Glutamate: The next psychiatric revolution
“Psychiatric medications should be prescribed after an accurate psychiatric diagnosis is made,” Stotland says. “They should be prescribed by someone who knows what they are doing. Patients should be closely followed up. And the drugs should be prescribed in the context of continuing medical care.” Psychiatric medications, Stotland says, are not the answer to all the problems posed by mental illness. Unfortunately, she says, private insurers often pay only for drugs and not for psychotherapy. “Our health insurance discriminates against care for mental illness, and it especially discriminates against psychotherapy,” she says. “Some insurers say you have to give a psychiatric medicine before they will pay for psychotherapy that is wrong.” Stotland says psychiatric drugs are just as useful and have just as much medical justification as cancer drugs.
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This is one specific application where psychiatric medication is critically important.” Yes, Levy says, psychiatric medications — as do all drugs — carry risks as well as benefits. But there can be very serious consequences to not taking them, too. Nada Stotland, MD, MPH, professor of psychiatry at Chicago’s Rush University, notes that there is a great deal of scientific debate over the merits of certain psychiatric drugs — but no more debate than seen over drugs used in many other fields of medicine. “Tom Cruise said there is no scientific basis for psychiatric drugs. But there is an increasing scientific basis,” Stotland tells WebMD. “For example, we can see differences between brain images of someone who is depressed and someone who is not depressed. And we if we give medications, the brain of the depressed person goes back to looking like a person not depressed.” Such experiments don’t prove that psychiatric medications are the only way to treat depression.
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The Psychiatric Drug Crisis
His most recent research, involving small patient studies, were published in Movement Disorders and the International Journal of Neuropsychopharmacology. Although they involved only a few dozen patients each, they were clear cut and convincing. Today, the Roche pharmaceutical company is conducting phase III trials on glycine reuptake inhibitor for schizophrenic patients. The drug companies have no interest in natural compounds because of patent difficulties, so they prefer new synthetic compounds. This is good because we expect this approach will bring a revolution in psychiatry, the first since the emergence of dopamine and serotonin drugs. Our schizophrenia research on NMDA agonists affects not only negative symptoms of the disease but also motor drug induced symptoms, Heresco-Levy said. AS FOR depression, this problem is major, as 30% or more of sufferers dont react well to anti-depression drugs.
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Psychiatrists Defend Psychiatric Drug Use
In one French hospital, the protocol also called for chlorpromazine, a new drug thought to increase the hibernation effect. One day, some nurses ran out of ice and administered the drug on its own. When it calmed the patients, chlorpromazine, later named Thorazine, was recognized in 1952 as the first drug treatment for schizophreniaa development that encouraged doctors to believe that they could use drugs to manage patients outside the asylum, and thus shutter their institutions. In 1956, the Swiss firm Geigy wanted in on the antipsychotics market, and it asked a researcher and asylum doctor, Roland Kuhn, to test out a drug that, like Thorazine, was an antihistamineand thus was expected to have a sedating effect. The results were not what Kuhn desired: when the schizophrenic patients took the drug, imipramine, they became more agitated, and one of them, according to a member of the research team, rode, in his nightshirt, to a nearby village, singing lustily. He added, This was not really a very good PR exercise for the hospital. But it was the inspiration for Kuhn and his team to reason that if the flat mood of schizophrenia could be lifted by the drug, then could not a depressed mood be elevated also? Under the brand name Tofranil, imipramine went on to become the first antidepressantand one of the first blockbuster psychiatric drugs. American researchers were also interested in antihistamines. In 1957, Leo Sternbach, a chemist for Hoffmann-La Roche who had spent his career researching them, was about to throw away the last of a series of compounds he had been testing that had proven to be pharmacologically inert.
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