Day and Night Pharmacy – Out of Africa

We’ve stopped at Nairobi Airport on our way to the Sorry State (Zim). Everyone here seems to have had a boost of serotonin and noradrenaline, two of some of the catecholamine chemical neurotransmitters responsible for good mood. I put this down to the recent Obama visit.

Back in the UK I feel there is a tendency to rush into prescribing mood elevating anti-depressants. In the brain we’ve got neurones that are like a mesh of electrical wires with many junctions (gaps) which need chemicals to transmit the current from one wire (neurone) to the next. The end tip of one wire fires the chemicals into the junction and the next wire sucks the chemicals and passes on the electrical impulse in the same manner to the next wire in line and so forth. However there is a problem: in the junction there are enzymes which act to break down the chemical neurotransmitters (and the firing neurone also sucks back some of the neurotransmitter) thus the message from one neurone to the next is ever diminishing. Antidepressant drugs come in to freeze these enzymes (and/or stop reabsorption) thus boosting the amount of neurotransmitter chemicals that get sucked into the next neurone to propel a stronger mood elevation. We think this is the basic way by which these drugs work however we are also aware that this is not enough to explain why these drugs take a number of weeks for their effect to kick in… I shall not bother explain that, this column is supposed to be dedicated to medicinal entertainment! After all laughter remains the best medicine. Everyone seems to be on it here.

Oxytocin is a chemical that the media like to mention when mood is discussed. The first thing that comes to my mind when this hormone is mentioned is induction of labour. A process I don’t know much about in spite of having had two children. Yes I am rather squeamish, call me a wimp. But my late grandmother was a veteran traditional midwife- men had no place around a woman in labour. It was a no-go area for men, they’d be cursed if they happened to venture anywhere near. Growing up, I’d been within earshot of the screams and shrieking cry of the new born ( no gas, no air, no pethidine)- enough to traumatise me for life.

The lady taught me a lot of good manners and I guess I inherited the gob plus the constant moan directly from her. God did she moan! My mother controlled her son…The wind always blew in the wrong direction pushing the clouds away from our area hence the dry spell and imminent failure of the maize crop…We were going to suffer another famine because the rain-making ceremonies were not performed in the traditional manner- the gods were upset… In the past it was known that one would not see their footprints coming back from such ceremonies because they’d be washed out in a torrent. Nowadays because the folks committed taboo after taboo the draught was more common…The tuck-shop business broke because of jealousy people casting bad spirits to it… Oh grandma, rest in peace. I can assure you there won’t be anyone casting bad spells upon Day & Night pharmacy, all is well. I’ll visiting your place of rest soon but I always get an eerie sense that I can hear your bones creak and whinge from 6 foot under. In England, in line with NICE guidelines, they’d have prescribed you enough drugs to keep you in line and asleep all day long, day after day.

 

The neurotransmitter chemical that predominates in psychosis is dopamine. So drugs used to treat the condition tend to work by blocking the the suction of dopamine from the neuro-junction (as explained earlier) with the effect that there is watered down excitation of subsequent neurones resulting in control of the mental illness. These medicines tend to cause drowsiness as one would expect. The older anti-psychotics although they are still very effective tend to be associated with debilitating muscle movement disorders that mimic Parkinson’s disease symptoms. This is because suppressing dopamine makes another chemical mediating movement (acetylcholine) predominate. Similarly, patients being treated for Parkinsonism can start exhibiting psychotic behaviour- so we just add other drugs to suppress the symptoms. God, I love pharmacy. I don’t have to prescribe, I just source, dispense, advise and counsel. There are more and more none-medical prescribers now including pharmacists. Call me backward; I am not joining them. My mood is always elevated where I am.

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