Posted by Elayne on March 24, 2002, at 7:54:53
In reply to Frontal lobe syndrome » Elayne, posted by BarbaraCat on March 24, 2002, at 1:15:35
> Elayne,
> Talk some more about 'frontal lobe syndrome'. Is this an actual phenomenon that's being reported or researched? I worry about long term physical changes in receptor density and would be interested in any info where this is being addressed.
>
> BarbaraBarbara,
I was actually referring to the link in Fachad's post of 3/22 above:http://www.dr-bob.org/tips/split/SSRIs-and-
apathy.htmlBut I have seen this term used by others as well. Garland describes a "reversible frontal lobe (amotivational) syndrome ...characterized by apathy, indifference, loss of initiative and/or disinhibition" associated with SSRI use. Although she is talking about adolescents, the description is generalizable I think. (Brown University Child and Adolescent Psychopharmacology Update 3(10):1, 6-8, 2001).
Stephen Stahl, in Essential Psychopharmacology of Depression and Bipolar Disorder (2000), refers to SSRI-induced apathy as one of several undesirable side-effects that "...can be understood as undesirable actions of serotonin in undesirable pathways at undesirable receptor subtypes. This appears to be 'the cost of doing business,' as it is not possible for a systematically administered SSRI to act only at the desirable receptors in the desirable places." In this case he theorizes, "...stimulation of serotonin 2A receptors in mesocortical pleasure centers may reduce dopamine activity there and cause apathy...or decreased libido." (p.99)Notice that Garland is describing a REVERSIBLE phenomenon. And Stahl is talking hypothetically.
It's my impression that "frontal lobe syndrome" is a term used by neurologists to describe similar symptom clusters in people with known organic brain problems (e.g.,lesions, tumors, trauma). I think psychiatrists have borrowed the term and use it descriptively, even metaphorically, in trying to understand what they see. (I am no neuroscientist and would welcome correction or elaboration on this point).
I guess we all worry about long-term physical changes. I hope my posting didn't make you worry even more. I think knowledge in this area is really primitive in some ways.
For me, the issue comes back to a balance of risk and benefits and the ability to tolerate a lot of ambiguity.
Elayne
poster:Elayne
thread:99188
URL: http://www.dr-bob.org/babble/20020322/msgs/99827.html