Not a Joking Matter

Lessons for Lovers

Romantic love is mental illness. But it's a pleasurable one. It's a drug.
It distorts reality, and that's the point of it. It would be impossible to fall in love with someone that you really saw.

- Fran Lebowitz

Love is an irresistible desire to be irresistibly desired.

- Robert Frost

There are two types of love - one originates in the hypothalamus (a part of the brain also present in other animals). It is programmed into DNA. It causes men to be attracted to women with larger breasts, wider hips and a waist size no more than 68% of the hips (this body shape subliminally appears to men to be more fertile). Women are attracted to men with broad shoulders, thin waists and larger muscles - in other words, strong and powerful.

A chemistry between lovers is not just a turn of phrase; it is a torrential release of brain chemicals and hormones.

Chemistry Chart

Testosterone - This hormone, produced in both men and women, regulates sexual desire and too much is counterproductive.

Progesterone - A testosterone antagonist, it lowers sex drive (in the pill as well). It is a mild sedative and has a calming effect.

Estrogen - Makes women sexually attractive and more receptive. It affects skin, lips, hair, fatty padding (curves), breasts, hips.

Phenylethylamine - A neurotransmitter released by a region of the brain called the hypothalamus, produce in capillaries and in catecholaminergic terminals. Phenylethylamine, or PEA, causes you to fall madly in love with someone. It is a natural form of amphetamine that floods the regions of the brain involved in sexual excitement. It generates feelings of euphoria. But it doesn't work alone when you are attracted to someone. People who profess high passion for each other have equally high levels. So-called "love at first sight" causes a circulatory surge. The decay rate means the effects last only 18 months to five years in a given relationship - long enough to procreate and protect a child during early years of life. Affairs and second (or third) marriages can cause the clock to be reset.

Dopamine - Involved in the "attention-getting" phase of attraction, it signals the brain that a reward is possible and helps to focus the attention. Under the influence of dopamine, people are more talkative and excitable. It is released when a person smokes a cigarette (one of tobacco's addictive components) and is a factor in attention deficit disorder. It promotes action.

Serotonin - Helps to control mood and reduce its fluctuations. A shortage of this brain chemical is widely associated with depression, so antidepressant drugs such as Prozac are designed to increase serotonin levels (as can pleasant conversation with your friends). High levels make you feel good about yourself and encourage mate selectivity but it may sometimes increase violent behaviour and thrill-seeking when levels are too high. Lower amounts are associated with less discriminating choices of mates and overly aggressive sexual behaviour.

Norepinephrine - Adrenalin: this neurotransmitter gets your blood racing and primes you for action. As part of the "fight or flight" response, it floods the brain while you are deciding whether to kill or kiss.

Prolactin - Decreases sex drive, especially in men.

Endorphins - Produced in the brain; released in response to touch and sex, they produce overall positive feelings.

Oxytocin - Secreted from the pituitary gland, it bathes the brain and reproductive tracts of both women and men. This chemical wash increases sensitivity to touch and encourages grooming and cuddling in both sexes. It reduces stress-causing hormones in the body and influences bonding between adults (friends as well). It peaks during orgasm and (for women) during childbirth and breastfeeding. It keeps relationships together after phenylethylamine has decayed. "Touch deprivation" depletes the supply and sends people running to their hairdresser or masseuse. Consuming several alcoholic drinks can decrease it. Stimulating oxytocin levels generates affection. One study showed people who have sex at least three times each week appear up to 10 years younger than their actual age. Oxytocin and its role in affection is one reason for such youthfulness.

Vasopressin - Hormone produced by the pituitary, it is an antidiuretic (causes water retention), increases blood volume and also blood pressure. It is identified as the "monogamy molecule" and modulates testosterone. It levels extremes of feelings (including anger), and increases focus in lovemaking.

Chocolate - The fats in dark chocolate trigger the brain's production of natural opiates. Three compounds in chocolate enhance a feeling of well-being: anandamide, a cannabinoid which activates the same receptors in the brain as the active ingredient in marijuana and two compounds which increase the appetite.

Pheromones - Chemicals in the body that send signals to others through a subliminal passageway of scent called the vomeronasal system.

DHEA (dehydroepiandrosterone) - Secreted by adrenal glands, it is a weak androgen. Most sex hormones and and pheromones are derived from it. Males and females have roughly equal amounts in their bloodstream.

Cultural belief in passionate love forever is misplaced!

Not Love You Need, But Trifluoperazine

Success and failure are both difficult to endure. Along with success come drugs, divorce, fornication, bullying, travel, meditation, medication, depression, neurosis and suicide. With failure comes failure.

- Joseph Heller

Today I had lunch with a psychiatrist. This is not a behavioural pattern that I have previously exhibited, partly because I have known no psychiatrists but also because I have not thought well of their trade.

In 20 years of teaching I saw a number of disturbed children packed off to the couch. It rarely seemed to do them much good. In general, I found that if anything mended the children, it was time. And if nothing did, it was the legal system.

My impression has always been that the brain is a dark, mysterious ocean and a large one, and that psychiatry is a blind fisherman in a very small boat. Nevertheless, this particular psychiatrist proved lively company at a party and we agreed to meet in one of the more fashionable bits of downtown Christchurch. As I waited for her, I sipped my beer and watched the crowd shuffling past in the winter sunshine. Perhaps it was the effect of my lunch-to-come but rather a lot of them looked mad.

The psychiatrist arrived 15 minutes late, smiled like the sun, sat and did not apologise. I silently admired the ploy. We ordered gewurztraminer and a dish of bits of fish. The conversation soared. We discussed meditation, Sanskrit vowels, chaos theory, 16th-century philosophy, 20th-century philosophy, the growing prevalence of depression, the nature of joy, the popularity and value of Prozac and whether bacteria could be happy - all with a formidable sweep of lightly held knowledge to which I contributed several ums. I also refilled her glass twice.

Then we got on to love. Now I know a bit about love, and I said so. On the inside of my locker at school I had a photograph of Geoff Boycott. There was something about the way he held his bat, something about the sweet stretch of flannel over thigh pad that sang to my 14-year-old soul. The psychiatrist looked quizzically at me over a slice of blackened monkfish but I persevered. And then, I said, over the horizon came puberty, marching strongly and letting nothing obstruct it. And with it came love.

She asked me to describe the symptoms of love.

Moping, I said, featured prominently, along with self-pity, grinding despair, sulking, moonlit vigils and a curious addiction to reading and writing poetry. Would she like to hear some? Despite the monkfish, she shook her head with some vigour, reached for a prawn and asked if I still suffered these symptoms. With a tolerant smile I explained that I had grown beyond such emotional intensity and had, indeed, been free of the effects of love for at least two years. The prawn went south, pursued by a swig of gewurtz.

"And you call this love?" she asked.

I asked her what she would call it. She told me. There were several phrases. The least offensive was "preoccupational emotive attachment." Oh, I said, and I meant it to sting, but she swept on.

She acknowledged that to some extent psychiatrists were, indeed, fishing blind in a dark ocean, but there were some well-lit bits. You could, for example, dose people up with something mildly radioactive in the bloodstream, then get them to think certain types of thoughts and with the help of a machine study the bits of the head that were being used to think these thoughts. Every sense impression, she said, every feeling, every thought in the end is just a chemical reaction in the head, an influx of serotonin across the synaptic cavity or whatever. Now, she said, it was a curious coincidence but a colleague of hers was studying the sort of infatuation I had described.

And her colleague had found a drug which seemed to cure it. The stuff was called - and I wrote this down to get it right - trifluoperazine. She paused for effect and a morsel of snapper.

I said that I thought they should put trifluoperazine in the water supply. It would have spared us, for example, Donny Osmond or Boyzone. With trifluoperazine the Beatles today would be dodgy mechanics in a Liverpool backstreet. Tom Jones would be buying his own underwear. Winston Peters wouldn't get a single blue-rinse vote. Lady Chatterley could have got some knitting done. Death in Venice would have had a happy ending. Someone would have punched Leonardo DiCaprio. And Lolita could have got School Cert.

"Yes, indeed," said the psychiatrist, and left me with the bill. It was $60.

Source: NZ Herald 14 July 2000

If he refilled her glass twice, that means she left with three glasses of wine in her. I hope she walked to the restaurant and I hope she had no appointment with a patient immediately afterward.

I thought trifluoperazine sounded like a great drug that could help a lot of the love-sick people I've met in my lifetime. I recently emailed a copy of the above article to a friend of mine. It just so happens this person spent some time in prison a couple of years ago. I received this message in reply.

Dear Ruth,

Trifluoperazine (stelazine) is a very powerful drug. I have seen it used [in prison] to control very aggressive behavior. It can make a threatening man into an almost vegetative shell of a person. It is not something taken lightly and almost certainly would counter any emotion, not a joking matter.

Trifluoperazine is indicated in:

Anxiety states: it controls excessive anxiety, tension and agitation seen in neuroses or associated with somatic conditions.

The treatment or prevention of nausea and vomiting of various causes.

The management of psychotic disorders, such as acute or chronic catatonic, hebephrenic and paranoid schizophrenia; psychosis due to organic brain damage, toxic psychosis, and the manic phase of manic-depressive illness.

I decided maybe there were better ways of recovering from a broken heart.

Also see:

The Perfect Aphrodisiac (a couple of pages back from this one) - for a different slant on love and chemistry....

I ran across an interesting site run by APANA - Autistic People against Neuroleptic Abuse ( www.dinahm.pwp.blueyonder.co.uk). They state:

The use of prescribed drugs - especially antipsychotics - to control the "challenging behaviour" of people with learning difficulties or autistic disorders has been of concern for many years. The Government has now officially recognised the problem in its recent white paper, Valuing People: A New Strategy for Learning Disability for the 21st Century:

Studies of the management of people with challenging behaviour have shown an over-dependence on the use of psychotropic drugs with poor outcomes as a result. (p60)

Challenging behaviours are best thought of as being a way in which people respond and try to gain control over difficult situations. Psychotropic medication may be very effective when there is an underlying psychiatric disorder but there is concern that too often this medication is used as an alternative to adequate staffing. (p110 )

There are concerns that alternatives are not properly considered before the use of drugs, many of which carry risks of side effects which can cause social exclusion as well as physical harm. Where the individual mentally incapable of making the decision him/herself, treatment can only be given if it is in his/her best interests. The "best interests" test is not just a question of whether the treatment is acceptable medical practice. Ethical, moral, social and welfare considerations are also relevant. The availability of a less restrictive or invasive approach - such as addressing communication difficulties which may generate "challenging behaviour" - is of particular importance.

I'd like to see the same principles applied to young children and the prescribing of Ritalin.

Also see:

Turn Out the Lights (in the section on Society and Culture) - for other ways in which drugs are used to control.

On the subject of treating prescription drugs more lightly than they deserve (promoting rather than prohibiting drugs), I read the following:

Studies' Clever Names May Oversell Drugs' Potential

by Dan Vergano

An overdose of catchy names adorns drug trials, not just the pills they test - a further sign that advertising pressures have invaded the sanctum of medical research, a report out today suggests. "If what lies behind this practice is individual researchers furthering their careers or sponsor industries pursuing their interests, then we may have a conflict of interest," says Michael Berkwits of the Philadelphia Veterans Affairs Medical Center. More than 2,000 human drug experiments have adopted eye-catching acronyms, including GUSTO, ALIVE, and CADILLAC, Berkwits says. Such names may implicitly promise better results from studies than they deliver and subtly influence the medical opinions of doctors, he writes in Annals of Internal Medicine.

Drug companies increasingly finance the clinical trials designed to measure the benefits of their products; annual spending grew from $7.5 billion to $9 billion over the past two years. Such sponsorship partly explains both growing numbers of drugs on the market and increasing concerns about financial incentives affecting study designs and outcomes.

"Baby-boomer yuppie patients may now cite trial names as readily as drug names," says Thomas Bodenheimer of the University of California at San Francisco, a physician who often comments on private companies' influence on medical research. "It's a product-pushing enterprise." Starting around 1985, catchy names for complex trials, often international in scope with numerous patient and researcher participants, began to take off, Berkwits says. In most cases, he and others say, such titles represent a handy way to mention a complicated trial amid the fast-paced, acronym-laced clatter of medical discussions. But "in at least some instances, the 'branding' of study groups and clinical trials may be a manifestation of a marketing strategy that works well, perhaps too well, in other areas of medicine," he concludes.

Joan Booth of the Cleveland Clinic, project manager for the long-running Gusto study, a trial of a heart attack drug, says: "It's nothing real exciting. [Really?] We just gave the study an acronym." Originally, it stood for Global Utilization of Streptokinase To Open occluded arteries [GUSTOOA?]; later, researchers replaced "Streptokinase" with "Strategies" to preserve the trial's name. "When you see GUSTO, you know it's a trial on how to manage heart attacks," Booth says.

But psychologists have long shown that some words carry implicit positive associations, Berkowits notes.

"My concern is that such acronyms, when used to impress a prospective research subject by implying a greater worthiness of the investigation, border on deception," says Sanford Chodosh, head of the Association for the Accreditation of Human Research Protection Programs.

Source: USA Today Tuesday 7 November 2000

It gets worse:

Marketing Madness

Prozac by Any Other Name

New York - Irritability, sudden mood changes, bloating? Ladies, if you suffer from these nasty symptoms just before your monthly period, you could have Premenstrual Dysphoric Disorder. Sounds serious? Eli Lilly certainly hopes you think so. You may never have heard of PMDD, but the American drug company wants you to take a pill for it. Prettily clad in a feminine pink and lavender capsule, the new drug is called Sarafem.

Lilly says that 3 - 5% of women of child-bearing age - 3 million in America alone - have premenstrual symptoms so severe that they interfere with daily life. Now Lilly's website boasts that Sarafem "is the first and only approved prescription treatment for both the mood and physical symptoms of PMDD."

But if PMDD is so serious, why hasn't some clever scientist developed a pill for it before? Surely the men in white coats would have been keen to find something to soothe irritable women? The truth is that Sarafem was not invented to cure a hidden problem - an article last month in Harvard Mental Health Letter, a health newsletter, points out that PMDD has not even been accepted as a psychiatric disorder. In fact, Sarafem is not new at all. It is Prozac, Lilly's blockbuster antidepressant drug, masquerading under a different name.

Lilly's patent on Prozac - one of the most profitable and heavily marketed drugs ever - is due to expire in August. Though Lilly insists that the timing of the launch of Sarafem is coincidental, its patent, which runs until 2007, will help Lilly offset the loss of high-margin branded Prozac sales to rivals selling cheaper generic versions. This is because the patent does not let doctors substitute generic Prozac for Sarafem for patients diagnosed with PMDD.

The reason for the name change is that women who do not consider themselves depressed or mentally ill are reluctant to take Prozac. Fair enough. After all, women who suffer from premenstrual mood changes and physical pains may be helped if they try Sarafem. However, many regard Sarafem's launch more cynically. Some folk complain that the TV ad for Sarafem, showing a woman snapping at her husband, is patronising.

Doctors also worry about the risk of overdosing, because only the small print tells women that Sarafem and Prozac are the same drug. Others are concerned about the trend for people to pop pills for problems that would otherwise not have been thought serious enough for medication. For its part, Eli Lilly seems to be trying to engineer a smart marketing coup. Whether PMDD is real or not, women beware. Those men in white coats really are after you.

Source: The Economist 21 July 2001 economist.com

And finally:

Lilly Seeks a Lift with Weekly Prozac

by Robert Davis

The pitch in the newspaper ad is simple: Clip the coupon, get your doctor's signature and get a month's worth of the new weekly version of Prozac - free. It's part of a national ad campaign by Eli Lilly & Company that urges the millions of Americans who take 20 milligrams of Prozac each day to ask their doctor "if a free one-month trial (of the weekly version) is right for you." Ads have run on TV, the Internet and in newspapers including USA Today and The Washington Post.

Taking a single pill designed to release the antidepressant medication slowly over the week will save patients about 5%, the drug company says. But if enough people make the switch, it could also give Eli Lilly a financial lift. The Indianapolis-based company is expected to lose about 80% of its $2.5 billion annual Prozac revenue when cheaper generic drugs hit the market, which could occur as early as this August. If people who take Prozac daily switch to the new weekly version, the company can keep them as customers and minimise its losses.

The ads directed at patients are sometimes the drug industry's best way to get its message to doctors. Doctors are generally more reluctant to see drug company representatives who come calling at this stage of a drug's life. Doctors tire of the pleas to keep their patients on the more expensive name brand. So drug companies now appeal directly to consumers. By offering a coupon for a free month's supply, marketers hope that patients will make the company's pitch to the doctor.

"The purpose of this campaign is to encourage depression patients who are stable on Prozac 20 milligrams daily to speak with their doctors about a new option that may simplify their treatment regimens and provide more convenience for their busy lifestyles," says Blair Austin, an Eli Lilly & Company spokesman. Elsewhere in the company, there is a battle to slow the inevitable. Lawyers are considering asking the Supreme Court to stop other companies like Barr Laboratories of Pomona, New York, from selling the generic version of Prozac. But Lilly insists that the fact that courts have recently ruled in favor of Barr, the industry underdog, nothing to do with the nationwide push to get patients into a new Prozac routine.

"Some people have suggested that this has to do with the patent situation, but it's coincidental," says John Plewes, a Prozac researcher. He says development of the weekly formula has been in the works at the company for years.

Source: USA Today Wednesday 6 June 2001

Report on Prozac's Risks Rocks Eli Lilly

Shares in Eli Lilly & Co fell on Friday after an article in a medical journal suggested that the drug maker had long concealed evidence that its well-known antidepressant, Prozac, could cause violent and suicidal behaviour. The accusations were made in the British Medical Journal, which said it had turned over documents related to the allegations to the US Food and Drug Administration (FDA). The FDA was reviewing papers which had been missing for more than 10 years, according to the Journal article, which said they were originally gathered during a lawsuit against Lilly on behalf of victims of a gunman in Kentucky who had reportedly been taking Prozac for a month before going on a rampage.

FDA spokeswoman Kathleen Quinn could not confirm on Friday whether the agency had received the documents mentioned in the medical journal. But at least one member of the US Congress said he had obtained copies of the documents reportedly given to the FDA. In a written response, Eli Lilly said: "To our knowledge, there has never been any allegation of missing documents" from lawsuits involving Lilly. The company also said it tried unsuccessfully to obtain copies of the documents from the British Medical Journal. "Lilly has consistently provided regulatory agencies worldwide with results from both clinical trials and postmarketing surveillance," including data related to Prozac, the company's statement said. Eli Lilly's stock fell US$0.75, or 1.3%, to US$56.75.

It is unclear what, if any, action might result from the matter. In October, the FDA ordered pharmaceutical companies to include "black box" warnings on the labels of their antidepressants, including Prozac. The warnings are the strongest restriction the government can impose on pharmaceutical companies, short of banning a drug. The warnings state that antidepressants increase the risk of "suicidal thinking and behaviour in children and adolescents." British medical regulators have recommended that many antidepressants not be prescribed for children and teenagers, but had not included Prozac in those advisories.

Even if the documents do not prompt legal or regulatory action, they could sully Eli Lilly's image. The company's fortunes have been closely tied to Prozac. The company has long defended the drug in the face of legal and medical challenges and insisted that it has not suppressed relevant information about the drug. The report comes at a time of renewed scrutiny of the pharmaceutical industry and the government's process for approving drugs.

US Representative Maurice Hinchey, a vocal opponent of the government's drug-approval process, said on Friday that he had some of the documents cited by the journal article. The congressman, who is a member of the Appropriations Committee, which oversees federal agencies including the FDA, said the documents date back to the 1980s and include memos between Eli Lilly employees. They "clearly show a link between Prozac and actions of violence perpetrated by people taking the drug against themselves and against others," Hinchey said. "The documents we have show that the company was instructing its employees to hide this information. We're seeing evidence here that it was a conscious act on the part of the company."

Source: taipeitimes.com 2 January 2005 from the New York Times news service