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The problem, I think, is that sometimes the chemicals come first and other times the emotions come first. Both can lead to a self-reinforcing downward spiral,

The problem, I think, is that sometimes the chemicals come first and other times the emotions come first. Both can lead to a self-reinforcing downward spiral, but trying to fix the wrong half is likely to be ineffective.

frgtpsswrdlame 9y ago
I'm out of my depth here so apologies if I'm stepping into some Very Bad Anatomy but my point is that neither one can come first because they are the same thing, that those chemicals are your emotions and vice versa.
- kolinko 9y ago
  They don't map one to one. There's a thousand variants of emotions, and just a few neurotransmitters. Also, even with all the chemistry being fine, there can be certain receptors messed up, or parts of brain not functioning properly. A story I read in "Listening to Prozac" was about a patient that for years couldn't get over his low self esteem issues. He worked through all of them, but the feeling persistent, and there were no other issues with his mood aside from that. He was finally put on antidepressants, and that issue was fixed. Unfortunately, whenever he tried to get off them, the issue - and only that issue - kept coming back. The theory is that something made that part of his brain resistant to serotonin. There are many kinds of serotonin receptors, and perhaps a genetic problem messed up one of them. Or there was an issue with serotonin not being delivered where it should've been. Or who knows what. In the end, increased serotonin levels fixed that. A blunt tool, but no other one worked. Similarly with attention deficit (which comes with anxiety and sleep issues quite often) - the original theory was that it was due to dopamine issues, because increasing dopamine levels helped most people. The current theory is that in many cases it may a whole class of issues - from a mechanical damage to prefrontal cortex to allergies, magnesium processing issues, tyrosine processing problems, or even a deficiency in nicotinic receptors (where supplementing nicotine is really a solution!) Also, in most cases it's probably more than issue at root. The problem is that it's difficult to figure it all out, and many cases medicine is simply not there yet.
  - pdkl95 9y ago
    > a deficiency in nicotinic receptors (where supplementing nicotine is really a solution!) My doctor actually recommended nicotine for that exact reason. My family's history with heavy tobacco use combined (my father in particular) and my experiences with nicotine in the past were positive, so the doctor suggested trying a strong nicotine patch for a while. It worked reasonably well, and more importantly it didn't have the (many) problems the usual SNRI or NDRI. Nicotine definitely does have its own problems, but it's an interesting option that deserves more research. (We had also discussed briefly the idea of trying a very small dose of one of the acetylcholinesterase inhibitors used for Alzheimer's, but eventually decided against it, because they can be somewhat dangerous drugs.) For decades, research on the nicotinic acetylcholine receptors was limited (probably tanks to the tobacco industry). Research in this area is improving a lot, but it will take time to make up for the lost time.
    - kolinko 9y ago
      Wow, that's an amazing doctor. When I discussed the subject with two psychiatrists, they seemed unaware of how it connects to psychiatric issues.

frgtpsswrdlame 9y ago

I'm out of my depth here so apologies if I'm stepping into some Very Bad Anatomy but my point is that neither one can come first because they are the same thing, that those chemicals are your emotions and vice versa.

kolinko 9y ago
They don't map one to one. There's a thousand variants of emotions, and just a few neurotransmitters. Also, even with all the chemistry being fine, there can be certain receptors messed up, or parts of brain not functioning properly. A story I read in "Listening to Prozac" was about a patient that for years couldn't get over his low self esteem issues. He worked through all of them, but the feeling persistent, and there were no other issues with his mood aside from that. He was finally put on antidepressants, and that issue was fixed. Unfortunately, whenever he tried to get off them, the issue - and only that issue - kept coming back. The theory is that something made that part of his brain resistant to serotonin. There are many kinds of serotonin receptors, and perhaps a genetic problem messed up one of them. Or there was an issue with serotonin not being delivered where it should've been. Or who knows what. In the end, increased serotonin levels fixed that. A blunt tool, but no other one worked. Similarly with attention deficit (which comes with anxiety and sleep issues quite often) - the original theory was that it was due to dopamine issues, because increasing dopamine levels helped most people. The current theory is that in many cases it may a whole class of issues - from a mechanical damage to prefrontal cortex to allergies, magnesium processing issues, tyrosine processing problems, or even a deficiency in nicotinic receptors (where supplementing nicotine is really a solution!) Also, in most cases it's probably more than issue at root. The problem is that it's difficult to figure it all out, and many cases medicine is simply not there yet.
- pdkl95 9y ago
  > a deficiency in nicotinic receptors (where supplementing nicotine is really a solution!) My doctor actually recommended nicotine for that exact reason. My family's history with heavy tobacco use combined (my father in particular) and my experiences with nicotine in the past were positive, so the doctor suggested trying a strong nicotine patch for a while. It worked reasonably well, and more importantly it didn't have the (many) problems the usual SNRI or NDRI. Nicotine definitely does have its own problems, but it's an interesting option that deserves more research. (We had also discussed briefly the idea of trying a very small dose of one of the acetylcholinesterase inhibitors used for Alzheimer's, but eventually decided against it, because they can be somewhat dangerous drugs.) For decades, research on the nicotinic acetylcholine receptors was limited (probably tanks to the tobacco industry). Research in this area is improving a lot, but it will take time to make up for the lost time.
  - kolinko 9y ago
    Wow, that's an amazing doctor. When I discussed the subject with two psychiatrists, they seemed unaware of how it connects to psychiatric issues.