The Brain

2008 January 25

Before I get too far into other topics, I thought I would discuss the brain. This is what I know about the brain. It may be right. It may be wrong. It may be partially right. But this is my understanding as of today. At least anyone reading this will be on the same page with my understanding.

The brain is a huge mass of neurons. Neurons work by sending electrical signals from one end of them to the other. At either end of a neuron (at least, I think that neurons only have two ends–maybe they have more) is a gap between the neuron and one or more neighbors. This gap is called a synapse. To communicate with another neuron, a neuron will release one or more neurotransmitters. These are special chemicals that will fit into receptors on the adjacent neurons. The neurotransmitters that seem to matter most (at least to me) are serotonin, norepinephrine, and dopamine. It seems that a lack of serotonin has something to do with depression.

I have no idea what, exactly, norepinephrine and dopamine do, but I know that they are important. The current way of boosting serotonin (and norepinephrine) is through a mechanism called a re-uptake inhibitor. That is, when a neuron releases a neurotransmitter, the neurotransmitter traverses the synapse and attaches to the receptor of another neuron. However, the neurotransmitter cannot stay attached because, after all, that would prohibit other neurons from sending their own neurotransmitters. So after the receiving neuron has received the message, it releases (through magic) the neurotransmitter. Now, neurotransmitters are, apparently, complex and expensive to manufacture. The released neurotransmitter, therefore, is not just discarded, but, rather, re-absorbed by the neuron that originally released it. The neuron can then re-use it. Very efficient. A re-uptake inhibitor, however, interferes with how quickly the neuron re-absorbs, or re-uptakes, the neurotransmitter, so that the neurotransmitter stays in the synapse longer. The net effect is that if a neuron is not releasing enough of a given neurotransmitter, a single glob (a molecule, I guess) of the neurotransmitter has time to connect with more than one receptor, mimicking the effect of having more of the neurotransmitter material available at any one time. Clever, huh?

So, there is a class of drugs called Selective Serotonin Re-uptake Inhibitors (SSRI’s). There are called “Selective” because they selectively only inhibit the re-uptake of serotonin. Re-uptake of other neurotransmitters (like dopamine) is not affected by SSRI’s.

One of the first SSRI’s available in the United States was Fluoxetine Hydrochloride. I had a very brief, very unpleasant experience with this in 1990. Maybe some time I will tell you about it. (While we’re one the topic, I also was given some sort of antidepressants in the early 1970’s. My guess at this time is that they were tricyclic antidepressants. They didn’t do bupkis.) In January of 2000 I was given Citalopram by a real ass-hole of a psychiatrist (and, yes, to be an ass-hole by psychiatrist standards is quite a feat). Despite the fact that this guy’s only redeeming feature for using oxygen for many, many years was that he prescribed Citalopram for me, it did wonders for me. Well, after a while. Getting onto it was a real bitch. Lots of nausea and other side effects. In order to help with the side effects, Dr. A-Hole prescribed something else for me (I don’t remember what) that made the nausea go away. Unfortunately, it was at the cost of hallucinations and manic episodes. I opted for the nausea. But, after getting over the nausea, Citalopram worked a treat until August, 2006. Then, all of a sudden, it just gave up. I have no idea why.

So, I started on Duloxetine Hydrochloride. Duloxetine inhibits the re-uptake of not only serotonin, but also norepinephine, so it is known as SNRI. It was even better than Citalopram! But, it only worked for about a year. Then, all of a sudden, it just gave up. The Doc upped the dosage, with no effect. So he added a form of Valproic Acid. Valproic Acid is supposed to affect the re-uptake of a neurotransmitter called GABA, about which I know nothing. It worked a little. He upped the dosage on that, but things didn’t get any better. Then he gave me some samples of L-Methylfolate. It was wonderful. L-Methylfolate is, allegedly, necessary for the production of various neurotransmitters. (I have no idea what the “L” stands for, if anything.)

Apparently, some people (I guess I am one) have some kind of problem generating L-Methylfolate. So, taking a supplement helps.

But, here is where things get complicated. While I was taking the samples, I sent the prescription to a mail-order pharmacy, as my insurance company instructed. After about a month of studying it, they decided that they (either the insurance company or the mail-order pharmacy, not sure which) wanted nothing to do it. So they sent the prescription back to me, taking another three weeks or so to get it back to me. Of course, my samples were long gone. So, here’s the conundrum: Do I stay where I am, operating at about 75%, but figuring that I probably won’t have any more of the medication suddenly giving up on me? Or, do I buy the L-Methylfolate, feel great, and worry about what happens when I suddenly plunge back into depression?

Well, anyway, that’s more than I wanted to say in this post. I’ll have more thoughts on it later.


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