Posted by Chairman_MAO on March 7, 2006, at 23:49:17
In reply to Re: oh, posted by linkadge on March 7, 2006, at 21:59:04
Good luck driving the brain into depression at 80% MAO inhibition with modest doses of a catecholamine releaser! If this maxim really held true (I will pretend it does for the sake of argument, but my conclusion will show why it cannot), then psychostimulant+MAOI would not be one of the last bastions of antidepressant pharmacotherapy.
I know phenelzine brings about an unprecendented, long-lasting improvement in mood. The amphetamine helps out my concentration problems and gives me more energy to carry out tasks. I also know that the benefit of it does not build much tolerance, either. While there are of course some exceptions, those using psychostimulants for ADHD do not build tolerance to the therapeutic effect. The initial EUPHORIA fades as homeostasis sets in, but it is possible to have a new homeostasis that allows for better functioning than the old one. The increased focus/energy sticks around. Thus, I am combining the two drugs. I respond well to both for distinctly different purposes; why not put them together?
It is absurd to think that ABSOLUTE tolerance builds to a psychostimulant such that what once was an effective dose no longer has any effect whatsoever. There is no reason to believe that the new homeostasis created after administration of modest doses of d-amphetamine is inherently depressive. One could apply this logic to MAOIs (or SSRIs) as well; take away the MAOI too abruptly, and you could well have a rebound depression that is greater than what existed before. Furthermore, there are is actually SENSITIZATION to some amphetamine effects over time while others build tachyphylaxis (I LOVE THAT WORD).
Also, for his statement to have its implied theoretical import, one must assume that the mechanisms involved in psychostimulant action are the ones involved in the neurobiological substrate of the depression. In reality, the brain is far too complex for this to be the whole situation. I see his point, but it seems as if it could be expressed as "what goes up must come down". How far back down relative to the original level, though?
Ultimately, all this theoretical posturing is not worth much, as the problem actually lies in the mind, about which none of these hypotheses even apply.
Dr. Manji's statement, while obviously of value at least as a thought experiment, cannot be true because the mind is driven into depression, not the brain. And now we're back to square one: the impossibility of mental illness as a medical disease. For if the brain were the diseased entity, there would be some observed structural pathology indicating as such. However, depression is never diagnosed by observing the brain with diagnostic instruments alone. Rather, the patient's MIND is depressed--assume he's not faking it--not his brain. Minds can only be at most metaphorically sick, as they are metaphysicial entities which defy direct examination. Therefore, although use of certain drugs may activate certain mechanisms which could in theory lead to excacerbated depression, the important effect to evalute is "how do you feel", asked many times over the course of the therapeutic engagement.There were many users of drugs such as Dexamyl (amobarbital/d-amphetamine) who used 3 caps regularly for 10+ years who did not build tolerance and attained a consistent therapeutic effect. Did it feel like the first day on the drug? I doubt it...but that doesn't mean Happy Hoover Lady (the Dexamyl 'mascot') didn't feel better than her default state most of the time while on the drug.
poster:Chairman_MAO
thread:613775
URL: http://www.dr-bob.org/babble/20060304/msgs/617324.html