Recently there was an item in the media that caught my attention. Actor Tom Cruise had gone to visit actress Brooke Shields to formally apologize to her, after he openly criticized her for using Paxil, which she believes helped her recover from post-partum depression after the birth of her daughter in 2003. Cruise, a Scientologist, had previously insulted Shields and told her that such medication was never necessary.
Since 2004, Cruise has spoken openly about Scientology and its rejection of psychiatric drugs. On one occasion Cruise referred to psychiatry as a “Nazi science” in an interview in Entertainment Weekly.
Cruise's beliefs come straight out of Scientology and the writings of L. Ron Hubbard, founder of Scientology, who believed that psychiatrists denied human spirituality. To some extent, Hubbard, in my opinion, is correct in his view that psychiatry (and psychology) has largely ignored man's spiritual nature. Hubbard also proclaimed that psychiatry was “an evil enterprise, a form of terrorism, and the cause of crime.” According to Hubbard, “The psychiatrist kidnaps, tortures and murders without any police interference or action by western security forces.” Hubbard also claimed that the human mind was governed by biochemical reactions. I have to agree with him about that, but Hubbard saw that as a very bad thing, as if acknowledging the biochemical side of human beings was a denial of our spiritual side.
Tom Cruise's attacks on the use of anti-depressants, and all physical compounds whose purpose is to foster better brain function, arise directly out of the rather warped mind of L. Ron Hubbard. While Cruise's popularity in America has dramatically plunged over the past two years, I am concerned about fans of his who might take his opinions to heart, people who might greatly benefit from some medication.
History of Psych Meds
Let me step back in time to give you a brief history of psychiatric medication. Sigmund Freud, a neurologist, was one of the founders of modern psychiatry. He experimented with a number of compounds to assess their benefit for the mind. Not a great researcher in this area, cocaine was one of the favorite “medications” Freud was testing on himself.
On a more serious note, the discovery of Thorazine, was a huge turning point for psychiatry and for millions of psychotic people. Like many discoveries, Thorazine was an accident. It was being developed as an anti-histamine, but through a series of serendipitous events, scientists discovered that it helped schizophrenic patients. Within a few years, psychotic patients in long-term mental hospitals were being treated with Thorazine. The results were dramatic. Most schizophrenics, who had spent years locked in rather dismal facilities, suffering with voices and delusions, benefited tremendously from Thorazine. The benefits were so great that plans were made to begin emptying out the state mental hospitals. The overall plan was to build a county mental health system (CMH) throughout the country. Psychotic patients were discharged from the state hospitals with the idea that they could live on their own or in less structured, open facilities, and would go to CMH for medication and group therapy.
It was a wonderful idea that largely failed. It wasn't that the medication stopped working. The failure was that huge numbers of schizophrenic people stopped going to CMH and stopped taking their medication. They lapsed back into a disorganized, confused schizophrenic state . . . and many of those people now form the foundation of the homeless people of America .
Another breakthrough in psychopharmacology, the first anti-depressant, amitryptiline (Elavil), was also made by astute scientists, who were not looking for anti-depressant medication. Amitryptiline had been invented and was being tested as a new anti-psychotic medication. Numerous schizophrenic patients received amitryptiline. The study had good news and bad news. The bad news was that this new medication did not help schizophrenics with their psychosis. However, one researcher observed that some of these patients were less depressed. And the rest is history. Amitryptiline was tested as an anti-depressant and it had significant benefit for people who were clinically depressed.
Generations of medications have come and gone since thorazine and amitryptiline. In the sixties, there was a backlash against psychiatry, and the anti-psychiatry movement was born. At the same time, psychiatry was struggling to find its identity. Was it more of an art or a science? That debate continues.
As a psychiatrist, I have often felt caught in a very strange place. I have treated thousands of people with serious mental illness, have worked with hundreds of people who attempted suicide, and have seen the light side and the dark side of psychiatry. I'm a pragmatist. First, I'm interested in what works. Secondly, I'm interested in why a particular approach works. During my psychiatric residency, which ended in 1978, I was taught that enormous research had proven that, in the treatment of depression, a combination of medication and psychotherapy was the most effective approach. Research continues to support that conclusion, but in many cases, I will use natural treatments, such as amino acid therapy, rather than a medication, and to the shock of nearly every new patient, I insist on psychotherapy as part of their treatment. The exact nature of my psychotherapy approach is not the point of this article, but I have not found that talk therapy is very useful after a couple of visits.
Driven by changes in insurance, the birth of managed care, rising overhead, and the desire to be perceived as “real doctors” by the rest of Medicine, many psychiatrists stopped honing their skills as counselors. Most people who see psychiatrists now expect a 15-minute medication evaluation. Huge numbers of psychiatrists are referring their patients to psychologists and the like for their “counseling needs.” For me, it is impossible to look at an individual as a “medication issue.”
My personal quandary is that I believe that, in general, psychiatry ignores spirituality and nutrition, over-diagnoses mental illness, over prescribes psychiatric medication, and has largely been ignoring psychotherapy. On the positive side, enormous suffering has been alleviated by psychiatrists and psychiatric medications.
Mental health is not different from holistic health. It is always best to treat the whole person. Medicine, in general, began to fragment patient care with the advent of specialties. Most of you know, that if you have a primary care physician, he or she will treat just so much, and will then make a referral to a specialist. As often as not, you get lost in a large bureaucracy in which the many doctors treating you may not all be communicating with each other. Even the specialists have sub-specialties, leading to further fragmentation in treating the whole person.
I have worked in every kind of psychiatric facility that exists, including: office outpatient, psychiatric hospital, medical patients in the hospital with psychiatric problems, board-and-care facilities, long-term lockup facilities in San Diego , long-term residential treatment facilities for children and adolescents, and long-term state psychiatric hospitals. When you have seen mental patients, by the tens of thousands, in so many facilities, you have seen a piece of society that very few people can comprehend. I've seen and treated every kind of mental suffering in huge numbers, worked with suicide and homicide, multiple personalities, alcoholism, and everything under the sun.
I would like to take Tom Cruise for a visit in a psychiatric hospital. I'd especially like just to sit with Tom in one of the long-term locked wards of the state mental hospitals. The patients there are the ones for whom nothing worked . . . not counseling, not medication, not all the work of social services. It is the end of the line. I'd like for me and Tom to sit down with a depressed schizophrenic patient and talk with that man. I would ask Tom to use the methods he has learned from Scientology to “cure that patient.” The problem is that Tom would probably be so terrified to sit in a large room filled with people with chronic psychosis that this scenario would never take place, and if it did, Cruise would probably be requiring psychiatric medication in a short period of time to handle anxiety. It's not that these people are dangerous. Mental patients are no more dangerous than the average person. It's just that, if you have not spent years working with the mentally ill, it is a scary experience because you just don't have a clue how to really connect, and how to be helpful. It's understandable. That's why psychiatrists have 8 years of training after college, and clinical psychologists spend 5 to 7 years getting their doctorate.
I'm a bit peeved that a celebrity, who has no training, who has not spent one hour in a psychiatric hospital, is making comments that are likely to cause at least a few people to stop taking a life-saving medication. There's a real possibility that there will be some suicides caused by Tom Cruise's ignorant and biased remarks, the possibility that someone who really would benefit from treatment with an anti-depressant medication won't take it, because he believes Tom, and he'll kill himself.
Psychiatry, like the rest of medicine, is an art and a science. Healing is the merging of the art and the science. In terms of psychiatry, there is not much science that generally goes into the consideration of what medication or other treatment you might need. Psychiatry is about brain, mood, thought, and behavior. That's what we treat.
While there are countless factors that affect mental health that most psychiatrists don't deal with (such as: mercury toxicity, candida, parasites, food allergies, electromagnetic fields, spiritual disconnection, and lack of purpose), this article will focus on brain chemistry and neurotransmitters.
Anatomy of a Neuron
Here's a brief description of the anatomy of a neuron (nerve cell):
Cell body - contains the nucleus.
Axon - the long extension that carries nerve impulses away from the cell body.
Axon Terminals - the hair-like ends of each axon.
Dendrites - the branchlike structure of a neuron that receives messages from another neuron's axon terminal.
Synapse — the space between 2 nerves, or between one axon terminal and one dendrite.
Myelin sheath - the fatty substance, made of phospholipids, that surrounds axons.
In order to understand how nerves communicate with each other, almost all of our attention needs to be focused on the synapse. Here's how that communication takes place. An electrical impulse shoots down an axon. In the axon terminals are nutrients that get converted into neurotransmitters. For example, the amino acid, L-tyrosine, is present in billions of axon terminals. Using L-tyrosine as an example, here is what happens. When the electrical charge reaches L-tyrosine in the axon terminal, the L-tyrosine is converted into norepinephrine, which then moves into the synapse, the space between two nerves. Norepinephine is one of many neurotransmitters. Neurotransmitters are the compounds that allow for one nerve to communicate with other nerves. A single nerve can connect with 10,000 other nerves.
Continuing to watch this one nerve: norepinephrine floats into the synapse, and much of it will reach the dendrite of the next cell, setting off chemical reactions within what we'll call “Cell 2.” That chemical reaction turns into an electrical reaction when it reaches the axon of Cell 2, leading to the same sequence of events that just took place in Cell 1.
The main neurotransmitters are norepinephrine, serotonin, dopamine, endorphin, acetylcholine, GABA, glycine, glutamic acid, aspartic acid, and taurine. The first three neurotransmitters in this list are made “from” amino acids. The last four “are” amino acids. There are also hundreds of less common neurotransmitters called “neuropeptides,” which are short chains of amino acids. Dr. Candace Pert, in the movie “What the Bleep!?,” mentioned that every thought is associated with the release of a specific neuropeptide. The number of neuropeptides may be in the thousands or more. Science is not at a point of identifying specific neuropeptides associated with specific thoughts or emotions. While Dr. Pert is on your mind (and those Pert peptides are going off in your brain), it is worth noting that nearly all recent research on anti-depressant medication, and most other medications like antacids, are based on Pert's discovery of receptor sites.
When you see a psychiatrist for any problem, remember that he is first a medical doctor. He needs to ask a lot of questions to find out if you have a clinical depression, a thyroid problem, or a brain tumor. Be patient when he asks you a lot of questions that may seem irrelevant to you. George Gershwin was in psychoanalysis for years for treatment of depression. He didn't need psychoanalysis. He needed a neurosurgeon, for he died of an undiagnosed brain tumor.
If I determine that you: 1) are depressed, 2) do not have a medical problem causing you to feel depressed, the next question I ask myself is, 3) can this problem be completely healed through psychotherapy, meditation, mental imagery, body-centered trauma resolution, and a host of other psycho-spiritual modalities?
During my initial evaluation, I am gathering a very extensive history, and am also working, moment-by-moment, to help with the healing. Step 4: If you have extreme suffering, are hearing voices, are delusional, acutely suicidal or homicidal, or have unbearable depression, anxiety, panic, insomnia (the list goes on), I may recommend a medication at the end of that first visit.
If you are “hanging in there,” possibly already feeling somewhat better at the end of the first session, and want a natural approach, and I do not think you are going to go home and kill yourself or wreck your life or someone else's, I'll recommend brief intensive counseling and some nutritional supplements. Shortly after that, we'll do lab work to map out your brain chemistry for more accurate, long-term, targeted treatment.
If you tell me that your depression “is entirely brain chemistry,” and “I don't have any emotional stress or conflict,” you're going to be a tough patient for me, and you're probably in the wrong office. The reason is this. Whether you are depressed, have CFS, IBS, or cancer, there is always an emotional component. One thing I am assessing throughout our initial meetings is the degree to which you want to take personal responsibility for your suffering. If you want me to “fix” you, you really need one of the psychiatrists who only spend 15 minutes, gives you a medication, and sends you home. That's not me.
Let's say that you're motivated. You're depressed, your memory and concentration are not so great, you feel like something is missing in life, your sex life could be better and you want it to be, and you're struggling to discover what your passion or mission in life is. But, you're motivated, which means you want to understand the causes of your suffering, all the possible treatments, and everything that you can do for yourself to make yourself better than normal, or better than you've ever been. If you're that person, then we can move deeper into the science of psychiatry.
The next step for us is to discover what is going on with your neurotransmitters, and we can do that through lab testing. While psychiatrists are prescribing large quantities of drugs that increase serotonin (like Prozac, Paxil, and Zoloft), drugs that increase norepinephrine (like Wellbutrin), and drugs that increase both serotonin and norepinephrine (like Effexor), medication recommendations really are a shot in the dark. The fact is that, unless you have a psychotic disorder, you are probably going to be prescribed a drug that increases serotonin, and that recommendation will not be based on science.
The two most important tests for you are an amino acid test and a urine test for organic acids. Amino acids are the “input” side to brain chemistry. Most neurotransmitters are made from amino acids. So, if your amino acid test shows a deficiency in L-tyrosine, chances are good that your brain is deficient in norepinephrine and possibly dopamine, because those neurotransmitters are made from L-tyrosine.
The organic acids test, which Genova Labs (formerly Great Smokies Diagnostic Labs) calls “The Metabolic Analysis Profile” or MAP, is a urine test that examines 46 organic acids. This is the “output” side of brain chemistry. These are the breakdown products of 46 different, important biochemical processes. The MAP is extensive, and includes testing for the breakdown products of catecholamines (norepinephrine and dopamine) and serotonin. If your VMA (vanilmandelic acid) is quite low, I “know” that you are deficient in norepinephrine. On the other hand, if your 5-HIAA (5-hydroxy-indolacetic acid) is low, you have a deficiency in serotonin.
These 2 tests are the input and output side of brain chemistry. This is not simple, but it's also not quantum mechanics. Let's say that you test high on L-tryptophan on the amino acid test. Because L-tryptophan turns into serotonin, I would expect your 5-HIAA (breakdown product of serotonin) to be high on the MAP. But sometimes it isn't, and the reason is usually pretty clear. Both tryptophan and tyrosine require P-5-P, the active form of Vitamin B-6, to get converted into their respective neurotransmitters. So, if you have lots of L-tryptophan, but very little serotonin, chances are that you are deficient in P-5-P, which is required to make serotonin. What we have is a measurable, scientific picture of part of your brain chemistry. We have begun to build a Scientific Psychiatry.
At this point, if you are working with a general psychiatrist, he can tell you which category of medication would best suit you. If your VMA and tyrosine are low, but your serotonin chemistry looks good, then the best drug for you is Wellbutrin, because it boosts norepinephrine. That's the science. But after 9/11, vast numbers of New Yorkers were treated with Paxil and other drugs that boost serotonin. Frankly, I would rather have seen comprehensive support and treatment by trauma specialists before medicating an entire city, since 9/11 was not a disease. It was a trauma, and the two are different. If the trauma is not worked through in a healthy way, it can turn into depression, something that may require medication.
Had all of the New Yorkers in question gone through scientific lab testing, doctors would have been shocked to learn that at least half their patients would have had a problem with norepinephrine chemistry and not serotonin chemistry. That's an educated guess on my part.
What I have described is a way that “any” psychiatrist can more scientifically figure out which medication is best for you. Now, I am not making a case for medications, although they clearly have their place. Obviously, I favor a more natural approach, so if my patient has a norepinephrine deficiency, I am going to recommend the amino acid L-tyrosine along with P-5-P to normalize chemistry, and I'm very unlikely to recommend a medication until we have tried more natural approaches, and have used a variety of verbal and non-verbal psycho-spiritual counseling techniques.
What I have described is just the beginning of a Scientific Psychiatry. There are other ways of testing for neurotransmitters. There are some neurotransmitters that are very difficult to test for right now, like GABA, because very little of it crosses the blood-brain barrier, making it difficult to measure with any kind of test. However, there are other neurotransmitter tests that provide valuable information beyond what even amino acid and organic acid testing can provide.
By seriously thinking about the neurotransmitters involved with any mental/emotional/brain problem, we can target treatment with much greater accuracy than is the standard today.
David Gersten, M.D. practices Psychiatry, Interactive Guided Imagery, and Nutritional Medicine out of his Encinitas office and can be reached at 760-633-3063. Please feel free to access 1,000 on-line pages about holistic health, amino acids, and nutritional therapy at www.aminoacidpower.com.
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Over the last month, I've been experiencing all sorts of mental troubles, such as mood swings, extreme anxiety, alienation, extreme boredom, obsessive thoughts, and trying to figure out why we're all here. I can only describe this as depression.. I'm between a rock and a hard place, as I don't know whether I truly have a chemical imbalance and need medication or whether this is a gift to heal.
I'm finding it difficult, as I'm so blessed with my life at 22 years but find it difficult to find happiness and balance in things and am afraid that this will jeopardize opportunities to come.
What on earth are you eating? Sounds like a sugar attack. Go to a good nutritionist and get your diet evaluated. That's the best place to start. Medication needs to be the last resort. You'll never find happiness in “things.” Your happiness is in your thoughts and in your own heart. Clean up your diet, quiet your thoughts, and breathe deeply. Affirm: I am surrounded with peace, and it permeates my being. All is well.
What is it about machines that I cannot seem to grasp? I know that I'm intelligent about a lot of things, but when it comes to electronics, I seem to lose all my confidence. Thanks for an answer. It's really important for me to try to figure this out!
F.A., Los Angeles
You've come to the wrong person for an answer! I'm equally challenged by computers and sound systems. Thank heavens I have my personal assistant, Shelley, to come to my rescue. When I get stuck, I call out “Shelley, help!” and she solves all my problems.
Seriously, find a young person in your neighborhood, and have him or her teach you what you need to know. Perhaps even take lessons. Once you learn the processes, it will be easier. Remember, modern-day electronics are just that, modern day. We weren't taught to cope with them in the past. That's why it's so easy for the kids of today, because they begin to use computers at the ages of two or three!
Affirm: I am willing to move beyond the limitations of my childhood. I can and will learn the new things in life. It gets easier all the time.
My loved ones shape their own lives, but can I help them in prayer by realizing that we're all one and affirming and visualizing all the best for them? I've heard that you can affirm for another, but I feel that maybe I'm doing my loved ones harm by worrying. Thank you for your help!
D.V., Detroit, MI
You are definitely causing yourself trouble by worrying, and you're doing your loved ones no good by worrying for them. It's a total waste of mental energy. You can certainly affirm and visualize the best for them as long as it's what they want , not what you've decided would be best for them. You can't interfere with other people's destinies. You have no idea what's really for their highest good.
The more you work on releasing your own childhood negative patterns, the more you help others. Be the example you want to see in the world. Just know and affirm that you're all being divinely guided to experience your highest good. You are perfect just as you are.
Louise L. Hay is a metaphysical teacher and the bestselling author of numerous books, including You Can Heal Your Life , Empowering Women, and I Can Do It! . Subscribe to the Louise Hay Newsletter! Call for a Free Issue: (800) 654-5126. Questions for Louise? Write to: Dear Louise Column, c/o Hay House, Inc., P.O. Box 5100, Carlsbad, CA 92018-5100 (letters may be edited for length and clarity). Visit Louise and Hay House at: www.LouiseHay.com or www.hayhouse.com.
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