Monday, January 3, 2011

Hey Joe

Yesterday’s post attracted a long and thoughtful comment from Joe Pomykala that I think is too hidden as a simple comment, so I have reproduced it as the majority of this post. I performed a few edits in transforming it to prettier html, but due to my lackadaisical editing skills I am sure that any typos and all of the original content are preserved intact (I may even have accidentally added a few typos).

Joes’s comment is well thought out, well referenced, and worth a read. He is the curator of a page on Behavior Economics which I have frequented several times for interesting references. I am not surprised by Joe’s insight as he is a wickedly intelligent, thoughtful, caring (father of two awesome kids), and dynamic individual.  If he were just a tad more charming and attractive people would mistake him for me (Just kidding Joe).   

Joes Comment:
I am totally against the widespread overuse of selective serotonin reuptake inhibitors unless the patent has a diagnosed genetic condition (they did a DNA analysis) missing the enzymes which code the serotonin (5-HTP) or dopamine receptors in the brain (7 receptors types for serotonin, 5 for dopamine) Ok for prescription reuptake inhibitors if the patent is missing one, if you want a list of chromosomes to look at, see NIH study of DNA of criminal offenders as if the gene HTR2B which encodes one serotonin receptor is knocked out of turn off, then such deficient serotonin levels can lead to impulsivity and violence, also see Study: PET imaging shows fewer dopamine receptors in drug addicts “found that people with [drug] addictions in general have 15-20 percent fewer dopamine receptors than normal subjects” - question is if those lower levels are natural by lower receptors by DNA in those persons, or if drug usage destroyed receptors.).

They want to block reuptake of serotonin to raise levels in synapses, problem is that at higher than normal levels leads to shutting down natural production - thus when people stop taking the drug, their serotonin levels will (temporarily - maybe a few months for full recovery) fall to below what they were prior (similar to heroin and normal beta endorphin levels). If low serotonin and dopamine levels are the cause of depression or what is diagnosed as hyperactivity disorder, then such illnesses would become worse when going off the reuptake inhibitors, since the body shuts down natural production, sometime permanently to a lower level. Too high levels of these neurotransmitters can also lead to the body literally burning out the brain receptors, thus leaving the patient with permanently lower natural levels making things worse. Extremely high levels of serotonin and dopamine are toxic. “There are a total of 10 billion total cells in the cerebral cortex alone, there are only one million dopaminergic cells in the entire brain.” That is just one out of 10,000 brain cells with a dopamine receptor. The illegal drug ecstasy is similar to serotonin and dopamine reuptake inhibitors raising the levels of neurotransmitters dopamine, serotonin, and also hormones prolactin and oxytocin, but the levels are much much higher, the body reacts and some of the few brain cells with serotonin and dopamine receptors being permanently destroyed (to much fuel, they blew up). Lower levels of elevation with legal drugs could do the same. There are few studies of the impacts long term use of selective serotonin reuptake inhibitors.

For Utah and high antidepressant use, I would not necessarily blame the LDS church. But for the LDS defense cited, Judd is a BYU professor ancient scripture which is crap and biased. What is needed is cross-sectional data and proper multivariate regression analysis. Maybe LDS drink less alcohol and have fewer other vices leading to higher antidepressants use as a substitute for all we know. Saying Utah has higher antidepressant use and 58% Mormons does not say anything about causality. Utah had the highest per capita bankruptcy rate in the nation, but and also highest antidepressant use - does that mean bankruptcies cause depression? Not necessarily, there are allot of other factors.

Some articles picked up the data by gender with women in Utah having double antidepressant use as men and blamed the lifestyle of the typical LDS woman. However, that’s also a bunch of garbage. Note “Gender differences found in brain's serotonin system,”, so natural gender differences in brains impact serotonin levels (as well as a whole lot of other things). And also see
Nat. Center for Health Statistics and Centers for Disease Control “Health, United States” (2009), page 347,Table 94, “Selected prescription and nonprescription drugs recorded during physician office visits and hospital outpatient department visits, by sex and age: United States, 1995–1996 and 2004–2000" where nationally for all ages, Antidepressants (depression and related disorders) recorded per 100 population by patent visits to their physicians is:













So national antidepressant use is a tad more than double for women than men, so not unique for Utah, but jezz - one third of the population had a prescription for some antidepressant over the last two year period? It tripled over 9 years? People have not changed that much over the last 9, or 90, or 900 years, now one-third of the population has a mental disorder necessitating antidepressant use? Mental illness spreading like a plage? Give me a break, over-prescriptions by a bunch of doctors, psychologists, etc., after a 10 minute interview, “try this, see if it works,” again long term effects unknown. I feel sorry for all the children on such for years because their parents could not deal and zombied out their kids or trusted an “expert” opinion by someone possibly with no medical training or just a psych degree which can be a wish washy a social science.

Note, the perfecter of the lobotomy operation, ice pick through eye socket and a simple twist scrambling the brain’s frontal lobes “fixing” things, Egas Moniz, thought damaging the brain would then let it heal for a normal condition fixing mental illness, won the 1949 Nobel Prize in Medicine for: "his discovery of the therapeutic value of leucotomy[lobotomy] in certain psychoses" and lobotomy operations quickly increased in popularity and usage. At the Nobel Banquet (Dec. 10, 1949) at the Swedish Academy in Stockholm when Moniz was awarded the prize in absence, in his address Carl Skottsberg, President of the Royal Academy of Sciences, said:
"Professor Moniz was a notorious savant in various fields when, accidentally, he came to the conclusion that the surgeon's knife would bring relief or even recovery to patients suffering from certain serious psychic disturbances. Boldly he went to work. He was 61 when he made his first brain operation for this purpose. Today his method is practiced everywhere with very good results. We regret that he has been unable to come, for we would have loved to meet this wonderful man, a famous scientist, a writer of historical books, a politician, statesman and diplomat, all in one person, .. whose career is crowned with a Nobel prize."
The award for the lobotomy operation is considered by many as the worst mistake the Noble committee has ever made.(hey, they also gave the prize to Paul Müller the year prior for his discovery of the now banned pesticide DDT.) What we could be seeing now is modern slow chemical lobotomies with selective serotonin and dopamine reuptake inhibitors, wait to see long term effects. But in any case, some people have normally low levels due to genetics where they miss genes which code for one of the receptors, in that case prescriptions are OK.  Just for a misbehaving kid - no, or for adults and the antidepressants usage - call the same an alcohol substitute with a prescription, or maybe the soma envisioned form Huxley’s Brave New World. Never trust the experts.

There are several places where I would not interpret the data in the same way as Joe. Most notably in the detail with which he infers serotonin levels from serotonin receptor prevalence, and the prescription amplitudes he pulls from the CDC data. I think inferring fine detail about the serotonin levels from the serotonin receptor data is like inferring traffic patterns from prevalence of garages; real information can be gleaned from these data, but both the time and concentration resolutions are limited. I suspect the CDC data because I am confused about how they estimated their numbers; the CDC methods may be better described in companion publications.

What really struck me was that this discourse is one of ideas and consideration. As an “OUT” atheist I am used to my communications attracting the same tired questions about my core understanding of the universe. I’m not really interested right now in telling anyone “How there could be a clock without a clockmaker” again; there is little gained by remarking that trail (Maybe I’ll change my mind and do a couple of posts on it one of these days). In Joe’s discourse there are actionable ideas with consequential impacts. Notice how he starts off with identification of real diagnostic tools for mentally ill folks. This is followed by a discussion of the arenas of impact for incorrect diagnosis, and then real numbers about the prevalence of these diagnoses. The discussion is then tied up with a bit of interesting historical context.

Thoughtful communication provides a context for disagreement. It would be ludicrous to invalidate this information by insisting that mental illness was due to: demon-possession, and that by masking the symptoms with drugs we are allowing Satan to gain the upper hand in the battle for souls as we approach End-Times. If you are heavily invested in the Satan theory I suggest that you personally try some of the real diagnostic tools for mental illness that are being developed.

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