Posted by Rick on January 22, 2002, at 20:24:40
Thomas Kramer is back at Medscape and he's done it again in his new column. This makes for fascinating and provocative reading. I don't know if it's appropriate to copy the entire article here (due to copyright, not length), so I'll just include a snippet and then the link. To view the link, you need to sign up for (free) access to Medscape at www.medscape.com. This is probably the premier website for physicians is all areas of practice, but it is open to the public as well.
Rick
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I propose a reframing of the paradigms that we use for psychopharmacology and its relationship to neurotransmitters. Neurotransmitters slosh around the body, and specifically inside the brain, in relatively constant amounts. The drugs that we give, even MAOIs, do not really affect the number of neurotransmitters in the body very much. What these drugs do is affect receptors. Instead of being concerned about the effect of norepinephrine and serotonin, we really need to redefine our concept of psychopharmacology as receptor drugs. Saying, for example, that selective serotonin reuptake inhibitors (SSRIs) treat depression by increasing serotonin is like saying that a boat sinking on the ocean needs to have reduced water levels. The water is there and all around. To fix the boat you need to plug the holes. That will be a great deal more effective than worrying about decreasing the overall amount of water in the system.SSRIs affect the serotonin transporters in cell membranes; they do not necessarily affect the overall level of serotonin. There is no deficit or surplus of serotonin; there are cells with impaired ability to have certain levels of serotonin on either side of their membranes. If serotonergic drugs really did affect serotonin overall, they would cause absolutely horrible GI side effects, since the gut has considerably more serotonin and serotonergic neurons than the brain has. This is also why different patients get better on different SSRIs.
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poster:Rick
thread:91143
URL: http://www.dr-bob.org/babble/20020116/msgs/91143.html