February 2013 - Page 3 of 3 - Ashley F. Miller

Alternately titled: Yes, but isn’t EVERYBODY kinda mentally ill? What is mental illness anyways? Aren’t we just pathologizing being weird?! BUT SO MANY PEOPLE SEEM TO BE MENTALLY ILL NOW!

If you talk about mental health and mental illness long enough someone is going to pull one of these.

You know, aren’t we all just different?

It seems like everyone has a mental illness.

I mean, like, isn’t everyone sad/anxious/depressed/a little obsessive-compulsive?

Yes, but mental illness is just a social construct! We just decide what behaviors we don’t like and those are the ones we treat!

I mean, it’s all just a bell curve!

I’ve always imagined myself shouting BECAUSE REASONS!!11!1, and then promptly brandishing a list at the offending questioner. This post is the internet equivalent to that word waving. Beware of snark.

1) The ‘Useful Heuristic’ Explanation

We, as humans, categorize things, then use shortcuts to understand what’s going on in our world. These can break down and aren’t always helpful (see every racist, sexist, heterosexist stereotype ever) but they do save cognitive time and space and increase processing speed. “Having X mental illness” or even “having a mental illness” is a useful heuristic that conveys specific information. I don’t have to tell you that I am statistically more likely to find food anxiety-provoking, while also having significant distorted bodily perception, obsessive behaviors related to food and drink consumption and discussion of the aforementioned–I can just tell you (or anyone else) that I have an eating disorder.

2) The ‘Special Snowflake’ Explanation

The experiences of those with mental illness are quantifiably different from those without mental illness. In fact, when people respond with “Oh, I get/understand/could imagine [whatever aspect of mental illness I was talking about].” I’m actually faintly uncomfortable. Because no you don’t.

By attempting to cheerfully shoehorn the experiences of the mentally ill into your Just Like Me box, you’re actually ignoring their experience–and also refusing to acknowledge that the ways in which they inhabit the world are fundamentally different from yours. You don’t understand it, and you can’t, and that’s fine. The solution is to get used to it, not to pretend you’re the same people with slightly different idiosyncracies. Mental illness not having a membership to a Special Club for the Quirky. It’s overwhelming, distressing, and the vast, vast majority of people with it spend their time wanting it to go away, now.

And for heaven’s sake, mental illness is not a cute little talent like juggling geese, rearing its head when convenient.

3) Dammit, It’s Hard to Do Research Without Diagnoses

Without some way of quantifying the clusters of symptoms that make up different mental illnesses, we’d have extraordinarily poor research. The anxiety surrounding food in anorexia is different from the anxiety of a phobia or the anxiety of PTSD. The You’re Ostracizing People Who Are Just Different crowd usually fail to consider that research lies almost entirely in developing and learning from divisions of differentness.

4) The Medical Model has Some Uses.

Before I have a riot on my hands, this is not me throwing my support to the medical model of mental illness. (Medical model redux: Diagnose via a checking boxes on a list of symptoms, find appropriate fix.) I don’t particularly like it for any sort of understanding about actual illnesses. Go biopsychosocial!

But the model is useful for explaining why being neurodivergent is not the same as being neurotypical. By equating mental illness to physical illness, (Another note: I’m not endorsing mind-body dualism here either–or the excessive use of parenthetical notes.) we’ve benefitted greatly. You can say “someone with cancer has physical differences from someone without cancer!” and then substitute ‘depression’ for ‘cancer’, and people wil get it. Not only that, but they’ll understand why treatment is a necessity, why it should be covered under insurance, and why people with depression alter their lives around it. Pretty sure no claims office shelled out for “being a different kind of normal”.

So.
[Dusts off hands.]
Mental illness is A Thing.

Weekly series! As per previous discussion, I will be publishing a big information blog on each Friday. Unfortunately, it’s midterms for me, which means a shorter post for you. Blame the paper(s) and exams and readings and stuff. I promise to be back on schedule next week. Also, I’ve commissioned a post on bulimia from Tetyana, who runs the spectacular Science of Eating Disorders blog, a skeptical look at research on ED’s.

Anyways, today we look at the types of antidepressants.

Selective Serotonin Reuptake Inhibitors (SSRI’s)

[Note to neurobiologists: I am simplifying massively here. I know that.]

These are the most popular medications for depression, and include a bunch of names you probably recognize: Zoloft, Prozac, Paxil, Celexa, Lexapro.

How do they work?

Neurons don’t connect directly to each other–they have a very tiny space (the synaptic cleft) between each end of one and beginning of the next. Neurotransmitters (like serotonin, dopamine, GABA, etc) are released from the presynaptic neuron, and partially absorbed by the postsynaptic neuron. The neurotransmitter that isn’t absorbed is mainly taken back by the presynaptic neuron. SSRI’s work by blocking the reuptake mechanism for serotonin, leaving more available serotonin in the brain, which seems to relieve depression in some people.

But, this is grossly oversimplified, and depression is not as basic as not having enough serotonin. In the words of Ozy, brain chemicals are not fucking magic.

Side effects of SSRI’s can include lack of sex drive, hyperactivity or lowered energy, etc. In some, these are so life-disrupting that other medications are preferred.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRI’s)

SNRI’s include Cymbalta, Effexor, and Pristiq. They work very much like SSRI’s, except they inhibit both the reuptake mechanism for norepinephrine and serotonin.

The effectiveness of SSRI’s lends support to the Monoamine Hypothesis–an incomplete explanation for depression, suggesting that several neurotransmitter systems (including serotonergic) are responsible. The hypothesis does hold up to scrutiny, but doesn’t explain why many antidepressants also help with anxiety and obsessive-type disorders.

Tricyclic Antidepressants

Color me happy to have done my research before publishing–turns out I didn’t have all of my facts straight. Tricyclics are antidepressants that operate somewhat like SSRI’s by inhibiting the reuptake of serotonin–but they also have a laundry list of possible side effects, and, like MAOI’s, are used more and more rarely.

Monoamine Oxidase Inhibitors (MAOI’s)

MAOI’s can be super effective! However, they come with hefty diet restrictions, and resultingly, are used rarely–mostly as a last resort.

People taking MAOI’s need to avoid all sorts of things, like pickled foods, most cheeses, wine, decongestants, and SSRI’s. Failure to do so can cause a stroke–the result of buildup of tyramine in the brain. Since other antidepressants are available, MAOI’s have fallen out of favor.

Norepinephrine and dopamine reuptake inhibitors (NDRIs)

Wellbutrin! NDRI’s are good because they usually don’t have the sexual side effects. They too, lend support to the Monoamine Hypothesis, by altering the dopaminergic and norandronergic pathways.

St. Johns Wort

Okay. This is alt-med, but it’s been gaining mainstream popularity. It’s one of those that might work on mild to moderate depression. And if taken without doctor supervision and with other medications it can cause you all sorts of problems. In combination with SNRI’s, it can cause Serotonin Syndrome–an excess of the neurotransmitter which overloads the central nervous system. It also appears to decrease the effectiveness of oral contraceptives, might cause problems if you’re breast-feeding, and oh, right, as an herbal supplement, isn’t all that regulated. What I’m saying is, self-prescribing this stuff is not a great idea, and right now, there’s not evidence that it works for major depression. But some people do use it, so I’ll include it.

Ashley F. Miller

Month: February 2013

Abusing ‘Normal’

Psychopathology Sum-Up: Types of Antidepressants