Thursday, March 27, 2014

Neuroplasticity- the bane of psychopharmacology

I just read another article suggesting that long term use of antipsychotic increases psychotic symptoms and worsens outcomes in schizophrenics. Now there are a lot of problems with the study- no randomization- maybe schizophrenics given more antipsychotics were "crazier" to begin with. But it is not good, not what you want to here if you are a psychopharmacologist.

As an OT, neuroplasticity is a good thing. It is how people can adjust to a nerve injury or a stroke. In psychopharmacology, it can mean that what a drug does in the first weeks or even months is the exact opposite of what it does over years of use. The brain adapts. Block dopamine receptors? The brain becomes super-sensitive to dopamine. Flood the brain with serotonin? The serotonin receptors down-regulate.

We don't need six week studies on drugs that we put people on for a life time. We need six year studies. Sixty years studies. Studies to show us if we are doing more harm than good.

A study recently came out showing that cortisone injections for tennis elbow had some limited short term efficacy but worsened long term outcomes. I wouldn't get a steroid injection for tennis elbow. But I suspect that some of the drugs we take in psychiatry are the equivalent of getting that steroid injection.


Unknown said...

I imagine that a lot of them are band-aids. But some aren't and I don't know how you could tell sometimes (I do know that I am taking 2 bandaid meds right now but they help a little). I can't imagine doing better off meds; when I had to go off just imipramine to go on Emsam I thought I was going to die. On the other hand I was on Depakote for many years and we have agreed that it was absolutely useless and the detrimental side effects made it a poentially harmful drug that we kept trying to make work because it was what we had at the time and if my body kept a stable level it was great. My body rarely did that though.

I don't know. You seem to have more ability to adjust things downward when you feel ok and up when you don't than I do so maybe that's why I can't imagine doing this. My brain tends to shriek "MORE, MORE, MORE" and I don't think yours does.

Yet I do see the bad in these meds for so many years. I keep waiting for that blood sugar that starts the diabetes and now that artifical sweeteners give me migraines I dread that more than ever (my family is always diabetic by age 50 anyway). Getting off lithium seems to have reversed my diabetes insipidus and it is amazing how much easier it is to not be constantly desperately thirsty and constantly urinating dilute urine. Yellow pee is still a surprise.

I guess I am just taking a leap of faith that taking meds can't be worse than not taking them (for me) and I think I've just accepted that if they limit my lifespan so be it. That's probably easier when your life is rather limited as mine is though.

Just ME Jen

Unknown said...

Oh, and thanks again for the help with my sister's MIL. She's going to find a hand therapist and a different surgeon. Hopefully they can fix it or at least improve it enough she can work more easily.

Jean Grey said...

I'm not against band-aids. And I even accept that there are some physical down-sides to these meds. But what I want to know is that they will not make me more depressed, more manic, or more dysfunctional over the long term. Or at least I'd like informed consent if they do.