The commonly recognised legal and illegal recreational drugs offer poor prospects for sustained biological mood-enhancement. So what about the heterogeneous group of compounds uninvitingly labelled as anxiolytics and antidepressants? Have they potentially anything significant to add to most people's quality of life? Official medical doctrine says no. Allegedly, only sufferers from clinically-sanctioned psychiatric disorders will benefit from such agents; though in recent years it has at last been formally recognised that depressive disorders are under-diagnosed and under-treated even by the twentieth century's abjectly poor standards of acceptable ill-being. Most of humanity, however, still doesn't fit any of the official diagnostic boxes. Can "diagnostic creep" triumph over therapeutic minimalism and enhance their quality of life? Yes. Must the goal of pharmacotherapy be as limited as Freud's aspiration for psychotherapy: "to transform hysterical misery into common unhappiness"? No.
First, the boring but crucial preliminaries. Optimal nutrition and exercise will increase the efficacy of all the potential life-enhancers touted here. A rich supply of precursor chemicals (e.g. tryptophan, the rate-limiting step in the production of serotonin) can also reduce their effective dosages. By choosing to eat an ideal "stone-age" diet rich in organic nuts, seeds, fruit and vegetables, and drastically reducing one's consumption of saturated fat (red meat, fried foods), sugar (sweets etc) and hydrogenated oils (found in margarine and refined vegetable oils), then one's baseline of well-being - or at least relative ill-being - can be sustainably lifted. Visitors to HedWeb probably don't expect to be assailed by sermons on the benefits of exercise any more than food-faddism. Yet regular and moderately vigorous physical exertion releases endogenous opiates, enhances serotonin function, stimulates nerve growth factors, and leads to a livelier, better-oxygenated brain.
Alas, clean living and wholesome thoughts typically aren't enough. We need stronger medicine to flourish. At first glance, however, the standard, State-rationed chemicals aren't a brilliant bunch.
The so-called minor tranquillisers, the benzodiazepines such as diazepam (Valium) and the shorter-acting temazepam, are sometimes useful but still dreadfully crude anti-anxiety agents. They act primarily on the GABA (gamma aminobutyric acid) receptor complex. GABA functions as the main inhibitory neurotransmitter in the central nervous system. The progress of molecular biology and neurogenetics in unravelling the fiendish complexity of GABA's receptor sub-types should eventually allow more targeted compounds to be developed. These more selective and site-specific drugs will lack the sedative and hypnotic properties of today's marketed brands. In the meantime, benzodiazepines in current use tend to induce dependence, dull consciousness and impair the intellect. So there's not much chance of radical life-enrichment here.
Buspirone (Buspar), is somewhat more promising. It acts on an autoreceptor subtype of serotonin. This means it has mood-brightening properties too; and hence it is useful in anxious depressive states. Buspirone lacks the intellect-clouding effects of other clinical and alcoholic anti-anxiety agents. Yet its weak and equivocal effects on sub-types of dopamine function, while useful for the purposes of commercially touting its lack of "abuse potential", mean it isn't very exciting or especially effective.
The so-called anti-depressants fall into several categories. Their mood-brightening effect is correlated with alterations in the concentration of catecholamines and/or serotonin in the central nervous system and the long-term receptor re-regulation these changes provoke.
The tricyclics, prototypically imipramine (Tofranil), and their allies are relatives of the neuroleptic drug chlorpromazine. Chlorpromazine is also known as Largactil, the notorious "chemical cosh". Tricyclics block to varying degrees the reuptake of serotonin and noradrenaline into the nerve cell terminals from where they are released. Perhaps unsurprisingly given their parentage, they are all dirty drugs, though some are dirtier than others.
Their anti-cholinergic effects harm memory and intellectual performance. Their anti-histamine action induces drowsiness and sedation. Their adverse effect on cardiac function makes them dangerous in overdose. Most "euthymic" volunteers on whom they have been tested don't like their dulling effects of consciousness. Unlike chlorpromazine, the tricyclic antidepressants don't noticeably block the dopamine receptors. But with one notable exception, they do precious little to stimulate dopamine function either. Hence they're not much fun even for the severely depressed people who can benefit from taking them. For three decades they were the mainstay of the treatment of clinically-acknowledged depression. They contributed to the widely-held medical opinion that anything classed as an antidepressant won't help "normal" people; unless of course they were "really" depressed. Basically, tricyclics are cheap, nasty and best avoided.
Much better, but still in some ways deeply flawed, are the selective serotonin reuptake inhibitors.
Serotonin, "the civilising neurotransmitter", plays a vital role in mood, memory, appetite, sleep, pain perception and sexual desire.
Fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), and citalopram (Cipramil, Celexa) are currently licensed and marketed. More of their "me-too" relatives are on the way from pharmaceutical companies eager for a lucrative piece of the action. The SSRIs all differ in their half-lives, chemical structure and precise specificities. Their functional effects are broadly similar. Their mood-brightening, resilience-enhancing and anti-anxiety properties really can make a modest percentage of the population feel "better than well". As a class, they don't have the physically unpleasant and cognitively debilitating anti-cholinergic effects of the tricyclics. A much larger section of the community - folk who daily knock back huge quantities of ethyl alcohol in the socially accepted fashion - could surely gain from the durably enhanced serotonin function SSRIs can yield. Such a switch would necessitate a big change in marketing strategy.
The beneficent properties of the SSRIs are celebrated in Peter Kramer's contemporary classic Listening to Prozac. Kramer has written a remarkably honest book. It's a discursive memoir by a therapist who is forced to admit that many of his clients seemed rapidly to fare far better on a pill than on his industrial-strength regimen of caring talk-therapy. Kramer's discussion of "cosmetic psychopharmacology" and "designer personalities", however, enraged traditionalists. For chemical Calvinist orthodoxy finds the notion that people should have a right pharmacologically to choose who and what they want to be profoundly offensive.
Two common problems limit the usefulness of SSRIs, at least when taken on their own. The problems stem from the indirect inhibitory effect of Prozac-style drugs on dopamine function, a consequence of deliberate selective targeting on the functional enhancement of subtypes of serotonin pathway.
First, SSRIs can compromise libido and sexual performance. This isn't always a disadvantage in over-excitable young males. It can still be a very distressing phenomenon for people too embarrassed to talk about it. Technical performance difficulties can sometimes be counteracted by taking (the alpha-2 adrenergic agonist) yohimbine; the phosphodiesterase inhibitor sildenafil (better known as the sexual rocket-fuel Viagra); or a dopamine agonist, licit or otherwise, before bedtime action. Yet this is scarcely an ideal solution.
Second, though some subjects may feel mildly euphoric, in other users the SSRIs serve more as mood-stabilisers and -flatteners in their lives. By increasing the user's emotional self-sufficiency, too, SSRIs may subtly change the "balance of power" in personal relationships - for good or ill. In some cases, SSRIs may even act as thymoanaesthetisers which diminish the intensity of felt emotion; by contrast, a mood-brightening serotonin reuptake-enhancer like tianeptine may intensify emotion instead. Affective flattening may be welcome to someone in the pit of unmitigated clinical depression. It is scarcely a life-enriching property for "normal" people who lack any convenient diagnostic category which acknowledges their malaise.
Sunday, August 2, 2009
Monday, June 29, 2009
Some dead drugs
One spectacularly incompetent route to a lifetime of happiness involves taking illegal psychostimulants such as cocaine or the amphetamines. In the short term, their activation of the sympathetic nervous system tends to elevate mood, motivation and energy. Users tend to talk a lot. Self-confidence is enhanced: these are "power drugs". Physical strength and mental acuity are variably increased. Whereas cocaine blocks the neuronal re-uptake of the catecholamines (noradrenaline; dopamine), amphetamine triggers to a much greater extent their synaptic release as well. It is thus more potent.
In either case, libertarian indignation that the State presumes to subject its citizens to totalitarian-style mind-control should not obscure the fact that for most purposes these are not useful drugs. This is because the central nervous system supports a web of mutually inhibitory feedback-mechanisms. In response to a short-term increase of mood-mediating monoamines in the synapses, the genes and neuronal receptors re-regulate. So at best no real long-term benefit is derived from the use of such compounds. Neither cocaine nor amphetamine yield the sustained activation of intracellular signal-transduction cascades needed to cheat the hedonic treadmill.
Some people continue to take psychostimulants casually for years without serious harm. Yet the potential risks of adverse physical, psychological and social ill-effects are high. Hence their use is best discouraged.
The depressant opioids are marginally more benign. They can be extremely pleasurable. Next century, their customised and site-selective successors may play a valuable role in promoting emotional superhealth. We could all do with having our native endorphin systems enriched. Unfortunately, the present crop are physiologically addictive They lose quite a bit of their euphoriant effect as tolerance sets in. Typically, they inspire a dreamily contented disengagement from the problems of the world. They diminish any drive to constructive activity. Sadly, too, their use impairs the release of endogenous opioids normally induced by social interaction with friends and family.
The physical risks of opioid use shouldn't be exaggerated. Most of the problems that users suffer ultimately derive less from their choice of drug itself than from the illegal status of exogenous opioids in contemporary society. Yet even if they were legal and given away in cereal packets, they wouldn't make a good choice of mood-booster - or at least not in their present, crudely non-specific guise. kappa- agonists, for instance, have dys phoric and psychotomimetic effects; one might as well drink ethyl alcohol spiced with meths. The paradise-engineers of posterity will surely weed out such adulterants from their elixirs altogether.
By contrast to today's opioids, marijuana isn't usually addictive in the traditional sense of the term. It can, however be habit-forming. It has euphoriant, psychedelic and sedative properties. Experiments with stoned rats suggest the drug reduces the amount of corticotrophin-releasing factor in the amygdala. Excess secretion of CRF is associated with abnormalities in the HPLA axis and depression. The rebound surge of CRF on ceasing cannabis-use is associated with increased vulnerability to stress and a withdrawal-reaction; arguably one good reason not to stop in the first instance.
The primary psychoactive ingredient in marijuana is THC, tetrahydrocannabinol. Smoking or eating marijuana and its complex cocktail of compounds may rarely trigger episodes of depersonalisation, derealisation and psychosis. Sometimes it can induce paranoia, particularly in advocates of The War Against Drugs. More commonly, it just leaves the user pleasantly and harmlessly stoned. It's fun. Sleepiness, pain relief and euphoria are typical responses. Indeed the first brain-derived substance found to bind to our cannabis receptors was christened "anandamide", a derivative of the Sanskrit word for internal contentment. Getting high may thus serve as an innocent recreational pastime in an uncaring world.
Yet marijuana is not a wonderdrug. Cognitive function in the user is often impaired, albeit moderately and reversibly. Marijuana interferes with memory-formation by disrupting long-term potentiation in the hippocampus. It seems that one of the functions of endogenous cannabinoids in the brain is to promote selective short-term amnesia.
Forgetting is not, as one might have supposed, a purely passive process. Either way, choosing deliberately to ingest an amnestic agent for long periods is scarcely an ideal life-strategy. It's especially flawed given the centrality of memory to human self-identity. Some artists and professional bohemians, it is true, apparently do find smoking grass an adjunct to creative thought. For persons of a more philistine temperament, on the other hand, it's hard to see such a drug as a major tool for life-affirmation or the self-development of the species. This does not, one ought scarcely need to add, suggest users should be persecuted and criminalised.
The empathogen "hug-drug", ecstasy (methylenedioxymethamphetamine; MDMA) offers a wonderfully warm, sensuous, loving, and empathetic peak experience to the first-time user. Distrust, suspicion and jealousy evaporate. They are replaced by a serene sense of universal love. The sensorium remains clear. Emotion is intensified. Much recreational drug-use tends to be self-centred. It is often branded as selfish. Yet here is a "penicillin of the soul" which promises to subvert our selfish-DNA-driven tendency to self-aggrandisement.
Disappointingly, whether due to enzyme-induction or other causes not fully understood, most users never fully recapture the magic of their first few trips. Moreover ecstasy is neurotoxic to serotonergic axons. It may even be harmful at sub-therapeutic doses. As the uncertain process of neural recovery sets in, heavy users in particular may experience the subtle long-drawn-out reversal of all the good effects they initially enjoyed from the drug. Taking a post-trip selective serotonin re-uptake inhibitor (SSRI) such as fluoxetine (Prozac) 2-6 hours afterward is prophylactic against the measurable post-E serotonin dip otherwise experienced some 48 hours later. Yet taking SSRIs on a regular basis largely nullifies the already attenuated benefits of prolonged ecstasy use. In any case, the duration of the peak experience is a mere 90 minutes. So taking ecstasy scarcely amounts to a full-scale strategy for life either. It does, on the other hand, deliver an exquisite foretaste of the beautiful forms of consciousness that ultimately await us.
Another tantalising and deliciously sensuous hint of the sublime is offered - infrequently and unpredictably - by gamma-hydroxybutyric acid (GHB). GHB usually takes the form of a clear, odourless, slightly salty-tasting liquid.
It's also an endogenous precursor and metabolite of the inhibitory neurotransmitter GABA. GHB is non-toxic; but it mustn't be mixed with alcohol or other depressants. It's metabolised quickly to carbon dioxide and water. GHB's steep dose-response curve means naive users run the severe risk of falling asleep. When used lightly in recreational rather than stuporific or anaesthetic doses, GHB is a touchy-feely compound which typically induces deep muscular relaxation, a sense of serenity, and feelings of emotional warmth. Often it enhances emotional openness and the desire to socialise. Tactile sensitivity and the appreciation of music are enriched. Most remarkably, the moderate user may awake refreshed after a deep restful sleep: GHB appears temporarily to inhibit dopamine-release while increasing storage, leading to the brightened mood and sharpened mental focus of a subsequent "dopamine-rebound". GHB acts both as a disinhibitor and an aphrodisiac. The intensity of orgasm is heightened. Hence GHB is potentially useful in relieving the psychopathologies of prudery and sexual repression. Unfortunately, its therapeutic value has been eclipsed by its demonization in the mass-media. Stories of chaste virgins turning into sex-crazed nymphomaniacs make great copy and poor medicine. Moreover GHB is sometimes confused with the amnestic "date-rape" benzodiazepine, flunitrazepam - better-known as the potent and fast-acting sedative-hypnotic "forget pill", Rohypnol. Bought on the street, GHB may be confused with all sorts of other substances too.
Yet even pure GHB is no magic elixir. Not everyone likes it. GHB's psychological effects are unpredictable and poorly understood. Nausea, dizziness, inco-ordination are common; reaction-time is slowed. GHB does not usually promote great depth of thought. Its very status as "an almost ideal sleep inducing-substance" makes it of limited use to those who aspire instead to be more intensely awake. The lack of any discernible body-count to fuel the periodic moral panics its use induces may allow a partial rehabilitation. Yet GHB evokes - at best - only a faint and fleeting parody of the life-long chemical nirvana on offer to our transhuman successors.
Alcohol - the traditional date-rape drug of choice - and, most insidiously of all, cigarettes are the really sinister mass-killers. With that poker-faced Alice-In-Wonderland logic popular amongst the world's sleazier governments, not merely do the authorities preserve the legal status of cigarette sales here in the UK on grounds of upholding personal liberty. The slickly expensive marketing and glamorisation of tobacco products to potential victims is sanctioned on similar grounds too. We ought to be as shocked at tobacco promotion as we'd certainly feel if instead the billboards urged kids to try heroin because it's cool. Yet familiarity breeds moral apathy. Youngsters are typically hooked before they are in any position to make an informed choice of poison - or even to abstain altogether.
Meanwhile a state-supported export drive targets the poor in vulnerable Third World countries. With a cynicism that almost beggars belief, one celebrated ex-British Prime Minister accepted a million-dollar bribe from a leading member of the drug-cartels for her services. Her party's ineffable Home Secretary then delivered himself of blood-curdling calls for a crack-down on evil drug-pushers(!). He went on to increase the draconian penalties already available for personal users of cannabis.
So long as our governments collude with the organised drug cartels to share out the billions of dollars of tax revenues mulcted from nicotine-addicts - thereby keeping direct taxes visibly down and themselves visibly in office - there seems little hope of a more intelligent approach to psychoactive drugs as a whole.
In either case, libertarian indignation that the State presumes to subject its citizens to totalitarian-style mind-control should not obscure the fact that for most purposes these are not useful drugs. This is because the central nervous system supports a web of mutually inhibitory feedback-mechanisms. In response to a short-term increase of mood-mediating monoamines in the synapses, the genes and neuronal receptors re-regulate. So at best no real long-term benefit is derived from the use of such compounds. Neither cocaine nor amphetamine yield the sustained activation of intracellular signal-transduction cascades needed to cheat the hedonic treadmill.
Some people continue to take psychostimulants casually for years without serious harm. Yet the potential risks of adverse physical, psychological and social ill-effects are high. Hence their use is best discouraged.
The depressant opioids are marginally more benign. They can be extremely pleasurable. Next century, their customised and site-selective successors may play a valuable role in promoting emotional superhealth. We could all do with having our native endorphin systems enriched. Unfortunately, the present crop are physiologically addictive They lose quite a bit of their euphoriant effect as tolerance sets in. Typically, they inspire a dreamily contented disengagement from the problems of the world. They diminish any drive to constructive activity. Sadly, too, their use impairs the release of endogenous opioids normally induced by social interaction with friends and family.
The physical risks of opioid use shouldn't be exaggerated. Most of the problems that users suffer ultimately derive less from their choice of drug itself than from the illegal status of exogenous opioids in contemporary society. Yet even if they were legal and given away in cereal packets, they wouldn't make a good choice of mood-booster - or at least not in their present, crudely non-specific guise. kappa- agonists, for instance, have dys phoric and psychotomimetic effects; one might as well drink ethyl alcohol spiced with meths. The paradise-engineers of posterity will surely weed out such adulterants from their elixirs altogether.
By contrast to today's opioids, marijuana isn't usually addictive in the traditional sense of the term. It can, however be habit-forming. It has euphoriant, psychedelic and sedative properties. Experiments with stoned rats suggest the drug reduces the amount of corticotrophin-releasing factor in the amygdala. Excess secretion of CRF is associated with abnormalities in the HPLA axis and depression. The rebound surge of CRF on ceasing cannabis-use is associated with increased vulnerability to stress and a withdrawal-reaction; arguably one good reason not to stop in the first instance.
The primary psychoactive ingredient in marijuana is THC, tetrahydrocannabinol. Smoking or eating marijuana and its complex cocktail of compounds may rarely trigger episodes of depersonalisation, derealisation and psychosis. Sometimes it can induce paranoia, particularly in advocates of The War Against Drugs. More commonly, it just leaves the user pleasantly and harmlessly stoned. It's fun. Sleepiness, pain relief and euphoria are typical responses. Indeed the first brain-derived substance found to bind to our cannabis receptors was christened "anandamide", a derivative of the Sanskrit word for internal contentment. Getting high may thus serve as an innocent recreational pastime in an uncaring world.
Yet marijuana is not a wonderdrug. Cognitive function in the user is often impaired, albeit moderately and reversibly. Marijuana interferes with memory-formation by disrupting long-term potentiation in the hippocampus. It seems that one of the functions of endogenous cannabinoids in the brain is to promote selective short-term amnesia.
Forgetting is not, as one might have supposed, a purely passive process. Either way, choosing deliberately to ingest an amnestic agent for long periods is scarcely an ideal life-strategy. It's especially flawed given the centrality of memory to human self-identity. Some artists and professional bohemians, it is true, apparently do find smoking grass an adjunct to creative thought. For persons of a more philistine temperament, on the other hand, it's hard to see such a drug as a major tool for life-affirmation or the self-development of the species. This does not, one ought scarcely need to add, suggest users should be persecuted and criminalised.
The empathogen "hug-drug", ecstasy (methylenedioxymethamphetamine; MDMA) offers a wonderfully warm, sensuous, loving, and empathetic peak experience to the first-time user. Distrust, suspicion and jealousy evaporate. They are replaced by a serene sense of universal love. The sensorium remains clear. Emotion is intensified. Much recreational drug-use tends to be self-centred. It is often branded as selfish. Yet here is a "penicillin of the soul" which promises to subvert our selfish-DNA-driven tendency to self-aggrandisement.
Disappointingly, whether due to enzyme-induction or other causes not fully understood, most users never fully recapture the magic of their first few trips. Moreover ecstasy is neurotoxic to serotonergic axons. It may even be harmful at sub-therapeutic doses. As the uncertain process of neural recovery sets in, heavy users in particular may experience the subtle long-drawn-out reversal of all the good effects they initially enjoyed from the drug. Taking a post-trip selective serotonin re-uptake inhibitor (SSRI) such as fluoxetine (Prozac) 2-6 hours afterward is prophylactic against the measurable post-E serotonin dip otherwise experienced some 48 hours later. Yet taking SSRIs on a regular basis largely nullifies the already attenuated benefits of prolonged ecstasy use. In any case, the duration of the peak experience is a mere 90 minutes. So taking ecstasy scarcely amounts to a full-scale strategy for life either. It does, on the other hand, deliver an exquisite foretaste of the beautiful forms of consciousness that ultimately await us.
Another tantalising and deliciously sensuous hint of the sublime is offered - infrequently and unpredictably - by gamma-hydroxybutyric acid (GHB). GHB usually takes the form of a clear, odourless, slightly salty-tasting liquid.
It's also an endogenous precursor and metabolite of the inhibitory neurotransmitter GABA. GHB is non-toxic; but it mustn't be mixed with alcohol or other depressants. It's metabolised quickly to carbon dioxide and water. GHB's steep dose-response curve means naive users run the severe risk of falling asleep. When used lightly in recreational rather than stuporific or anaesthetic doses, GHB is a touchy-feely compound which typically induces deep muscular relaxation, a sense of serenity, and feelings of emotional warmth. Often it enhances emotional openness and the desire to socialise. Tactile sensitivity and the appreciation of music are enriched. Most remarkably, the moderate user may awake refreshed after a deep restful sleep: GHB appears temporarily to inhibit dopamine-release while increasing storage, leading to the brightened mood and sharpened mental focus of a subsequent "dopamine-rebound". GHB acts both as a disinhibitor and an aphrodisiac. The intensity of orgasm is heightened. Hence GHB is potentially useful in relieving the psychopathologies of prudery and sexual repression. Unfortunately, its therapeutic value has been eclipsed by its demonization in the mass-media. Stories of chaste virgins turning into sex-crazed nymphomaniacs make great copy and poor medicine. Moreover GHB is sometimes confused with the amnestic "date-rape" benzodiazepine, flunitrazepam - better-known as the potent and fast-acting sedative-hypnotic "forget pill", Rohypnol. Bought on the street, GHB may be confused with all sorts of other substances too.
Yet even pure GHB is no magic elixir. Not everyone likes it. GHB's psychological effects are unpredictable and poorly understood. Nausea, dizziness, inco-ordination are common; reaction-time is slowed. GHB does not usually promote great depth of thought. Its very status as "an almost ideal sleep inducing-substance" makes it of limited use to those who aspire instead to be more intensely awake. The lack of any discernible body-count to fuel the periodic moral panics its use induces may allow a partial rehabilitation. Yet GHB evokes - at best - only a faint and fleeting parody of the life-long chemical nirvana on offer to our transhuman successors.
Alcohol - the traditional date-rape drug of choice - and, most insidiously of all, cigarettes are the really sinister mass-killers. With that poker-faced Alice-In-Wonderland logic popular amongst the world's sleazier governments, not merely do the authorities preserve the legal status of cigarette sales here in the UK on grounds of upholding personal liberty. The slickly expensive marketing and glamorisation of tobacco products to potential victims is sanctioned on similar grounds too. We ought to be as shocked at tobacco promotion as we'd certainly feel if instead the billboards urged kids to try heroin because it's cool. Yet familiarity breeds moral apathy. Youngsters are typically hooked before they are in any position to make an informed choice of poison - or even to abstain altogether.
Meanwhile a state-supported export drive targets the poor in vulnerable Third World countries. With a cynicism that almost beggars belief, one celebrated ex-British Prime Minister accepted a million-dollar bribe from a leading member of the drug-cartels for her services. Her party's ineffable Home Secretary then delivered himself of blood-curdling calls for a crack-down on evil drug-pushers(!). He went on to increase the draconian penalties already available for personal users of cannabis.
So long as our governments collude with the organised drug cartels to share out the billions of dollars of tax revenues mulcted from nicotine-addicts - thereby keeping direct taxes visibly down and themselves visibly in office - there seems little hope of a more intelligent approach to psychoactive drugs as a whole.
Drugs for mental health
Could we live happily ever after? Perhaps. One's interest in the genetically pre-programmed states of sublimity sketched in The Hedonistic Imperative is tempered by the knowledge that one is unlikely to be around to enjoy them.
It's all very well being told our descendants will experience every moment of their lives as a breathtakingly magical epiphany. For emotional primitives and our loved ones at present, most of life's moments bring nothing of the sort. In
centuries to come, our base-line of emotional well-being may indeed exceed anything today's legacy wetware can even contemplate. Right now, however, a future Post-Darwinian Era of paradise-engineering can seem an awfully long way off. Mainstream society today has a desperately underdeveloped conception of mental health.
There's clearly a strong causal link between the raw neurobiological capacity to experience happiness and the extent to which one's life is felt to be worthwhile. High-minded philosophy treatises should complicate but not confuse the primacy of the pleasure-pain axis. So one very practical method of life-enrichment consists in chemically engineering happier brains for all in the here-and-now. Yet how can this best be done?
Any strategy which doesn't subvert our in-built hedonic treadmill of inhibitory feedback mechanisms in the CNS will fail. Political and socio-economic reforms offer at best a lame stopgap. To the scientific naturalist, all routes to happiness must ultimately be biological: "culture" must be neurochemically encoded to exert any effect.
Some of these routes to happiness involve the traditional environmental detours. They are too technical, diverse and futile to tackle here. If the quality of our lives is to be significantly enhanced in the long term, then the genetically predisposed set-point of our emotional thermostats needs to be recalibrated. The malaise-ridden norm typically adaptive in humanity's ancestral environment must be scrapped. So while we wait for germ-line gene-therapy to become standard, it's worth considering instead how ordinary late twentieth-century Homo sapiens can sustainably maximise emotional well-being with only present-day pharmacology to rely on. No less importantly, how is it possible to combine staying continuously high - one's embarrassment at using the frisson-charged term from the vernacular is revealing - with retaining one's sense of social and ethical responsibility to other people and life-forms?
Extracting reliable information on this topic is extraordinarily difficult for laity and professionals alike. The layman is more likely to be given heavily slanted propaganda. Unvarnished fact might confuse his uneducated and functionally diminutive brain. Career-scientists, on the other hand, are bedevilled by a different problem. Access to funds, laboratories, raw materials, journal publication, professional preferment, and licenses to conduct experimental trials is all dependent on researchers delivering results their paymasters want to hear. The disincentives to intellectual integrity could scarcely be greater; and they are cloaked in such reputable disguise.
By way of illustration, it's worth contemplating one far-fetched scenario. How might an everlasting-happiness drug - a drug which (implausibly!) left someone who tried it once living happily-ever-after - find itself described in the literature?
"Substance x induces severe, irreversible structural damage to neurotransmitter sub-system y. Its sequelae include mood-congruent cognitive delusions and several chronic and intractable cases of toxic affective psychosis".
Eeek! Needless to say, no sensible adult would wish to mess around with such a potent neurotoxin under this description.
Several excellent researchers play the game by the rules. They keep their heterodox opinions to themselves. Others find such cognitive dissonance too unpleasant. They gradually internalise the puritanical role and tendency to warped scientific prose expected of them. [Whereas horribly-tortured experimental animals, for instance, blandly get "used" and "sacrificed", certain drugs always get "abused" by "drug-abusers"] On the other hand, some of the most original and productive minds in the field of psychopharmacology - pre-eminently Alexander Shulgin - have already been silenced. Many more careers have been intellectually strangled at birth or consigned to professional oblivion. The danger of poisoning the wells of information, for whatever motives, is straightforward. When young people discover they have been lied to or deceived, over cannabis for instance, they will pardonably assume that they have been lied to or deceived over the dangers of other illegals too. And this, to put it mildly, would be exceedingly rash.
Most recently, the Internet daily delivers up an uncontrollable flood-tide of fresh ideas to counter official misinformation. Unfortunately, a lot of it isn't much more objective in content or style than the professional journals it complements. Devising one's own system of filtering and quality-control to drown out the noise is a challenging task for anybody.
It's all very well being told our descendants will experience every moment of their lives as a breathtakingly magical epiphany. For emotional primitives and our loved ones at present, most of life's moments bring nothing of the sort. In
centuries to come, our base-line of emotional well-being may indeed exceed anything today's legacy wetware can even contemplate. Right now, however, a future Post-Darwinian Era of paradise-engineering can seem an awfully long way off. Mainstream society today has a desperately underdeveloped conception of mental health.
There's clearly a strong causal link between the raw neurobiological capacity to experience happiness and the extent to which one's life is felt to be worthwhile. High-minded philosophy treatises should complicate but not confuse the primacy of the pleasure-pain axis. So one very practical method of life-enrichment consists in chemically engineering happier brains for all in the here-and-now. Yet how can this best be done?
Any strategy which doesn't subvert our in-built hedonic treadmill of inhibitory feedback mechanisms in the CNS will fail. Political and socio-economic reforms offer at best a lame stopgap. To the scientific naturalist, all routes to happiness must ultimately be biological: "culture" must be neurochemically encoded to exert any effect.
Some of these routes to happiness involve the traditional environmental detours. They are too technical, diverse and futile to tackle here. If the quality of our lives is to be significantly enhanced in the long term, then the genetically predisposed set-point of our emotional thermostats needs to be recalibrated. The malaise-ridden norm typically adaptive in humanity's ancestral environment must be scrapped. So while we wait for germ-line gene-therapy to become standard, it's worth considering instead how ordinary late twentieth-century Homo sapiens can sustainably maximise emotional well-being with only present-day pharmacology to rely on. No less importantly, how is it possible to combine staying continuously high - one's embarrassment at using the frisson-charged term from the vernacular is revealing - with retaining one's sense of social and ethical responsibility to other people and life-forms?
Extracting reliable information on this topic is extraordinarily difficult for laity and professionals alike. The layman is more likely to be given heavily slanted propaganda. Unvarnished fact might confuse his uneducated and functionally diminutive brain. Career-scientists, on the other hand, are bedevilled by a different problem. Access to funds, laboratories, raw materials, journal publication, professional preferment, and licenses to conduct experimental trials is all dependent on researchers delivering results their paymasters want to hear. The disincentives to intellectual integrity could scarcely be greater; and they are cloaked in such reputable disguise.
By way of illustration, it's worth contemplating one far-fetched scenario. How might an everlasting-happiness drug - a drug which (implausibly!) left someone who tried it once living happily-ever-after - find itself described in the literature?
"Substance x induces severe, irreversible structural damage to neurotransmitter sub-system y. Its sequelae include mood-congruent cognitive delusions and several chronic and intractable cases of toxic affective psychosis".
Eeek! Needless to say, no sensible adult would wish to mess around with such a potent neurotoxin under this description.
Several excellent researchers play the game by the rules. They keep their heterodox opinions to themselves. Others find such cognitive dissonance too unpleasant. They gradually internalise the puritanical role and tendency to warped scientific prose expected of them. [Whereas horribly-tortured experimental animals, for instance, blandly get "used" and "sacrificed", certain drugs always get "abused" by "drug-abusers"] On the other hand, some of the most original and productive minds in the field of psychopharmacology - pre-eminently Alexander Shulgin - have already been silenced. Many more careers have been intellectually strangled at birth or consigned to professional oblivion. The danger of poisoning the wells of information, for whatever motives, is straightforward. When young people discover they have been lied to or deceived, over cannabis for instance, they will pardonably assume that they have been lied to or deceived over the dangers of other illegals too. And this, to put it mildly, would be exceedingly rash.
Most recently, the Internet daily delivers up an uncontrollable flood-tide of fresh ideas to counter official misinformation. Unfortunately, a lot of it isn't much more objective in content or style than the professional journals it complements. Devising one's own system of filtering and quality-control to drown out the noise is a challenging task for anybody.
Saturday, June 6, 2009
Herbal and dietary products
Herbal and dietary products are chemicals that have druglike effects in people. Unfortunately, their effects are largely unknown and may be dangerous for some people because there is little reliable information about them. For most products, little research has been done to determine either their benefits or their adverse effects.
The safety and effectiveness of these products are not documented or regulated by laws designed to protect consumers, as are pharmaceutical drugs. As a result, the types and amounts of ingredients may not be standardized or even identified on the product label. In fact, most products contain several active ingredients and it is often not known which ingredient has the desired pharmacologic effect. In addition, components and active ingredients of plants can vary considerably, depending on the soil, water, and climate where the plants are grown.
These products can be used more safely if they are manufactured by a reputable company that states the ingredients are standardized (meaning that the dose of medicine in each tablet or capsule is the same).
The product label should also state specific percentages, amounts, and strengths of active ingredients. With herbal medicines especially, different brands of the same herb vary in the amounts of active ingredients per recommended dose. Dosing is also difficult because a particular herb may be available in several different dosage forms (eg, tablet, capsule, tea, extract) with different amounts of active ingredients.
These products are often advertised as "natural". Many people interpret this to mean the products are safe and better than synthetic or man-made products. This is not true; "natural" does not mean safe, especially when taken concurrently with other herbals, dietary supplements, or drugs.
When taking herbal or dietary supplements, follow the instructions on the product label. Inappropriate use or taking excessive amounts may cause dangerous side effects.
Inform health care providers when taking any kind of herbal or dietary supplement, to reduce risks of severe adverse effects or drug-supplement interactions.
Most herbal and dietary supplements should be avoided during pregnancy or lactation and in young children.
The American Society of Anesthesiologists recommends that all herbal products be discontinued 2-3 weeks before any surgical procedure. Some products (eg, echinacea, ephedra, feverfew, garlic, gingko, ginseng, kava, valerian and St. John's wort) can interfere with or increase the effects of some drugs, affect blood pressure or heart rhythm, or increase risks of bleeding; some have unknown effects when combined with anesthetics, other perioperative medications, and surgical procedures.
Store herbal and dietary supplements out of the reach of children.
Read about Hemorrhoids herbal cream
The safety and effectiveness of these products are not documented or regulated by laws designed to protect consumers, as are pharmaceutical drugs. As a result, the types and amounts of ingredients may not be standardized or even identified on the product label. In fact, most products contain several active ingredients and it is often not known which ingredient has the desired pharmacologic effect. In addition, components and active ingredients of plants can vary considerably, depending on the soil, water, and climate where the plants are grown.
These products can be used more safely if they are manufactured by a reputable company that states the ingredients are standardized (meaning that the dose of medicine in each tablet or capsule is the same).
The product label should also state specific percentages, amounts, and strengths of active ingredients. With herbal medicines especially, different brands of the same herb vary in the amounts of active ingredients per recommended dose. Dosing is also difficult because a particular herb may be available in several different dosage forms (eg, tablet, capsule, tea, extract) with different amounts of active ingredients.
These products are often advertised as "natural". Many people interpret this to mean the products are safe and better than synthetic or man-made products. This is not true; "natural" does not mean safe, especially when taken concurrently with other herbals, dietary supplements, or drugs.
When taking herbal or dietary supplements, follow the instructions on the product label. Inappropriate use or taking excessive amounts may cause dangerous side effects.
Inform health care providers when taking any kind of herbal or dietary supplement, to reduce risks of severe adverse effects or drug-supplement interactions.
Most herbal and dietary supplements should be avoided during pregnancy or lactation and in young children.
The American Society of Anesthesiologists recommends that all herbal products be discontinued 2-3 weeks before any surgical procedure. Some products (eg, echinacea, ephedra, feverfew, garlic, gingko, ginseng, kava, valerian and St. John's wort) can interfere with or increase the effects of some drugs, affect blood pressure or heart rhythm, or increase risks of bleeding; some have unknown effects when combined with anesthetics, other perioperative medications, and surgical procedures.
Store herbal and dietary supplements out of the reach of children.
Read about Hemorrhoids herbal cream
Sunday, May 17, 2009
Prescription drugs
Prescription drugs are always prescribed by a physician or a doctor and are very effective on the body.
Some people get confused with prescription drugs and over-the-counter drugs which are available without any prescription. All prescription drugs come in market after getting approved by concerned legitimate body such as FDA.
The reason behind taking approval is that all the prescription drugs contain medicinal values which can prove to be fatal for life if taken without any prescription. Even then some people, other than the patient, get access to these drugs and after consuming heavy doses feel vulnerable.
Perhaps this is the main reason behind all those warnings mentioned on the cover of each prescription drugs. It is also noticed that some patients consume heavy doses of prescription drugs, without consulting their doctors, to get rid of the pain. However, such patients usually end up fighting for their lives against the side effects of prescription drugs.
In order to avoid such complications doctors advice their patients to consume specified amount of drugs for safe and effective results. However, there are some people who knowingly abuse prescription drugs. Generally, these people abuse prescription drugs either to lose weight or to get high on life. While abusing prescription drugs people often forget that they can die because of this.
Undoubtedly, abuse of prescription drugs is increasing day by day. However, it is believed that many prescription drug abusers are ignorant teenagers who consume drugs to get high. Also these kinds of drug abusers are increasing at an alarming rate. Due to lack of proper information teenagers, unknowingly, abuse prescription drugs that adversely affect their body in the long run.
FDA and other concerned bodies are putting all their efforts in order to stop prescription drug abuse. They have issued several guidelines to which every drug manufacturing company needs to abide. For instance, it is mandatory for every drug manufacturing company to obtain a license before selling their prescription drugs in the market. Also drugs sold whether generic or branded must be genuine and as per the guidelines of FDA.
No Prescription Drugs
In some countries, there is a need to obtain what is called a prescription before medicine can be obtained. These prescription drugs can't always be accessible to some, so there is a need for such people to get alternative treatments. But how does one go about getting a dependable drug without the prescription given by a doctor?
Drugs That Don't Need Prescriptions: Several types of drugs are not regulated this included herbs, minerals, vitamins, and food supplements. Since these items are not regulated, there is no prescription required for them.
It should be noted that since these drugs are not, in fact, regulated they may not live up to their claims. It is commonplace to see an herbal remedy make falsified claims, simply because they can get away with it and make extra sales.
The majority of these drugs do work, however. But there is still a need for more powerful and dependable drugs- such as the kind that would have a prescription attached to them. But how do we obtain a prescription drug without a doctor's approval?
How to Get Prescription Drugs without a Prescription: There are several legit reasons why one would need a prescription drug without the prescription. Cost is a large factor- not every family has the money that is needed to see a doctor and then pay for the medicine too. Others can't make it to the doctor's office because of disabilities. Whatever the case, there are truly logical reason why one would need such drug without a prescription.
The beautiful thing about the Internet is that it has become a large marketplace of goods and services. Literally anyone around the world can obtain items and services from locations throughout every country on Earth.
The best part of the scheme is that not every country has prescription laws- meaning that prescription drugs could be shipped to one's household from another country. In many cases, it is even less expensive than what the medicine would cost otherwise. This is due to the fact that there is no regulation- and because drugs can often be produced cheaper outside country borders.
It's very important that one take care when buying drugs without a prescription online. First, there are many scams or tricks that fake Internet companies play on needy consumers. There is also concern in the fact that prescriptions are usually required for a reason. A doctor may be needed to check for family history or problems that one might encounter from the drug.
In most cases, buying online drugs without a prescription is perfectly safe. With a little research and optimism, reliable sources of prescription drugs can be found. And thanks to the global shipping system that only takes days to get an item around the world (given enough money is paid), emergencies can be tended to whereas they might not have been previously.
Final Thoughts on Obtaining Drugs without a Prescription: As with everything, make sure you engage in a sense of caution. Do your research, and make sure that the drug is completely safe to use. If there is any high risk or doubt, be sure to see a doctor. In every other case, you may enjoy the benefits of cheap drugs- both from saving you doctor visits and bloated medicine fees at the pharmacy.
Here you can order pills viagra soft tabs
Some people get confused with prescription drugs and over-the-counter drugs which are available without any prescription. All prescription drugs come in market after getting approved by concerned legitimate body such as FDA.
The reason behind taking approval is that all the prescription drugs contain medicinal values which can prove to be fatal for life if taken without any prescription. Even then some people, other than the patient, get access to these drugs and after consuming heavy doses feel vulnerable.
Perhaps this is the main reason behind all those warnings mentioned on the cover of each prescription drugs. It is also noticed that some patients consume heavy doses of prescription drugs, without consulting their doctors, to get rid of the pain. However, such patients usually end up fighting for their lives against the side effects of prescription drugs.
In order to avoid such complications doctors advice their patients to consume specified amount of drugs for safe and effective results. However, there are some people who knowingly abuse prescription drugs. Generally, these people abuse prescription drugs either to lose weight or to get high on life. While abusing prescription drugs people often forget that they can die because of this.
Undoubtedly, abuse of prescription drugs is increasing day by day. However, it is believed that many prescription drug abusers are ignorant teenagers who consume drugs to get high. Also these kinds of drug abusers are increasing at an alarming rate. Due to lack of proper information teenagers, unknowingly, abuse prescription drugs that adversely affect their body in the long run.
FDA and other concerned bodies are putting all their efforts in order to stop prescription drug abuse. They have issued several guidelines to which every drug manufacturing company needs to abide. For instance, it is mandatory for every drug manufacturing company to obtain a license before selling their prescription drugs in the market. Also drugs sold whether generic or branded must be genuine and as per the guidelines of FDA.
No Prescription Drugs
In some countries, there is a need to obtain what is called a prescription before medicine can be obtained. These prescription drugs can't always be accessible to some, so there is a need for such people to get alternative treatments. But how does one go about getting a dependable drug without the prescription given by a doctor?
Drugs That Don't Need Prescriptions: Several types of drugs are not regulated this included herbs, minerals, vitamins, and food supplements. Since these items are not regulated, there is no prescription required for them.
It should be noted that since these drugs are not, in fact, regulated they may not live up to their claims. It is commonplace to see an herbal remedy make falsified claims, simply because they can get away with it and make extra sales.
The majority of these drugs do work, however. But there is still a need for more powerful and dependable drugs- such as the kind that would have a prescription attached to them. But how do we obtain a prescription drug without a doctor's approval?
How to Get Prescription Drugs without a Prescription: There are several legit reasons why one would need a prescription drug without the prescription. Cost is a large factor- not every family has the money that is needed to see a doctor and then pay for the medicine too. Others can't make it to the doctor's office because of disabilities. Whatever the case, there are truly logical reason why one would need such drug without a prescription.
The beautiful thing about the Internet is that it has become a large marketplace of goods and services. Literally anyone around the world can obtain items and services from locations throughout every country on Earth.
The best part of the scheme is that not every country has prescription laws- meaning that prescription drugs could be shipped to one's household from another country. In many cases, it is even less expensive than what the medicine would cost otherwise. This is due to the fact that there is no regulation- and because drugs can often be produced cheaper outside country borders.
It's very important that one take care when buying drugs without a prescription online. First, there are many scams or tricks that fake Internet companies play on needy consumers. There is also concern in the fact that prescriptions are usually required for a reason. A doctor may be needed to check for family history or problems that one might encounter from the drug.
In most cases, buying online drugs without a prescription is perfectly safe. With a little research and optimism, reliable sources of prescription drugs can be found. And thanks to the global shipping system that only takes days to get an item around the world (given enough money is paid), emergencies can be tended to whereas they might not have been previously.
Final Thoughts on Obtaining Drugs without a Prescription: As with everything, make sure you engage in a sense of caution. Do your research, and make sure that the drug is completely safe to use. If there is any high risk or doubt, be sure to see a doctor. In every other case, you may enjoy the benefits of cheap drugs- both from saving you doctor visits and bloated medicine fees at the pharmacy.
Here you can order pills viagra soft tabs
Monday, May 11, 2009
Medical Terminology
Medical terminology is made up of terms that describe human anatomy and physiology (body organs, systems, and their functions), body locations, diseases, diagnostic imaging and laboratory testing, together with clinical procedures, surgeries, and diagnoses.
Why do we need medical terminology?
A medical term usually describes in one word a disease or condition that, under normal circumstances, would take several words to describe.
Building a medical vocabulary involves breaking down a word by identifying its prefix, suffix, and root word. The root word is the foundation or basic meaning of the word. It can appear with a prefix and suffix or between a prefix and suffix, as prefixes and suffixes never stand alone. They must be attached to a root word.
- Prefix: Appears at the beginning of a word and tells the how, why, where, when, how much, how many, position, direction, time, or status.
- Root word: Specifies the body part to which the term refers.
- Suffix: Appears at the end of a word and indicates a procedure, condition, or disease.
Each prefix, root, and suffix has its own meaning, so it’s your job to remember them and put the three meanings together into one greater word meaning.
Medical language is an entity unto itself and followed a historical development.
Common medical vocabulary used today includes terms built from Greek and Latin word parts, some of which were used by Hippocrates and Aristotle more than 2,000 years ago. That’s quite an extensive pedigree, and one that only continued to build as time flew by, right into the modern age.
One type of medical term is the eponym, a term named after the personal name of someone. An example would be Parkinson’s disease, named after the English physician Dr. James Parkinson.
With the great advancements in medicine throughout the 20th century, medical language changed with the times and continues to do so today. Some words are discarded or considered obsolete, whereas others are changed, and new words are continually added.
Now available in several formats including traditional print, CD-ROM, Web sites, databases, and even wall charts, medical dictionaries grow bigger with each new edition. Check out Chapter 24 for a list of great resources. The rapid increase in medical and scientific knowledge necessitates new medical vocabulary to describe it. Changes in medicine in the 20th century became apparent in the growing size of medical dictionaries. Knowledge about immunology, antibodies, allergies, and viruses was in the infancy stage in early editions of dictionaries.
Greek and Latin
You can thank the two founding fathers of medical terminology for getting the ball rolling: Hippocrates and Aristotle. Hippocrates, considered the father of medicine, was a student, teacher, and great physician. Aristotle was a Greek philosopher and a physical scientist. He stressed observation and induction. His major studies were of comparative anatomy and physiology.
The Hippocratic Oath — an oath of professional behavior sworn by physicians beginning a medical career — is attributed to Hippocrates. The Greeks were the founders of modern medicine, but Latin is the basic source of medical terms. With origins in ancient Rome and thanks to good, old-fashioned conquest, Latin quickly made its way through the world, solidifying its rep as the language of choice for medicine and science.
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Why do we need medical terminology?
A medical term usually describes in one word a disease or condition that, under normal circumstances, would take several words to describe.
Building a medical vocabulary involves breaking down a word by identifying its prefix, suffix, and root word. The root word is the foundation or basic meaning of the word. It can appear with a prefix and suffix or between a prefix and suffix, as prefixes and suffixes never stand alone. They must be attached to a root word.
- Prefix: Appears at the beginning of a word and tells the how, why, where, when, how much, how many, position, direction, time, or status.
- Root word: Specifies the body part to which the term refers.
- Suffix: Appears at the end of a word and indicates a procedure, condition, or disease.
Each prefix, root, and suffix has its own meaning, so it’s your job to remember them and put the three meanings together into one greater word meaning.
Medical language is an entity unto itself and followed a historical development.
Common medical vocabulary used today includes terms built from Greek and Latin word parts, some of which were used by Hippocrates and Aristotle more than 2,000 years ago. That’s quite an extensive pedigree, and one that only continued to build as time flew by, right into the modern age.
One type of medical term is the eponym, a term named after the personal name of someone. An example would be Parkinson’s disease, named after the English physician Dr. James Parkinson.
With the great advancements in medicine throughout the 20th century, medical language changed with the times and continues to do so today. Some words are discarded or considered obsolete, whereas others are changed, and new words are continually added.
Now available in several formats including traditional print, CD-ROM, Web sites, databases, and even wall charts, medical dictionaries grow bigger with each new edition. Check out Chapter 24 for a list of great resources. The rapid increase in medical and scientific knowledge necessitates new medical vocabulary to describe it. Changes in medicine in the 20th century became apparent in the growing size of medical dictionaries. Knowledge about immunology, antibodies, allergies, and viruses was in the infancy stage in early editions of dictionaries.
Greek and Latin
You can thank the two founding fathers of medical terminology for getting the ball rolling: Hippocrates and Aristotle. Hippocrates, considered the father of medicine, was a student, teacher, and great physician. Aristotle was a Greek philosopher and a physical scientist. He stressed observation and induction. His major studies were of comparative anatomy and physiology.
The Hippocratic Oath — an oath of professional behavior sworn by physicians beginning a medical career — is attributed to Hippocrates. The Greeks were the founders of modern medicine, but Latin is the basic source of medical terms. With origins in ancient Rome and thanks to good, old-fashioned conquest, Latin quickly made its way through the world, solidifying its rep as the language of choice for medicine and science.
Here you csn read about For piller pa natet
Friday, May 8, 2009
Sexual Health
Sexual difficulties may begin early in a person's life or they may develop after an individual has previously experienced enjoyable and satisfying sex. A problem may develop gradually over time, or may occur suddenly as a total or partial inability to participate in one or more stages of the sexual act.
What causes Sexual Problems?
The causes of sexual difficulties can be physical, psychological, or both.
Emotional factors affecting sex include both interpersonal problems and psychological problems within the individual. Interpersonal problems include marital or relationship problems, or lack of trust and open communication between partners. Personal psychological problems include depression, sexual fears or guilt, or past sexual trauma.
Physical factors contributing to sexual problems include:
Drugs, such as alcohol, nicotine, narcotics, stimulants, antihypertensives (medicines that lower blood pressure), antihistamines, and some psychotherapeutic drugs (drugs that treat psychological problems such as depression)
Injuries to the back
An enlarged prostate gland
Problems with blood supply
Nerve damage (as in spinal cord injuries)
Disease (diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis)
Failure of various organs (such as the heart and lungs)
Endocrine disorders (thyroid, pituitary, or adrenal gland problems)
Hormonal deficiencies (low testosterone, estrogen, or androgens)
Some birth defects
Sexual dysfunctions are more common in the early adult years, with the majority of people seeking care for such conditions during their late 20s through 30s. The incidence increases again in the geriatric population, typically with gradual onset of symptoms that are associated most commonly with medical causes of sexual dysfunction.
Sexual dysfunction is more common in people who abuse alcohol and drugs. It is also more likely in people suffering from diabetes and degenerative neurological disorders. Ongoing psychological problems, difficulty maintaining relationships, or chronic disharmony with the current sexual partner may also interfere with sexual function.
Types of Sexual Problems
Sexual dysfunction disorders are generally classified into 4 categories:
sexual desire disorders
sexual arousal disorders
orgasm disorders, and
sexual pain disorders.
Sexual desire disorders (decreased libido) may be caused by a decrease in the normal production of estrogen (in women) or testosterone (in both men and women). Other causes may be aging, fatigue, pregnancy, and medications -- the SSRI anti-depressants which include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) are well known for reducing desire in both men and women. Psychiatric conditions, such as depression and anxiety, can also cause decreased libido.
Sexual arousal disorders were previously known as frigidity in women and impotence in men. These have now been replaced with less judgmental terms. Impotence is now known as erectile dysfunction, and frigidity is now described as female sexual dysfunction, a term that covers a range of several specific problems with desire, arousal, or anxiety.
For both men and women, these conditions may appear as an aversion to, and avoidance of, sexual contact with a partner. In men, there may be partial or complete failure to attain or maintain an erection, or a lack of sexual excitement and pleasure in sexual activity.
There may be medical causes for these disorders, such as decreased blood flow or lack of vaginal lubrication. Chronic disease may also contribute to these difficulties, as well as the nature of the relationship between partners. As the success of Viagra attests, many erectile disorders in men may be primarily physical, not psychological conditions.
Orgasm disorders are a persistent delay or absence of orgasm following a normal sexual excitement phase. The disorder occurs in both women and men. Again, the SSRI antidepressants are frequent culprits -- these may delay the achievement of orgasm or eliminate it entirely.
Sexual pain disorders affect women almost exclusively, and are known as dyspareunia (painful intercourse) and vaginismus (an involuntary spasm of the muscles of the vaginal wall, which interferes with intercourse). Dyspareunia may be caused by insufficient lubrication (vaginal dryness) in women.
Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by menopause, pregnancy, or breast-feeding. Irritation from contraceptive creams and foams may also cause dryness, as can fear and anxiety about sex.
It is unclear exactly what causes vaginismus, but it is thought that past sexual trauma such as rape or abuse may play a role. Another female sexual pain disorder is called vulvodynia or vulvar vestibulitis. In this condition, women experience burning pain during sex which may be related to problems with the skin in the vulvar and vaginal areas. The cause is unknown.
Symptoms
Men or women:
Lack of interest in sex (loss of libido)
Inability to feel aroused
Pain with intercourse (much less common in men than women)
Men :
Inability to attain an erection
Inability to maintain an erection adequately for intercourse
Delay or absence of ejaculation, despite adequate stimulation
Inability to control timing of ejaculation
Women:
Inability to relax vaginal muscles enough to allow intercourse
Inadequate vaginal lubrication before and during intercourse
Inability to attain orgasm
Burning pain on the vulva or in the vagina with contact to those areas
Diagnosis
Specific physical findings and testing procedures depend on the form of sexual dysfunction being investigated. A complete history is usually taken and a physical examination performed to:
Identify predisposing illnesses or conditions
Highlight possible fears, anxieties, or guilt specific to sexual behaviors or performance
Uncover any history of prior sexual trauma
A physical examination of both the partners should include the whole body and not be limited to the reproductive system.
Call your doctor if:
Call for an appointment with your health care provider if sexual problems persist and are a concern.
Treatment Options
Treatment depends on the cause of the sexual dysfunction. Medical causes that are reversible or treatable are usually managed medically or surgically. Physical therapy and mechanical aides may prove helpful for some people experiencing sexual dysfunction due to physical illnesses, conditions, or disabilities.
For men who have difficulty attaining an erection, the medication sildenafil (Viagra), which increases blood flow to the penis, may be very helpful, though it must be taken 1 to 4 hours prior to intercourse.
Men who take nitrates for coronary heart disease should not take sildenafil. Mechanical aids and penile implants are also an option for men who cannot attain an erection and who find that sildenafil isn't helpful.
Women with vaginal dryness may be helped with lubricating gels, hormone creams, and -- in cases of premenopausal or menopausal women -- with hormone replacement therapy. In some cases, women with androgen deficiency can be helped by taking testosterone.
Vulvodynia can be treated with testosterone cream, with use of biofeedback, and with low doses of some antidepressants, which also treat nerve pain. Surgery has not been successful.
Behavioral treatments involve many different techniques to treat problems associated with orgasm and sexual arousal disorders. Self-stimulation and the Masters and Johnson treatment strategies are among the many behavioral therapies used.
Simple, open, accurate, and supportive education about sex and sexual behaviors or responses may be all that is required in many cases. Some couples may benefit from joint counseling to address interpersonal issues and communication styles. Psychotherapy may be required to address anxieties, fears, inhibitions, or poor body image.
Prevention
Open, informative, and accurate communication regarding sexual issues and body image between parents and their children may prevent children from developing anxiety or guilt about sex and may help them develop healthy sexual relationships.
Review all medications, both prescription and over-the-counter, for possible side effects that relate to sexual dysfunction. Avoiding drug and alcohol abuse will also help prevent sexual dysfunction.
Couples who are open and honest about their sexual preferences and feelings are more likely to avoid some sexual dysfunction. One partner should, ideally, be able to communicate desires and preferences to the other partner.
People who are victims of sexual trauma, such as sexual abuse or rape at any age, are urged to seek psychiatric advice. Individual counseling with an expert in trauma may prove beneficial in allowing sexual abuse victims to overcome sexual difficulties and enjoy voluntary sexual experiences with a chosen partner.
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What causes Sexual Problems?
The causes of sexual difficulties can be physical, psychological, or both.
Emotional factors affecting sex include both interpersonal problems and psychological problems within the individual. Interpersonal problems include marital or relationship problems, or lack of trust and open communication between partners. Personal psychological problems include depression, sexual fears or guilt, or past sexual trauma.
Physical factors contributing to sexual problems include:
Drugs, such as alcohol, nicotine, narcotics, stimulants, antihypertensives (medicines that lower blood pressure), antihistamines, and some psychotherapeutic drugs (drugs that treat psychological problems such as depression)
Injuries to the back
An enlarged prostate gland
Problems with blood supply
Nerve damage (as in spinal cord injuries)
Disease (diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis)
Failure of various organs (such as the heart and lungs)
Endocrine disorders (thyroid, pituitary, or adrenal gland problems)
Hormonal deficiencies (low testosterone, estrogen, or androgens)
Some birth defects
Sexual dysfunctions are more common in the early adult years, with the majority of people seeking care for such conditions during their late 20s through 30s. The incidence increases again in the geriatric population, typically with gradual onset of symptoms that are associated most commonly with medical causes of sexual dysfunction.
Sexual dysfunction is more common in people who abuse alcohol and drugs. It is also more likely in people suffering from diabetes and degenerative neurological disorders. Ongoing psychological problems, difficulty maintaining relationships, or chronic disharmony with the current sexual partner may also interfere with sexual function.
Types of Sexual Problems
Sexual dysfunction disorders are generally classified into 4 categories:
sexual desire disorders
sexual arousal disorders
orgasm disorders, and
sexual pain disorders.
Sexual desire disorders (decreased libido) may be caused by a decrease in the normal production of estrogen (in women) or testosterone (in both men and women). Other causes may be aging, fatigue, pregnancy, and medications -- the SSRI anti-depressants which include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) are well known for reducing desire in both men and women. Psychiatric conditions, such as depression and anxiety, can also cause decreased libido.
Sexual arousal disorders were previously known as frigidity in women and impotence in men. These have now been replaced with less judgmental terms. Impotence is now known as erectile dysfunction, and frigidity is now described as female sexual dysfunction, a term that covers a range of several specific problems with desire, arousal, or anxiety.
For both men and women, these conditions may appear as an aversion to, and avoidance of, sexual contact with a partner. In men, there may be partial or complete failure to attain or maintain an erection, or a lack of sexual excitement and pleasure in sexual activity.
There may be medical causes for these disorders, such as decreased blood flow or lack of vaginal lubrication. Chronic disease may also contribute to these difficulties, as well as the nature of the relationship between partners. As the success of Viagra attests, many erectile disorders in men may be primarily physical, not psychological conditions.
Orgasm disorders are a persistent delay or absence of orgasm following a normal sexual excitement phase. The disorder occurs in both women and men. Again, the SSRI antidepressants are frequent culprits -- these may delay the achievement of orgasm or eliminate it entirely.
Sexual pain disorders affect women almost exclusively, and are known as dyspareunia (painful intercourse) and vaginismus (an involuntary spasm of the muscles of the vaginal wall, which interferes with intercourse). Dyspareunia may be caused by insufficient lubrication (vaginal dryness) in women.
Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by menopause, pregnancy, or breast-feeding. Irritation from contraceptive creams and foams may also cause dryness, as can fear and anxiety about sex.
It is unclear exactly what causes vaginismus, but it is thought that past sexual trauma such as rape or abuse may play a role. Another female sexual pain disorder is called vulvodynia or vulvar vestibulitis. In this condition, women experience burning pain during sex which may be related to problems with the skin in the vulvar and vaginal areas. The cause is unknown.
Symptoms
Men or women:
Lack of interest in sex (loss of libido)
Inability to feel aroused
Pain with intercourse (much less common in men than women)
Men :
Inability to attain an erection
Inability to maintain an erection adequately for intercourse
Delay or absence of ejaculation, despite adequate stimulation
Inability to control timing of ejaculation
Women:
Inability to relax vaginal muscles enough to allow intercourse
Inadequate vaginal lubrication before and during intercourse
Inability to attain orgasm
Burning pain on the vulva or in the vagina with contact to those areas
Diagnosis
Specific physical findings and testing procedures depend on the form of sexual dysfunction being investigated. A complete history is usually taken and a physical examination performed to:
Identify predisposing illnesses or conditions
Highlight possible fears, anxieties, or guilt specific to sexual behaviors or performance
Uncover any history of prior sexual trauma
A physical examination of both the partners should include the whole body and not be limited to the reproductive system.
Call your doctor if:
Call for an appointment with your health care provider if sexual problems persist and are a concern.
Treatment Options
Treatment depends on the cause of the sexual dysfunction. Medical causes that are reversible or treatable are usually managed medically or surgically. Physical therapy and mechanical aides may prove helpful for some people experiencing sexual dysfunction due to physical illnesses, conditions, or disabilities.
For men who have difficulty attaining an erection, the medication sildenafil (Viagra), which increases blood flow to the penis, may be very helpful, though it must be taken 1 to 4 hours prior to intercourse.
Men who take nitrates for coronary heart disease should not take sildenafil. Mechanical aids and penile implants are also an option for men who cannot attain an erection and who find that sildenafil isn't helpful.
Women with vaginal dryness may be helped with lubricating gels, hormone creams, and -- in cases of premenopausal or menopausal women -- with hormone replacement therapy. In some cases, women with androgen deficiency can be helped by taking testosterone.
Vulvodynia can be treated with testosterone cream, with use of biofeedback, and with low doses of some antidepressants, which also treat nerve pain. Surgery has not been successful.
Behavioral treatments involve many different techniques to treat problems associated with orgasm and sexual arousal disorders. Self-stimulation and the Masters and Johnson treatment strategies are among the many behavioral therapies used.
Simple, open, accurate, and supportive education about sex and sexual behaviors or responses may be all that is required in many cases. Some couples may benefit from joint counseling to address interpersonal issues and communication styles. Psychotherapy may be required to address anxieties, fears, inhibitions, or poor body image.
Prevention
Open, informative, and accurate communication regarding sexual issues and body image between parents and their children may prevent children from developing anxiety or guilt about sex and may help them develop healthy sexual relationships.
Review all medications, both prescription and over-the-counter, for possible side effects that relate to sexual dysfunction. Avoiding drug and alcohol abuse will also help prevent sexual dysfunction.
Couples who are open and honest about their sexual preferences and feelings are more likely to avoid some sexual dysfunction. One partner should, ideally, be able to communicate desires and preferences to the other partner.
People who are victims of sexual trauma, such as sexual abuse or rape at any age, are urged to seek psychiatric advice. Individual counseling with an expert in trauma may prove beneficial in allowing sexual abuse victims to overcome sexual difficulties and enjoy voluntary sexual experiences with a chosen partner.
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