Thursday, December 31, 2020

Problematic Psychiatric Diagnosis

 As both a psychiatrist and a patient, I know how slippery a diagnosis can be


At the outset I must make this perfectly clear. Psychiatric disorders exist, have as yet an undiscovered physical substrate which may have a genetic and environmental components, typically a result of the gene and environmental interaction. Psychiatric drugs have made huge improvements to society and individuals. My focus on this post is where psychiatry and psychology needs to change. 

 The controversies surrounding psychiatric diagnosis are decades old. Thomas Szasz is the seminal figure on the issue and his work, "The Myth of Mental Illness"(1961), began a debate that continues today. Today the problem is worse. The above article is another example of how psychiatry as a profession and our culture needs to seriously reevaluate how psychiatric diagnoses are made and how psychiatric conditions are treated. 

Wednesday, December 30, 2020

Evolution is Depressing.

 

New Antidepressants Can Lift Depression and Suicidal Thoughts Fast, but Don’t Expect Magic Cures


Ketamine is an NMDA antagonist. I've long had concerns about using it for depression treatment because the NMDA receptors play a cardinal role in activating the CREB pathway which in turns is important for synaptic consolidation. So the long term use of ketamine, which will be required because the effect only lasts a few days, raises troubling questions about synaptic density.