That's the rumor, based on the rumored fact that he is unable to eat certain things, notably cheese and Chianti wine. These are foods rich in tyramine, a chemical that's normally harmless, but can be toxic in people taking MAOis. So, if Brown is indeed on a Chianti-and-cheeseless regime, he almost certainly is taking one of the several MAOis on the market today.The original source for this idea is this blogger, who claims to have heard it from an unnamed Brown aide. Is he to be believed? A glance over his website shows he is hardly an impartial commentator, and he goes on to demonstrate his psychological insight with statements like
"Obsessive Compulsive Disorder (OCD) is relatively common. Most of us display some obsessive features in everyday life, but under stress a minority of people become borderline or actual OCD in their behaviour, and need medication to control both this and the depression which almost always presents soon afterwards. ... Gordon Brown's symptoms are obvious when viewed in this light: the constant repetition of phrases, and an almost embarrassing (for his Party) need to spray every Parliamentary answer with statistics... they - and the constant speech repetition - represent Brown's unconscious means of controlling the severe anxiety that accompanies depression with OCD."So one might think that his credibility is somewhat questionable. This hasn't stopped certain corners of the British blogosphere from getting very excited, however, and even respected political journalist Andrew Marr yesterday quizzed Brown about the issue.
Unfortunately, while many are eager to write about Brown and his possible pills, few of them seem to know anything about psychiatry or antidepressants, which has led to some embarrassing errors. So, for the benefit of British pundits, here are some helpful facts.
MAOis -
- are not "powerful", "heavy duty" antidepressants. In terms of effectiveness, they are no better, on average, than Prozac. In fact, no antidepressant is much better than any other one. They differ in terms of side effects, but not "strength". For what it's worth, current opinion is that if there is a best antidepressant, it is escitalopram, a modern Prozac-like SSRI with very mild side effects, which is just about as unlike a MAOi as you can imagine.
- do not "impair" or "affect judgment". Antidepressants don't. Except that they treat depression, and someone who's happy might make different judgments to someone who's depressed. But these drugs do not affect judgment in the way that intoxicants like alcohol or cocaine do. You don't get high on them. This is why they have no street value. Most drugs which impair judgment get used recreationally, because having your judgment impaired can be fun. Antidepressants aren't.
- are not exclusively used in "severe depression". They are usually reserved for when a patient has not responded to other drugs. This is because of their troublesome side effects, including high blood pressure, and the fact that you can't eat cheese. But "treatment-resistant" depression is not the same as "severe" depression. In fact, the more severe the depression, the more likely it is to respond to treatment with conventional drugs. If Brown is on MAOis, he has probably tried at least two or three other drugs, but this is by no means uncommon because antidepressants just don't work especially well. According to the largest trial in a real-world setting, the STAR*D project, only 30% of people fully recover on their first antidepressant and only 30% of the rest respond to the second one.
- are not especially effective in OCD, as the source of the rumor claimed - "this older class of drugs has one huge advantage: for severe depression and obsessive compulsive disorder it remains very effective", emphasis in the original. This is just flat-out wrong. Other antidepressants are more useful in OCD. Here's a recent review of drug therapy for OCD. MAOis get a mention... right at the end, after (deep breath) SSRIs, clomipramine, atypical antipsychotics, SNRIs, pregabalin, tricyclic antidepressants, and benzodiazepines. Here's the only published trial comparing a monoamine oxidase inhibitor to another drug, Prozac, for OCD. The MAOi didn't work, Prozac did.
- were the first class of antidepressants to be discovered; the very first, iproniazid, was discovered in 1952. Others followed, such as tranylcypromine, phenelzine, and selegiline. Today, there are a handful of MAOis on the market. These include some newer drugs such as moclobemide (which has milder side effects) and the selegiline transdermal patch (which carries fewer dietary restrictions). MAOis are primarily used to treat depression, but are also used in Parkinson's disease.
Realistically, none of this is going to change people's minds. No-one is really concerned about the possibility that Gordon Brown is using MAOis, or even the possibility that he's depressed. Rather, a lot of people just really don't like him, and this rumor is the latest stick with which to beat him. Blogger Guido Fawkes has been asking "Is Brown Bonkers?" for months. As one journalist put it, "Whether literally the case or not, however, this rumor carries the kind of psychological truth that tends to be more damaging than fact." Which didn't stop him from repeating the rumor uncritically.
[BPSDB]
20 comments:
You don't get high on them.
Sorry, but I do get unpleasantly high on Escitalopram (Seroplex) with twitching eyes!
Currently using S-Adenosyl-L-Methionine without any noticeable side effects.
Well, drugs affect people differently. I've been high on a number of things, and citalopram isn't like that, for me, or for most people AFAIK. But it does happen.
To be fair, there are reports of people recreationally using certain MAOis, so I wouldn't like to say that you can never get high off them. But there are reports of people getting high off almost everything. It's not generally an issue with antidepressants.
Brown may be a lousy PM but he was a truly awful Chancellor, so things are improving.
a no cheese / no red wine diet is also compatible with migraine avoidance.
Also there are non-psychiatric indications for MAO-class drugs. Azilect (rasagaline) is used for parkinsons. In the UK there is no cheese restriction but in the US there is.
True, I have heard of mild stimulant-like effects with some MAOis. But this might not be because they are MAOis, for example phenelzine (Nardil) is metabolised to phenylethylamine which is amphetamine-like (and phenelzine is amphetamine-like in structure as well).
And to be honest that post on Dr Bob sounds like someone who has gone hypomanic...
As to MAOis being more effective than others, I agree that pharmacologically they look as if they ought to be, but the clinical evidence is weak. On the other hand, that could be because the clinical evidence is flawed, which it certainly is.
Basically my goal here was to question what's being written about MAOis in the context of Gordon Brown. Some of the finer points might be debated.
There's also the fact that MAOIs aren't prescribed much at all these days. They're considered old-hat compared to the new super-duper (supposedly) SSRIs, and if you give them an SSRI they can still have their cheese and marmite.
I can't remember the last time I administered an MAOI
Anyway, may be depression is good for you, you should rejoyce having a more "focused" prime minister.
SSRI's can also impair judgement, regardless of what the pharmaceutical companies say. Raising someone's serotonin is NOT a natural thing in nature. The street drug Ecstasy also raises serotonin levels and while SSRIs are not as quick acting nor as powerful in normal usage, they CAN have the effect of making someone 'too happy'...in other words not have the 'normal' doubt and self-reflection that might make someone make a different decision than if they weren't on the drug. This usually happens when a non-depressed person is put on an SSRI for some other reason...like OCD, smoking cessation, migraines etc. The person's emotions were 'fine' but the SSRI now makes them 'too fine' and apathetic about things they oridinarily would have more caution or worry about which is natural. Don't assume just because a doctor or pharma company says they are always safe that they are. Doctors get their information FROM the pharma companies who have a vested financial interest in making their drugs appear safer and more effective than they really are so they can continue to make billions off of them.
Rob L, doctors don't get their information from the pharma companies. It would be lovely to think that we did and it was all a big conspiracy, but, as always it's a little bit more complicated than that. We get our information from our experience of treating patients, independent bodies like NICE and from the peer reviewed literature, of which a lot has links to pharma, this is true. But whilst much of the literature is drug company sponsored, and much of the rest of it often has questionable methodology, most of us have the sense not to take any notice of the stuff that's written by people who clearly have a vested interest (or just don't know what they're doing).
Besides, most of the antidepressants that are prescribed now are off-patent so the drug company gets nothing. You know how much a month's worth of Prozac costs the NHS? 28p. You pay more for Paracetamol from Boots.
Some other points from my experience- MAOis, and other ADs, certainly have the potential to make people 'high', but it seems rarer than one might think, and usually transient. Oftentimes people with depression recover briefly at the start of treatment just because 'something is being done'. MAOis do have some street value- I have come across them (Phenelzine and Moclobemide in particular) being used recreationally with LSD and other psychedelics to enhance the effect. In clinical practice we occasionally combine Phenelzine with Trimipramine, but generally speaking these drugs have fallen out of favour now, which is a pity perhaps because they suit some people very well.
Anyway, I digress. As for Gordon Brown being on a MAOi, who cares? MAOi or no MAOi, he'd still be the same ineffective leader.
Rob - I don't just trust what drug manufacturers say & I hope my other blog posts will confirm that. I'm speaking from personal experience & from talking to a lot of people who have taken SSRIs for depression or as part of research. Plus of course there's the published evidence, not all of which is linked to Pharma money.
Becoming "too happy" is very uncommon and even if some people do respond in that way, it's not as if Prozac is the only thing that can lift mood. We wouldn't consider someone who had just got engaged to have "impaired judgment"...
The one situation in which MAOi drugs are considered the "big guns" is treatment-resistant depression of the atypical subtype.
You can find a number of references to "MAOIs and atypical depression" in the literature. While I can't find much evidence for why that is, I suspect it's because MAOIs have a reputation for being more activating (less anxiolytic but better for anergic depressions) than the SSRIs, save perhaps for Prozac.
They are also a better choice than the TCAs (after SSRIs/SNRIs/NDRIs/NaSSAs) if there's a concern about suicide risk.
I can imagine limited street potential. Tranylcypromine is definitely buzzier than phenelzine. Selegiline is used to potentiate other drugs (for the wonky psychonauts, it's used when available in place of botanical MAO inhibitors like the harmala alkaloids). All three, I think, have amphetamine or methamphetamine metabolites that can show up as a positive on a drug test.
The selegiline transdermal patch was a great idea but it doesn't seem to be delivering so well (look at the studies on it, and you see an improvement in the HAM-D of only a few points over placebo). This might be because the dosages top out at 12mg patches, but I wouldn't know.
I still wonder why they made an antidepressant transdermal patch out of an MAOI that is primarily used as a Parkinsons drug, though. The advantage of transdermal systems, of course, is bypassing the first-pass hepatic metabolism and mostly bypassing the gut, where those nasty tyramine interactions occur. And selegiline is not as notorious as the totally nonselective antidepressant MAOIs for tyramine reactions. So you'd imagine there ought to be some incentive to make a transdermal patch out of tranylcypromine (Parnate) or some other depression-focused MAOI.
Lastly, MAOIs are generally considered more powerful among the patient community. This is probably because by the time you get to an MAOI, you've had ongoing depression (and depression degenerates and becomes a self-reinforcing spiral as you fail treatments - so I would argue that severe depression is perfectly likely to be treatment-resistant, or perhaps vice versa).
If you have a lifelong case of biological, recurrent depression, your chances of repeated tachyphylaxis (aka "Prozac poop-out") on the first- and second-line drugs is very high, simply because of the duration of treatment.
(Happened to me...)
So as each medication and class of medications either doesn't work, or eventually stops working, the MAOIs can be the "last stop" on the treatment line before ECT. If they work, then, they are considered a powerful miracle.
There is a good reason why he should be on an MAOI: PD, of which he has fairly clear signs. So I'd ease back on your scepticism, or at least on the authority with which you dish it out. And that diagnosis would certainly be relevant to his capacity for decision-making.
Parkinson's Disease - possible, but he's shown no symptoms of it; I haven't been looking very closely but the rumour mill would be in full swing by now if he had any motor symptoms. Anyway, even if he did have PD, the problem would be that he had PD, not that he was on MAOis.
I'll keep dishing out scepticism so long as people like Notbornyesterday keep dishing out rubbish...
Katusha - Yeah, the MAOis for atypical depression story is an old one, and expert opinion seems to be that it's true, although there's little hard evidence. I can believe it. There's also an interesting idea that MAOis work well in people who enjoy amphetamines (not everyone does), which makes sense (dopamine).
Atypical depression is not the same as "severe depression" though - most people would say quite the opposite, melancholia is considered worse - which further undermines the "powerful drugs for severe depression" idea.
The PD story needs no more than a look here:
http://www.youtube.com/watch?v=7ba7glghZ4w
If you know what you are looking at then you will know the clip is misnamed - this is not the tremor of anxiety.
What is interesting about all of this is that unless he suddenly drops dead it is bound to become apparent, in time. By then, of course, he will not be prime minister, but questions will be asked....
It's possible I 'spose. We have a sample of handwriting now as well thanks to the Sun - can that be used to diagnose PD?
Physicians are not being adequately informed by the pharmaceutical companies of the enormity of the problem and they are not being taught about the 'down-regulation' of serotonin production that occurs in the brains of those taking these drugs that can take 6-12 months for the brain to 'up-regulate' and produce the amount of serotonin that it normally does when taken off the drug.
There has never been conclusive proof that low serotonin is the cause of depression. It is a theory...only one among many. In fact, most recent research shows it is quite the opposite...low serontonin is a SYMPTOM of depression, not a cause.
Just as if you had a swollen elbow from a 'tennis elbow' diagnosis you would realize it is the 'symptom' of overusing your elbow when for instance playing tennis or from bad form. You wouldn't go on overusing the elbow would you and just treat the inflammation of the elbow. Of course not. You would fix the cause...the bad use of the elbow.
Depression is a RESULT of a person keeping themselves in a bad situation for extended amounts of time where they pass through the normal emotional warning reactions of stress and anxiety and proceed towards hopelessness or 'depression'.
Taking an antidepressant does not and will never 'cure' or 'treat' the cause of depression. It is nothing more than a pain killer. Just like aspirin for physical pain is. The only way to 'fix' depression is to fix the person's life. Then, the brain heals itself and as the stress is lifted from the person the brain re-balances and the depression lifts. That's how the brain works.
The idea that the brain is somehow 'fixed' or 'stuck' in a certain way is a falsehood that has never been proven.
On the contrary, Neurogenesis and Neuroplasticity show that the brain is constantly adapting and remaking itself to cope with whatever current environmental/social conditions it is in. If a person is in an unhealthy environment they suffer emotionally...if they fix the environment...the emotions reflect that and they feel better. Drugs are simply a band-aid.
Anyone that thinks otherwise is simply fooling themselves, looking for a shortcut and doesn't understand how the human emotional system works.
Unfortunately, pharma companies have billions of dollars at stake and they don't make a dime on people fixing themselves and not using their drugs. They are the LAST people that would tell you any of this.
Doctors, unfortunately are not the most business or corporate savvy people around. I have an MBA from Columbia and am in the unique position to have seen the other side of pharma through my business contacts and experience in school and work.
Having grown up in a medical family it was a huge eye opener when I had executives and researchers inside major pharmaceutical companies tell and show me that a large part of pharmaceutical companies are the propaganda and marketing operation to manipulate doctors into giving out their drugs.
Unfortunately, most..not all...but most doctors are naive. They don't have the business savvy and don't have access to truly independent information. Virtually all the material that doctors get is in some way sourced from the pharma industry. It's simply a fact. There is no 'consumer reports' that doctors or psychiatrists can go to that gives 100% independent evaluation of antidepressants. Those doctors that don't follow what the pharma companies dictate and that the insurance companies mandate are often labelled 'alternative' or worse. I'm not talking about true quack doctors, I'm talking about those that simply see through much of the bs that pharma companies try to pass off as 'fact' when it is not.
As a last note I should mention that this corruption goes all the way to the FDA. Jim, you say that thinking this is a big conspiracy is unrealistic. You're wrong. It might not be a conspiracy like in a movie where various companies are colluding together in some kind of secret meeting.
What it is however is a systemic conspiracy.
Did you know that approximately 50% of the budget of the FDA is provided by pharma companies? Did you know that many of the members of the FDA that are in charge of approval of drugs later go on to get lucrative grants and positions with major pharma companies? Are you really naive enough to think this doesn't cloud their judgement to approve certain things they shouldn't?
Were you aware that the United States is the only major nation to allow direct to consumer marketing of prescription medications? You won't find that in any european country. This was denied in Britain, France, Italy, Germany...all the major european countries...but it is allowed here due to the enormous deep pockets of the lobbying groups for the pharma companies in this country.
Is it no wonder that millions of people in the US go to their primary care doctors...doctors that have no in depth training of mental health at all...and they ask for antidepressants? Did you know that antidepressants ARE addictive for a great number of people that are on them? The pharma companies literally petitioned the FDA to change their definition of addiction to exclude the massive withdrawal symptoms that SSRI users go through when trying to stop the drug. The FDA agreed to change the definition of addiction so that it now only means a 'craving' for more and more of a drug rather than a dependence. Do you really think that is ethical?
I'm not one to say there is no place for modern medicine and i'm no scientologist, but there is not a doubt in my mind that antidepressants are massively overused by the population in this country and it is by design...not by accident or by need. Pharma companies have set up a system where doctors like you have been systematically brainwashed and misled to believe in something that is based on a falsehood.
The entire 'chemical imbalance' theory that is told to people is enormously misleading and does not accurately reflect the truth that the brain is literally always in a state of imbalance of neurotransmitters because that is what emotions are.
If you laugh you technically arein an imbalance. If you stub your toe and feel pain you are in an imbalance. If you yawn and feel tired u are in an imbalance. What they aren't telling people is that depression, anxiety, sadness, etc are normal emotions that are warning signals for people to tip them off things aren't going right in their lives. Medicating away your warning signals is just plain wrong and is hurting people far more in the long run not to mention taking billions in dollars needlessly while wasting people's time and acting like a false prophet.
I would suggest you take some time to google and do some indepedent research NOT in pharmaceutical produced studies. go read some message boards after googling SSRI withdrawal syndrome or try Effexor withdrawal or Celexa or Prozac side effects. See how many thousands and thousands of people you'll find that will tell of experiences that are completely unreported by the pharma companies to you.
Just as a car company will try and say their car is the best ever and will downplay anything bad or poor...so do drug companies. Drugs are their PRODUCT and they hae a long history of exagerating the benefits and downplaying the negatives. As a rule I would double or triple the percentages of negative reactions that a pharma company says are reported on any psyhotropic drug and I would cut in half the lever of efficacy they predict. That usually is far more close to the truth. I also, would step back and think...is the whole theory of even using these drugs even correct? I personally find them to not be except for the most extreme life and death situations...and even then only for short periods. Unfortunately we are now faced with a situation where we have literally millions of americans on these drugs unnecessarily and who are being 'tricked' to believe they are fixing something...when they simply aren't.
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