{"id":4639,"date":"2011-01-27T19:16:07","date_gmt":"2011-01-28T00:16:07","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=4639"},"modified":"2011-01-27T19:36:07","modified_gmt":"2011-01-28T00:36:07","slug":"nimhreceptalator","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/01\/27\/nimhreceptalator\/","title":{"rendered":"NIMH·receptalator<\/font>…"},"content":{"rendered":"\n

<\/p>\n

I realize as I’ve read through the Psychopharmacology literature recently and looked over the Clinical Trials scene that I am developing an unsettling view of people. Drawing it out on paper [above], it looks kind of simplistic. I probably could’ve added Lithium [Li] and anticonvulsants [DPK] to the input; put in a dial for trial type [Double Blind, Open Label, Crossover] and another for number of subjects; maybe added in a trial duration slider; even beefed up the range of output assessment scales. Then again, those could be enhancements for the NIMH·receptalator II<\/font><\/strong>. <\/p>\n

I even had a fantasied study – sort of a flow diagram. I’d start with a large bunch of depressed people [MDD][SCID->DSM IV] and put them on antidepressants [SSRI, SNRI, or TCA] giving the ones on SSRIs a Benzo [BDZ] to prevent akithisia. Then with the non-responders [HAM-D], I’d add an Atypical Antipsychotic [Second Generation Antipsychotic][SGA]. I’d treat the ones that developed Extrapyramidal Symptoms [EPS] with an Anticholinergic [ACH]. In the responders who developed weight gain or an abnormal glucose tolerance [GTT], I’d add on a Glucocorticoid antagonist [G2B]. Conceivably, I could have some single person with Norepinephrine, Dopamine, Serotonin, Acetyl Choline, Benzodiazapine, and Cortisol receptors all tweaked in one direction or another at the same time. Now that’s some treatment! <\/p>\n

Obviously, I’m being facetious with my NIMH·receptalator<\/font><\/strong>, but I’m trying to make a serious point. If you browse around in clinicaltrials.gov<\/font><\/strong><\/a> or the NIH RePORTER  <\/font><\/strong><\/a>looking at the studies in Psychiatry, a large portion of them fit into some version of my fantastic NIMH·receptalator<\/font><\/strong> machine – lets try this or that<\/em> end-plate neurotransmitter and\/or receptor altering chemical in this or that<\/em> condition and see what happens to this or that<\/em> scale. It’s a whole branch of science unto itself with its own supporting industry.<\/p>\n

I’m thinking we’re crossing to the far side of paradigm exhaustion with our neuronal end-plate theories. Much of what’s being done these days is looking for a better something-we-already-have<\/em>, mostly for marketing purposes. And I’m sorry, but the new-drug-that’s-better-than-the-old-drug<\/em> rarely pans out. The more they say "exciting," "emerging," "promising," the greater the disappointment. More often than not, the property of the drug that’s therapeutic is the same property that causes side effects so the race to ameliorate them is also  disappointing. Another way to say this is that we’re reaffirming the law of diminishing returns, and a lot of it is "tired science." There’s a high premium on new drugs, but our time and money would probably be better spent learning more about the ones we have now and how to use them until a new direction raises its head. A lot of the NIMH·receptalator<\/font><\/strong> research is just spinning our wheels. We’re running out of rainbow and I doubt there’s a pot of gold [or a silver bullet] at the end. Time for a paradigm shift…<\/div>\n","protected":false},"excerpt":{"rendered":"

I realize as I’ve read through the Psychopharmacology literature recently and looked over the Clinical Trials scene that I am developing an unsettling view of people. Drawing it out on paper [above], it looks kind of simplistic. I probably could’ve added Lithium [Li] and anticonvulsants [DPK] to the input; put in a dial for trial […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-4639","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/4639","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=4639"}],"version-history":[{"count":0,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/4639\/revisions"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=4639"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=4639"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=4639"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}