5 ms·

Former neuroscientist here. The fundamental problem of psychiatric medications is that the brain is wildly complex and the drugs are very broad-spectrum, activa

by KingMob 10y ago

Former neuroscientist here. The fundamental problem of psychiatric medications is that the brain is wildly complex and the drugs are very broad-spectrum, activating multiple receptors, including ones you don't want. If you're lucky, a medication is both effective and not too onerous in its side effects. It's like trying to fix a bad logic gate in your CPU with a soldering iron. Unfortunately, brain science is still in its infancy, and it may be decades more before we have good drugs for mental illnesses (assuming they can be treated by drugs at all, which may be impossible for certain diseases/people.)

falcolas 10y ago
But what's the alternative? Do no medication whatsoever? If you tell a parent "this drug has been shown to have a N percent chance at improving your child's life, with the following potential risks", and don't give them an alternative, what else are they supposed to do?
- poikniok 10y ago
  Yes, no medication whatsoever seems like a much better option compared to randomly taking things and hoping for the best.
  - SubiculumCode 10y ago
    I think that depends on the quality of your psychiatrist and physician. ADHD treatment with pharmaceuticals (e.g. adderal) is fairly effective and proven. Outcomes are frequently worse when left untreated, as they too frequently seek to self medicate (leading to drug abuse) or end it (suicide) when left untreated.
  - AstralStorm 10y ago
    Based on what evidence? Even for mild cases we have a small bit of evidence for treatment, even in adult untreated cases. Not a lot. It is very tricky to differentiate from other psychiatric disorders, especially as they often are comorbid.
SubiculumCode 10y ago
I am a cognitive neuroscientist currently in a post-doctoral training program in autism spectrum disorder. Autism spectrum disorder (ASD) is a disorder typified presence of repetitive behaviors and restricted interests, and by disruption to social behaviors, and yet is very heterogeneous in how it presents. A first point I'd like to make is that there is no pharmaceutical treatment currently approved for ASD. The drugs mentioned by the article are primarily used to treat disorders such as ADHD, anxiety, schizophrenia, or gastrointestinal irritation, which are frequently co-morbid with ASD. These co-morbid disorders typically have large impacts on the quality of life of people with ASD, and frequently aggravate ASD symptomatology. However, the costs and benefits of treating co-morbid disorders have to be weighed and tested at the individual level by a responsive and knowledgeable physician and psychiatrist. In terms of treating ASD itself, this has turned out to be really really hard. There is a saying that goes, "If you've met one person with autism, you've met one person with autism." This saying captures the tremendous heterogeneity (aka spectrum) of the disorder. There is not one cause of autism, there are hundreds or thousands of genetic causes of autism. Hundreds of genes are implicated in autism, and no single genetic mutation accounts for more than half a percent of autism cases. While many of the known genes contribute to the same major pathways (e.g. the seretonin pathway, or involved in processes of snyaptic pruning), they effect different parts of those complex pathways. Some genetic mutations will severely impact the function of the pathway, while others just make it less efficient, or different. Modern drug treatments would like to target a specific chain link in the pathway with a pharmaceutical, but such a drug would likely just help a small sliver of those with autism. Hundreds of different targeted drugs would need to be developed and then target the specific cases of autism it might help. That is a very difficult task indeed. The FDA drug approval process doesn't make this easy. Many drugs seeking approval fail because they only help a portion of their sample, (not enough to effect the overall mean above placebo), and until researchers are able to subdivide their ASD sample into the appropriate subgroups that respond and don't respond to a treatment a priori, the FDA won't approve those drugs for treatment.
- SubiculumCode 10y ago
  I feel compelled to add that aside from (or interact with) genetic risk factors for autism, exposure to excessive immune system antibodies during pregnancy appears to be involved in a significant number of autism cases. Moreover, in rodent models ASD like symptoms in pups have been created by exposing the dam to compounds that ramp up the immune response in the pregnant dam. I think there are real possibilities for preventive medicine here. Citation: http://www.sciencedirect.com/science/article/pii/S0006322316327391 http://www.sciencedirect.com/science/article/pii/S0006322316...
6stringmerc 10y ago
Honest question - do you think dietary fiddling around with different intakes / vitamins / fibers / sugars might also be worthwhile avenues to test on a case-by-case basis? I mean, I ask simply because I've seen a couple anecdotal tales of behavior changes (just a difference, not all Pro/Con) by eliminating cow milk. Switching that out changed, well, something and it seemed to have significant effects. Considering I agree with you that drugs / compounds are like hammering a sewing needle into a pillow, I wonder about diet (+ exercise?) that could be started with cheaper and lower risk.
- SubiculumCode 10y ago
  Gastrointestinal issues are common is ASD, and can aggravate ASD symptomatology. This is a hot topic of research.
- AstralStorm 10y ago
  The problem is that such interventions have low quality support if any at all. In some cases removing underlying allergy or intolerance can help, even immensely. (Typically casein, gluten or both.) These diets are still quite hard to follow especially for a child. Moreover, common replacements are potentially problematic too (soy, nuts) Contact a nutrition specialist, don't attempt on your own. Diet rarely if at all leads to a cure, but can be a useful tool. Rarely. Evidence is more against.
- KingMob 10y ago
  Perhaps. My area of expertise wasn't ASD, but I know that for other disorders, like epilepsy, extreme ketogenic diets can be helpful, especially for children. I wouldn't be surprised, especially given how many gastrointestinal issues are comorbid with ASD.

by KingMob 10y ago

falcolas 10y ago

But what's the alternative? Do no medication whatsoever? If you tell a parent "this drug has been shown to have a N percent chance at improving your child's life, with the following potential risks", and don't give them an alternative, what else are they supposed to do?

poikniok 10y ago
Yes, no medication whatsoever seems like a much better option compared to randomly taking things and hoping for the best.
- SubiculumCode 10y ago
  I think that depends on the quality of your psychiatrist and physician. ADHD treatment with pharmaceuticals (e.g. adderal) is fairly effective and proven. Outcomes are frequently worse when left untreated, as they too frequently seek to self medicate (leading to drug abuse) or end it (suicide) when left untreated.
- AstralStorm 10y ago
  Based on what evidence? Even for mild cases we have a small bit of evidence for treatment, even in adult untreated cases. Not a lot. It is very tricky to differentiate from other psychiatric disorders, especially as they often are comorbid.

SubiculumCode 10y ago

I am a cognitive neuroscientist currently in a post-doctoral training program in autism spectrum disorder. Autism spectrum disorder (ASD) is a disorder typified presence of repetitive behaviors and restricted interests, and by disruption to social behaviors, and yet is very heterogeneous in how it presents. A first point I'd like to make is that there is no pharmaceutical treatment currently approved for ASD. The drugs mentioned by the article are primarily used to treat disorders such as ADHD, anxiety, schizophrenia, or gastrointestinal irritation, which are frequently co-morbid with ASD. These co-morbid disorders typically have large impacts on the quality of life of people with ASD, and frequently aggravate ASD symptomatology. However, the costs and benefits of treating co-morbid disorders have to be weighed and tested at the individual level by a responsive and knowledgeable physician and psychiatrist. In terms of treating ASD itself, this has turned out to be really really hard. There is a saying that goes, "If you've met one person with autism, you've met one person with autism." This saying captures the tremendous heterogeneity (aka spectrum) of the disorder. There is not one cause of autism, there are hundreds or thousands of genetic causes of autism. Hundreds of genes are implicated in autism, and no single genetic mutation accounts for more than half a percent of autism cases. While many of the known genes contribute to the same major pathways (e.g. the seretonin pathway, or involved in processes of snyaptic pruning), they effect different parts of those complex pathways. Some genetic mutations will severely impact the function of the pathway, while others just make it less efficient, or different. Modern drug treatments would like to target a specific chain link in the pathway with a pharmaceutical, but such a drug would likely just help a small sliver of those with autism. Hundreds of different targeted drugs would need to be developed and then target the specific cases of autism it might help. That is a very difficult task indeed. The FDA drug approval process doesn't make this easy. Many drugs seeking approval fail because they only help a portion of their sample, (not enough to effect the overall mean above placebo), and until researchers are able to subdivide their ASD sample into the appropriate subgroups that respond and don't respond to a treatment a priori, the FDA won't approve those drugs for treatment.

SubiculumCode 10y ago
I feel compelled to add that aside from (or interact with) genetic risk factors for autism, exposure to excessive immune system antibodies during pregnancy appears to be involved in a significant number of autism cases. Moreover, in rodent models ASD like symptoms in pups have been created by exposing the dam to compounds that ramp up the immune response in the pregnant dam. I think there are real possibilities for preventive medicine here. Citation: http://www.sciencedirect.com/science/article/pii/S0006322316327391 http://www.sciencedirect.com/science/article/pii/S0006322316...

6stringmerc 10y ago

Honest question - do you think dietary fiddling around with different intakes / vitamins / fibers / sugars might also be worthwhile avenues to test on a case-by-case basis? I mean, I ask simply because I've seen a couple anecdotal tales of behavior changes (just a difference, not all Pro/Con) by eliminating cow milk. Switching that out changed, well, something and it seemed to have significant effects. Considering I agree with you that drugs / compounds are like hammering a sewing needle into a pillow, I wonder about diet (+ exercise?) that could be started with cheaper and lower risk.

SubiculumCode 10y ago
Gastrointestinal issues are common is ASD, and can aggravate ASD symptomatology. This is a hot topic of research.
AstralStorm 10y ago
The problem is that such interventions have low quality support if any at all. In some cases removing underlying allergy or intolerance can help, even immensely. (Typically casein, gluten or both.) These diets are still quite hard to follow especially for a child. Moreover, common replacements are potentially problematic too (soy, nuts) Contact a nutrition specialist, don't attempt on your own. Diet rarely if at all leads to a cure, but can be a useful tool. Rarely. Evidence is more against.
KingMob 10y ago
Perhaps. My area of expertise wasn't ASD, but I know that for other disorders, like epilepsy, extreme ketogenic diets can be helpful, especially for children. I wouldn't be surprised, especially given how many gastrointestinal issues are comorbid with ASD.