Posted by Cam W. on October 28, 2000, at 10:53:08
In reply to 3Day to 2 Week Responses. Proof, not myth., posted by JohnL on October 28, 2000, at 8:59:45
John - Sorry to step into this, but if you can check the original articles (not MEDLINE abstracts) you will find that greater than 80% (possibly higher) of the studies that claim quick response (less than 2 or 3 weeks) are funded by the company who make the drug.
I usually attribute early response of antidepressants to positive expectation (including, but not exclusively placebo response) or misattribution of the start-up side effects as positive effects of the drug. There is nothing wrong with this and may improve compliance to therapy.
True response requires a modification of electrical flow through neurons in various brain structures. This adaptation (upregulation of some receptors and downregulation of others) takes time, as the neuronal cell membranes need to envelope and degradate some receptors and insert others into the nerve cell membranes. This is where c-Fos, the inositol pathway, etc. come into play, adjusting calcium levels to modify nerve cell excitability. Other secondary messengers shuttle proteins (receptors) from the nucleus and endoplasmic reticulum (where mRNA is making them due to these different-than-normal signals from membrane receptors created by an extracellular concentration change in one, or probably several of the numerous neurotransmitters effected by antidepressant therapy.
I too, have not read Dr.Jensen's book (and most likely will not - a fault of mine - I try to stick to peer reviewed information to decrease confusion). I have asked several world reknown researchers ( >10) if they have heard of Dr.Jensen and so far none of them has heard of him or his book.
Now, this being said. I think that there is some merit to what it is you say that Dr.Jensen is saying. We all agree that depressive symptomatology is an end result that can result from innumerable possible breakdowns of a variety bodily systems regulating stress and emotion. For simplicity I will use an example of just one a neurotransmitter-regualted breakdown, leading to depression. If you give an SSRI to someone who has a depression caused by a malfunction of norepinephrine, 'initially' you will get immediate and pronounced serotonergic side effects. This does not mean that an SSRI cannot be effective in this sort of depression, it is just that it may take longer to "correct" the electrical flow abnormalities causing the depression. It may make more sense to switch to an NRI antidepressant in these instances, but not always. I believe that Dr.Jensen's 3 day method gives up on a therapy too soon.
I used to think that it was silly to keep a person with OCD on Prozac of months on end, with little effect, but after 6 months the person responded with significant decreases in both obsessions and compulsions. Another instance where I thought it was silly to continue therapy was with a person with severe tardive dyskinesia. This person was place on Clozaril and month by month the dosage increased (to 600mg daily) with no apparent (to me) change in the symptoms. This person could not keep a hat on their head at 5 months. A year and a half later this person is now riding a bike and you would be hard pressed to pick him out in a crowd.
In our "fast food" society we expect instant gratification and results. Medicine, particularily psychiatry, is a far too complex field for this and sometimes we have to force ourselves to wait for results.
John, I truly enjoy your input, don't stop. It is hard to stick to one's guns in an onslaught from the mainstream. You are doing admirably, but until I see some other researchers "prove" that Dr.Jensen's method has merit, I cannot endorse it. Sorry, I am just an incredible skeptic, at heart. On the other hand, in 5 years you may be telling us, "I told you so".
"If the brain were simple enough for us to understand, than we would be too simple to understand it." Dr.E.Pugh (I believe, not positive).
Thanks for the lively debate - Cam.
poster:Cam W.
thread:47596
URL: http://www.dr-bob.org/babble/20001022/msgs/47602.html