mindfulness interventions for psychosis: a meta-analysis. Schizophrenia Research 2013; 150(1): 176-184.

    Additionally, mindfulness practices also appear to be effective even as a ‘prevention’ intervention – please check out the following article:

    Tang YY, Leve LD (2016). A translational neuroscience perspective on mindfulness meditation as a prevention strategy, Translational Behavioral Medicine. 6 (1): 63–72.

    “Here is a 2017 paper published by the AMA on the heritability of
    Autism Spectrum Disorders”

    I have heard that twin studies have various problems (such as “equal-environment assumption,” circular reasoning, etc.). However, even if I give you the benefit of the doubt and assume that autism is definitely genetic, that doesn’t mean giving medicines to them would solve their problems (as I have explained in other comments here).

    By the way, according to the following studies, children with autism who received sensorimotor enrichment show significant improvements on a wide range of autism symptoms:

    Aronoff, Eyal, Robert Hillyer, and Michael Leon. “Environmental Enrichment Therapy for Autism: Outcomes with Increased Access.” Neural Plasticity 2016 (2016): 2734915. PMC. Web. 8 Mar. 2018.

    Woo, Cynthia C. et al. (2015). “Environmental Enrichment as a Therapy for Autism: A Clinical Trial Replication and Extension.” Behavioral neuroscience 129.4 (2015): 412–422. PMC. Web. 8 Mar. 2018.

    Woo CC, Leon M. (2013). Environmental enrichment as an effective treatment for autism: a randomized controlled trial. Behav Neurosci. 2013 Aug; 127(4):487-97.

    “By astonishing coincidence, around midnight last night, a women,
    outside, was screaming surrounded by five police officers several cars
    and two vans.”

    Perhaps this woman has a medical history of taking psychiatric drugs (or she may have suddenly stopped taking them and therefore displaying withdrawal symptoms). Did you know that the latest school shooter (Nikolas Cruz) as well as the Las Vegas mass shooter had been taking psychiatric drugs?
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  • phil rimmer #52:

    “antipsychotic medication after which she will substantially come to
    her senses in all likelihood.”

    As I mentioned in my earlier comment, it was most probably the prescription drugs that led her to this plight in the first place. Studies also support this assertion. Please see the following studies (that suggest the link between psychiatric drugs and violence:

    Moore TJ, Glenmullen J, Furberg CD. Prescription drugs associated with reports of violence towards others. PloS One. 2010;5(12):e15337.

    Molero, Y., et al. (2015). Selective serotonin reuptake inhibitors and violent crime: a cohort study. PLoS medicine, 12(9), e1001875.

    “Have you given any thought to how lethal that could be?”

    This statement is your opinion only. Your statement is NOT based on scientific evidence. Meta analyses have shown that active drugs and placebos have similar effect sizes – please see the following study:

    Howick, J., et al. (2013). Are treatments more effective than placebos? A systematic review and meta-analysis. PloS one, 8(5), e62599.

    Please also see:
    Rutherford, B. R., Pott, E., Tandler, J. M., Wall, M. M., Roose, S. P., & Lieberman, J. A. (2014). Placebo response in antipsychotic clinical trials: a meta-analysis. JAMA psychiatry, 71(12), 1409-1421.

    Khan, Arif, and Walter A Brown. “Antidepressants versus Placebo in Major Depression: An Overview.” World Psychiatry 14.3 (2015): 294–300. PMC.

    Barbui, C., et al. (2011). Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis. The British Journal of Psychiatry, 198(1), 11-16.

    “Placebos most probably work by giving the brain permission to turn
    the immune system up to max..”

    Placebos work by the encouragement patents feel about being treated, as well as improvement due to the natural history of remission and fluctuating symptom levels. Placebos provide ‘hope’ and can be extremely powerful. You are underestimating the power of placebos – please see the following:

    Kirsch, I (2014). “Antidepressants and the Placebo Effect.” Zeitschrift Fur Psychologie 222.3 (2014): 128–134. PMC.

    Laferton, J. A., et al. (2015). Psychiatrists’ Attitudes Toward Non-Pharmacologic Factors Within the Context of Antidepressant Pharmacotherapy. Academic Psychiatry, 1-7.

    A Comprehensive Review of the Placebo Effect: Recent Advances and Current Thought Donald D. Price Annu. Rev. Psychol. 2008. 59:565–90

    Fortunately Risperidone works quickly to relieve the devastating
    symptons.

    How about the harm done through psychiatric drugs? – I provided references regarding this on comment #47, but below are some additional reference:

    Moore, T. J., & Furberg, C. D. (2017). The harms of antipsychotic drugs: evidence from key studies. Drug safety, 40(1), 3-14.

    Cosima Locher, et al. (2017). Efficacy and Safety of Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, and Placebo for Common Psychiatric Disorders Among Children and Adolescents. JAMA Psychiatry, 2017

    Harrow, Martin, and Thomas H. Jobe. (2013). “Does Long-Term Treatment of Schizophrenia With Antipsychotic Medications Facilitate Recovery?” Schizophrenia Bulletin 39.5 (2013): 962–965.

    Danborg, P. B., et al. (2017). Long-term Changes in Observed Behaviour after Exposure to Psychiatric Drugs A Systematic Review of Animal Studies.

    Viola S, Moncrieff J. Claims for sickness and disability benefits owing to mental disorders in the UK: trends from 1995 to 2014. BJPsych Open 2016;2:18-24

    “sold some half-baked stuff and extended it way beyond where it might
    have been half useful

    Sorry – I am extremely confident about ALL what I have posted. I have also provided references for everything I have posted. You are the one who is ignoring scientific evidence.
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  • Alan4discussion #49

    “I think the word you are missing is “diagnosis”.”

    Diagnosis is merely based on checklists (as I said before, there are no objective tests).

    “mitigate the distracting symptoms and allow the patient’s mind to
    move on to develop more constructive activities.”

    Please note that is your opinion only – you have this nice image in your mind that the medicines “mitigate the distracting symptoms and allow the patient’s mind to move on to develop more constructive activities”. However, scientific evidence paints a completely different picture.
    Scientific evidence has shown that drugs and placebos have similar effect sizes (please see comment #57). Also, scientific evidence has shown these drugs result in numerous adverse effects (please see references listed in comment #47 and comment #57).

    “return of the previously treated suppressed symptoms!”

    That’s circular reasoning.
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  • LaurieB – #53
    You are providing anecdotal evidence. To get scientific evidence, you need to look at actual research studies that have been conducted. Please see my comments on placebo effects and harm done by psychiatric medicines (posted within comments above).
    Report abuse

  • Dayane

    Until you start to notice the specifics of what I am saying this is pretty fatuous and getting repetitive for onlookers. Antidepressants are problematic and massively over-prescribed. Anti-psychotics can be bad when badly applied/selected and under-monitored. Treatments fail most often when the user fails to keep up the regimen. As I have described those with paranoid tendencies fear their treatment and start to love their condition. Your anecdote of shooters being on anti-psychotic drugs (I presume, because that is all Laurie and I have been talking about)) is no proof of a psychotic person prescribed anti-psychotics thereby becoming psychotic as a result of it!! Of course, the usual problem is they go off meds. I have seen it often enough.

    All good drug trials control against placebo effect, but it is becoming increasingly difficult to maintain this protocol with antipsychotics. Dropout rates (mostly due to a worsening of the underlying condition) in the Placebo arm of the trial greatly exceed other drop out rates of the other arms, worsening the utility of the trails. Clinicians are becoming increasingly reluctant to withhold medication and increase obvious suffering.

    Here’s a discussion of some of this (it has paper links. I have others)…

    http://www.huffingtonpost.ca/marvin-ross/schizophrenia-placebo-study_b_7839894.html

    Much more to the point these tests are on patients with already controlled psychosis. No such trials can be carried out on the newly and devastatingly afflicted or relapsed. A schizophrenic may experience any number of relapses due to medication reduction, stress, other neural insults from illness. New onset episodes treated by placebo would be immoral.

    Stop pretending all conditions and all pills are equivalent. This is, well, frankly, childish nonsense.
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  • Dayane #58
    Mar 8, 2018 at 6:37 pm

    Alan4discussion #49 – “mitigate the distracting symptoms and allow the patient’s mind to move on to develop more constructive activities.”

    Please note that is your opinion only –
    you have this nice image in your mind that the medicines

    “mitigate the distracting symptoms and allow the patient’s mind to move on to develop more constructive activities”.

    I have personal observations of the beneficial effects on someone using them over an extended period, which shows precisely that result!

    However, scientific evidence paints a completely different picture.

    Really? Could that be cherry-picked examples to meet with preconceptions?

    While the anti-depressants covered on the link below, do not include some anti-psychotic drugs discussed here, there are certainly parallels in the supposed controversy generated, and the spurious dissing of effective mainstream medicine!

    http://www.bbc.co.uk/news/health-43143889

    Scientists say they have settled one of medicine’s biggest debates after a huge study found that anti-depressants work.

    The study, which analysed data from 522 trials involving 116,477 people, found 21 common anti-depressants were all more effective at reducing symptoms of acute depression than dummy pills.

    But it also showed big differences in how effective each drug is.

    The authors of the report, published in the Lancet, said it showed many more people could benefit from the drugs.

    There were 64.7 million prescriptions for the drugs in England in 2016 – more than double the 31 million in 2006 – but there has been a debate about how effective they are, with some trials suggesting they are no better than placebos.

    The Royal College of Psychiatrists said the study “finally puts to bed the controversy on anti-depressants”.

    The so-called meta-analysis, which involved unpublished data in addition to information from the 522 clinical trials involving the short-term treatment of acute depression in adults,found the medications were all more effective than placebos.

    However, the study found they ranged from being a third more effective than a placebo to more than twice as effective.

    Lead researcher Dr Andrea Cipriani, from the University of Oxford, told the BBC: “This study is the final answer to a long-standing controversy about whether anti-depressants work for depression.

    “We found the most commonly prescribed anti-depressants work for moderate to severe depression and I think this is very good news for patients and clinicians.”

    Prof Carmine Pariante, from the Royal College of Psychiatrists, said: “This meta-analysis finally puts to bed the controversy on anti-depressants, clearly showing that these drugs do work in lifting mood and helping most people with depression.

    “Importantly, the paper analyses unpublished data held by pharmaceutical companies, and shows that the funding of studies by these companies does not influence the result, thus confirming that the clinical usefulness of these drugs is not affected by pharma-sponsored spin.
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  • Dayane

    I am well aware that my comment above was anecdotal. I had hoped to elicit compassion by offering a window into the world of the unmedicated and their families.
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  • Dayane #57
    Mar 8, 2018 at 6:34 pm

    Please also see:

    Khan, Arif, and Walter A Brown. “Antidepressants versus Placebo in Major Depression: An Overview.” World Psychiatry 14.3 (2015): 294–300. PMC.

    Barbui, C., et al. (2011). Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis. The British Journal of Psychiatry, 198(1), 11-16.

    Placebos work by the encouragement patents feel about being treated,
    as well as improvement due to the natural history of remission
    and fluctuating symptom levels.
    Placebos provide ‘hope’ and can be extremely powerful.
    You are underestimating the power of placebos –

    please see the following:

    Kirsch, I (2014). “Antidepressants and the Placebo Effect.” Zeitschrift Fur Psychologie 222.3 (2014): 128–134. PMC.

    Laferton, J. A., et al. (2015). Psychiatrists’ Attitudes Toward Non-Pharmacologic Factors Within the Context of Antidepressant Pharmacotherapy. Academic Psychiatry, 1-7.

    A Comprehensive Review of the Placebo Effect: Recent Advances and Current Thought Donald D. Price Annu. Rev. Psychol. 2008. 59:565–90

    I think #61 and its links, deal comprehensively with these issues, by clearly portraying the informed expert scientific view!

    @#61 – Scientists say they have settled one of medicine’s biggest debates after a huge study found that anti-depressants work.

    The Royal College of Psychiatrists said the study “finally puts to bed the controversy on anti-depressants”.
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  • phil rimmer #60
    Mar 9, 2018 at 4:03 am

    Dayane

    Stop pretending all conditions and all pills are equivalent.
    This is, well, frankly, childish nonsense.

    The analysis of the scientific evidence shows a clear picture!

    @#61 – information from the 522 clinical trials involving the short-term treatment of acute depression in adults, found the medications were all more effective than placebos.

    However, the study found they ranged from being a third more effective than a placebo to more than twice as effective.
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