Friday, 24 February 2012

Serotonin and Original Sin

I sing and play bass in a band called All Possible Humans, with this line up we have now done only two shows, the second of which I took 20 mg of cipralex the day before and the actual day of the gig.  After the first one I went into a deep depression that persisted for at least week afterwards, but the second one last Thursday has left me craving more of are unique blend electric rockabilly.  So why not just take cipralex every day you ask?

You can have my brain Lundbeck but you can’t have my dick!

One of my favorite books of all time is Dr. Peter Kramer’s Listening To Prozac, which I read while taking the drug for the first time – and the synergy between reading about and swallowing fluoxetine hydrochloride proved exhilarating.  Dr. Kramer has an undergraduate degree in comparative literature and even correctly diagnosed epilepsy in a patient based on her affinity for an epileptic poet.  He argues that Prozac increases hedonic capacity, affect tolerance and mental agility while reducing depressive/anxious thoughts and feelings.  Germane to psychedelic therapy he argued in 1993 that the nature-nurture debate had strayed too far towards nature.

Epilepsy is a kindled disease, which means it takes less and less stress to induce seizure due to a reverse tolerance.  Kramer made the argument that depression was similar, which it likely is, as less and less stress is needed to trigger an episode.  However the implication is that taking antidepressants will prevent this sensitization – unfortunately this does not appear to be the case.

A paper published in the journal Frontiers in Evolutionary Psychology in July 2011 – - puts that claim into question.  Dr. Andrews et al looked at the long-term outcomes of people who received active vs. placebo antidepressants and while those receiving placebo had a relapse rate of 25% while those receiving antidepressants relapsed 42%.   The authors argue that the antidepressants elevate serotonin, noradrenaline and dopamine alone or in combination so that when the drug is discontinued due to a “negative feedback loop” the brain ends up with lower neurotransmitter level and therefore even greater vulnerability to stress.  This is sometimes called “tardive dysphoria”

While some people have called into question the effectiveness of antidepressants because they only beat placebo by a small margin in most studies – this is likely really due to the mild nature of the depression in many subjects – “a brisk walk at dusk, sit-ups or a fruit cup” were all suggestions by the late Comedian Bill Hicks as mood improvers that may work too in these marginally depressed individuals. 

Personally I have taken antidepressants off and on since 1993 and I find the placebo argument absurd – these drugs affect the neurotransmitters involved with mood.  The problem is they tend not to sustain their effects, which has resulted in higher doses or more drugs being added – which may work for a while but not in the long run. 

Imagine the choice between fixing the diabetic’s pancreas versus supplementing it with cow insulin.  As infamous Yoga guru Bikram Choudry described it “if you take a drug the body goes to sleep.”  

Keep in mind this coming from a man who uses alcohol, caffeine and cannabis almost every day with a week break every three months.  But I’m not alone 80% use at least one psychoactive drug every day and another 15% use one at least once a month, 4% less than that but less than 1% of the population is completely drug free.  (statistics estimated based on a random survey of a touring a funk band)

But surely part of that reason for this regular psychoactive consumption could be that inferring with a brain chemical long enough causes a long-term change in that system – an allostatic load – indefinitely impeding its ability to return to homeostasis.  But then one researcher noted that if you added the energy of a pack of sugar over a year to an animal in nature the evolutionary advantage would be significant, therefore he argued humans and some other animals supplement their natural neurotransmitters with external psychoactive which has become as universal as masturbation in modern society.

Whatever broad evolutionary purpose psychoactives serve one the toothpaste is out of the tube, the camels nose under the tent, the thin edge of the wedge entered and the horse leaves the barn there is no turning back.  As surrealist writer Franz Kafka observed, “each level of liberation brings a greater level of slavery.”