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:

Years	1995–6	2004-5
Total	13.8	35.5
Men	9.1	22.8
Women	18.2	47.7

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.

Ice Fishing

The days between Christmas and New-Years are the season of gift returns and after-Christmas sales. Many people casually discard their holiday congeniality during this time. Some people suffer from the boxer-day blues. Some people give way to Seasonal Affective Disorder when they realize that the days may be getting longer, but are doing so at an incredibly slow pace. Whatever the reason, agitation is palpable at some venues. 2010 provided both seasonal agitation and snow during this time.

Snow is more lovely when it is not seen from a moving vehicle. Footfalls are muffled in fresh snow. As snow gets older it crunches like some delicate confection. In a parking lot snow becomes a grayish slippery insult. Slipping wheels whine. Shoppers trudge awkwardly using wet flop-slop-fop for footfalls. There is a little bit of sublime agitation available for anyone who visits a slush coated post-holiday shopping-center parking lot.

I received a gift-card to a national chain of recreation equipment stores and ventured forth into this madness to score a big sale-fueled discount on something I could not live without. All I had to do was to figure out what that something was, and get myself safely in and out of the store.

In Utah there is a popular way of dealing with agitation. Here we use antidepressants; lots of antidepressants.

Utah leads the nation in antidepressant use. The antidepressant use per capita here is three times higher than some other states. Doctors had reported higher than normal rates of antidepressant use in Utah for years, but when Express Scripts published their prescription drug atlas for year 2000 drug prescriptions the suspicions were officially validated. We use a truly phenomenal amount of antidepressants in Utah.

When the prescription drug atlas was published there was quite a bit of speculation about what effect the Mormon church had on the high rates of antidepressant use in Utah. Some statistics from the Mormon church set the percentage of Mormons in Utah at 70% of the state's population. There was rapid response from the Mormon church.

A “sociologist” from Brigham Young University by the name of Sherrie Mills Johnson apparently presented data gleaned from “national” surveys to show that Mormon women were  “less likely to be depressed than American women in general”; she was widely quoted for this work.  Daniel K. Judd (also from BYU) was also widely quoted as stating that Mormons are better off than anyone else. Other experts were trotted out to provide Mormon-supportive data.

Just who are Johnson and Judd? Just what authoritative works on the demographics of mental illness have they penned when not responding to information the owners of BYU might find inconvenient? There might be something, but I have not found it.

I did find the study by the National Mental Health Association (now called Mental Health America) that raked Utah as “the most depressed state”.

So either Mormons are somewhat more depressed demographically or those people living amongst the Mormons are almost universally depressed. However you slice it there is some heavy-duty correlation happening here.

I know that correlation does not equal the causation I imagine when dealing with other drivers in a icy post-holiday parking lot. I ultimately did not discover the item I could not live without, and so I was attempting to leave the parking lot empty-handed. The fellow in the BMW who was idling just behind my Corolla's parking space was talking on the phone. I think Mr. Parking Vulture was calling the pharmacy to order up a jumbo bottle of Prozac.

I have seen a truly jumbo bottle of Prozac once. The previous owners of our house had dropped one behind the kitchen stove. The bottle was as big as a gibbon's head and could not have fallen behind the stove without first pulling it out from the wall a bit. The cap was off the bottle when we found it. Several dozen pills had spilled out.

I picture the bottle being lost in the confusion of a spirited breakfast ritual. Mom is shaking the stove in her furious attempt to pump out pancakes for her enormous brood (there were 11 resident people in the family that sold us the house) . “SHUT UP! SHUT UP! SHUT UP!” she lovingly calls to her children. Suddenly she hits upon an idea, but should she open up the little green and white pills to invisibly blend their contents with the pancakes or should she just throw in a handful and tell the kids they are “special blueberries”? I think she just throws a handful in. Then, without noticing she has pulled the stove away from the wall in her energetic pursuit of breakfast, she tries to place the bottle on the back of the stove, and it falls.

I often find a breakfast of warm waffles is comforting, but I just can't get them made with the love Mom put into them.

After I carefully examined my apparently blocked-in situation in the parking lot I realized that I could leverage the amazing turning radius of my tiny sensible Toyota and squeak out. Sure enough I was able to pull out of my slot with way more than six inches to spare. Mr Vulture noticed my driving skill, and it looked to me like he was telling me something about it.

Unfortunately it did not appear that he was impressed by the slim margin which I had missed hitting his BMW by. With phone still held to ear it looked like he was yelling. I could not make out what he was saying. Maybe it was in French? Perhaps he did a mission for the LDS church in France. Elizabeth Smart is doing a mission in Paris. Maybe they know each other.

I did not notice Mr. Vulture's hypothalamus pumping out oxytocin and vasopressin. It is very difficult to determine the amounts of neurologically active hormones produced by a living brain. Much of what we know about the chemical nature of emotion or mental illness lack good empirical corroboration. I'm not sure what I would have done if I had known about the state of Mr. Vulture's glands.

Several pshcyo-active chemicals are prescribed because they have a known effect on some of the neurotransmitters sloshing around in our skulls. Prozac affects the amount of serotonin. We think that incorrect serotonin levels contribute to clinical depression. We confirm this by giving serotonin modulating chemicals to people who are experiencing the symptoms of clinical depression (interestingly enough rage is a symptom of clinical depression) and seeing those symptoms decrease in intensity. Unfortunately the chemicals sometimes increase the symptoms.

Michael McDermott was calmly sitting an a chair on boxing day (December 26th) 2000. Three weeks earlier he had increased his Prozac dose by a factor of two, and had finally been able to contact god. God had told Mike that he had no soul, but that he should not worry because he had a plan for Mike to earn one. All Mike had to do was travel back in time -with his AK47- and kill Adolf Hitler (and as many other Nazis as he could find). God would take care of the pesky time-travel details. All Mike had to do was gather his weapons and enough ammunition.

Eventually the nice people explained to Mike that Hitler and the six other Nazis looked a lot like his co-workers at Edgewater Technology. They did not understand the divine transformation Mike had undergone.

I was not understanding the transformation the Mr. Vulture was undergoing. The oxytocin was stimulating his pituitary to release large amounts of adrenocorticotropic hormone.

Since my conversational French is embarrassingly poor I chose to simply drive away from the now gesticulating Mr. Vulture. I may have reached a top speed of 5MPH when Mr Vulture shot out past me, and made as if to cut me off. The slick surface of the parking lot made the “cut me off” move more of a “Slide a little sideways” move, but I got the gist. I cranked down my window to get a better understanding of what he wanted to say. His passenger-side window rolled down automatically; the BMW had electric windows.

It Seemed that Mr. Vulture wanted to discus my parents for some reason. I responded with my best “I feel your pain” look and said: “You know, if you did not try to talk on the cellphone and drive at the same time you might be a competent driver”.

Mr Vulture lapsed into French again. I think his adrenal cortex was now busily pumping out corticosteroids in response to his pituitary's messages.

Perhaps he thought I could understand his French better without the car in the way. Whatever the reason Mr. Vulture decided to exit his car. I pulled a bit forward.

“I would be happy to get out and discuss your poor driving habits with you, but I am sure you will not like what I have to say” I told him calmly.

I then drove off.

I was not yet out of the parking lot when I began to wonder if Mr. Vulture's car had one of those little fish icons on the back of it. A couple of months earlier I had been confronted by a wildly gesticulating angry person in Washington DC; they had a little silver fish outline with cross-eyeballs on the back of their car. I decided to see if Mr. Vulture's BMW was similarly decorated. Instead of pulling out onto the feeder road I circled back through the parking lot.

Mr. Vulture was already back in his car, and he was maneuvering into a couple of spaces. I think he was going to do one of those “park a little skew in two spaces so nobody will park too close to me” parking jobs.

I pulled up close enough behind him to see if he had a fish.

I think he noticed me in his rear-view mirror. Instead of taking the two spaces he simply sped off and left the entire parking lot, and me, behind. Maybe his prescription was ready?

I did not see a fish, but he did speed off pretty fast.

HNY

2011 invites a new decade-like time-span into history. It will be called the “twenty-teens” even though it will not really be "teens" for another two years. Because history requires punctuation as much as English composition there will be an apparent pause in events as 2011 begins.

Some historians will refer to the proper decade as the “twenty-tens”. They will do this because of a misguided desire to cover all of the 21st century in similar-sounding precisely-defined increments of time. They will do this because they are insufferable dweebs.

By calling the time-span from 2011-2019 the twenty-teens one gleans the delicate fruit of psychological allusion.

“The twenty-teens behaved like its eponymous ill-mannered child”. “The twenty-teen neo-cons became the teen-mom to the teabagger love-child that someone else would have to raise”. “The developed world’s twenty-teenage experimentation with geo-engineering became an addiction whose grip proved almost impossible to break”.

 Much will appear to happen in the next nine years simply because it will be cool to blame it on the twenty-teenage years.

That is, of course, if we make it to the actual twenty teens. I allude to the “End of the World” which is supposed to take place on December 21st 2012. I love it when the world ends; I got way too much enjoyment out of Y2K. I have a special project I am working on to mark the last days. It will involve my penchant for snide historical commentary, and I will reveal what it is just before December 21st of this year.

This past year I was wildly successful with all of my characteristically feeble New-Years-Resolutions. I planned on posting at least once-a-month to this blog, and instead I posted over a hundred times. I resolved to write a poem and read it to an audience of strangers, and I wrote several and read four. It is true that my audience consisted of only three people so my hand-waving beat-poet-at-the-lectern image of myself dissolved in a puff of disillusionment, but the audience made up for their small numbers in their crowded strangerness.

For this next year I’ve decided to bring in more readers to this blog. I've become part of  "The Atheist Blogroll" and "Planet Atheism". You can see both the Atheist Blogroll and Planet Atheism badges in my sidebar. The Atheist Blogroll is like any other topical blogroll; basically a list of topically-related blogs.  Planet Atheist is a aggregator blog which publishes topically-related feeds from a number of blogs; this makes it a convenient place to read a bunch of atheist blogs at once.

The Atheist blogroll is a community building service provided free of charge to Atheist bloggers from around the world. If you would like to join, visit Mojoey at Deep Thoughts for more information.

If you would like to join Planet Atheism you can find more information on how to do that by clicking on the Planet Atheism badge in the sidebar.

The blog has been very successful in bringing in readers this past year. Thousands of people have read this blog, not counting some who get it on direct feed. They have clicked in from every continent, and every state of the union (except Iowa).

Readership stokes more than just my ego. When people click on the automatically-generated advertisements on the side panel I make money. This year I made more than a dollar and seventy-five cents. I am going to blow the entire wad of cash as a partial sponsor of a racer in the 2011 Los Angeles marathon. I should be able to buy him at least two gels with the money (to be consumed at mile 7 and 14). If I can find a sharpie on March 20th he will be sporting “Adult Onset Atheist (adultonsetatheist.blogspot.com)” somewhere on his running outfit.

Ego-stroking was accomplished in spades by another project which I will cryptically call “PTIP”. A collateral yield of PTIP was the contacting of a couple dozen folks I had not seen in decades. I was reminded again and again how very awesome people can be. Sometimes it is easy to get a distorted picture of the Human species when looking at it as an amalgam. Time had worn down some of the people to shiny stubs which sparkled in amazing intensity when they even mentioned the people they loved. Some had diffused into the very structure of their surroundings; when they smiled everything around them smiled just as brightly. Some had risen through adversities so sublime they empathized with unique authority. With some I discovered strange new friendships and converse with them regularly about profound interests. Only one retreated into a passive aggressive cave with a sign reading “I did not even return his last e-mails” nailed above its gaping mouth. Most filtered through our brief time together, and left an amazingly optimistic sweetness in their wake.

I feel like the year called twenty-ten left an optimistic sweetness in its wake. I can’t add up some score value, and say it was a positive year on average. I can’t look at an emotional tide-chart, and say it has ended on a high note. I can say that I cared about some people in 2010, and it feels very likely that I will do so even more in the future. I can say that I loved some people in 2010, and it feels more than likely that I will do so even more in the twenty-teens.