Medicalized Meddling with Neurotransmitters Leaves Us in a Big Mess
With Synthetic Oxytocin for Giving Birth and Dopaminergic Supplementation for Parkinson's as Examples
Many of the medicalized drug-based interventions for chronic conditions target one or more of our neurotransmitters, hormones, or peptides. These drugs may given in order to try to bump up or dial down the amount of a specific chemical in our system. Else they may be “antagonist” or “agonist” classes of drugs, intended to either [partially] block or activate, respectively, the corresponding cell receptors for that chemical. Cell receptors are proteins on the surface of cells which fit like a puzzle piece to a given a chemical, that activate or inhabit specific cellular functions when a molecule of the chemical is attracted to “dock” there.
Indeed, the highly reductionist mechanistic view of the current medical paradigm sees many chronic problems as being due to the excess or dearth of a single neurotransmitter, and hence envisage that this can be treated by attempting to control the levels of that neurotransmitter in the body and/or brain, or by making cells more or less sensitive to that chemical via blocking or activating the corresponding cell receptors.
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This is the height of medical reductionism, and underlines the hubris of the current system. When it comes to human biochemistry, we need humility in the face of its sheer complexity, because in reality it is vastly more complex than we may ever even be able to know. Indeed, the inner workings of our biochemistry is not just complicated, it is an example of a “complex system”.
A complicated system may have many variables or parts, and may be governed by very intricate rules, yet has behaviours that are ordered, and, with sufficient compute power, is always predictable. A car is an example of a complicated system.
A complex system may have few parts or variables (e.g. the orbits of three stars in a trinary system), or be governed by very simple rules (e.g. cellular automata), yet can have fractal and fully chaotic behaviours, and is fundamentally unpredictable, such that exceedingly small interference in the system, can create massive and unforeseeable changes.
Human biochemistry is of the complex kind. One reason is that all neurotransmitters have a large array of different functions in the body, but rarely are the medical interventions able to target one specific function, and hence this untargeted approach cause all sorts of other processes to become inhibited or get activated. This is why unwanted side-effects always abound.
Furthermore, our systems have all sorts of check and balances to maintain equilibrium, which work against interventions. For example, flooding the system with an exogenous source of a neurotransmitter, in response to the body not being able to make enough of its own, often results in cell receptors for this neurotransmitter getting sequestered inside the cell. The effect of this is to actually reduce the body’s responsiveness to the already low amounts of endogenous supply, meaning higher doses of the drug are required to have an effect, in an ever-escalating arms race.
Furthermore, different neurotransmitters work together or counteract each other in very complex dances. So it is very rarely the case that the concentration of a single neurotransmitter being too low or too high in some absolute sense is the actual root issue. It is the imbalances, or relative levels, with other chemicals which this causes that is the main issue. Likewise, intervening in one neurotransmitter with drugs throws the balances with other ones out in different ways, resulting in yet more unwanted side-effects.
For example, I have written a series of posts about how it is not the shortage of dopamine in folks with Parkinson’s which is the issue per se, but it is the imbalances with several other chemicals that this results in. Likewise, the practice of prescribing exogenous dopamine supplementation for folks with Parkinson’s, just throws these balances out in a different way. Unfortunately, since the 60s, we have been stuck with dopaminergic interventions, which lead to ever increasing dependency, requiring more and more of the drugs to have any effect, with escalating side effects, and ending up in the drugs no longer working at all. What a mess!
This also brings back to mind the book on evolutionary biology, "The Hunter-Gatherer's Guide to the 21st Century", which highlights that whenever we interfere with our biology, there are always trade offs, unforeseen circumstances and unintended consequences, and the Precautionary Principle should be applied.
Another example, is the synthetic oxytocin ubiquitously used in the “medicalized condition” known as giving birth. The effects of the medicalized hubris in this one are truly ghastly. This is something I have been meaning to report on here for sometime. Synchronously, facebook flagged up a post on this in my memories yesterday, so it felt like the right time and place.
The below abridged excerpts are from the UNICEF report “Intrapartum administration of synthetic oxytocin and downstream effects on breastfeeding: elucidating physiologic pathways.” I will just copy-paste without comment.
“Oxytocin (OT) is involved in the mediation of uterine contractions. Oxytocin cell receptors (OTRs) are found on the smooth muscle cells in the uterus and the breast, where they work to contract the uterine muscles during labor and birth and the myoepithelial cells in the breast to eject milk.
Oxytocin is predominantly produced in the hypothalamus, stored and secreted in a periodic bolus fashion or pulses from the posterior pituitary and then into the blood stream When OT is secreted into the blood it also pulses further into the brain.
The central nervous system, including the spinal cord and the brain, have OTRs; the hippocampal clusters of OTRs in the brain are thought to be integral in facilitating social learning, memory consolidation and bonding."
SynOT (Pitocin or Syntocinon) is a manufactured product identical to endogenous oxytocin (OT).
The drug became integrated into clinical practice as an induction and augmentation agent in labor (via continuous IV infusion), to reduce blood loss after birth (via IM injection), and to stimulate milk ejection (nasal spray)... a near universal exposure to synOT for birthing women in the United States."
Dysregulation of the mother’s OT system - can be understood to be similar to the physiologic process of insulin dysregulation.
The administration of exogenous OT, synOT, may inhibit the action of the maternal endogenous OT in the immediate postpartum through desensitization [internalization+] of OT receptors, first via negative feedback mechanisms that inhibits the release of the mother’s own OT and subsequently a greater production of endogenous circulating OT, possibly due to receptor site damage or the resetting of the OT system upwards to a higher level.
Breastfeeding outcomes were negatively affected. The mothers with the highest amounts of OT transferred the least amount of milk.
The finding that women who had been administered intrapartum synOT compared to mothers who had not been exposed had a more than 30% increased relative risk of depressive and anxiety disorders in the first year postpartum is concerning.
SynOT crosses the Fetal Blood Brain Barrier. SynOT administered to the laboring woman is thought to cross the placenta and the not-completely-mature fetal blood-brain barrier during labor and desensitize the infant’s central nervous system OTRs negatively affecting the function of the infant’s nervous system OTRs.
Studies of the expression of newborn neurobehavioral pre-feeding cues and reflexes demonstrate the sensitivity to synOT of the exposure of the baby during labor.
Other researchers studying newborn’s primitive neonatal reflexes (PNRs) identified the inhibition of several of the reflexes including all of those associated with breastfeeding (the rhythmic reflexes – suck, jaw jerk and swallowing) as significantly lower in the exposed group”.
“Newborns who were skin-to-skin with their mothers in the first hour after birth had a different experience of whether or not they suckled in the first hour."
Uterine Hyperstimulation - the uterine myometrium contains OTRs which increase as pregnancy advances. The uterus is responsive to oxytocin throughout pregnancy and, because synOT is biochemically identical to endogenous OT, when OTRs are occupied by either synOT or OT, myometrial contractions result.
Receptor sensitivity to oxytocin rapidly increases when a woman is in spontaneous labor. Because OT is normally released in a pulsatile fashion, the smooth cells of the myometrium in the uterus are allowed to recover between pulses."
However, receptor desensitization as well as a decrease in the percentage of receptor cells can result when women are exposed to longer times of synOT infusions or higher amounts of synOT.
Hyperstimulation, defined as more than 5 contractions in 10 minutes for 2 consecutive 10 minute periods, was documented in 30.2% of labors induced with synOT..
[We should] espouse the pre-cautionary principle when considering the use of synOT which still lacks reasonable assurance that it is non-harmful for perinatal and immunological development.”
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