Aswad
Posts: 9374
Joined: 4/4/2007
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quote:
ORIGINAL: subfever
Generally speaking, prescription drugs treat symptoms, not causes. Stop taking the drug, and the symptoms return.
The medical community wants to prescribe either drugs or surgery as treatment.
There's not nearly as much profit to be made in cures.
There's definitely a core of truth to this.
People want simple solutions, and that is catered to.
Companies want steady revenue, and that is emphasized.
That said, it is an oversimplification to say symptoms return, as such.
Stop taking penicillin before the bacteria are dead, and the symptoms return.
You can analyze most mental illnesses in terms of three components: biology, psychology and environment.
Each of these components can be a cause, and each can act as a feedback loop to sustain the illness, effectively completing a downward spiral. All successful treatment consists of altering one or more of these components, or altering one or more of the feedback loops they entail. As regulatory mechanisms in the human body and psyche tend to follow a hysteretic sigmoid function, there is a range where these things are variant normal, and two ranges where they have "locked up" and do not respond in the usual ways.
When the configuration of this triangle allows, spontaneous remission is common, but can take a great deal of time in some instances. Typically, though, people have a good configuration that just becomes slightly offset by some life event, and they end up with a recovery in the course of a few months to a couple of years. This means typical first-line drugs are hard to measure, efficacy-wise, as those are so inefficient as to make this kind of spontaneous remission a significant factor. That, and the placebo response itself can be enough to temporarily overcome the conservation of energy response and boost the psychology to the point where these factors allow a person to repair the damage.
Treating by changing environment requires lifestyle changes, societal changes or aid.
Lifestyle changes are met with resistance from the patient, and if the illness is severe, it is unfeasable to make large changes in a short span of time without inpatient care. Small changes accumulate over time, however, which is one of the pillars of Cognitive Behavioural Therapy (CBT, amusingly enough), the only therapy shown to be generally effective across a wide range of illnesses, when compared to an untrained but sympathetic listener.
Societal changes are met with resistance from society, as they do not wish to change to help someone else. Similarly, aid tends to be met with resistance, as such aid is usually a limited quantity in the person's remaining social network by the time things have reached a clinical level, meaning it needs to be supplied externally. That often deadlocks against financial issues, which are part of the environmental component.
Treating by changing psychology requires therapy and time.
Few forms of therapy directed at this can demonstrate long-term success when the illness has reached a clinical level, but some can, like CBT. Applying the latter takes time and effort which may not be available, since the factors in the triangle interlock. Being ill for a long time adversely affects your environment (especially finances and social relations), along with your biology (the evolutionary conservation of resources responses and progressively worsening dietary influences). Hence, only the stable conditions are viable to treat in this way, most of the time. And even that is something which after all tends to require an expensive therapist over a lot of time, a negative influence in itself.
Treating by changing biology requires skill, money and a bit of time.
Doctors who think all depressions are the same, or that antidepressants are like antiinflammatory agents, are usually a lottery. No more, no less. Any honest expert in the field will tell you as much. However, those who know a bit about matching the right kind of drugs (or ECT or supplements or whatever) with the symptoms a patient is exhibiting, and how to go about interpreting patient feedback, can have a great deal of success. An expert can make lasting, life-changing improvements in a short amount of time. This is the skill factor.
Time is always relevant, of course, especially since it influences the other parts of the triangle (most prominently finances), and depending on the nature of the biological intervention, the time before improvement begins can vary from hours to years. Typical first-line treatments tend to require weeks to two years, and 2-3 different drug trials, if the illness is of clinical severity. Expert first-line treatments usually take a week to a few months, on average.
Money figures in, as most people cannot afford the drugs that act quickly, or the expert care required to use those properly. Parnate (trans-2-cyclopropyl-phenethylamine), for instance, costs USD 200 for 5000mg, purchased in bulk from a chemical supplier. This is enough for anywhere from a year to three weeks, depending on the dose you need. I tried the usual maximum dose of 2.4mg/kg/day, which at the time equated to 200mg. A local pharmacy delivered that at a subsidized cost of about USD 40 per day. Usually, this dose yields a response as rapidly as ECT does, and as effectively, but with more short-term side effects and no long-term side effects. Dietary restrictions are needed, though, and the doctor must have the skill to handle interactions.
In any case, the optimal treatment is to work all three components of the "illness triangle".
But few people are positioned so that they can get such treatment.
That leaves us with a lot of people not getting a cure.
Whether those who don't need treatment still get it, isn't much of a concern for me.
Yes, it's pointless, and it doesn't really do them any good.
But they end up subsidizing those who do need it.
And that does a whole lot of good.
Now, if legal obstacles could be removed as well, so more people could receive dopaminergic interventions, we would end up saving society a significant number of billions every year, which could be spent on the lost War on Drugs to pacify those who feel that is a worthwhile way to spend it. Some estimates indicate it could even cover the war in Iraq, so it makes socioeconomic sense. Alas, the tragedy of the commons is ever the collective illness of certain societies, and ignorance the illness of all societies I know of.
_____________________________
"If God saw what any of us did that night, he didn't seem to mind.
From then on I knew: God doesn't make the world this way.
We do." -- Rorschack, Watchmen.
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RE: medications... needed or a money spinner? - 
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