NEUROPSYCHIATRIC CONDITIONS
(this page is under construction)
Depression is a word that means unhappy.
Major Depression is a psychiatric term that means you have experienced at least two weeks of daily symptoms such as change in appetite, change in sleep pattern, low energy, poor memory, poor concentration, irritability, anxiety, restlessness, slow thinking and feelings of hopelessness, worthlessness, sadness, unexplained physical symptoms and/or suicidal ideation.
Major depression is often referred to as “depression” which is why there is often confusion. When you can clinically diagnose Major Depression based on these symptoms as well as family history there is usually a corresponding change in brain chemicals called neurotransmitters. The two that are most frequently reduced are serotonin and norepinephrine.
Medications such as Prozac, Lexapro, Zoloft and Paxil all work by blocking the re-uptake of serotonin at the synaptic junction between two neurons or brain cells. This results in an increase of serotonin which, if sustained for several weeks, can result in these symptoms getting better or going away altogether. These medications are called serotonin re-uptake inhibitors or SSRIs.
Medications such as Reboxetine inhibit the re-uptake of norepinephrine in a similar fashion and are called a norepinephrine re-uptake inhibitor or NRI.
Medications such as Effexor inhibit both and are called SNRIs.
The neurotransmitter dopamine is also implicated in Major Depression but it works in a different way compared to serotonin and norepinephrine. Dopamine agonists, or medications that increase the effect of dopamine, may help in major depression but the evidence is not as strong compared with serotonin and norepinephrine. Effexor also acts to some degree as a dopamine agonist which may explain evidence that indicates it is a tiny bit more efficacious compared to SSRIs and SNRIs when studied in large groups of patients.
All of these neurotransmitters exist in very small concentrations in the brain and are all produced in brainstem nuclei. They are called regulatory neurotransmitters because they act to increase or decrease the two main neurotransmitters GABA(+) and glutamate(-). They do this in multiple brain areas and have numerous specific activities most of which we do not fully understand.
We know that if you correct the lack of serotonin or norepinephrine then function will return to the pre-frontal cortex but we still do not fully understand what actually causes Major Depression.
We don’t even really know if it is the replacement of neurotransmitter that reverses the depressive symptoms or if these medications cause other direct effects that make people feel better for other reasons.
The point here is that anti-depressant medications do not kill a pathogen or replace a lost hormone that we know for sure is responsible for the pathology. Instead, these medications do pretty much what the brain tries to do when there is an insult. It produces neurotransmitter to offset the imbalance and attempt to re-establish homeostasis.
We have discovered recently that non-pharmacologic therapies can do exactly the same thing.
You can’t simply look at someone and say, “Get better.” What has to happen is that the brain must be played according to how it is programmed in order to facilitate a beneficial response. We have spent the last century figuring out how to do this with psychotherapy and the last millennium figuring out how to do this with alternative medicine.
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