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Schizophrenia drugs may have been off target for decades, study finds

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Re: Schizophrenia drugs may have been off target for decades, study finds

#51

Post by hinkley »

astrange wrote: post #48
dontknowwhyihn wrote: post #40

Earlier quoted context omitted.

Don’t people still talk about “low seratonin levels?” I always found it suspect that we say someone’s levels are low without actually measuring them.

Yes, and psychiatrists never believed it was "low serotonin" at all, or at least claim to have never believed it. For ADHD, stimulants actually do treat it by fixing "low dopamine"… in specific areas of the brain. But "low dopamine" is also a description of Parkinson's disease. But SSRIs don't work like stimulants do; they take a lot more than half an hour to take effect. We don't actually know how SSRIs work in the…

The fact we still called them SSRIs is the part that gets me. But I suppose until we know how they actually work we can’t just call them “thingy”.

Re: Schizophrenia drugs may have been off target for decades, study finds

#52

Post by calibas »

I have a theory. Antipsychotic medications just need to make the person more "manageable" to be considered effective. It doesn't need to eliminate the psychosis directly, it could just make the person more sedated, and it would appear to be "working" properly.

Re: Schizophrenia drugs may have been off target for decades, study finds

#53

Post by whats_a_quasar »

aatd86 wrote: post #25
whats_a_quasar wrote: post #5

The brain is really complicated, and all psychiatric medications affect multiple receptors and subsystems. Framing this study as "antipsychotics were off target" is an editorial choice. The title could just as easily have been "Improved understanding of antipsychotic action means we may be able to design better antipsychotics." Edit: It also ought to be noted that the study was on mice that had been given amphetamine…

I think you might miss the point slightly, moving too far the discussion on the other side. It's perfectly normal to wonder how can one administrate something when one doesn't understand it. Especially when there can be such debilitating effects. In clinical settings, things are way less clear than you make it seem. All psychosis are not equal and even all diagnostic of a same patient are not equal. There is a lot mo…

The goal is to maximize the life outcomes and quality of life of people with schizophrenia. I think in the conversation here there are two questions: What should the public conversation on schizophrenia be like? And, how should the medical system use antipsychotics in the treatment of schizophrenia?

I think, on the first question, the public conversation about schizophrenia is not ideal for improving outcomes. In particular, people in their 20s who have a first psychotic episode need to be pushed by their friends and family to get medical care immediately. Schizophrenia treated early is associated with much better outcomes later in life, and long periods of untreated psychosis are associated with much worse outcomes. I think that poor quality articles like this one sustain that section of the population who distrust psychiatrists, which leads some schizophrenics to seek treatment too late or not at all.

On the second question, I think that doctors are doing about as well as they can with antipsychotics with the current state of knowledge. Though it sounds like your concern about overprescription is from experience, and my feelings about the right level of long-term antipsychotic use are much weaker than my feelings about the public conversation.

I agree that it would be better for antipsychotics to be better targeted. Measuring individual neurotransmitter levels sounds like a very interesting way to better target treatment, though I don't think it is straightforward to measure neurotransmitters in a living brain.

I agree that many patients are on antipsychotics for longer than is necessary. The challenge is distinguishing between patients who should discontinue antipsychotics and the patients who will immediately relapse into psychosis without meds.

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Other thoughts:

> It's perfectly normal to wonder how can one administrate something when one doesn't understand it.

This is a mischaracterization of the state of the science. Antipsychotics are well understood, though not fully understood. We at this point have decades of data on the efficacy of antipsychotics, the prevalence and severity of side effects. We know most of the interactions between the drug and the body. What is not well understood is the exact mechanism by which these interactions moderate psychosis.

> there is no attempt at finding the base neuro-transmitter levels in and out of psychotic phases for each patient before deciding on the posology of a treatment

To my non-expert ears this sounds like an interesting approach to make treatment more targeted. I am not aware of a technology that could currently be used to measure neurotransmitters in a living brain, and I worry that measurement would be invasive.

> Some people even only have a few episodes every few years and are still put on life-long treatment with all the side-effects that can then be seen.

Re: Schizophrenia drugs may have been off target for decades, study finds

#54

Post by chrsig »

fragmede wrote: post #16
Aurornis wrote: post #10

The study used a mouse model where amphetamine is used to simulate schizophrenia. Obviously, it's not guaranteed to map to real humans having real schizophrenia. That doesn't mean it's a useless result, but everyone should remember that research is an accumulation of decades of many little pieces of information. This is another clue, not a "nail in the coffin" of old theories. The ultimate evaluation of medication is…

While everyone should be keenly aware the limitations of taking experimental results in mice and extrapolating to humans (aka, they often don't ), doesn't that mean what we really have, is a bunch of well tested medication for meth addicts? Which; if there was a way to get meth addicts off meth, would be a boon?

To be fair, there is a meth problem in the US.

Also there's a huge chasm between lab grade amphetamine and street meth.

Re: Schizophrenia drugs may have been off target for decades, study finds

#55

Post by mtlmtlmtlmtl »

hinkley wrote: post #51
astrange wrote: post #48

Earlier quoted context omitted.

Yes, and psychiatrists never believed it was "low serotonin" at all, or at least claim to have never believed it. For ADHD, stimulants actually do treat it by fixing "low dopamine"… in specific areas of the brain. But "low dopamine" is also a description of Parkinson's disease. But SSRIs don't work like stimulants do; they take a lot more than half an hour to take effect. We don't actually know how SSRIs work in the…

The fact we still called them SSRIs is the part that gets me. But I suppose until we know how they actually work we can’t just call them “thingy”.

They're called SSRIs because pharmacodynamically, that is what they do. Not sure what's so wrong with that.

Re: Schizophrenia drugs may have been off target for decades, study finds

#56

Post by whats_a_quasar »

m_0x wrote: post #46
11235813213455 wrote: post #32

I was diagnosed with schizophrenia, given some strong antipsychotics, it was a disaster I could barely talk or hand-write properly, gained 15kg. Fortunately I didn't listen the advices and stopped after 4 months, my therapy now is just walking, running, cycling, outdoor, trees, vegetable, minimalism

Pardon my ignorance and prejudice, but how are you not a danger to the people that surround you? Or is schizophrenia a spectrum very much alike as autism?

Schizophrenics are less violent than the general population. In general, schizophrenia is not dangerous to others around, even untreated. People who are in a psychotic episode act oddly, which can scare others, but the perception of danger comes from that erratic action, not from actual danger.

Re: Schizophrenia drugs may have been off target for decades, study finds

#57

Post by mtlmtlmtlmtl »

AmericanChopper wrote: post #41
mtlmtlmtlmtl wrote: post #24

Earlier quoted context omitted.

The "serotonin model", actually called the monoamine hypothesis, hasn't really been taken seriously in the field for decades, except by naysayers like yourself who continue to use it as a strawman.

> hasn't really been taken seriously in the field for decades, except by naysayers like yourself who continue to use it as a strawman. …and by basically the entire general public. Big pharma did a great job on the “depression is a just a chemical imbalance…” awareness campaign, but absolutely dropped the ball on the “actually we were wrong about that” campaign, so that’s still what most members of the public tend to…

Can you name one topic of bleeding edge research on which the general public's understanding is not either outdated, oversimplified, or both?

Re: Schizophrenia drugs may have been off target for decades, study finds

#59

Post by wheelerof4te »

m_0x wrote: post #46
11235813213455 wrote: post #32

I was diagnosed with schizophrenia, given some strong antipsychotics, it was a disaster I could barely talk or hand-write properly, gained 15kg. Fortunately I didn't listen the advices and stopped after 4 months, my therapy now is just walking, running, cycling, outdoor, trees, vegetable, minimalism

Pardon my ignorance and prejudice, but how are you not a danger to the people that surround you? Or is schizophrenia a spectrum very much alike as autism?

"Or is schizophrenia a spectrum very much alike as autism?"

It is exactly that. There are a lot of people with pcychosis-related symptoms who go about their lives without treatment.

They experience attacks once in a blue moon, but that is just about it. A few calming words or moments alone help.

Re: Schizophrenia drugs may have been off target for decades, study finds

#60

Post by horsawlarway »

aatd86 wrote: post #49
retrac wrote: post #44

Earlier quoted context omitted.

> It's perfectly normal to wonder how can one administrate something when one doesn't understand it. Especially when there can be such debilitating effects. A theoretical/principled understanding of how a drug works has never been required for useful medicine to happen. For example, we don't know how general anaesthesia works. We don't know why some people have extremely bad reactions to certain anaesthetics (and the…

The anaesthetic agent is not a drug that one is supposed to take for the remaining of their life and has no observed side-effects in general. It's also treated with the utmost care and in most interventions, if there is a choice to do without, the patient is offered the choice. There is a lot more consent involved. So it's not the same thing. To answer your other question, yes, neurotransmitter levels can be measured…

> The anaesthetic agent is not a drug that one is supposed to take for the remaining of their life and has no observed side-effects in general.

This is notably untrue. General anaesthesia is associated with higher risks of dementia. Especially the older the person being treated.

While there's some disagreement here - short term cognitive decline is inarguable as a side-effect (called post-operative cognitive decline), and many suspect it's related to long term cognitive issues:

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From: https://www.alzheimers.org.uk/about-dementia/risk-factors-an...

> There is a link between surgery and short-term changes in thinking and memory, called post-operative delirium or post-operative cognitive decline. This condition particularly seems to affect older people. Some studies have also found that these short term changes may be associated with higher risk of dementia later in life but other studies have found no association.

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