Reverse Psychiatry?

One of the big problems with psychiatric medications is they tend to stop working over time. Mundanely, they do this as your body processes and excretes the chemicals: they wear off. More annoyingly, brains will actually up- or down-regulate their own activities over time in order to reestablish normalcy. Alcohol, for example, is a depressant, so the brains of alcoholics actually become more active over time in order achieve a more normal brain state. At this point, if you remove the alcohol, the brain can no longer function, because it is now too active: alcoholics in withdrawal can go into seizures.

If you’re trying to give people medications to make them feel better, like anti-depressants or anti-anxieties, then you have to fight against these two problems: 1. you don’t want the medication to just wear off every evening, leaving the patient in a funk for the rest of the day; and 2. you don’t want the patient to become habituated to the medication, where it not only no longer works, but if they try to go off of it (perhaps to switch to another medication,) things get much worse.

So I was thinking, why not use the rebound effects? Suppose a depressed person took a medication right before bed that, like alcohol, was effectively a downer, but would wear off in 8 hours and leave them in a happier state? And after three months of constant use, maybe their brains would habituate to the medication by producing more of whatever counteracts an unhappy state?

Has anyone studied or tested any drugs that work like this?

There’s an obvious downside here, which is that you’re intentionally trying to make someone who already feels bad feel worse, which is why you’d probably want to couple it with some sort of sleep aid (and that probably wouldn’t work with anything that makes people anxious, so maybe it’s not an effective anxiety treatment). You’d want to keep a very close eye on people when starting such a treatment, of course.

But more generally, has anyone tried to use rebound states and habituation to get the brain to where they want it to be, rather than fighting against these? If it worked, we could call it reverse psychiatry.

4 thoughts on “Reverse Psychiatry?

  1. I can think of a two reasons why it will never be tried:

    1) If people are being treated for some condition and you’re giving them a drug that makes the condition worse to get the body to down-regulate whatever process is causing the problem the initial reaction will be to make it worse. For some number of people that will be fatal or have dire consequences. Our drug testing regimen doesn’t have the subtlety needed for “give this for condition x, but not a severe case of x unless y and z”. Study design doesn’t let them make those statements (and drug study design is truly abysmal).

    2) If it works for some disorders it has *implications* that absolutely no one in pharmaceuticals or medicine wants to consider – namely that the entire paradigm of drug treatments is worse than useless except for in acute circumstances. If the long term effect of a drug decreasing x is to increase x then this works when you want to increase x as well as *every drug on the market that does the converse and tries to decrease x by decreasing it*. “Oops, sorry we were wrong about everything for 60 years” is the outcome there.

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  2. Interesting thought, though I think it oversimplifies what is going on in the brain when people get depressed. On a quick read I can think of two problems.
    1) Depressed patients are at elevated risk for suicide and often have trouble sleeping. I suspect you can see where that’s going.
    2) Most CNS depressants cause dependence, ie addiction. Again, that would skew the outcomes in a bad direction.

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  3. “Suppose a depressed person took a medication right before bed that, like alcohol, was effectively a downer, but would wear off in 8 hours and leave them in a happier state?” – I think this is pretty much how a lot of European derived cultures have functioned- not so much happier/sadder as loose/relaxed at night via alcohol and uptight/energetic in day. The uric acid rise associated with alcohol wakes you up; too much and it makes you (more) hungover, but the right amount probably gets you moving the next day.

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