2008-04-09
Aaron Beck devised a treatment for depression caused by errors in thinking, a logic loop, errors in your thinking, these lead to conclusions that contribute to your depression. Usually on some negative personal feedback or blame. Focus on illogical thoughts. You start to spin into a loop that keeps you in a depressed state. Blame setback on personal inadequacies. You can help people with reality testing: is it true that you are not lovable? So that's a faulty thought if there are others. The therapist echoes back your thinking, and see if your black and white thinking really is as black and white as you think it is. They help you to rewrite your conclusions. It is like behavior therapy, you are rewriting the conclusion, so you are making new pairs just like new stimulus-response pairs in behavior therapy. Professional athletics have this therapy all the time, there's "performance psychology" - so they make them frame mistakes in a game or something so that they can get over it. In your book, there's roots of Beck's views, he says this stuff adds to depression: blame setbacks on personal inadequacices, focus selectively on negative events, make unduly pessimistic projections about the future, draw negative conclusions about personal worth. You can accept some responsibility for your role, sure, but too much might produce negative spin. Cognitive isolation. Rewirte your perspective.
Group therapy - insight therapy with more people. The most common are 12-step programs like Alcoholics Anonymous, where you bring your own stories and talk about the common solutions. It's you and common people like you, and you are helping each other out. You might have a therapist sitting in to make sure the group can keep on track, but not always. The size of the group? You have to get under 15, otherwise people start getting afraid to share, and for some reason 8 is the ideal group size. So if you're going to go do group therapy, and you find out your group is between 12 and 15, well, don't do it. And with too few people, it causes interpersonal issues since there's too few people. There are same sex groups. Sitting in and talking with a bunch of guys, some people like that -- but there's no proof of this, it's really just a comfort level thing. The best thing that comes out of group therapy is interpersonal skills: how to deal with people better. And learning to trust.
Biomedical therapies
Biomedical theory is completely related to physiology, so we do lots of animal trials and FDA testing. Psychopharmacotherapy - drugs for mental disorders: (1) anti-anxiety, (2) anti-psychotic, (3) anti-depressant. The premise is that if you fix the chem, you can fix the behavior and the outcome. These are very targetted drugs: the lateral hippocampus, for example, has very specialized neurotransmitter receptors. So we can do very awesome drugs.
Antianxiety - Valium, Xanax, Buspar.
Antipsychotic - Thorazine, Mellaril, Haldol, Tardive dyskinesia is caused by these drugs, clozapine (secondary antipsychotic, a booster - also used with lithium for mood stabilization),
Antidepressant -
* tricyclics - elavil, tofranil
* Mao inhibitors (MAOIs) - Nardil
- Selective serotonin reuptake inhibitors (SSRIs) - Prozac, Paxil, Zoloft
Mood stabilizers - lithium, valproic acid. See the Henry Markram article on supercomputer brain simulations. Elevated NMDA receptor levels and enhanced postsynaptic long-term potentiation induced by prenatal exposure to valproic acid.
Electroconvulsive therapy (ECT)
We do not really know why lithium works. But we know that it does work. Yes, we know that it is poison, it shuts down your thyroid, and you get hypothyroid. And yes, problems with your thyroid cause depression. It's a lifetime commitment. You can't just stop taking lithium without organ damage. So in people with bipolar, on their manias, they are going to stop taking lithium, which further damages their body. Lithium toxicity will shut off your liver. They found out that the people living next to watering holes with lithium, well, they were bubbly and happy, and we accidentally discovered that lithium helps with bipolar, and we don't know why. We also know that lithium is dangerous.
Recreational drugs - bars, LCD, .... with valium you have to go physically show up to your doctor to get prescribed. Vikadin is a very abused drug. Advil is lethal out of date - don't let your pets get near it, it'll kill them. Reverse osmosis - these molecules are not being broken down. More likely than not, even with your liver, but chances are it's going to be stored in your fat. They are fat-soluble, they will float as molecules in water. One of the explanations about American heaviness is that you need more fatness re: how poisoned you are.
Lorazepam is an overused antianxiety drug, it has become deregulated, so your regular doctor might prescribe it, and one of the side-effects is heart pain, shallow breathing, heart palpitations, and acnea. Before you take anything prescribed, go read about it. Don't just take it. Multivitamins influence this. Take all of your prescriptions to your doctor. PDA - RXMinder software.
You can't afford to disagree with your doctor, because of the insurance policies.
Clozaril - John Nash was mentioned as taking Haldol. The side effects are brutal. It's like using a tank to squash a fly, you might hit the fly but you will take out everything else. Clorazil will make you a zombie, same with Haldol, it will make you a zombie as well.
The biggest issue with any medication in psychopharmacology - you are not going to get prescribed one drug. You are going to get a mix. And so you've got to manage the mix. The doctor is not going to. You have to report side-effects, whether it is working or not, and so on. And in schizophrenia, you will probably take an anti-anxiety, anti-depressant, anti-psychotic, and maybe an anti-panic. For depression, they don't just give you Prozac or Zoloft, unless it's really mild and situation. It's a mood stabilizer. There are two sides to this medical thing: (1) yay, we've figured out it's biochemical, and (2) you're a walking experiment.
anti-epileptics are used with antipsychotics
Trycyclic antidepressants - inhibit reuptake at serotonin and norepinephrine synapses, which elevates activity at both types of synapses. Tricyclics also blockade activity at several subtypes of postsynaptic receptors. It deals with the inhibition of reuptake of both serotonin and norepinephrine, and it blocks or influences dopamine at some level. It elevates the activity of the synapses (the speed of absorption), and we're not manufacturing norepinephrine (Parkinson's, motor control issues), etc.
Selective serotonin in reuptake inhibitors (SSRIs) - slow reuptake at serotonin synapses, so activity is increased only at serotonin synapses. Reuptake is the vacuuming back into the presynaptic neuron. With SSRIs, we block that ability. Therefore, leaving more serotonin in the synapse to be taken up next time. We do not let it leak back in to the neuron that fired. The presynaptic cell still continues to make serotonin. We can force the body to make more, even though we can't make more.
MAO inhibitors - work by disabling MAO enzymes that would normally metabolize and inactivate neurotransmitters at dopamine, norepinephrine, and serotonin synapses. These disable the enzymes that come in and absorb or break down left over neurotransmitters. When we talked about extra neurotransmitters in the synapse, well, they are either reabsorbed or broken down. The MOAi is inhibiting that break-down process. MOAis are broader - acetylcholine, norepinephrine, dopamine, serotonin. If you read almost any vitamin bottle, tylanol bottle, it will say "do not take this drug with an MAOi" - because you don't want anything else in that system. You shouldn't have aspertine either (no calorie stuff - it's nasty - it effects your synapses).
Anti-anxiety: relieves tension, apprenhension, nervousness ,eliminates feelings of anxiety. Valium, Xanax, Diazepam, Alprozolam, or Buspar (new with less side effects). This is to chill - seriously, just chill. Effects are short lived. Side effects are drowsiness, depression, nausea, dependency. Works by depressing the CNS by stimulation GABA. Have you had surgery with valium? (Tentacle arm in surgery? LSD, no, it's probably TSD). Valium numbs you. Valium and morphine have a tendency to cause funky dreams.