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paraicodonnell's profile
Paraic O'Donnell
Paraic O'Donnell
Paraic O'Donnell
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@paraicodonnell

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Paraic O'DonnellVerified account

@paraicodonnell

Writer. Lives in a small way.

Wicklow, Ireland
paraicodonnell.com
Joined February 2011

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    Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

    Paraic O'Donnell Retweeted The Poisonous Euros Atmosphere Fan

    When you have a neurological illness, you see a lot of lists like these. They can be alarming at first, so it’s important to inform yourself. That way you can be properly terrified. Here are some fun things you may not know about neuropharmacology.https://twitter.com/DawnHFoster/status/1143224288171974657 …

    Paraic O'Donnell added,

    The Poisonous Euros Atmosphere FanVerified account @DawnHFoster
    Absolutely stonking side effects pic.twitter.com/uVlgHVv9Ab
    4:31 AM - 25 Jun 2019
    • 23 Retweets
    • 61 Likes
    • Ed Benjamin McElwee 𝐆𝐫𝓐ʰΔⓜ x Ŵ𝓱𝕀𝓉𝔢 gastrogeorge 🌹 dull thud Jen Thompson Shaahin Pishbin Tania Berry Tim Ripley
    4 replies 23 retweets 61 likes
      1. New conversation
      2. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        Until the 1930s, we didn’t really have any medicines to treat diseases of the nervous system. That was because no one really knew how the nervous system worked. When we did begin to develop treatments, it was mainly by accident.

        1 reply 0 retweets 8 likes
        Show this thread
      3. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        Since the 1870s, scientists at BASF and elsewhere had been synthesising derivatives of phenothiazine and testing them as treatments for diseases like malaria. The results were mixed, but they did happen upon derivatives like promethazine.

        2 replies 0 retweets 3 likes
        Show this thread
      4. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        Researchers at what is now Sanofi were trying to develop treatments for worms. Instead, they accidentally produced the first antihistamine. Also, the particular sedative properties of promethazine turned out to be beneficial to patients with Parkinson's disease.

        2 replies 0 retweets 5 likes
        Show this thread
      5. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        Other derivatives of phenothiazine, like chlorpromazine, ended up becoming the first generation of antipsychotics. By way of an interesting sidelight, it was later discovered that sustained treatment with chlorpromazine can itself give rise to parkinsonism.

        1 reply 0 retweets 4 likes
        Show this thread
      6. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        See, the thing was, until the late 1940s, all neurologists knew about the diseases they were treating was what they could figure out by cutting up dead brains. Which wasn't nothing, to be fair.

        1 reply 0 retweets 2 likes
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      7. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        Multiple sclerosis, for instance, was so named by the pioneering French neurologist Jean-Martin Charcot, who made post-mortem observations of 'sclérose en plaques' (disseminated plaque-like lesions) and was the first to correlate them with clinical findings.

        1 reply 0 retweets 1 like
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      8. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        But as for the mechanisms of these diseases – how they arose, progressed and gave rise to symptoms – no one had much of a clue. You just gave stuff to patients to see what happened. Because fuck it, it was worth a shot, right?

        1 reply 0 retweets 2 likes
        Show this thread
      9. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        This was true until the 1930s and 1940s, when we started to figure out how neurotransmitters like dopamine and serotonin might be involved. Now, this was definitely a big deal. For the first time, a patient's response to a brain medicine could be objectively measured.

        1 reply 0 retweets 2 likes
        Show this thread
      10. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        For the first time, too, patients with schizophrenia could be effectively treated. The barbaric carceral regimes that had been central to psychiatric treatment began to be dismantled.

        1 reply 0 retweets 3 likes
        Show this thread
      11. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        However, we still only knew this one thing, still only had this one therapeutic target, and we got kind of carried away. We went crazy over amphetamines, for instance, and then previously healthy patients started presenting with schizophrenia. I mean, who knew, right?

        1 reply 0 retweets 4 likes
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      12. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        But things are different now, right? I mean, we know so much more, and everything is so closely regulated. Well, yes and no.

        1 reply 0 retweets 4 likes
        Show this thread
      13. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        I take a drug called fampridine to help me walk. It works by blocking potassium channels in cell membranes, which can improve conductivity in demyelinated nerve cells. Until quite recently, we didn't even know that mechanism existed. Knowing things helps, obviously.

        2 replies 0 retweets 6 likes
        Show this thread
      14. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        However, I also take a drug called modafinil to help me maintain alertness. Here are some of its potential side effects, which @DawnHFoster's earlier tweet reminded me of.pic.twitter.com/pCAM1JqYAU

        2 replies 0 retweets 6 likes
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      15. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        Now, modafinil was originally marketed as a treatment for narcolepsy. It's prescribed for multiple sclerosis on what's known as an off-label basis. On an off-off-label basis, it's also routinely chugged by tens of thousands of tech industry dudebros who want to be 'enhanced'.

        1 reply 0 retweets 5 likes
        Show this thread
      16. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        And it's great, don't get me wrong. Modafinil is fantastic. It's like being on a serene and highly refined form of speed. It's kept me productive for years. Here's the thing, though. No one knows how it works.

        1 reply 0 retweets 7 likes
        Show this thread
      17. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        It's therapeutic mechanism of action, to quote the literature, remains unknown. Is this starting to sound familiar?

        2 replies 0 retweets 5 likes
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      18. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        There are two reasons why that list of potential side effects is long and scary. First, modafinil is centrally active, which means it acts on the central nervous system. The main component of the central nervous system is the brain.

        1 reply 0 retweets 3 likes
        Show this thread
      19. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        Your brain, obviously, controls all of you. Walking, breathing, swallowing, regulating blood pressure, rage, bliss, thinking about cake, all that good stuff. You put novel organic compounds in there, basically anything could happen. It probably won't, but could.

        2 replies 0 retweets 5 likes
        Show this thread
      20. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        The second reason is this. Hundreds of thousands of random punters all over the world, many of them perfectly healthy, are horsing this stuff into them. Sometimes bad shit happens to them. I mean, some of them are tech bros with cyborg complexes, and they deserve it. But still.

        1 reply 0 retweets 5 likes
        Show this thread
      21. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        Did the drug cause the bad shit to happen. Meh. I mean, maybe? But it's still someone's job to write all this stuff down. And therefore: scary lists of side effects.

        1 reply 0 retweets 3 likes
        Show this thread
      22. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        NB: I'm not suggesting that the lists are nonsense, or that you shouldn't read them carefully. However, while clinical trials are generally well designed and regulated, they're focused on therapeutic endpoints and side effect data tends to be captured incidentally.

        2 replies 0 retweets 7 likes
        Show this thread
      23. Paraic O'Donnell‏Verified account @paraicodonnell 25 Jun 2019

        In conclusion, then, it's a better time than ever before to have a neurological illness, but that's not saying much. Brains are still vastly complicated and medicine still proceeds, quite literally, by trial and error. Thanks for coming, everyone. Grab a muffin and a handout.

        5 replies 0 retweets 32 likes
        Show this thread
      24. End of conversation

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