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Does nortriptyline make you sweat ?" "Yup. But the placebo effect is huge," doctor assured me. "What kind of drug? "The best-ever placebo drug. You might be able to do the same stuff without drug if you take this once a day." A year earlier, I'd walked into a doctor's office looking for guidance (a little like that buy modafinil online ireland young man earlier), when he had handed me a stack of pills labeled 'placebo-controlled' and said, "This is a real treatment." "But how can you expect to help someone if you don't even know what you're doing?" I wanted to Can i get modafinil over the counter shout. I'd been in a mental hospital since 2002. I'd been given an ECT, but the medication was supposed to make me more schizophrenic, not cure it. But I wasn't going to accept any kind of treatment that didn't come from experts. So I did one better and signed up for a study. lot of things had changed since 2002, but I didn't need medical research to know what was happening in my head - or so I thought. And as soon went into a clinic to start the study, a doctor named William G. Davis, head of the Center for Cognitive Therapy of Schizophrenia, had me start taking a new kind of drug and it didn't work the way others did. Davis is a very smart man, in his 80s, with a white beard. He had worked extensively in both the psychiatric and scientific fields as an investigator and consultant, so I felt comfortable asking him about how all this stuff worked. is a transcript of my conversation with Dr. Davis - he will provide a very long answer in the next section of this essay; in an appendix, he will explain what all does. "There are very few people who not a little bit mad," I told him. It sounds paradoxical to start with this, but in many different ways the world of mental health care has become much more sophisticated in the last twenty years. When I got here, the most common treatments we gave people were psychiatric drugs and talking therapies, which were only marginally effective and mostly gave you a good laugh or two while you lay in bed. Now we have an almost unparalleled array of drugs ranging from antipsychotics to anxioses brain-wave entrainments even more exotic combinations such as lithium, fenfluramine and ritalin. Most of these substances, when used right, work very reliably and they all improve the quality of life when applied properly. It's been the case for past thirty years that in most studies, patients on medications perform no longer poorer for having them in their bodies than they did for lack of them - even though we've just been through the most expensive drug research, with the results showing that our current medications are probably a lot better than most people would have thought possible even thirty years ago. So what's happening? If you take into account the fact that these drugs reduce the number and severity of relapses, that most people recover without treatment once they are off the antidepressants, that they do not increase suicide rates, and that they have no side effects, then we might conclude that what is actually occurring here just one thing: patients are being asked to be human test subjects in a new and exciting way, so they need to feel happy when they're on the medication. "It's all a matter of what the drugs can do and what they can't do." The most fascinating thing is that our treatment modalities appear to be the least informative and useful of our medicines. That seems counter to everything we know about the brain. It's been known for generations that a new disease or injury can often trigger a change in brain function that is not obvious at first, and yet we don't really understand how this new activity emerges out of a background old neurochemical activity. In the case of schizophrenia, we might assume that, just by the nature of disease, there needs to be new information coming into the brain that is not yet present. The truth is that a single change in brain function can everything. Take the placebo effect for example. is the idea that by simply thinking about taking a medicine, the patient's illness can be changed - and this in fact happens all of the time. In a placebo controlled study, researcher prescribes you a drug or placebo and the patients are given a chance to report on how the medicine/placebo affects their symptoms. If the people get worse and it looks like their illnesses have increased without knowledge, then there's really something happening in the brain; if they get better and it looks like their illnesses have decreased without knowledge, it's just a mistake. But if the patient gets both medicine and the placebo, then there does need to be some new information coming into the brain that didn't occur during the initial trial.



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