Advances in cognitive neuroscience make cosmetic neurology in some form inevitable and will give rise to extremely difficult ethical issuesConsider the following hypothetical case study. A well heeled executive walks into my cognitive neurology clinic because he is concerned that he is becoming forgetful. It turns out that he is going through a difficult divorce and my clinical impression is that his memory problems stem from the stress he is experiencing. I place him on a selective seratonin reuptake inhibitor, (...) class='Hi'>sertraline, and in a few weeks he feels better. Around this time his 13 year old daughter has difficulty at school and is diagnosed by the school psychologist as having attention deficit disorder. I place her on adderall, a stimulant combination drug, which seems to help with her behaviour in school. My patient then comes to me because he is experiencing the “tip of the tongue” phenomena more frequently. He is concerned that his word finding difficulty interferes with his ability to function in high level meetings. I suggest we try a cholinesterase inhibitor to see if this helps. I am careful to explain that the Food and Drug Administration does not approve such a use for this medication. He wants to try it and is pleased with the results.A few months later, this patient visits me with his 16 year old son, a talented middle distance runner. His father thinks if he were just a bit better, among the elite high school runners in the state, he would be far more competitive as an applicant for selective colleges. We discuss various options. Because of a recent report that sildenafil, which is used conventionally for male impotence, may improve oxygen carrying capacity, I prescribe this medication. The son does not object.Encouraged by these pharmacologic successes, my patient …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:In Defense of My Reading of Husserl and a Final NotePeter Hadreas (bio)KeywordsSSRI, Prozac, Fluoxetine, Zoloft, Sertraline, Paxil, Paroxetine, Husserl, phenomenologyI want to acknowledge Dr. Mark D. Rego and Professor Marilyn Nissim-Sabat for the care they put into the responses to my paper "Husserlian Self-Awareness and Selective Serotonin Reuptake Inhibitors." One of the abiding strengths of Philosophy, Psychiatry and Philosophy is its debate format.Thanks to the debate format, (...) I am not constrained from openly (and sincerely) contesting Marilyn Nissim-Sabat's reading of my paper. In my opinion, Marilyn Nissim-Sabat remarks suffer from many misconceptions. I'll respond in some detail to these misconceptions and misapprehensions. Contrastingly, I am largely in agreement with Mark Rego's commentary. After discussing Nissim-Sabat's misconceptions, I'll use the remaining space to propose how some of Mark Rego's suggestions might be filled out for further psychological research using the model of prereflective awareness.Nissim-Sabat brings many misunderstandings to my paper. They extend to the paper's purposes, its manner of evidence, as well as its consequences for psychotherapy. I respond to each of these issues.First about the paper's purpose. She writes: "I share with Hadreas the conviction that Husserlian phenomenology is the best philosophical approach to understanding, and indeed, possibly improving the treatment of mental disorders" (54). Nissim-Sabat and I do not share the same point of view regarding Husserlian philosophy and mental disorders. I am keen on Edmund Husserl's theories of pre-reflective awareness inasmuch as they provide a model for understanding mental disorders. Given the space limits, I focus my paper on puzzles emerging from case histories of people treated with SSRIs. Even so, I think it is a mistake to make Husserl's philosophy into a Rosetta stone for decoding this topic. This may mislead the reader as well as misrepresent the history of philosophy. As I point out in the section of the paper titled, "Husserl on Self-Awareness," Husserl is not the only well-known philosopher or psychologist who proposes a pre-reflective account of self-awareness. William James proposes an analogous notion of self-awareness. G. W. Leibniz, at the and of the seventeenth and the beginning of eighteenth centuries, worked out a very sophisticated understanding of pre-reflective awareness, which he applied to a multitude of psychological, epistemological, and ethical topics (Leibniz 1996, 53, 11, 164, 194). Husserl's account of pre-reflective awareness is 'better' inasmuch as it is systematically connected to an epistemology that can enable a researcher to understand how pre-reflective awareness fits both personal self-understanding and empirical psychological [End Page 61] experimentation. But James' and Leibniz 's accounts also have their strengths. Their descriptions of pre-reflective awareness are less burdened with technical language than Husserl's and, in the case of Leibniz, broadly applied to topics outside of psychology and epistemology.Perhaps in keeping with Husserl's philosophy as "the best," Nissim-Sabat argues that I am unfaithful to Husserl's true mission as she sees it. I fail to uphold the essence of Husserlian philosophy. She reminds us: "… Husserl's view that the raison d'etre of phenomenology is to develop an attitude that 'overcomes naturalism once and for all' …" (55–56). She quotes from Husserl's "Vienna Lecture," in support of the claim that overcoming naturalism is the raison d'etre of Husserl's phenomenology. Nissim-Sabat picks out one theme of Husserl's philosophy and makes it into its "raison-d'etre." Those familiar with Husserlian philosophy, and circumspect of its application to current issues in psychiatry and psychotherapy, would find her position worrisome. Specifically, as regards the application of Husserlian philosophy to current issues, a more specific obstacle than a looming naturalism is the prospect that researchers in the empirical sciences will doubt the efficacy of Husserlian philosophy for establishing causal relations through statistical correlations. Because Husserlian philosophy is intentionality based, it might seem (falsely) that it cannot handle the rigorous quantitative analysis of after and side effects that psychopharmacology requires.There should be little worry that anyone who would apply Husserlian philosophy to current psychological or psychiatric issues might... (shrink)

Neuroenhancement offers the prospect of improving the cognitive, emotional and motivational functions of healthy individuals. Of all the conceivable interventions, psychopharmacology provides the most readily available ones, such as antidepressants which are thought to make people “better than well”. However, up until now, whether they possess such an enhancing ability remains controversial and therefore in this systematic review we will evaluate the effect and safety of modern antidepressants in healthy individuals. A search of MEDLINE and EMBASE databases and cross-references was (...) carried out and the pharmaceutical industry was contacted for suitable data. Trials published in any language through the third week of July 2007 were regarded. Included were single or double blind randomised or quasi-randomised controlled trials that compared a placebo to one or more of the following antidepressants: bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, moclobemide, paroxetine, reboxetine, sertraline or venlafaxine in any dose or dosing schedule. Eligible studies were those involving healthy people of any age and either sex who showed no evidence of a psychiatric disorder, cognitive decline or other disease. One hundred thirty-five articles met our inclusion criteria reporting single dose trials and trials with repeated drug administration. Sixty-five of these articles were eligible for a statistical analysis. Based on a linear mixed model, a meta-analysis and a fixed effects meta-regression were performed. Pooling of results by meta-analysis was stratified by the outcome measures mood, emotional processing, wakefulness, attention, memory, and executive functions. On a significance level of p < 0.05 the following significant results emerged: After a single dose of an antidepressant, a significant effect was shown in two of the analysed outcomes. Firstly, there was a small yet significant negative effect on wakefulness. On memory, a positive effect after several measurements was found, but this result could be traced to the results of the one study out of all included studies, which had that many assessment points. The analysis of trials with repeated drug administration yielded the following effects: on mood, a non-significant positive effect was detected that was continuously increasing and reached significance at the last assessment point. Regarding attention, a fluctuating effect was found, while for memory, the fact that the two groups started with a group difference confounded the results. For wakefulness there was no significant effect in any particular assessment point, while for emotional processing and executive functions, the small number of studies did not allow for any effect to emerge. In summary, no consistent evidence for enhancing effects of antidepressants could be found. There is little evidence so far to support the popular opinion that antidepressants have a positive effect on the mood of healthy individuals after repeated administration. No evidence of a significant adverse event profile could be found. The studies included in this systematic review not only provide insufficient evidence for or against any effect in healthy people, but they are inapt to be used for answering this question. This may be explained by the fact that most of them were not designed to examine neuroenhancement effects. The growing public interest in neuroenhancement stands in stark contrast to the paucity of data on enhancement effects of available psychopharmacological agents. (shrink)