Medicalized Meddling With Neurotransmitters Leaves Us in a Big Mess

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From Dr. Gary Sharpe: “Many of the medicalized drug-based interventions for chronic conditions target one or more of our neurotransmitters, hormones, or peptides. These drugs may given in order to try to bump up or dial down the amount of a specific chemical in our system. Else they may be ‘antagonist’ or ‘agonist’ classes of drugs, intended to either [partially] block or activate, respectively, the corresponding cell receptors for that chemical . . .

Indeed, the highly reductionist mechanistic view of the current medical paradigm sees many chronic problems as being due to the excess or dearth of a single neurotransmitter, and hence envisage that this can be treated by attempting to control the levels of that neurotransmitter in the body and/or brain, or by making cells more or less sensitive to that chemical via blocking or activating the corresponding cell receptors.

This is the height of medical reductionism, and underlines the hubris of the current system. When it comes to human biochemistry, we need humility in the face of its sheer complexity, because in reality it is vastly more complex than we may ever even be able to know. Indeed, the inner workings of our biochemistry is not just complicated, it is an example of a ‘complex system.’

A complicated system may have many variables or parts, and may be governed by very intricate rules, yet has behaviours that are ordered, and, with sufficient compute power, is always predictable. A car is an example of a complicated system.

A complex system may have few parts or variables (e.g. the orbits of three stars in a trinary system), or be governed by very simple rules (e.g. cellular automata), yet can have fractal and fully chaotic behaviours, and is fundamentally unpredictable, such that exceedingly small interference in the system, can create massive and unforeseeable changes.

Human biochemistry is of the complex kind. One reason is that all neurotransmitters have a large array of different functions in the body, but rarely are the medical interventions able to target one specific function, and hence this untargeted approach cause all sorts of other processes to become inhibited or get activated. This is why unwanted side-effects always abound.

Furthermore, our systems have all sorts of check and balances to maintain equilibrium, which work against interventions. For example, flooding the system with an exogenous source of a neurotransmitter, in response to the body not being able to make enough of its own, often results in cell receptors for this neurotransmitter getting sequestered inside the cell. The effect of this is to actually reduce the body’s responsiveness to the already low amounts of endogenous supply, meaning higher doses of the drug are required to have an effect, in an ever-escalating arms race.

Furthermore, different neurotransmitters work together or counteract each other in very complex dances. So it is very rarely the case that the concentration of a single neurotransmitter being too low or too high in some absolute sense is the actual root issue. It is the imbalances, or relative levels, with other chemicals which this causes that is the main issue. Likewise, intervening in one neurotransmitter with drugs throws the balances with other ones out in different ways, resulting in yet more unwanted side-effects.

For example, I have written a series of posts about how it is not the shortage of dopamine in folks with Parkinson’s which is the issue per se, but it is the imbalances with several other chemicals that this results in. Likewise, the practice of prescribing exogenous dopamine supplementation for folks with Parkinson’s, just throws these balances out in a different way. Unfortunately, since the 60s, we have been stuck with dopaminergic interventions, which lead to ever increasing dependency, requiring more and more of the drugs to have any effect, with escalating side effects, and ending up in the drugs no longer working at all. What a mess!

This also brings back to mind the book on evolutionary biology, The Hunter-Gatherer’s Guide to the 21st Century, which highlights that whenever we interfere with our biology, there are always trade offs, unforeseen circumstances and unintended consequences, and the Precautionary Principle should be applied.”

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