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re: Rethinking childhood depression
- Kate Walker (10 December 2004)
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For the season that's in it...
- K D'Arcy (10 December 2004)
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An awesome responsibility
- AMARASINGHE A.W. AMARASINGHE,MD, (11 December 2004)
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Ignorance of Freud and Klein
- Anthony C Walsh, Bedford MK42 0RU (11 December 2004)
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Read On - please
- Ian P Palmer (12 December 2004)
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such a fine balance
- Christine Singh (13 December 2004)
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Why only childhood depression?
- John Stone (13 December 2004)
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pathologising the normal range of human emotion
- R E Laube (13 December 2004)
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Does childhood depression exist?
- D B Double (14 December 2004)
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Childhood depression is not a myth; the management may be problematic.
- Albert M. E. Coleman (14 December 2004)
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Depression and nutritional deficiencies in children
- Ellen C G Grant (14 December 2004)
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The generalist's perspective
- Christopher I Pelton (14 December 2004)
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medicalizing morality
- NANCY K OCONNOR, Pawhuska OK (14 December 2004)
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Rethinking childhood depression
- Alan W Fowler (19 December 2004)
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Linear versus Circular Thinking
- Mark Vettraino (20 December 2004)
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Family Life is an education for relationships
- Anne M Williams (31 December 2004)
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Rethinking Childhood Depression AND Abandoning the Diagnosis
- Herzl Lowenstein (22 January 2005)
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Kate Walker, Co-ordinator with Kaiyu Enterprises. http://www.kaiyu.org.au/ Newcastle, NSW, Australia
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Congratulations to Sami Timimi for this article. What I sense we, as clinical practitioners (or, as in my own case, ex - practitioner, now service co-ordinator of sorts) may need to well learn is that beneath the surface of the supposed patently obvious, is that the patently obvious is often obscured by our particular conditioned professional mindsets: and, the latter influenced, variously and to degrees, by a) the sociopolitic of health care delivery and, b) I rather suspect, an overly major foci upon the individual (at the expense of the social and collective). No secret that children these days are getting much less regular physical exercise than they used to twenty or so years ago, and indeed for that matter, much less *opportunities* for that exercise; no secret that the prescribing of antidepressant medications has gone through the roof in the last decade; no secret that kids these days don't have as much the opportunities just merely, and simply, for the essential of play, be a part of a social support network, be part of a cogent extended or otherwise 'family' (read, again, 'social support network'); and, have a reasonably viable 'outlet', for any/all those of the above, conflicts and frustrations. Something has to be very wrong, don't you think? Kate Walker bicycle@kooee.com.au Competing interests: a) Former Clinical Nurse Consultant (NSW Mid North Coast Area Health Services, Australia). b) Current Secretary, Bicycle Federation of Australia. c) List owner, Physical Activity for Mental Health ( http://uk.groups.yahoo.com/group/PhysicalActivityforMentalHealth/ ) |
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K D'Arcy, Junior doctor and childcare worker Ireland
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Dear Sir, Because I know it will be overlooked in the current debate, I want to comment on the point made by the author about this society's attitude towards its children. Individual psychosocial factors aside, the carelessness with which all children are viewed and used as consumers is something that will hopefully be looked back on with regret in the future. I think it's especially obvious at this time of year that the commercial media have almost unlimited power to influence childrens' attitudes and behaviour. This really can't be ignored in the quest to better understand and treat childhood psychiatric disorders. Nor do I think that, as medical and psychiatric professionals, we can hand the responsibility to protect children from this element to other groups - there will have to be multidisciplinary consensus on the issue if change is ever to be brought about. Competing interests: I am currently working with severely disturbed young people. |
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AMARASINGHE A.W. AMARASINGHE,MD,, Consultant Psychiatrist 102 Bayberry Hills McDonough Ga USA30253 4005
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My perception is that only few other professionals shoulder more awesome responsibilities than the present child mental health therapists. Each encounter between the therapist and the child overflows with an abundance of potentialities. Whether the therapeutic encounters are fleeting or prolonged , the outcomes can have lasting impact on the individual recipient. There is hardly a chance to correct therapeutic mis- steps. Child mental health has to be the exclusive domain of well trained, well meaning , well rounded professionals. Competing interests: None declared |
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Anthony C Walsh, GP 141a Harrowden Road, Bedford MK42 0RU
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It is odd that Sami Tamini only bothers to go back 60y as though teachers, philosophers, psychoanalysts, writers did not exist before 1944. Until we accept that depression is a normaal reaction to death, divorce etc we will remain muddled about how to hold children as they go through the stages of their emotions. SSRIs are simply the politically correct version of the pullyourselftogether idea - stop blubbing take the pills and keep smiling. Why not stick them all on pot? Competing interests: None declared |
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Ian P Palmer, Professor of Military Psychiatry N7 9LP
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Dear Sir, I thoroughly enjoyed Sami Timimi's excellent article, particularly the concept of 'context deprived notions leading to context deprived solutions'. It seems so very much out of vogue to contextualise our diagnostic deliberations and avoid contemplation of their social costs by falling back onto the biological [and therefore 'medicalized' individualized, 'not my fault', 'what are you - specialist - going to do about it] and dismissing, or is it 'trumping' or patronising, the social and psychological. The Macnamara Fallacy [Handy C. The empty raincoat. London. Hutchison, 1994] may be of interest to medical readers: Step 1: Measure what can easily be measured - This is OK as far as it goes. Step 2: Disregard that which cannot be easily measured or give it an arbitrary quantitative value - This is artificial and misleading. Step 3: Presume that what cannot be measured easily is not important - This is blindness. Step 4: Say, that which cannot be measured does not really exist - This is suicide. I would recommend any interested party to read Lloyd deMause's History of Childhood, find out more at: www.psychohistory.com/htm/bio.html I would also urge all readers of Sami's article to read Derek Wade & Peter Halligan's article on pp1398 of the same issue. Season's Greetings, Ian Palmer Competing interests: None declared |
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Christine Singh, women's health fellow- family medicine Women's College Hospital Toronto M6G 2T4
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This well written discussion about childhood depression highlights the urgency of our recognition as physicians and citizens, that improving the social determinants of health will be our only hope in "curing" illness like depression from the world. We are fortunate to be in a time of paradigm shifts where the need for balance is becoming clear. Of course, as the author points out, families being stressed beyond their limits for time or money or energy will not be able to nurture and grow their children. And as humans we need to ensure all children have access to positive social interactions, green, safe places to play, and opportunities to grow through education, culture, physical activity and love. It is not suprising that we, as a society, are increasing our medicalization of our human crisis. Our ideology is no longer one of faith in religion or in socially just governments; but instead we are asked more and more to believe in the equalizing ability of market forces.As physicians we shift our language subtley with advise from the creators of new logos for social disparity. Patients being represented as clients and consumers hinders our attempt to approach health with our patients and communities in a wholistic way. I believe we will figure it out eventually, and our fine balance will shift away from money towards humanity. Competing interests: None declared |
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John Stone, none London N22
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This is article contains an important argument, but surely one that extends to adults as well. Our world has become very bad at attending to people's feelings - how much more expedient to give them a pill to make them go away (people or feelings that is). Competing interests: None declared |
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R E Laube, consultant clinical psychologist Sydney, Australia
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The letter from Dr Timimi, and related responses, highlights an area that we all see when it is pointed-out to us, but few acknowledge in daily practice. Pathologising the broad range of human emotion is similar to observing social problems and seeking someone to blame, [often 'the government']. We comfort ourselves with the myth that a homogenised and predictable world is 'normal' and life is under control. Personal distress becomes a disease and the health community is charged to 'fix it'. We are pleased to be judged good citizens when we take-up this challenge; it makes us feel important and powerful. The benchmarks for depression are set by DSM and ICD committees. These are the people who told me as a student that same sex attraction was a disease. Their predecessors diagnosed run away slaves in the US as mentally ill. My colleagues from the former USSR have similar tales. The criteria for psychological diagnosis are contextual. As long as we do not allow ourselves to honestly report ‘this isn’t a medical problem’, we will keep grasping for labels and fooling ourselves and the public by pretending we can cure normal life. Competing interests: Clinical supervisor swimming upstream |
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D B Double, Consultant Psychiatrist Morfolk and Waveney Mental Health Partnership
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I think it unfortunate if the debate about childhood depression degenerates into a semantic argument about its existence.1 Reification of biomedical diagnosis acts as a justification for so-called evidenced-based treatments, which at present in the case of childhood depression are antidepressant medication, cognitive behaviour therapy and interpersonal therapy. The question is whether this process of reification is necessary for clinical practice, and personally I agree with Sami Timimi that it is not.1 The onus is on Spender and Wilkinson to define exactly what they mean when they use the term childhood depression, which they do not do in their commentaries.1 Do they mean a biologically based illness? No-one disputes that children have emotional problems. What more are they saying than this? Do they want to narrow the treatment of emotional problems in children to medically trained practitioners? If not, what more can a doctor add to such treatment apart from medication? Another article in the same issue of the BMJ raises the question of whether biomedical models of illness make for good healthcare systems.2 The potential danger of the biomedical model is reductionism. By contrast, psychosocial diagnosis does not necessarily require a single-word label, and that single-word label may not add much to the understanding and meaning of emotional problems. Such an approach is consistent with patient-centred medicine,3 and means that the patient is not merely seen as a passive recipient of treatment for which s/he has no responsibility. There are, therefore, advantages to a psychosocial perspective in clinical practice. I suspect the issue in this debate boils down to the readiness to use antidepressant medication in children. Both Spender and Wilkinson quote the Treatment for Adolescents with Depression Study (TADS)4 in favour of the use of fluoxetine. However, they do not mention criticisms of this study.5 Despite their conclusion, fluoxetine was not in fact statistically better than placebo in this study, and only became so when added to cognitive behavioural therapy in an unblinded arm of the study. Strictly speaking, Spender and Wilkinson have, therefore, not provided support for their position. I prefer Timimi's critical approach, which takes a sceptical stance on the evidence, more in keeping with the spirit of scientific enquiry.
Competing interests: I am a member of the Critical Psychiatry Network as is Sami Timimi |
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Albert M. E. Coleman, Associate specialist psychiatrist. Greenarces CMHT, WSHSS NHS Care trust, Homefield road. Worthing, BN11 2DH. W. Sussex.
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Editor. - The paper by Timimi was interesting reading and informative; My concern was that part of the paper could be misconstrued as promoting the notion of childhood depression just being an aberration of ordinary childhood unhappiness, and only an invention of wayward western civilization.1 I will rather tend to agree with the fact that childhood depression is a true psychopathology seen in some children including adolescence that may exist with other comorbid childhood mental conditions, or in some cases as a lone entity.2,3 The condition if unrecognised or untreated may adversely contribute to impaired social functioning, poor academic performance, school absenteeism and substance misuse among others in children and adolescents.3 Having trained and practised in child and adolescent psychiatry both in the developed and developing worlds I can admit to the fact that childhood depression is a reality and not a myth indifferent of culture or setting, 3 that it is not apparent to the untrained eye is another issue. The current controversy surrounding childhood depression and it treatment, specifically the use of anti-depressants, especially the selective serotonin re-uptake inhibitors (SSRI). 4 Specifically SSRIs have been the revealed to be inappropriate use in childhood depression, this against the apparent voluntary decision of the manufactures of the culprit drugs to withhold serious adverse information (including risk of suicidality) from prescribers and consumers.4 For some illnesses example depression, specialists have been shown to treat patients better than generalists. With a difficult condition as childhood depression, especially in the face of the current controversies, patients should be initially managed with non-pharmacological interventions, and pharmacologic interventions should be a last resort for those with persistent and severe illness resistant to non-pharmacologic intervention. And in these cases pharmacological intervention should be only with anti-depressants that have been approved specifically for childhood depression, example, flouxetine.6 1 Tamimi Sami. Rethinking childhood depression. BMJ 2004; 329:1394-6 2 Lima Denio. Bipolar disorder and depression in childhood and adolescence. Jornal de Pediatria. 2004; 80(2 Suppl.): S11-S20. 3 Weller EB, Weller RA. Depression in adolescents growing pains or true morbidity?. J Affec Disord. 2000; 61(Suppl. 1): 9-13. 4 Herxheimer Andrew Mintzes Barbara. Antidepressants and adverse effects in young patients: uncovering the evidence. CMAJ 2004; 170(4): 487-489. 5 Donohue MT. Comparing generalists and specialists care: discrepancies, deficiencies, and excesses. Arch Intern Med1998; 158:1596-608. 6 Garland Jane E. Facing the evidence: antidepressant treatment in children and adolescents. CMAJ 2004; 170(4): 489-491 Competing interests: None declared |
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Ellen C G Grant, physician and medical gynaecologist 20 Coombe Ridings, Kingston-upon-Thames, KT2 7JU, UK
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There are risks for doing nothing for children or adolescents with depression but safe treatments are needed. An adequate nutritional status is particularly important for growing children and adolescents.1 For 35 years I have been assessing the nutritional status of children and adults with a range of symptoms including depression and learning difficulties.2 Zinc deficiency in children has become increasingly prevalent.3 Copper, magnesium, B vitamins and/or essential fatty acids may also be markedly deficient. High protein low-allergy diets, monitored nutritional supplementation, avoiding drugs including hormones, smoking and alcohol, are effective treatments but also prevent depression in my experience.(4,5) The Schizophrenia Association of Great Britain is concerned that practitioners often do not understand the illnesses they treat and ridicule nutritional treatment for mental illnesses.(6) 1.Matkovic V, Badenhop NE, Ilich JZ. Trace elements and mineral nutrition in adolescents. In: Clinical Nutrition of the Essential Trace Minerals and Elements. 2000 Eds Bodgen JD, Kelvay LM, Humana Press, Totawa, New Jersey pp153-182. 2. Grant ECG. Re: Depression, antidepressants and breast cancer:Considering only the "facts" that fit? http://bmj.com?cgi?eletters?329?7465?529#76040,28Sep2004 3 Grant ECG. Increases in childhood allergies and asthma may relate to an increasing prevalence of zinc deficiency. http://bmj.com/cgi/eletters/329/7464/489#72482, 29 Aug 2004 4. Grant ECG.The influence of hormones on headache and mood in women. Hemicrania 1975;6:2-10. 5. Grant ECG. Allergies, smoking and the contraceptive pill. In: Biological Aspects of Schizophrenia and Addiction. 1982 Ed Hemmings G, John Wiley & Sons, Chichester pp263-272. 6. Hemmings G. Editorial Summer 2004 Newsletter, The Schizophrenia Association of Great Britain. 2004;38:2-12. Competing interests: None declared |
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Christopher I Pelton, General Practitioner Wellington Medical Practice Telford TF1 1PZ
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Working in a large urban practice in a new town, I have witnessed a rise in the prevalence of distressed and, according to one's definition, depressed children in the past 15 years. I have also been a School Medical Officer. Over the same period I have seen attention and resources diverted from psychiatric and children's services to chronic disease in the elderly. Thus I have often faced the dilemma of either offering antidepressant medication or effectively nothing. I welcome the debate in response to this article and sympathise with the author's contention, but society has given me the responsibility to "treat" unhappy children without the means. Politically, I feel that the agenda for the Health Service is driven by our aging voters. It is far easier for me to access comprehensive support for someone with Alzheimer's than it is for me to help a family with young children. Grandparents, support your grandchildren! C Pelton Competing interests: I have a daughter who was depressed. |
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NANCY K OCONNOR, Medical Officer Pawhuska Indian Health Center, Pawhuska OK
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When faced with a 14 year old sexually active depressed child living with a druggie mom and her fifth "boyfriend", about all I can do as a doctor is refer for counselling, put her on Depo Provera, and give her Prozac. After all, I can only use the tools available to me. Depression is probably biochemical, but don't forget that the "alternative" to Prozac is alcohol, marijuana, Crank, or illicit drugs. Our children live in a "toxic" social environment (TV, movies, negative peer pressure with no counteracting "positive" peer pressure) etc. and alas too many parents are not parenting...nor do many "advice" experts encourage them to do so...for example, see the "non judgemental" approach: http://www.bbc.co.uk/parenting/your_kids/teen_risky.shtml Where is John Wesley when we need him? Competing interests: None declared |
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Alan W Fowler, Retired BRIDGEND CF31 1QJ
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Rethinking childhood depression Few will dispute Timimi’s assertion that the increasing incidence of so-called childhood depression in the Western world is due to changes in child rearing practices.¹ Timimi suggests that the unhappiness and behaviour disorders are symptoms of faulty psychoeducation rather than evidence of clinical depression. He therefore cautions against treating these disruptive children with anti-depressants. His two critics, Spender and Wilkinson, while agreeing with the importance of psychosocial factors, point out that the ensuing unhappiness may eventually lead to true clinical depression needing antidepressant medication. Thus what begins as a social disorder, ends up as a mental illness. The problem we are facing stems from ignorance of a fundamental law of human nature, namely that offspring need to learn from their parents. This need arises because, as so ably shown by Wilfred Trotter.² man is, essentially, a herd animal. For the proper functioning of human society we must be taught to restrain our instincts of self-preservation in favour of the needs of society. So the concept of a peaceful permissive human society is nonsense because a permissive society will destroy itself. The malign effect of permissiveness begins at a very early age. A baby is a bundle of selfish genes, programmed with very powerful instincts of self-preservation. If the baby learns that it can always get his own way, the herd instinct, which is essentially unselfish, will be suppressed. So when confronted later with the demands of an ordered society, the child will become frustrated, angry, anti-social, unhappy and possibly depressed. Our society is paying the penalty for neglecting the ancient wisdom contained in the ten commandments, the fifth of which says, “Honour your father and your mother” and in the Proverbs of Solomon who said, “Folly is bound up in the heart of a child, but the rod of correction will drive it far from him”³. Those familiar with Bible metaphor will understand that ‘rod of correction’ is a metaphor for discipline. References 1. Timimi S. Rethinking childhood depression. BMJ 2004; 329: 1394-6, (11 December) 2. Trotter W Instincts of the herd in peace and war, Fisher Unwin, 1916. 3. Holy Bible. Exodus 20:12 and Proverbs 22:15 Competing interests: None declared |
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Mark Vettraino, Child Psychiatrist Lanrkshire, ML5 4DN
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I agree with the main points of Timimi's article. It appears to be difficult to set up a constructive dialogue with peers when we think in such different ways. Holding firmly onto a concept of depression as an illness requires one to think in a linear manner, as Spender does when he seeks to label school failure, social withdrawal etc as "consequences" of depression. For me, this is an example of how the medical model lacks utility when trying to help these children. Important contexts are reduced to "consequences" or "co-morbidities". The medical model doesn't empower us to address and work with these issues. Circular thinking suggests that we can work with these issues and I disagree with Spender that there is not much we can do to change the contexts that contribute to childrens' unhappiness. In the same manner, Wilkinson feels that psychiatric epidemiology has "established" that the full range of depressive symptoms exists in children. Doesn't this simply indicate the circular nature of getting people to fill out questionnaires? The figures themselves have no meaning, it is our theories that give them meaning and if we start off believing that there are illnesses to be found then we will find them.1 I'm impressed by Wilkinson's optimism that we will eventually have psychiatric diagnoses differentiated by hormonal markers. This has been psychiatry's dream for such a long time now. Timimi has compared this to religious faith in the past.2 1. Lincoln, Y. & Guba, E. (1985): Naturalistic Inquiry, London, SAGE 2. Timimi, S. (2002): Pathological Child Psychiatry and the Medicalisation of Childhood, Brunner-Routledge Competing interests: None declared |
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Anne M Williams, GP 140Thurston Rd G52 2AZ
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In reading this article, I wonder whether we have all given in to the pressures of commercialism or whether it is a natural tendency for people to think of themselves. Whatever the initial cause, it is easy to see how this spirals out of control. As a GP, I meet many parents who do not want their children to be without ‘things’ in the way they were. They work hard to get the children anything they may dream for, this may seem laudable but the children may need to be amused less and learn how to interact more. Little do the parents realise how they cut a child off from the normal socialisation that can take part in a family by first, working long hours and secondly by isolating them, when they buy them a TV or other luxuries for their room. How can we learn how to get on with others if we do not occasionally give way over a disagreement about which programme to watch? If we are just out to satisfy ourselves, we will not find happiness. The joy of giving is seen at Christmas and family reunions are treasured, even if they are difficult and cause a lot of trouble. If this training ground for relationships is not fostered then the children do suffer, and also they may not form successful relationships as they are used to getting what they want. I tell my patients that marriage can seem like 90% giving and 10% receiving. At least that is the attitude needed to make it a success. Maybe, seeing the effect that a broken relationship can have on children, we should work harder to defend the family. Competing interests: None declared |
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Herzl Lowenstein, Consultant 103 - 5667 Smith Avenue, Burnaby, BC Canada V5H 2K7 Telephone/Fax (604) 437-4950
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The Canadian Oxford dictionary helps us to clarify the situation by providing a linguistic differentiation for a medico-scientific problem. The term “depression” is too strong, and “unhappiness” is too weak. “Dejection” appears to be closest to the correct word: “Depression: a state of extreme dejection or morbidly excessive melancholy.” “Unhappiness: Miserable, displeased, dissatisfied, upset.” “Dejection: Sadness, dispiritedness.” If the above simplifies the debate, a better understanding can be arrived at by quoting a well known maxim which does not appear in either the American or Canadian Oxford Dictionaries: “One misses the wood for the trees” -- the wood being the anxiety and tension which result from ubiquitous stress. The word “stress” is seldom used in this context, whereas the eminent British organic psychiatrist, Prof. Alwyn Lishman, correctly emphasizes its importance. In his textbook, Organic Psychiatry, Prof. Lishman also explains how the prolonged anxiety and tension then cause depression. This anxiety-produced depression differs from other forms of depression. The anxiety of bi-polar depression accompanies the depression (in 48% of cases). The word “stress” is seldom used but is frequently implied, for example in such terms as “psychosocial.” Is it not incredible that an organic psychiatrist should clarify an important psychodynamic sequence so clearly, when the rest of us working in the area remain confused! When antidepressants, especially the SSRI’s prove effective, it is because they have an additional action: They block nor-adrenalin. Micro currents, on the other hand, work dramatically, even after 40 years of torment, as a result of an increase of the amount of healthy glutamate (4, 5, 6), now accepted as being the major excitatory neurotransmitter in the brain (7, 8): Electric currents evoke glycine (9) and glycine activates glutamate(10). Glutamate is also involved in the pathophysiology of infantile autism(11, 12, 13) and the addictions(14, 7, 8) and schizophrenia(10,14). References for mood disorders are: 15, 16. Micro currents such as in TENS (Transcutaneous Electro Nerve Stimulation) and CES (Cerebral Electro Stimulation) also stimulate the immune system, thus helping to relieve a number of illnesses, such as allergies and the resulting asthma, and cancer. With little knowledge of functional somatic symptoms and syndromes in children, allow me to write about the situation in adults: The hyperventilation syndrome remains the most commonly missed diagnosis in medicine, and is still being debated today by prominent British psychiatrists (17) in a leading world psychiatric journal with a three-column list of equally prominent psychiatrists constituting its editorial board (18). In spite of an introductory section describing the importance of functional somatic symptoms and syndromes, no correspondence or commentary has appeared five (5) months later (19). The same neglect followed an article on the subject by one of the debaters in the Lancet five years earlier (20). Nor is the situation new or reappearing as is suggested by the author of a recent biography of Charles Darwin (1809-1882) who lived two centuries ago. Grouped together with Darwin as enduring “an illness of the time” are George Eliot, Charles Dickens, Florence Nightingale, George Biddle Airy (The Astronomer Royal), Thomas Henry Huxley, William Wallace, Herbert Spencer, George Henry Lewes and Dr. Joseph Hooker. Darwin’s son, Horace experienced identical gastro-intestinal symptoms. (21). In addition to 2 books on the subject of hyperventilation (22), the biography by the eminent British child psychiatrist, John Bowlby, Darwin – A New Life, was published in 1990. Bowlby lists the symptoms that invalided Darwin and explains the role of heightened anxiety and hyperventilation. Glenn Gould (1932-82), Canada’s world-acclaimed pianist, saw many doctors, including Canada’s most eminent psychiatrists, as well as shared a friendship with American psychiatrist Peter F. Ostwald for 30 years. The hypertension that killed Glenn Gould at age 50 was attributed to “nephritis” even though the laboratory tests for his kidney function were reported as being “normal!” Sincerely yours, Herzl Lowenstein Formerly consultant to the Dept. of Psychiatry, University of British Columbia. email HerzlLowenstein@shaw.ca References: 1. Timini, S. (2004) Rethinking Childhood Depression, BMJ 329: 1394-1396 2. Spender, Q. (2004) Commentary: Abandoning the diagnosis will endanger severely depressed children, BMJ 329: 1396 3. Wilkinson, P. (2004) Commentary: a controversy too far? BMJ 329: 1397 4. Tsapakis, E.M. and Travis, M.J. (2002) Glutamate and psychiatric disorders, Advances in Psychiatric Treatment 8: 189-197 5. Bergink, V. et al. (2004) Glutamate and anxiety, European Neuropsychopharmacology, 14 (2): 175-183 6. Schoep, D.D. et al (2003) Receptor agonists as a novel approach to treat anxiety/stress, Stress 6: 189-197 7. Holden, C. (2001) Zapping Memory Center Triggers Drug Craving. Science, 292: 1039 8. Holden, C. (2001) - quoting Alan Leshner, same page as 7. 9. Cheng, N. et al (1982) The effect of electric currents on ATP generation, protein synthesis and membrane transport in rat skin, Orthopedics and Related Research, 171: 264-272 10. Goff, D.C. & Coyle, J.T. (2001) The emerging role of glutamate in the pathophysiology and treatment of schizophrenia, American Journal of Psychiatry, 158: 1367-1377 11. Trudeau, L.E. (2004) Glutamate co-transmission as an emerging concept in monoamine neuron function, Journal of Psychiatry and Neuroscience 29 (4): 296-310 12. Carlson, M.L. (1998) Hypothesis: Is infantile autism a hypoglutamatergic disorder? J. of Neurotransmission 105: 525-535 13. Casanova, M.F. et al (2003) Disruption in the inhibitory architecture of the cell minicolumn: Implications for autism, Neuroscientist 9 (6): 496-507 14. Tamminga, C.A. and Frost, D.O. (2001) Editorial: Concepts in the neurochemistry of schizophrenia, Am. J. Psychiatry 158 (9): 1365-1366 15. Drevets, W.C. (2004) Neuroplasticity in Mood Disorders, Dialogues in Clinical Neuroscience 6 (2): 199-216 16. Harvey BH, McEwen BS, Stein DJ. (2003) Neurobiology of antidepressant withdrawal: implications for the longitudinal outcome of depression, Biol. Psychiatry 54 (10): 1105-1117 17. Wessely, S. and White, P.D. (2004) There is only one functional somatic syndrome, British Journal of Psychiatry 185: 95-96. 18. British Journal of Psychiatry (2004) 185: A5 19. Cannon, M., McKenzie, K. & Sims, A (2004) Introduction to: There is only one functional somatic syndrome, British Journal of Psychiatry 185: 95-96. 20. Wessely, S. et al (1999) Functional Somatic Symptoms: one or many? Lancet 354: 936-939 21. Browne, J. (2002) Power of Place. 22. The books on the hyperventilation syndrome are: 1. Hyperventilation and Hysteria, edited by Thomas P. Lowry (1967) 2. The Hyperventilation Syndrome Research and Treatment, by Robert Fried (1987) 3. Charles Darwin – A New Life, by John Bowlby (1990) Competing interests: None declared |
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