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When Panic Attacks - Chapter 4 - The one all against medication? - Coggle…
When Panic Attacks - Chapter 4 - The one all against medication?
Actual title
"
The truth about antidepressants and anti-anxiety medications
"
Is it even going to be a useful thing to summarise?
As it doesn't have anything to do with practicing techniques
What the hell, in for a penny and all that...
It feels like a bit of a waste of time...
Since so much of this is still "we don't know why", why does he rate medications so poorly?
Unless of course the techniques he talks about are proven to be more effective than medication in scientific studies
He might not have come across a medication yet which
does
work
How does he know medication can
never
work?
What's the best way to get over depression and anxiety?
Drugs, psychotherapy, or some combination of the two?
Drugs
According to the chemical imbalance theory
This theory has been around for a long time
Hippocrates called depression "melancholia"
Because he thought it resulted from som kind of black poison secreted by the gallbladder
Melanin is a black pigment
And cholia refers to the gallbladder
Scientists today are still looking for some type of chemical imbalance that causes depression and anxiety
But they're now looking in the brain rather than the gallbladder
Serotonin
Is the chemical that's received a lot of the attention
It is one of the chemical that transmits electrical signals between the nerves in the brain
Many psychiatrists believe depression and anxiety result from too little serotonin in the brain
And that mania (states of extreme euphoria) results from too much
If so, medications that boost brain serotonin levels should have antidepressant and anti-anxiety effects
So, you could think of serotonin as the happiness molecule
The author
Did several years of research on the chemical imbalance theory
After his psychiatric residency training
And published research studies...
Wrote chapters for psychopharmacology textbooks
Lectured at scientific meetings in the US and abroad
Also won the A.E. Bennett Award
"One of the top awards for basic psychiatric research"
Currently
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For his work on brain serotonin metabolism
Right, that's his credentials out of the way
But I don't know that they're that authoritative?
In the 1970s the author and his colleagues did a variety of experiments to test the theory that depression results from a serotonin deficiency in the brain
Their results simply were not consistent with this theory
One study: Boosting brain serotonin levels in depressed veterans
By giving them massive daily supplements of L-tryptophan
An essential amino acid
that rapidly crosses into the brain
where it's converted to serotonin
However, their moods did not improve at all
This study was published in
Archives of General Psychiatry
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The author also
"reviewed the entire world literature on brain serotonin but couldn't find one shred of compelling evidence that a deficiency of serotonin, or any chemical imbalance in the brain,"
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To this day, he's still not aware of any studies that have ever validated the chemical imbalance theory
Has he looked? Is he just biased from his earlier work? Is he right?
The 1970s was a long time ago in terms of scientific research
Antidepressants that began to come out in the late 1980s
Like Prozac
Called SSRIs
Selective Serotonin Reuptake Inhibitors
Because they had extraordinarily potent effects on the brain serotonin system
If the serotonin deficiency theory was valid
These new drugs would undoubtedly have vastly superior antidepressant and anti-anxiety effects
In other words, patients who take SSRIs should recover quickly
But this hasn't been the case
In fact, the latest studies raise serious questions about whether these new antidepressants have
any
true antidepressant effects at all
Above and beyond their placebo effects.
According to the author, many neuroscientists no longer consider the chemical imbalance theory of depression and anxiety to be valid
Instead they're researching the neural circuits in the brain
Lots of people who suffer from depression or anxiety still believe their moood problems result from a chemical imbalance in their brains
This is understandable
Your doctor may have told you
Your doctor may be confusing a theory with a fact
Most doctors work hard and mean well, and they want to do their best for their patients
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You may have heard it on television
This theory is fueled more by drug company marketing
Than by solid scientific proof
Billions of dollars of annual profits from the sale of antidepressant and anti-anxiety medications are at stake
So drug companies spend vast amounts of money promoting the chemical imbalance theory
They also subsidise a large proportion of the budget of the American Psychiatric Association
And underwrite an enormous amount of research and education at medical schools
Of course, supporting research and education is not a bad thing
But money buys influence
And drug companies are focused on marketing their drugs
Academic research should be all about getting to the truth
Drug company research is all about selling new products
As a physician, the author feels he isn't supposed to make claims that he can't document
If you've been feeling fatigued lately, and he suspects the problem results from iron deficiency anemia
He'll order some blood tests to find out
If the tests confirm the diagnosis
He'll give you a prescription for some iron supplements
And you'll soon be feeling perkier
If he tells you that your depression or panic attacks result from a chemical imbalance in your brain
Then he's telling you something that can't be proven
As there is no test for a chemical imbalance in the human brain
Pills or Skills?
Dr Burns's Prescription
Genetic and environmental factors undoubtedly play a huge role in how we think, feel, and behave, but there's no convincing evidence that depression and anxiety result from a chemical imbalance in the brain. Scientists don't yet know what causes depression and anxiety
It's not reasonable to claim that drugs are the most effective treatment for depression or anxiety. This claim has been made by the American Psychiatric Association and has been widely publicised by the pharmaceutical industry but it's not consistent with the latest reserch, whiich raises serious questions about the safety and effectiveness of the antidepressants and the benzodiazepines. The research also indicates that CBT, not pills, is the most effective treatment for depression and all the anxiety disorders, both in the short term and in the long term.
There are exceptions to every rule. Medications can be helpful or even lifesaving for some people who suffer from severe depression or anxiety but should be combined with CBT for the best effect.
Some severe psychiatric disorders, such as schizophrenia and bipolar illness, will require medications, but CBT can also help.
Longterm treatment with antidepressants usually isn't necessary. Once you've recovered completely from an episode of depression or anxiety, you probably can taper off your antidepressant medication if you've been treated with CBT or have learned to use the techniques in this book.
Many people can learn to use these techniques successfully on their own, without the help of a therapist. But a good therapist can speed your recovery, especially if your problems are severe.
Regardless of whether you're receiving medications, psychotherapy, or a combination, or simply working with these techniques on your own, you should monitor your moods at least once a week with the
Brief Mood Survey
to see whether you're improving. The only valid goal of any therapy is to get well.
Avoid the benzodiazepines, such as Xanax, Valium, Ativan, and others, because they're addictive.
Avoid polypharmacy (combining multiple drugs) whenever possible. Dangerous drug interactions can occur, and patients often end up feeling drugged and overmedicated.
If you are taking an antidepressant, watch out for the development of suicidal impulses, and seek help immediately if they occur. (Of course the same advice pertains to people who aren't taking antidepressants).
Never make any drug decisions on your own. Always consult your doctor first. Teamwork and trust are the keys to good therapy.
Evidence from research
Right, I'm finding this quite annoying
It's hard to work out the structure of this chapter
In fact, I don't know that there is one
So between the previous bit on the right, and the summing up of the chapter that appears over to the left of this, the bit in the middle of this chapter is mostly drivel
He's basically going on about research studies
And the importance of the Placebo Effect in trials of drugs
All the while ignoring things like the fact that CBT can't ever be researched in a double-blind trial
As by the act of getting the therapy, both the therapist and the patient know they're getting "real" CBT
So studies of CBT are inherently difficult, and he seems overly eager to prove it's effectiveness compared to drugs
Almost like he's trying to get you to
believe
in CBT
I've went back and read critical customer reviews of this book
And find a number of the complaints chime with mine
He's too heavy on stories, about wild successes
And it's a wall of almost impenetrable text, disguising the instructions for the techniques
and disguising even the structure of the text in general
as well as the argument he's making
But some other critical reviews indicate that without this waffle, the techniques described seem to be good
So I'm going to go forwards ignoring not just the waffle, but also the highly opinionated commentary
And try to just summarise the techniques
And then I'll try them
I've read other things the last couple of days
And I might be reformulating my theory how all of this works or doesn't
Tying all of that into my own (possibly bullshit) theories from meditation regarding
Attention and awareness
Distractions (as in thoughts)
Energy given to thoughts from attention
appearing to give them fuel
making them stronger
Maybe being able to just
be
with anxious thoughts
without getting swept away by them
is key to being able to deal with them effectively
but I don't know
Something I read about CBT
Indicated that recent studies had found CBT had become less effective over time
ie, since it was introduced in the 60s and 70s
it's effectiveness has declined
I'm wondering if
belief
is a huge component of this
and hence a large part of the earlier success was due to the
placebo
effect
in that, it only works if you believe it's going to work
and maybe it actually
does
work
But only because you give it enough of a chance to get a bit of space between you and the anxious thoughts
However, as people have become more discerning and sceptical
that's led to a decline in the successfulness of this form of therapy
So, I'm going to go and try to distill the techniques
with no bullshit
and just the bare instructions
and then try (most) of them out