Posted by Questionmark on October 29, 2008, at 16:08:23
In reply to Re: Tianeptine and Agomelatine, posted by Trotter on October 27, 2008, at 15:57:09
This was incredibly insightful and brilliantly articulated.
Oh wow this has so much significance in terms of philosophy, psychology, AND behavioral pharmacology.
I have been thinking about almost the same exact things you discussed quite a lot lately, particularly in the past year. But you put words to some of the ideas that I could not-- or qualified them in a way that I have not been able. Brilliant.
I agree and think there is a significant amount of conflict between desire and acceptance or contentment. Buddhism seems to be particularly aware of this conflict and has been speaking about it for over two millenia since the Buddha himself is said to have given us the Four Noble Truths-- one of which states that all suffering is a result of desire (or attachment to desire/s) and another that the only way to free oneself from suffering is to free oneself from desire. The simple yet profound brilliance of that is always amazing to me.More practically speaking, I think it's possible to have an overall life of relative happiness and contentment, even of course if some amount of suffering remains (as is the case for every person who regards themselves as "happy" and "content"). But even this, however, requires an adequate balance between unfulfilled desire, and acceptance-- as you have said. If the amount of desire far enough exceeds the amount of acceptance, then unhappiness, discontentment, and painful depression can ensue. But, i think it is even possible for an extreme enough *opposite* imbalance (e.g. too little desire compared to acceptance, so to speak) to have negative consequences: namely boredom, numbness, apathy, and anhedonia-- up to even an emotionless, empty depression. Also, as you touched on, people can fail to improve their lives to the point that, if/when they do have a sufficient fall in acceptance or rise in desire, they are left with disappointment, pain, and depression.
And getting into the psychiatric context, THIS is why I think it can be very detrimental (at least or especially in the long run) for people to be on too high a dose of serotonergic [or other desire-reducing, acceptance-enhancing] antidepressants, and for some-- many-- people to even be on them at all. Depression is an evolutionary adaptation. It must be. Otherwise we would probably not experience it-- esPECially so many of us. And it makes sense. The more our lives and our selves become unsatisfactory, the more unhappy and eventually depressed we will become, and the more we will *desire* to try to change things. So if we drug everyone so that they are content no matter what, what effect will this have on the individuals and society??? Now certainly there are those who are excessively susceptible to depression, and there are those-- such as myself-- whose depressions are so severe as to warrant pharmacological assistance (thank mercy for Nardil!). But even THOSE people should be adequately informed and cautioned about the ramifications of the drug effects and *carefully* tried to be given the most ideal dose (meaning the minimum effective-yet-sufficiently life-assisting dose, in my opinion). Most doctors when prescribing a psychiatric medication are less cautious than a car mechanic in trying to fix a problem while still trying not to create or exacerbate other problems in the process. And, as important as a motor vehicle is, I would say that a person's brain and life are more important (and at times even more expensive to try to fix-- incidentally).
I'm rambling now sorry. But I've tried to explain some of these concepts and my correspondent concerns to some psychiatrists at different times (though not nearly as thoroughly), including the evolutionary role of depression and all that, but they just relate to me the same dogma about how depression is much more damaging than medications could be, and how untreated depression frequently grows worse and worse over time. It's not that I don't believe or agree with these views to a large extent, although I do unequivocally believe there are times when antidepressant drugs can be more damaging-- neurologically AND/or behaviorally-- than depression itself. I just want these doctors to also understand where *I* am coming from, and what I am saying, and to give it some consideration.
So where the hell was I? I suppose that's mostly it. One last thing.A lot of the time when people make a statement about one of the roles of a certain neurotransmitter(s)-- as most of us who discuss these matters including myself have done at one time or another-- it is a gross generalization and vastly oversimplified. But I really think there is a great deal of truth in what you have just stated about dopamine and serotonin and their roles in the experience of desire and acceptance & contentment. It's too bad we are not researchers and could test this in some way. Of course, it's also possible there are already studies out there which support this. (Or we could try to convince Dr. Bob to try start one :?) .)
Regardless, I think the ramifications of all this are pretty significant-- in a *number* of ways. Great insight and great job on pointing this out. There is a lot to be considered in relation to all this.
> I have spent a lot of time studying the nature of happiness. This has been motivated by a desire to be more happy (as in not depressed), but also because it is in my personality to want to understand things.
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> In my research I have indentified a paradox between desire and acceptance. Desire leads to purpose, meaning, goals, passion and energy, all of which can contribute to a sense of happiness. On the other hand, acceptance, as in feeling satisfied with oneself and one's world also gives one a sense of happiness. Yet there is much conflict between the two. A highly motivated, passionate person will have great difficulty feeling contentment, and vice versa.
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> Okay, you are no doubt thinking, where is he going with this? Well, I believe the desire system is largely controlled by dopamine, and acceptance/contentment is more a function of serotonin. If you suffer anxiety, low self-esteem and depression, then you will likely benefit from raising serotonin. If you suffer anhedonia, lack of energy, passion etc, then you will likely respond to increasing dopamine.
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> A problem with this is that I believe there is a conflict between dopamine and serotonin. Raise serotonin and you lower dopamine (SSRI emotional blunting). My understanding is that Tianeptine raises dopamine by lowering serotonin. This can address anhedonia, but risks causing anxiety and dissatisfaction (lower serotonin).
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> I tend to think whether one benefits more from a SSRI or Tianeptine is an individual thing based on one's relative lack of serotonin or dopamine. For me, I respond well to SSRIs, which probably predicts a poor response to Tianeptine. Does this make sense, or am I just rationalzing my decision to stop Tianeptine?
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> Of course many depressed people suffer low serotonin AND dopamine, not to mention noradrenaline. Perhaps this explains why most ADs do not result in remission.
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> Sorry if this reads like a psycho's babble. :)
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> Trotter
poster:Questionmark
thread:855890
URL: http://www.dr-bob.org/babble/20081027/msgs/859757.html