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A Neuro Dawn

© John McManamy

"Left unsaid is the possibility of a breakdown in the distinctions between various forms of mental illness."

We've been told that the new generation of antidepressants act by blocking the reuptake of the neurotransmitter serotonin in the brain, but what precisely is that supposed to mean? In a Medscape article, Thomas Kramer MD is candid enough to admit:

"Put simply, we know these drugs work, but we have very little idea how. We make guesses based on the neurochemical effects of these compounds. We have very little proof, and sometimes very little data, about whether the neurochemical effects that we find have anything to do with the therapeutic effect of the medication."

In support of his argument, he cites the antidepressant, tianeptine, available only in Europe, that is a selective serotonin reuptake ENHANCER - ie, it works exactly opposite to SSRIs but with the same therapeutic effect. He speculates both classes of drugs may work because of their action rather than type of action, each succeeding in "jolting" the firing of neurons.

To illustrate the principle, Kramer cites a story dating from the golden age of radio when a malfunction in the main transmitter caused CBS to go off the air. When the company's own engineers failed to figure out what was wrong, they called in an outside expert. The expert walked up to the transmitter, stared at it, then gave it a sharp kick, which put CBS back in commission. The next day CBS got an itemized bill that read: "One kick, $1. Knowing where to kick, $9999."

Tomorrow's psychiatrist may have to know more than merely where to kick. For now, a rose by any other name may smell just as sweet to Shakespeare, but the odds of getting a psychologist, a psychiatrist, and a neurologist to agree on even that are about the same as Stephen Hawking embracing astrology as a science. What a psychologist sees as a behavior problem, a psychiatrist views as an Axis I disorder, which a neurologist interprets as something gone haywire in the signal transduction pathways.

You want to be intimidated, try on for size the titles of these articles from the latest issue of Neuroscience:

"Differential Expression of KCNQ2 Splice Variants: Implications to M Current Function during Neuronal Development"

"Anandamide Excites Central Terminals of Dorsal Root Ganglion Neurons via Vanilloid Receptor-1 Activation"

I'm not sure about you, but I think I had the flu the day those particular items were brought up when I was in college.

The copyright of the article A Neuro Dawn in Depression is owned by John McManamy. Permission to republish A Neuro Dawn in print or online must be granted by the author in writing.