Posted by Lorraine on August 25, 2001, at 17:01:55
In reply to Re:SP Cocktail/Mechanisms of Action/Memory Culprit » PaulB, posted by Rick on August 23, 2001, at 21:54:54
> > >This led me back to Thomas Kramer's wonderful “jolt the system” article on “Mechanisms of Action” in Medscape. At the beginning of the essay, he wisely states:
>
> “The question of putative mechanisms of action continues to haunt psychopharmacology. Put simply, we know these drugs work, but we have very little idea how. We make guesses based on the neurochemical effects of these compounds. We have very little proof, and sometimes very little data, about whether the neurochemical effects that we find have anything to do with the therapeutic effect of the medication.”
>
> He then talks about a European serotonin reuptake *enhancer* (!) that defies all logic by working well for depression.
>
> If you’d like to read the whole article – highly recommeded – go to:
> http://www.medscape.com/medscape/psychiatry/journal/2001/v06.n01/mh0116.kram/226620.html
> (Free but requires simple registation; medical credential NOT required.)
>
> But I will include his conclusion here:
>
> “The crucial point in any discussion of mechanisms of action of psychotropic medication is to maintain a healthy respect for our ignorance. Fundamentally, we have no idea how these medications work. It is the nature of high-quality scientific discourse to postulate plausible theories and try to prove or disprove them. When any currently accepted theory no longer explains all of the data, it must be either modified or discarded. Psychopharmacology has had its share of discarded theories. We once thought that schizophrenia was exclusively a disease of dopamine and that depression was exclusively a disease of deficit of either serotonin or norepinephrine. Lately, we have been focused on the idea that "less is more" as far as the mechanisms of action of our medications. It is certainly true that as we have developed medications with less side effects, patients are more likely to take them regularly and stay on them, and, as such, these newer medications have more effectiveness than older ones. We must always remember, however, that until we figure out exactly what psychiatric illness is on a neurochemical level and what medications that seem to make it better actually do, all mechanisms of action for any effective medication may have potential benefit.” (Not surprisingly, Kramer also wrote an insightful defense of polypharmacy: http://www.medscape.com/medscape/psychiatry/journal/2000/v05.n03/mh0509.kram/mh0509.kram.html )I think we should all print these two paragraphs out and post them on our computers. They are humbling. And, everytime, I think we know a thing or two, I try to remember how little we know.
Lorraine
poster:Lorraine
thread:36517
URL: http://www.dr-bob.org/babble/20010822/msgs/76384.html