Posted by zeugma on January 16, 2005, at 10:28:12
In reply to Re: What is an antidepressant?Any input please? » ed_uk, posted by darkhorse on January 14, 2005, at 5:39:40
Hi Darkhorse (And Ed),
Your questions and observations are very on target. there is a historical answer to your question: the term 'antidepressant' was coined by Roland Kuhn, who observed the effect of imipramine on depressed patients and thought he saw a specific effect on the illness that was different from the stimulatory action of the amphetamines.
Nathan Kline, an American psychiatrist, had observed the effects of the first MAO inhibitor and coined the term 'psychic energizer' to describe its actions. Kuhn's term became more popular and imipramine and other TCA's became more widely used anyway because of incidences of serotonin syndrome and hypertensive crisis with MAOI use, which were more alarming because the reactions were so unexpected given the state of medical knowledge in the early 60's.
David Healy, in "The Antidepressant Era", says that since the SSRI's are more like the MAOI's in terms of being effective for OCD, that the current meaning of 'antidepressant' is more like the 'psychic energizer' concept, although Healy is also very aware that the MAOI's have an overall action that is very different. he also draws attention that clomipramine, which is the TCA with the strongest effects on serotonin, puzzled clinicians for many years because it seemed to have an effect closer to a 'psychic energizer' than a pure 'antidepressant' ('thymoleptic' was actually Kuhn's preferred term, but 'antidepressant' is a fair translation and is catchier).
In terms of my own observations, SSRI's do not seem to be like what Kuhn describes, or like what I have experienced on nortriptyline.
I think it's especially important to pay attention to these early conceptions, because they were formed in ignorance of their relationship to the biogenic amines, and so they were 'purer' because the clinicians were taken by surprise and didn't see what they thought they should see- in fact Kuhn expected imipramine to be an antipsychotic!
-z
poster:zeugma
thread:439864
URL: http://www.dr-bob.org/babble/20050113/msgs/442735.html