Cognitive Axis

I'm personally disappointed in the American Psychological Associations guidelines for treating depression. The reality is we each have a specific physiology. You can't ethically treat depression with uniform guidelines. The patients suffer with this approach. It all boils down to each individuals biochemistry. Maybe it is Serotonin. Maybe it's just Dopamine Maybe it's just Norepinephrine. Clinicians can of course deviate from the guidelines like they should, but if they do and something goes wrong, regardless of causality, the clinician is subject to serious legal litigation. So clinicians are mostly forced to conform to the guidelines that are myopic at best. You cannot adequately treat someone with depression without understanding their specific physiology and needs. Case Study: A patient suffered sexual abuse at a young age beginning before 5 years old and ending at 14 years old. The patients stress hormones skyrocketed at the onset of the abuse. Of course outside of their awareness and understanding because of their age. Their baseline norepinephrine needs have significantly elevated. So as they proceed into adult life they are chronically depressed. The memories of the abuse are repressed and they are successful professionally and have a good marriage and kids which for most people creates happiness. But this case study patient remains depressed. Goes to a clinician and is diagnosed with depression and given an SSRI. The SSRI is prescribed because the guidelines demand it, not because the patient needed it. So they fail the SSRI, but keep taking it. Next appointment the clinician tries another SSRI and the pattern continues. This particular patient is failed in every way by our entire system. An SSRI or SNRI fails because these medications will not raise the patients norepinephrine needs high enough to meet their individual baseline needs. They need something stronger like a stimulant. Oh, but those are addictive and prescribing habits as well as prescription fills are highly monitored and cross referenced through multiple systems. So what happens? The patient has lost faith in the medical system and they start self medicating with alcohol or other drugs. Now to be fair there are not tests available to understand a patients baseline Serotonin, Dopamine, or Norepinephrine needs. However, a very good clinician that is very thorough in examining the patients behavior patterns, should be able to narrow down what part of the patient's biochemistry is causing the behaviors. From a clinical perspective, this is where the failure of our entire system is failing patients. This is precisely why mental health problems are skyrocketing and patient's are not improving. It's a total failure of the entire system.

Sources: the Falcons are trading DT Ruke Orhorhoro to the Jaguars in exchange for DT Maason Smith.