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Diffusion MRI Tractography in the brain white matter.
Some drugs work well because they are designed to hit a single, well understood target. Consider penicillin.
In a simplified sense, penicillin destroys a single enzyme that bacteria need to divide and to infect you, thereby killing the harmful bacteria. But what about psychiatric drugs? Is there a comparable, single target in the brain to treat depression, anxiety, attention deficit disorder (ADD)? No.
So, it is no wonder that the popular drug Ritalin, used to treat ADD for millions of children and adolescents is, by some standards, a fallacy. In the long term, such drugs are at best placebos, and at worst could do more damage.
Here’s why: Our brains consist of some 100 billion neurons, and our understanding of how these cells communicate, are regulated and – more importantly – how they respond to our environment and what subset corresponds to a given psychological state, is in its infancy. Our brain’s “connectome” is shown to the right {is it not truly beautiful?}
From the insightful Op-Ed in today’s The New York Times by L. Alan Sroufe, professor emeritus of psychology at the University of Minnesota’s Institute of Child Development:
TO date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavior problems, the very things we would most want to improve. Until recently, most studies of these drugs had not been properly randomized, and some of them had other methodological flaws.
But in 2009, findings were published from a well-controlled study that had been going on for more than a decade, and the results were very clear. The study randomly assigned almost 600 children with attention problems to four treatment conditions. Some received medication alone, some cognitive-behavior therapy alone, some medication plus therapy, and some were in a community-care control group that received no systematic treatment. At first this study suggested that medication, or medication plus therapy, produced the best results. However, after three years, these effects had faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits.
However brain functioning is measured, these studies tell us nothing about whether the observed anomalies were present at birth or whether they resulted from trauma, chronic stress or other early-childhood experiences. One of the most profound findings in behavioral neuroscience in recent years has been the clear evidence that the developing brain is shaped by experience.
This is not to say that drugs such as Ritalin are useless. But Prof. Sroufe reminds us that we need to focus less on solving psychological problems with pills and more on a deeper understanding of environmental and societal impacts on that most complex and inscrutable part of us, our brain, and ultimately how to listen to and have empathy for those reaching out to us for help.
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