Everyday Psychopharmacology

Friday, March 27th, 2009

Dennis Mangan shares some everyday psychopharmacology from Bruce Charlton’s paper:

For neuroticism, Charlton proposes the use of diphenhydramine (Benadryl), chlorpheniramine (various cough suppressants), and St. John’s wort, all available over the counter. It turns out that the SSRI class of antidepressants — Prozac and the like — were developed from antihistamines after it was noticed that the latter had an inhibiting effect on serotonin re-uptake.

For a state typified by “malaise”, Charlton suggests tricyclic antidepressants — these are prescription only — and NSAIDs such as aspirin or acetaminophen. Interestingly, the TCAs have potent analgesic effects, which Charlton suggests are the true cause of their antidepressant action; Charlton’s hypothesis of depression is that it is a condition in which the brain senses the body’s malaise. As for aspirin and the like, these drugs can cause increased intestinal permeability (“leaky gut”), which has recently been shown to be a factor in depression and chronic fatigue; increased translocation of bacterial antigens from the intestine contributing to or causing the inflammation characteristic of these illnesses. So there’s my contribution to this debate: personally I would be wary of NSAIDs for this purpose. Acetaminophen also causes a depletion of glutathione, which in fact is the cause of liver damage in cases of overdose (the antidote used is n-acetylcysteine); glutathione depletion has been shown to be common in patients with chronic fatigue, another reason to be wary of this drug.

For “demotivated depression”, Charlton suggests, absent the more powerful prescription-only energizers like methylphenidate (Ritalin) and amphetamines, the old standbys caffeine and nicotine. In an epidemiological study, two to three cups of coffee daily reduced the risk of suicide by about two-thirds, which would seem to make it a powerful antidepressant. Nicotine, when used in a form that does not involve smoking, is probably about as safe as caffeine. “Nicotine does not cause cancer, heart attacks or emphysema.”

For seasonal affective disorder (SAD), light therapy is the treatment of choice and easily implemented by the patient.

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