Depression Medications - How antipsychotic medications work

Author

How antipsychotic medications work

Nom dePlume

2005-11-24, 12:57 am

We've had enough discussion about antipsychotic medications in this
group that I thought people might be interested to know how they work.
I've written a brief essay on the subject, which should eventually
evolve into a new chapter for my book. I'm interested in any feedback
people might have.

And here it is!

How Antipsychotic Medications Work
by Nom dePlume

Psychosis
=========
"Psychosis" is a term that describes a set of symptoms, which may be
found in conjunction with a variety of illnesses, schizophrenia being
only the most familiar. The symptoms of psychosis are divided into two
categories: "positive symptoms" (which represent an excess of normal
function, or symptoms which occur in addition to normal function), and
"negative symptoms" (which represent a decrease in normal function).
In the case of psychosis, the positive symptoms garner the most
attention, but the negative symptoms are also crippling and
distressing to the afflicted.

The positive symptoms of psychosis include delusions, hallucinations,
agitation, disorganized behavior or speech, and catatonic behavior.

The negative symptoms included emotional problems, such as flattening
(blunted affect), emotional withdrawal, and anhedonia (inability to
feel pleasure); difficulty initiating activities due to passivity,
apathy, lack of spontaneity, and "avolition" (incapacity for
goal-directed behavior); and cognitive (thinking) problems such as
difficulty with abstract thinking, tendency towards stereotyped
thinking, and "alogia" (impairment of fluency and quality of speech
and thought).

The neurotransmitter dopamine plays the lead role in current theories
regarding the neurochemical mechanisms responsible for psychosis. Many
neurons in the brain send signals to adjacent neurons, from which they
are separated by a synaptic gap, by emitting pulses of dopamine into
the synaptic gap. Receptors on the receiving neuron are activated
(register a signal) when dopamine molecules attach to them. While
there are several dopamine receptors, the "D2" receptor is believed to
play the most significant role in psychosis. (There are at least six
dopamine receptors, currently labeled D1, D2a, D2b, D3, D4, and D5, of
which D3 and D4 are subtypes of the more general category D2.)

Primary evidence for the "dopamine hypothesis" for psychosis comes
from the observation that all known effective antipsychotic
medications block the D2 dopamine receptor. For this reason, the
primary chemical mechanism for treating psychosis is often referred to
as "dopamine blockade". The effectiveness of antipsychotics in
treating psychosis has led researchers to hypothesize that psychosis
is at least partly a consequence of excess dopamine in certain parts
of the brain.

The difficulty with treating psychosis by stopping all dopamine-signal
transmission (by blocking all dopamine receptors completely) is that
it would "cure" the problem by removing the patient from the world of
the living. Thus the difficulty faced by psychopharmacologists is to
block enough of the undesirable dopamine signalling, while leaving the
desirable signalling alone (or bolstering it, if not enough occurs).
This is a tall order. The difficulty in achieving this goal is one
reason that the current generation of antipsychotic medications, while
helpful, is less than ideal in effectiveness. (Another reason is
likely that psychosis involves more than the simplified picture of
too much dopamine in some parts of the brain.)

In order to understand how antipsychotic medications work, and why the
newer generation of "atypical" antipsychotic medications work as well
as the original "typical" medications, but with reduced side effects,
it is necessary to understand more about the role of dopamine in the
brain. In particular, it is the impact of antipsychotic medications on
four "dopamine pathways" (specific areas of the brain for which
dopamine signalling is especially important) that determine both the
effectiveness, and the side effects, of antipsychotic medication.

Four Dopamine Pathways
======================
The four dopamine pathways of interest are described briefly below
(ignoring anatomy to focus on function). Note that much of the
information is hypothetical in nature, and awaits confirmation or
revision by further research. The available information represents the
best estimates available at this time, but should not be regarded as
final.

1) The Mesolimbic Dopamine Pathway

This pathway is believed to be involved in emotional disorders,
delusions, thought disorders, and auditory hallucinations.
Hyperactivity of the mesolimbic dopamine pathway is hypothesized to
account for the positive symptoms of psychosis, and possibly
hostility and excessive aggression as well. It is observed that
reduction of dopamine-related signaling in this pathway by the
blockade of D2 receptors does lead to a decrease in the positive
symptoms of psychosis.

2) The Mesocortical Dopamine Pathway

There is some evidence that some of the cognitive problems and
negative symptoms of psychosis are due to an inadequate level of
dopamine-related activity in this pathway. Assuming this is the case,
it is not clear if the problem arises from low levels of dopamine, or
damage to the neurons themselves (possibly due to poisoning from an
excess of glutamate). If these hypotheses are correct, then increasing
dopamine activity in this pathway may improve cognitive deficits and
alleviate the negative symptoms.

3) The Nigrostriatal Dopamine Pathway

This pathway is part of the "extrapyramidal nervous system." It
controls motor movements. Dopamine deficiencies in this pathway
produce movement problems ("Extrapyramidal Symptoms," or EPS), such as
Parkinson's disease. The types of movement problems caused by dopamine
deficiencies include akinesia and bradykinesia (lack, or slowing, of
movement, respectively), rigidity, tremor, akathisia (restlessness),
and dystonia (twisting movements, especially of the face and neck).

Unfortunately, antipsychotic medications that blockade the D2 receptor
in this pathway can produce these movement disorders. If the D2
blockade continues for an extended period of time, permanent dystonia
(which continues even after the medication is stopped) can set in, a
condition known as "Tardive Dyskinesia."

It is believed that an excess of dopamine in this pathway causes
"hyperkinetic" disorders, such as chorea, dyskinesias, and tics.

4) The Tuberoinfundibular Dopamine Pathway

Dopamine-related activity in this pathway inhibits prolactin release.
Not surprisingly, pregnancy and childbirth lead to a reduction of
dopamine activity in this pathway, thus increasing prolactin levels,
and causing lactation, thus enabling breastfeeding. Undesirably
dopamine reductions in this pathway (due uto lesions or drugs) will
also lead to prolactin increase, and can cause a variety of problems,
such as galactorrhea (breast secretions), amenorrhea, and sexual
dysfunction.

Once again, the undesirable consequences of dopamine suppression can
occur as a result of antipsychotic medications that blockade dopamine
in this area.

Antipsychotic Agents
====================
Much as has been the case with antidepressant medications,
antipsychotic medications have been developed in multiple
"generations." The first generation didn't acquire a name until the
second generation was developed, and terminology had to be invented to
distinguish between them. Now the first generation medications are
called "typical antipsychotics," while the second generation are
called "atypical antipsychotics."

Not surprisingly, the second generation medications are considered to
be better than the first generation, for the same reason that SSRIs
(selective serotonin reuptake inhibitors) are considered better than
TCAs (tricyclic antidepressants): Not because they are more effective
at treating the positive symptoms, but because they have much less in
the way of undesirable side effects. Given that the undesirable side
effects of typical antipsychotics can include permanent, crippling,
and disfiguring movement disorders, this is a major improvement.

Typical Antipsychotics
----------------------
The typical antipsychotics block the dopamine D2 receptors, a
mechanism sometimes referred to as "dopamine blockade." They vary
somewhat from one to the next in terms of the other effects they have,
and this variation is responsible for the differences a particular
person may experience when trying one drug versus another. As usual, a
particular drug may also have different effects on different people as
well.

The typical antipsychotics block the D2 receptor thoughout the brain,
in all dopamine pathways. Thus these medications can produce all of
the problems described above due to low dopamine levels in the
pathways.

Other side effects are due to the additional mechanisms characteristic
of the typical antipsychotics. These are also blockades, specifically
of the muscarinic-cholinergic (M1), Alpha 1 adrenergic (alpha 1), and
histamine (H1) receptors. These three mechanisms are also
characteristic of the TCAs mentioned above, and are as undesirable for
antipsychotic medications as they are for antidepressants.

- The M1 blockade can cause dry mouth, blurred vision, constipation,
and cognitive impairment.

- The Alpha 1 blockade can cause orthostatic hypotension (low blood
pressure on standing) and drowsiness.

- The H1 blockade can cause weight gain and drowsiness typical of
antihistamine medications.

The undesirable side effects of typical antipsychotics are distressing
at best, and crippling, dangerous, or even fatal at worst. The side
effects are so serious that many patients understandably choose to
skip the medication, and suffer the effects of psychosis as the lesser
of two evils.

Atypical Antipsychotics
-----------------------
The obvious problem with the mechanism of the typical antipsychotics
is that it blocks D2 receptors, and decreases dopamine signalling,
everywhere in the brain. Ideally, an antipsychotic medication should
only decrease dopamine signalling in the mesolimbic dopamine pathway.
To a large extent, the atypical antipsychotics do just this, and
therefore have much less in the way of undesirable effects than the
first generation antipsychotics.

The mechanism by which atypical antipsychotics target their dopamine
blockade to the mesolimbic pathway depends on the process by which
neurons emit dopamine in the first place.

Some dopamine neurons have serotonin 2A receptors, and the rate at
which these neurons emit dopamine (the "dopamine signal") is itself
controlled by the rate at which the emitting neuron receives serotonin
(the "serotonin signal") from adjacent neurons. The higher the
serotonin concentration, the less dopamine a neuron will emit. Thus
the serotonin signal acts as a "control input" to the dopamine neuron,
in a fashion familiar to engineers everywhere.

Atypical antipsychotics work by antagonizing serotonin (blocking the
serotonin 2A receptor) throughout the brain, in addition to
antagonizing dopamine (blocking the dopamine D2 receptor) throughout
the brain. The serotonin blockade changes the response of dopamine
neurons that have the serotonin 2A receptors by decreasing the
dopamine-suppression signal, and allowing them to emit more dopamine.
The dopamine blockade decreases the response of neurons to dopamine
emission.

Atypical antipsychotics rely on the mechanism of serotonin-modulated
dopamine emission to achieve their effects. The two influences of
serotonin and dopamine blockade are in conflict, but because the
influences occur to different degrees in the four dopamine pathways,
the net result differs between the pathways, as we'll see below.

1) The Mesolimbic Dopamine Pathway

Serotonin antagonism loses to dopamine antagonism. The dopamine D2
blockade suppresses positive psychotic symptoms, just as the typical
antipsychotics do.

2) The Mesocortical Dopamine Pathway

Serotonin antagonism wins strongly over dopamine antagonism, causing a
net increase in dopamine activity. Not only does the increase in
dopamine activity prevent undesirable side effects of dopamine
blockade, but can actually improve the negative symptoms of psychosis.

3) The Nigrostriatal Dopamine Pathway

Serotonin antagonism wins over dopamine antagonism, increasing the
amount of dopamine available (relative to what a typical antipsychotic
would do), and thus EPS (and propensity for tardive dyskinesia) is
reduced or eliminated.

4) The Tuberoinfundibular Dopamine Pathway

The effects of the simultaneous serotonin and dopamine blockade on
prolactin release are mixed. The dopamine blockade acts to decrease
prolactin, while the serotonin blockade acts, separately, to increase
prolactin. The net effect is that prolactin release is reduced
relative to the typical antipsychotics. Compared to the case where no
antipsychotic medication is used, the atypical antipsychotics may or
may not reduce prolactin emission.

Conclusion
==========
The atypical antipsychotic medications represent a major step forward
for the treatment of psychosis. To a large extent, this is because
they have a much-reduced side effect profile compared to the older,
typical antipsychotics.

However, the atypical antipsychotics are far from perfect. They don't
always work, and in some cases (e.g. Zyprexa, or olanzapine) are known
to cause diabetes in some people. So the quest for improvements in the
treatment of psychosis will continue. The good news is that
improvements are being found.

--
Nom dePlume, Ph.D.
Why, yes, in fact, I am a rocket scientist.

Guide to Medications for Mental Illness:
http://www.geocities.com/nomdeplume1000/

=====

LostBoyinNC

2005-11-24, 12:57 am

Why dont you go on one?

Eric

Steve

2005-11-24, 12:57 am

"LostBoyinNC" <Deepsand562@aol.com> wrote in message
news:1132805089.574216.10360@o13g2000cwo.googlegroups.com...
> Why dont you go on one?
>
> Eric
>

Why don't you go away?

You have been totally discredited now, you are simply a fool who provides
light amusements. You might have a more respectful audience at a barber
shop. I am sure your Chappel bits would be quite the hit there.

Nom dePlume

2005-11-24, 10:56 am

Because I am not psychotic. Why would you suggest that someone who is
not psychotic take antipsychotic medication? You object to the concept
I've mentioned that dopamine agonists may have a useful role to play
in *some* cases of depression that do not respond to serotonergic
medications (a suggestion that came from a researcher in
psychopharmacology, not from me), and yet you are casually suggesting
that someone who is not psychotic take an antipsychotic medication and
risk EPS, tardive dyskinesia, and diabetes. Yet you constantly remind
us that you know far more about psychotropic medications than everyone
else here. It doesn't show.

--
Nom dePlume, Ph.D.
Why, yes, in fact, I am a rocket scientist.

Guide to Medications for Mental Illness:
http://www.geocities.com/nomdeplume1000/

=====

"LostBoyinNC" <Deepsand562@aol.com> wrote in message
news:1132805089.574216.10360@o13g2000cwo.googlegroups.com...
> Why dont you go on one?
>
> Eric
>

nef5ht2a@yahoo.com

2005-11-24, 10:56 am

I thought it was a good discussion overall. You might want to consider
citing the relationship between Zyprexa/etc. and "insulin resistance,
a definite risk factor for developing full-blown diabetes mellitus in
susceptible people" to clarify the diabetes issue a little more. Also,
you may want to mention that psychosis often gets attention via
positive symptoms, and when treated with antipsychotics, can complicate
the diagnosis, due to the similarity of some side-effects of various
meds (in a fair number of patients) to the negative symptoms of schiz.

The last two sentences of the discussion have potential to be more
precisely worded; at the minimum, I'd remove the word "so". If I was
going to open the door to the idea of "improvements being found" I'd
probably want to cite an example or two, but that's just my own
opinion, for what it might be worth to you. Also, "as we'll see
below" has a somewhat odd sound to it - if your discussion/logic is
clear, obviously the reader will "see", so it seems a bit superfluous
at least, and possibly might be perceived as lofty or even
condescending by certain elements. Again, just my opinion. I
certainly do wish you success with your book.

Gary

LostBoyinNC

2005-11-24, 10:56 am

Nom dePlume wrote:
> Because I am not psychotic. Why would you suggest that someone who is
> not psychotic take antipsychotic medication? You object to the concept
> I've mentioned that dopamine agonists may have a useful role to play
> in *some* cases of depression that do not respond to serotonergic
> medications (a suggestion that came from a researcher in
> psychopharmacology, not from me), and yet you are casually suggesting
> that someone who is not psychotic take an antipsychotic medication and
> risk EPS, tardive dyskinesia, and diabetes. Yet you constantly remind
> us that you know far more about psychotropic medications than everyone
> else here. It doesn't show.
>
> --
> Nom dePlume, Ph.D.
> Why, yes, in fact, I am a rocket scientist.
>
> Guide to Medications for Mental Illness:
> http://www.geocities.com/nomdeplume1000/
>
> =====
>
>

Most of the info in your article came from things I had been describing
on here for the past several months dude. Such as the fact that
atypicals target the meso-limbic pathway more than the other dopamine
pathways. You infringed on my copyrights man.

Eric

Nom dePlume

2005-11-24, 12:53 pm

Good comments, Gary. Thanks.

--
Nom dePlume, Ph.D.
Why, yes, in fact, I am a rocket scientist.

Guide to Medications for Mental Illness:
http://www.geocities.com/nomdeplume1000/

=====

<nef5ht2a@yahoo.com> wrote in message
news:1132823269.948639.283660@f14g2000cwb.googlegroups.com...
> I thought it was a good discussion overall. You might want to
consider
> citing the relationship between Zyprexa/etc. and "insulin
resistance,
> a definite risk factor for developing full-blown diabetes mellitus
in
> susceptible people" to clarify the diabetes issue a little more.
Also,
> you may want to mention that psychosis often gets attention via
> positive symptoms, and when treated with antipsychotics, can
complicate
> the diagnosis, due to the similarity of some side-effects of various
> meds (in a fair number of patients) to the negative symptoms of
schiz.
>
> The last two sentences of the discussion have potential to be more
> precisely worded; at the minimum, I'd remove the word "so". If I
was
> going to open the door to the idea of "improvements being found" I'd
> probably want to cite an example or two, but that's just my own
> opinion, for what it might be worth to you. Also, "as we'll see
> below" has a somewhat odd sound to it - if your discussion/logic is
> clear, obviously the reader will "see", so it seems a bit
superfluous
> at least, and possibly might be perceived as lofty or even
> condescending by certain elements. Again, just my opinion. I
> certainly do wish you success with your book.
>
> Gary
>

Nom dePlume

2005-11-24, 12:53 pm

"LostBoyinNC" <Deepsand562@aol.com> wrote in message
news:1132837567.447167.154340@g14g2000cwa.googlegroups.com...

> You infringed on my copyrights man.

You have got to be joking.
--
Nom dePlume, Ph.D.
Why, yes, in fact, I am a rocket scientist.

Guide to Medications for Mental Illness:
http://www.geocities.com/nomdeplume1000/

=====

Some Heads Are Gonna Roll

2005-11-24, 5:55 pm

Nom dePlume wrote:
> "LostBoyinNC" <Deepsand562@aol.com> wrote in message
> news:1132837567.447167.154340@g14g2000cwa.googlegroups.com...
>
>
> You have got to be joking.
> --
> Nom dePlume, Ph.D.
> Why, yes, in fact, I am a rocket scientist.
>

It was a joke, dumbass. Goddamn you are a stuffed shirt. Do you even
have a sense of humor?

Eric

Nom dePlume

2005-11-24, 5:55 pm

"Some Heads Are Gonna Roll" <Deepsand562@aol.com> wrote in message
news:1132863087.287923.67400@g44g2000cwa.googlegroups.com...
>
> Nom dePlume wrote:
[vbcol=seagreen]
>
> It was a joke,

It can be hard to tell with you. Your sense of reality is sufficiently
skewed that you say ridiculous things that you didn't meant to be
funny, and things you mean to be funny that are dumb or just plain
offensive. If you want people to know you are telling a joke
(especially in a text-only medium like the newsgroups), put a smiley
in. Otherwise, expect to be misunderstood.

> dumbass.

Looking in the mirror again, are you?

> Goddamn you are a stuffed shirt. Do you even
> have a sense of humor?

I do. I just don't find you the least bit funny. Other things, yes,
but never funny.

--
Nom dePlume, Ph.D.
Why, yes, in fact, I am a rocket scientist.

Guide to Medications for Mental Illness:
http://www.geocities.com/nomdeplume1000/

=====

Steve

2005-11-24, 5:55 pm

"Nom dePlume" <nomdeplume1000-at-yahoo.com> wrote in message
news:dm4ud701vcg@news3.newsguy.com...
> "LostBoyinNC" <Deepsand562@aol.com> wrote in message
> news:1132837567.447167.154340@g14g2000cwa.googlegroups.com...
>
>
> You have got to be joking.
>

No, I think he is quite serious...
Copyright infringer!

Some Heads Are Gonna Roll

2005-11-25, 1:03 am

Nom dePlume wrote:
> Because I am not psychotic. Why would you suggest that someone who is
> not psychotic take antipsychotic medication?

It is debatable whether or not you are psychotic, nom.

You object to the concept
> I've mentioned that dopamine agonists may have a useful role to play
> in *some* cases of depression that do not respond to serotonergic
> medications (a suggestion that came from a researcher in
> psychopharmacology, not from me),

thats not what I said dude. I told you that it is practically unheard
of for a depressive to placed on ONLY a dopamine agonist for
depression. Sure, I have heard of augmenting an antidepressant with a
dopamine agonist plenty of times before you came here. I have tried
that combination myself several times. However I have NEVER read nor
heard anyone using a dopamine agonist BY ITSELF as you have in the past
suggested for major depression.

Do you understand that?

and yet you are casually suggesting
> that someone who is not psychotic take an antipsychotic medication and
> risk EPS, tardive dyskinesia, and diabetes. Yet you constantly remind
> us that you know far more about psychotropic medications than everyone
> else here. It doesn't show.

anti-psychotics are used for people who are not psychotic all the time
nom. Atypical APs are used for simple anxiety, as sleeping pills, for
"rumination" and for obsessive thinking. They are also used for
dementia off label.

In your case I think you could benefit from one for obsessed thinking
towards psychiatric drugs and your weird little obsession with dopamine
agonists. You write up a little usenet booklet like you are some formal
psychopharmacology doctor...strange.

You are a strange guy nom.

Eric

Some Heads Are Gonna Roll

2005-11-25, 1:03 am

Nom dePlume wrote:
> "Some Heads Are Gonna Roll" <Deepsand562@aol.com> wrote in message
> news:1132863087.287923.67400@g44g2000cwa.googlegroups.com...
>
>
> It can be hard to tell with you. Your sense of reality is sufficiently
> skewed that you say ridiculous things that you didn't meant to be
> funny, and things you mean to be funny that are dumb or just plain
> offensive. If you want people to know you are telling a joke
> (especially in a text-only medium like the newsgroups), put a smiley
> in. Otherwise, expect to be misunderstood.

Or it could be you are just an uptight XXXXXXX who doesnt have a warped
sense of humor like I do. You honestly believe I would be serious when
I say "you are infringing on my copyrights man?"

I think it is you who has the problem with having a skewed sense of
reality dude. The fact you couldnt tell I was being a total smartass
towards you is evidence of distorted perception. Others on here can
usually tell when I am being stupid or smartass but you dont seem to be
able to tell...you come over as soooooooooo serious.

Like a "Mr. Spock" from Star Trek. "That is not logical." Thats how you
come across online dude.

>
>
> Looking in the mirror again, are you?
>
>
> I do. I just don't find you the least bit funny. Other things, yes,
> but never funny.

You sound irritable man, perhaps it is time to go back on that
depakote?

Eric

Larry Hoover

2005-11-25, 1:03 am

"Some Heads Are Gonna Roll" <Deepsand562@aol.com> wrote in message
news:1132881295.447893.44450@f14g2000cwb.googlegroups.com...
>
> Or it could be you are just an uptight XXXXXXX who doesnt have a warped
> sense of humor like I do. You honestly believe I would be serious when
> I say "you are infringing on my copyrights man?"

Or it could be because you're a petty little bigot wannabe who couldn't stand to see
that someone could actually write a decent article, and you wanted to steal some of
his thunder.

Steve

2005-11-25, 1:03 am

"Some Heads Are Gonna Roll" <Deepsand562@aol.com> wrote in message
news:1132882412.318285.40230@g43g2000cwa.googlegroups.com...
>
> Nom dePlume wrote:
>
>
> It is debatable whether or not you are psychotic, nom.

Are you providing net DX, Eric?

http://www.ncleg.net/enactedlegisla...0/gs_90-18.html

>
> You object to the concept
>
> thats not what I said dude. I told you that it is practically unheard
> of for a depressive to placed on ONLY a dopamine agonist for
> depression.

Where does your knowledge of psychaitric practice come from?

http://www.ncleg.net/enactedlegisla...0/gs_90-18.html

Sure, I have heard of augmenting an antidepressant with a
> dopamine agonist plenty of times before you came here. I have tried
> that combination myself several times. However I have NEVER read nor
> heard anyone using a dopamine agonist BY ITSELF as you have in the past
> suggested for major depression.

Again, since you are neither an expert, nor trained in psychiatric
techniques how can anyone ascribe any weight you your claims, Eric?

>
> Do you understand that?
>
> and yet you are casually suggesting
>
> anti-psychotics are used for people who are not psychotic all the time
> nom. Atypical APs are used for simple anxiety, as sleeping pills, for
> "rumination" and for obsessive thinking. They are also used for
> dementia off label.
>
> In your case I think you could benefit from one for obsessed thinking
> towards psychiatric drugs and your weird little obsession with dopamine
> agonists.

Soa re you saying that Nom needs psychiatric meds, Eric?

Should I drop a dime on you?
http://www.ncleg.net/enactedlegisla...0/gs_90-18.html

You write up a little usenet booklet like you are some formal
> psychopharmacology doctor...strange.
>
> You are a strange guy nom.
>
>
> Eric
>

You will be in prison soon if you keep this up, Eric.

Steve

2005-11-25, 1:03 am

"Some Heads Are Gonna Roll" <Deepsand562@aol.com> wrote in message
news:1132881295.447893.44450@f14g2000cwb.googlegroups.com...
>
> Nom dePlume wrote:
>
> Or it could be you are just an uptight XXXXXXX who doesnt have a warped
> sense of humor like I do.

For those who have come to this discussion lately do a google on lostboyinnc
and warped sense of humor.

It's one of Eric's main defense mechinisims when he is in a corner.

Most 8 year olds learn this does not work. Alas poor Eric is still about 8
in many ways.

You honestly believe I would be serious when
> I say "you are infringing on my copyrights man?"
>
> I think it is you who has the problem with having a skewed sense of
> reality dude. The fact you couldnt tell I was being a total smartass
> towards you is evidence of distorted perception. Others on here can
> usually tell when I am being stupid or smartass but you dont seem to be
> able to tell...you come over as soooooooooo serious.
>
> Like a "Mr. Spock" from Star Trek. "That is not logical." Thats how you
> come across online dude.
>
>
> You sound irritable man, perhaps it is time to go back on that
> depakote?

http://www.ncleg.net/enactedlegisla...0/gs_90-18.html

Eric keeps asking to go to jail. Seems like he is tired of freedom.

Nom dePlume

2005-11-25, 10:56 am

"Steve" <someone@microsoft.com> wrote in message
news:saqdnb-_CqFI0hveRVn-qQ@comcast.com...
>
> "Nom dePlume" <nomdeplume1000-at-yahoo.com> wrote in message
> news:dm4ud701vcg@news3.newsguy.com...
>
> No, I think he is quite serious...
> Copyright infringer!

I am just *so* bad, I can't stand it!
--
Nom dePlume, Ph.D.
Why, yes, in fact, I am a rocket scientist.

Guide to Medications for Mental Illness:
http://www.geocities.com/nomdeplume1000/

=====

Nom dePlume

2005-11-25, 10:56 am

"Steve" <someone@microsoft.com> wrote in message
news:HcCdnX23kKRxAhvenZ2dnUVZ_sydnZ2d@comcast.com...
>
> "Some Heads Are Gonna Roll" <Deepsand562@aol.com> wrote in message
> news:1132882412.318285.40230@g43g2000cwa.googlegroups.com...
who is[vbcol=seagreen]
>
> Are you providing net DX, Eric?

Looks that way, doesn't it?

> Again, since you are neither an expert, nor trained in psychiatric
> techniques how can anyone ascribe any weight you your claims, Eric?

Because he told us he was an expert?

thinking[vbcol=seagreen]
dopamine[vbcol=seagreen]
>
> Soa re you saying that Nom needs psychiatric meds, Eric?

For about the tenth time or so. (Maybe more. I haven't been counting.)
Eric is very free with his medical advice, and his diagnostic
expertise. He is convinced that I have bipolar disorder, when he isn't
diagnosing me with psychosis. He is also convinced that I am Jewish (a
belief that I will neither confirm nor deny), and the strange thing is
that this matters to him. Finally, he is convinced that FDA approval
is required for a drug to be good for a particular purpose, except
when he is the one recommending off-label uses.

It would be difficult for me to express the amount of gratitude I feel
for Eric's diagnostic wizardry and psychological insight, mostly
because there is no attractive way to write scientific notation in a
text-only display.

Eric says:[vbcol=seagreen]

Those who can, do. Those who can't, criticize.

--
Nom dePlume, Ph.D.
Why, yes, in fact, I am a rocket scientist.

Guide to Medications for Mental Illness:
http://www.geocities.com/nomdeplume1000/

=====

Nom dePlume

2005-11-25, 10:56 am

"Some Heads Are Gonna Roll" <Deepsand562@aol.com> wrote in message
news:1132882412.318285.40230@g43g2000cwa.googlegroups.com...
>
> Nom dePlume wrote:
is[vbcol=seagreen]
>
> It is debatable whether or not you are psychotic, nom.

Only in the sense that any clearly-erroneous hypothesis (such as the
Earth being flat) is debatable.

> You write up a little usenet booklet like you are some formal
> psychopharmacology doctor...strange.

Those who can, do. Those who can't, criticize.

> You are a strange guy nom.

The only true thing you've said about me here. To you, I would indeed
be strange, but that says more about you than it does about me.
--
Nom dePlume, Ph.D.
Why, yes, in fact, I am a rocket scientist.

Guide to Medications for Mental Illness:
http://www.geocities.com/nomdeplume1000/

=====

Dave

2005-11-25, 10:56 am

Dave

2005-11-25, 5:55 pm

Nom dePlume wrote:

> We've had enough discussion about antipsychotic medications in this
> group that I thought people might be interested to know how they work.
> I've written a brief essay on the subject, which should eventually
> evolve into a new chapter for my book. I'm interested in any feedback
> people might have.
>
> And here it is!
>
> How Antipsychotic Medications Work
> by Nom dePlume
>
> Psychosis
> =========
> "Psychosis" is a term that describes a set of symptoms, which may be
> found in conjunction with a variety of illnesses, schizophrenia being
> only the most familiar. The symptoms of psychosis are divided into two
> categories: "positive symptoms" (which represent an excess of normal
> function, or symptoms which occur in addition to normal function), and
> "negative symptoms" (which represent a decrease in normal function).
> In the case of psychosis, the positive symptoms garner the most
> attention, but the negative symptoms are also crippling and
> distressing to the afflicted.

Example rewording of first paragraph:

Psychosis is a mental state comprised of symptoms that can be classified
as either positive or negative. Positive and negative symptoms can be
described in terms of their relationship to the continuum of normal
human behavior, each representing an extreme at opposite ends. Most
people are more familiar with the positive symptoms.

Your editor will tear it apart further (that's their job).

Nom dePlume

2005-11-25, 5:55 pm

"Dave" <askme@example.com> wrote in message
news:OpKdnagEObHg9xreRVn-tw@rcn.net...
>
> Example rewording of first paragraph:
>
> Psychosis is a mental state comprised of symptoms that can be
classified
> as either positive or negative. Positive and negative symptoms can
be
> described in terms of their relationship to the continuum of normal
> human behavior, each representing an extreme at opposite ends. Most
> people are more familiar with the positive symptoms.
>
> Your editor will tear it apart further (that's their job).

Thanks for the feedback, Dave. I appreciate it.
NdP
--
Nom dePlume, Ph.D.
Why, yes, in fact, I am a rocket scientist.

Guide to Medications for Mental Illness:
http://www.geocities.com/nomdeplume1000/

=====

Nom dePlume

2005-11-25, 5:55 pm

"Dave" <askme@example.com> wrote in message
news:WoadnUE8noDMUxveRVn-ig@rcn.net...
> Nom dePlume wrote:
>
this[vbcol=seagreen]
work.[vbcol=seagreen]
feedback[vbcol=seagreen]
>
> I have a funny mental image of someone asking his librarian for book
> under the author name "nom de plume". That would surely garner some
stares.

It would be entertaining, wouldn't it?

--
Nom dePlume, Ph.D.
Why, yes, in fact, I am a rocket scientist.

Guide to Medications for Mental Illness:
http://www.geocities.com/nomdeplume1000/

=====

Dave

2005-11-25, 5:55 pm

Some Heads Are Gonna Roll wrote:

> anti-psychotics are used for people who are not psychotic all the time
> nom.

> Atypical APs are used for simple anxiety, as sleeping pills, for
> "rumination" and for obsessive thinking. They are also used for
> dementia off label.

There's an alarming number of shrinks who have a fetish for low-dose
neuroleptics, but that doesn't mean their use is necessarily a good idea.

What is "obsessive thinking", and why would one want to medicate it with
antipsychotics? This is a serious question. And why would a dopamine
antagonist be preferred to an agonist? Toxic doses of the latter have
been shown to produce stereotypical behaviors in animals, but how is
that related to thought patterns in humans?

Obsession is a ubiquitous part of normal human behavior. Some drugs
that stimulate dopamine either directly (i.e., agonists) or indirectly
(e.g., stimulants, selegiline) increase human performance on
psychometric tests. Antipsychotics (atypical or otherwise) OTOH, have a
the tendency to make one as stoopid as a vegetable. Thus, it would seem
that except in the most severe cases, one might be better dealing with
obsessions through means other than antipsychotics. There is already
much too little thinking of *any* kind in our society.

I have also yet to find any consistency in the way that "obsession" is
defined in psychiatric medicine. It seems that many people describe
their excessive worrying (e.g., "what if ...?") as obsessive thinking.
If that's the case, then what is GAD? Not even the researchers seem to
agree on the distinctions. Some have attempted to retroactively
distinguish the terms by comparing results from their respectively
defined sample groups of neuroimaging studies (doh!).

The acronymical soup of psychiatric diagnoses seems to confound our
understanding of behavior more than improve it.