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What Is Bipolar Disorder?
Bipolar disorder, which is
also known as manic-depressive illness and will be called by both names throughout this publication -is a mental illness involving
episodes of serious mania and depression. The person's mood usually swings from overly "high" and irritable to sad and hopeless
and then back again, with periods of normal mood in between.
Bipolar disorder typically
begins in adolescence or early adulthood and continues throughout life. It is often not recognized as an illness, and people
who have it may suffer needlessly for years or even decades.
Effective treatments are available
that greatly alleviate the suffering caused by bipolar disorder and can usually prevent its devastating complications. These
include marital break-ups, job loss, alcohol and drug abuse, and suicide.
Here are some facts about bipolar disorder.
Manic-Depressive Illness Has a Devastating Impact on Many People.
- At least 2 million Americans
suffer from manic-depressive illness. For those afflicted with the illness, it is extremely distressing and disruptive.
- Like other serious illnesses,
bipolar disorder is also hard on spouses, family members, friends, and employers.
- Family members of people
with bipolar disorder often have to cope with serious behavioral problems (such as wild spending sprees) and the
lasting consequences of these behaviors.
- Bipolar disorder tends to
run in families and is believed to be inherited in many cases. Despite vigorous research efforts, a specific genetic defect associated with the disease has
not yet been detected.
- Bipolar illness has been
diagnosed in children under age 12, although it is not common in this age bracket. It can be confused with attention-deficit/hyperactivity disorder, so careful diagnosis is necessary.
D/ART: A National Educational Program
The National Institute
of Mental Health (NIMH) has launched the Depression/Awareness, Recognize, and Treatment (D/ART) campaign to help people:
- Recognize the symptoms of depressive disorders, including bipolar disorder
- Obtain an accurate diagnosis
- Obtain effective treatments
- Encourages and trains health care professionals to recognize the signs of manic-depressive illness and utilize the most up-to-date treatment approaches
- Organizes citizens' advocacy
groups to extend the D/ART program
- Works with industry to improve
recognition, treatment, and insurance coverage for depressive disorders
Bipolar disorder involves cycles of mania and depression.
Signs and symptoms of mania include discrete
Signs and symptoms of
depression include discrete periods of:
- Persistent sad, anxious, or empty mood
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure
in ordinary activities, including sex
- Decreased energy, a feeling
of fatigue or of being "slowed down"
- Difficulty concentrating,
remembering, making decisions
- Restlessness or irritability
- Sleep disturbances
- Loss of appetite and weight,
or weight gain
- Chronic pain or other persistent
bodily symptoms that are not caused by physical disease
- Thoughts of death or suicide; suicide attempts
It may be helpful to think
of the various mood states in manic-depressive illness as a spectrum or continuous range. At one end is severe depression, which shades into moderate depression; then come mild and brief mood disturbances that many people call "the blues," then normal mood, then hypomania (a mild form of mania), and then mania.
Some people with untreated
bipolar disorder have repeated depressions and only an occasional episode of hypomania (bipolar II).
In the other extreme, mania may be the main problem and depression may occur only infrequently. In fact, symptoms of mania and depression may be mixed together in a single "mixed" bipolar state.
Descriptions provided by patients
themselves offer valuable insights into the various mood states associated with bipolar disorder:
I doubt completely
my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually
useless....[I am] haunt[ed]...with the total, the desperate hopelessness of it all...
Others say, "It's
only temporary, it will pass, you will get over it," but of course they haven't any idea of how I feel, although they are
certain they do. If I can't feel, move, think, or care, then what on earth is the point?
At first when
I'm high, it's tremendous...ideas are fast...like shooting stars you follow until brighter ones appear...all shyness disappears, the right words and gestures are suddenly there...uninteresting people, things, become intensely interesting.
pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable
feelings of ease, power, well-being, omnipotence, euphoria...you can do anything...but, somewhere this changes.
The fast ideas
become too fast and there are far too many...overwhelming confusion replaces clarity...you stop keeping up with it--memory goes. Infectious humor ceases to amuse. Your friends become frightened...everything is now against the grain...you are irritable, angry, frightened, uncontrollable, and trapped.
Recognition of the various mood states is essential so that the person who has manic-depressive illness can obtain effective treatment
and avoid the harmful consequences of the disease, which include destruction of personal relationships, loss of employment,
Manic-depressive illness is often not recognized by the patient, relatives, friends, or even physicians.
- An early sign of manic-depressive
illness may be hypomania--a state in which the person shows a high level of energy, excessive moodiness or irritability, and impulsive or reckless behavior.
- Hypomania may feel good to
the person who experiences it. Thus, even when family and friends learn to recognize the mood swings, the individual often will deny that anything is wrong.
- In its early stages, bipolar
disorder may masquerade as a problem other than mental illness. For example, it may first appear as alcohol or drug abuse, or poor school or work performance.
- If left untreated,
bipolar disorder tends to worsen, and the person experiences episodes of full-fledged mania and clinical depression.
Most people with manic depressive illness can be helped with treatment.
- Almost all people with bipolar
disorder--even those with the most severe forms--can obtain substantial stabilization of their mood swings.
- One medication, lithium, is usually very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.
- Most recently, the mood stabilizing
anticonvulsants carbamazepine and valproate have also been found useful, especially in more refractory bipolar episodes. Often
these medications are combined with lithium for maximum effect.
- Some scientists have theorized
that the anticonvulsant medications work because they have an effect on kindling, a process in which the brain becomes increasingly sensitive to stress
and eventially begins to show episodes of abnormal activity even in the absence of a stressor. It is thought that lithium
acts to block the early stages of this kindling process and that carbamazepine and valproate act later.
- Children and adolescents
with bipolar disorder are generally treated with lithium, but carbamazepine and valproate are also used.
- Valproate has recently been
approved by the Food and Drug Administration for treatment of acute mania.
- The high potency benzodiazepines
clonazepam and lorazepam may be helpful adjuncts for insomnia.
- Thyroid augmentation may
also be of value.
- For depression, several types
of antidepressants can be useful when combined with lithium, carbamazepine, or valproate.
- Electroconvulsive therapy (ECT) is often helpful in the treatment of severe depression and/or mixed mania that does not respond to medications.
- As an adjunct to medications, psychotherapy is often helpful in providing support, education, and guidance to the patient and his or her family.
- Constructing a life chart
of mood symptoms, medications, and life events may help the health care professional to treat the illness optimally.
- Because manic-depressive
illness is recurrent, long-term preventive (prophylactic) treatment is
highly recommended and almost always indicated.
Anyone with bipolar disorder
should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease.
Other mental health professionals,
such as psychologists and psychiatric social workers, can assist in providing the patient and his or her family with additional
approaches to treatment.
Help can be found at:
- University- or medical school-affiliated programs
- Hospital departments of psychiatry
- Private psychiatric offices and clinics
- Health maintenance organizations
- Offices of family physicians, internists, and pediatricians
People With Manic-Depressive Illness Often Need Help To Get Help.
- Often people with bipolar disorder do not recognize how impaired
they are or blame their problems on some cause other than mental illness.
- People with bipolar disorder need strong encouragement from
family and friends to seek treatment. Family physicians can play an important role for such referral.
- If this does not work, loved ones must take the patient for
proper mental health evaluation and treatment.
- If the person is in the midst of a severe episode, he or she
may have to be committed to a hospital for his or her own protection and for much needed treatment.
- Anyone who is considering suicide needs immediate attention,
preferably from a mental health professional or a physician; school counselors and members of the clergy can also assist in
detecting suicidal tendencies and/or making a referral for more definitive assessment or treatment. With appropriate help
and treatment, it is possible to overcome suicidal tendencies.
- It is important for patients to understand that bipolar disorder
will not go away, and that continued compliance with treatment is needed to keep the disease under control.
- Ongoing encouragement and support are needed after the person
obtains treatment, because it may take a while to discover what therapeutic regimen is best for that particular patient.
- Many people receiving treatment also benefit from joining mutual
support groups such as those sponsored by the National Depressive and Manic Depressive Association (NDMDA), the National Alliance
for the Mentally Ill (NAMI), and the National Mental Health Association.
- Families and friends of people with bipolar disorder can also
benefit from mutual support groups such as those sponsored by NDMDA and NAMI.
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It's one of those things you think will never happen to you.
It happened so suddenly. Without any warning I dropped the telephone and slumped in my chair. The right side of my body was
completely paralyzed and I couldn't speak.
The next few hours were a complete blur. Words can't say how
terrified I was. What was happening to me? I kept shaking my dead arm and leg with my other hand, trying desperately to bring
it back to life. I felt as if my body was dying, bit by bit, in slow motion, before my eyes.
Although I couldn't speak, I was able to scream. I was totally
aware of what was going on around me; my horrified colleagues, the panic, the confusion, the ambulance, the sirens, arriving
at the hospital, lying there while people just stared at me.
In the most unusual way, a wave of peace seemed to pass over
me and I became the observer, helpless and detached from my body. I wanted Mum and Dad so much. It breaks my heart to think
of the desperate fear that they would now be going through as they got the call from work, but I knew that whatever was happening
to me was very serious and they had to be with me. I felt like a child again, totally stripped of everything.
In those few moments I thought about my life; how Mum and Dad
would have a disabled daughter needing constant care, how I'd never get married and have my own children, how I'd never succeed
in my career, how I'd never climb a mountain or swim in the sea again. It really is true when they say your life passes in
front of your eyes. This just couldn't be happening. I simply wanted the chance to be able to say that I understood the world
around me, my thoughts and feelings were still there, and maybe life wouldn't be quite so bad after all, even like this. Please
don't give up.
This was ten months ago. The feeling hasn't fully returned to
my hand and my voice sometimes slurs when I'm tired. I look normal but the emotional scars go a lot deeper. I've cried until
I can't cry any more. I've suffered flashbacks to those awful hours. I've felt anger and pain. But overriding all of this
I have the most unbelievable feelings of love and closeness to my family and those who have
supported and helped me along this difficult journey.
Although the doctors could not find a definite cause for what
happened, I've had my heart operated on and feel like a different person; something definite has been done in a battle against
something that felt so much out of my control. I have my spark back and can finally try to move on. One day I like to think
I will look back on this period in my life and see a reason for it happening. Maybe it was sheer bad luck. Or maybe it was
a warning and has saved me from something much worse later on in my life.
I used to think I was invisible and now I know I'm not. I think
it's only when you stare death in the face that you experience that sense of pure fear and I don't think I'll ever get over
that. When you realize you could loose something you want it even more. I love life and want to live it, more than ever before.
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10 People with Unbelievable Medical Conditions
Author: Koolaid Dude
1. The Woman Who has 200 Orgasms every day
UK’s Sarah Carmen, 24, is a 200-a-day orgasm girl who gets good, good, GOOD vibrations
from almost anything. She suffers from Permanent Sexual Arousal Syndrome (PSAS), which increases blood flow to the sex organs.
“Sometimes I have so much sex to try to calm myself down I get bored of it. And men I sleep with don’t seem to
make as much effort because I climax so easily.”
She believes her condition was brought on by the pills. “Within
a few weeks I just began to get more and more aroused more and more of the time and I just kept having endless orgasms. It
started off in bed where sex sessions would last for hours and my boyfriend would be stunned at how many times I would orgasm.
Then it would happen after sex. I’d be thinking about what we’d done in bed and I’d start feeling a bit
flushed, then I’d become aroused and climax. In six months I was having 150 orgasms a day—and it has been as many
She and her boyfriend split— and new partners struggle to keep up with
her sex demands. “Often, I’ll want to wear myself out by having as many orgasms as I can so they stop and I can
get some peace,” she said.
2. The Man Who Can’t Get Fat
Mr Perry, 59, can eat whatever he likes - including unlimited pies, burgers
and desserts - and never get fat. He cannot put on weight because of a condition called lipodystrophy that makes his body
rapidly burn fat.
He used to be a chubby child, but at age 12 the fat dropped
off “almost over night”. He initially tried to eat more to gain weight, but it had no effect. Mr Perry, of Ilford
in Essex, endured a decade of tests before the illness was diagnosed. It finally emerged that his body produces six times
the normal level of insulin. Doctors have admitted that the condition would be a “slimmer’s dream”.
3. The Man Who Doesn’t Feel Cold
Dutchman Wim Hof, also known as the Iceman, is the man that swam under ice, and
stood in bins filled with ice. He climbed the Mt. Blanc in shorts in the icy cold, harvested world records and always stands
for new challenges.
Scientists can’t really explain it, but the 48-year-old
Dutchman is able to withstand, and even thrive, in temperatures that could be fatal to the average person.
4. The Boy Who Couldn’t Sleep: stayed awake 24 hours
a day for years
Rhett Lamb is often cranky like any other 3-year-old toddler, but there’s
one thing that makes him completely different: he has a rare medical condition in which he can’t sleep a wink.
Rhett is awake nearly 24 hours a day, and his condition has
baffled his parents and doctors for years. They took clock shifts watching his every sleep-deprived mood to determine what
ailed the young boy.
After a number of conflicting opinions, Shannon and David Lamb
finally learned what was wrong with their child: Doctors diagnosed Rhett with an extremely rare condition called chiari malformation.
“The brain literally is squeezed into the spinal column.
What happens is you get compression, squeezing, strangulating of the brain stem, which has all the vital functions that control
sleep, speech, our cranial nerves, our circulatory system, even our breathing system,” Savard said.
5. The Girl Who is Allergic to Water
Teenager Ashleigh Morris can’t go swimming, soak in a hot bath or enjoy a shower
after a stressful day’s work - she’s allergic to water. Even sweating brings the 19-year-old out in a painful
Ashleigh, from Melbourne, Australia, is allergic to water of
any temperature, a condition she’s lived with since she was 14. She suffers from an extremely rare skin disorder called
Aquagenic Urticaria - so unusual that only a handful of cases are documented worldwide.
6. The Woman Who Can’t Forget
That’s the story of AJ, an extraordinary 40-year-old married woman who remembers everything.
McGaugh and fellow UCI researchers Larry Cahill and Elizabeth
Parker have been studying the extraordinary case of a person who has “nonstop, uncontrollable and automatic” memory
of her personal history and countless public events. If you randomly pick a date from the past 25 years and ask her about
it, she’ll usually provide elaborate, verifiable details about what happened to her that day and if there were any significant
news events on topics that interested her. She usually also recalls what day of the week it was and what the weather was like.
The 40-year-old woman, who was given the code name AJ to protect
her privacy, is so unusual that UCI coined a name for her condition in a recent issue of the journal Neurocase: hyperthymestic
7. The Girl Who Eats Only Tic Tacs
Meet Natalie Cooper, a 17-year-old teenager who has a mystery illness that makes her
sick every time she eats anything. Well, almost anything. She can eat one thing that doesn’t make her sick: Tic tac
For reasons that doctors are unable to explain, Tic tacs are
the only thing she can stomach, meaning she has to get the rest of her sustenance from a specially formulated feed through
8. The Musician Who Can’t Stop Hiccupping
Chris Sands, 24, from Lincoln, hiccups as often as every two
seconds - and sometimes even when he is asleep. He has tried a variety of cures, including hypnosis and yoga, but nothing
has worked. Mr Sands thinks his problem stems from an acid reflux condition caused by a damaged valve in his stomach. “If
the acid levels are severe enough they are going to do keyhole surgery and grab part of my stomach and wrap it around the
valve to tighten it,” he said.
Mr Sands, who is a backing singer in the group Ebullient, said
the condition has hampered his career as he has only been able to perform four times. In the next couple of weeks –as of the day of the report–, doctors at Nottingham’s
Queen’s Medical Centre will put a tube into his stomach to monitor acid levels and decide if keyhole surgery is possible.
9. The Girl That Collapses Every Time She Laughs
Kay Underwood, 20, has cataplexy, which means that almost any sort of strong
emotion triggers a dramatic weakening of her muscles. Exhilaration, anger, fear, surprise, awe and even embarrassment can
also cause sufferers to suddenly collapse on the spot.
Kay, of Barrow-upon-Soar, Leicestershire (UK), who was diagnosed
with the condition five years ago, once collapsed more than 40 times in a single day. She said: “People find it very
odd when it happens, and it isn’t always easy to cope with strangers’ reactions. ”
Like most cataplexy sufferers, Ms Underwood is also battling
narcolepsy - a condition that makes her drop off to sleep without warning. Narcolepsy affects around 30,000 people in the
UK and about 70 per cent of them also have cataplexy.
10. The Woman Who is Allergic to Modern Technology
For most people talking on a mobile phone, cooking dinner in
the microwave or driving in a car is simply part of modern living in 21st century Britain. But completing any such tasks is
impossible for Debbie Bird - because she is allergic to Cell Phones and Microwaves.
The 39-year-old is so sensitive to the electromagnetic field
(emf) or ’smog’ created by computers, mobile phones, microwave ovens and even some cars, that she develops a painful
skin rash and her eyelids swell to three times their size if she goes near them. As a consequence, Mrs Bird, a health spa
manager, has transformed her home into an EMF-free zone to try and stay healthy. ‘I can no longer do things that I used
to take for granted,’ Mrs Bird said. “My day-to-day life has been seriously affected by EMF”.
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'Trust Drug' Oxytocin Unbelievable For Now
Researchers Balk at Media Reports Hyping 'Love Drug' Hormone's Effects
By DAN CHILDS
ABC News Medical Unit
June 25, 2008
For the past few days, Paul
Zak's phone has been ringing off the hook.
Normally, this would not be
a problem. Zak, a professor of economics and the founding director of the Center for Neuroeconomics Studies at Claremont Graduate
University in Claremont, Calif., is generally happy to talk about his research, which focuses on the effect of the hormone
oxytocin on mood and emotion.
But lately, the phone calls
have been less about his research and more about media reports that have elevated the status of the oxytocin nasal spray his
team devised to that of a truth serum, a trust drug -- even a love potion.
"I have gotten an enormous
number of calls from patients," says Zak, adding that one e-mail he received was from a woman whose social phobia had confined
her to her house for the past 10 years. She hoped the oxytocin spray would help her overcome her fear of socializing.
"What do you write back to
that kind of message?" Zak says.
The impetus for these calls
and e-mails, he says, is his being quoted in a story that ran in the U.K. press. The article sported the provocative headline
"Scientists Find Childbirth Wonder Drug That Can 'Cure' Shyness."
"They were very much too hyperbolic,"
Zak says of the piece. "I think media around the world have started to use the word 'cure.' … This hormone does not
But that might not always
be the case.
Zak says that more than a
dozen studies at his lab, as well as several other projects at other institutions, are taking aim at the hormone with the
hope of teasing out therapeutic benefits in the years and decades to come.
But to some Internet marketers,
news of the sprayable hormone's development in 2005 already carried the sweet smell of success.
Improved Social Live, Career
A Google search reveals at
least two proprietary formulation nasal sprays containing oxytocin. One spray, OxyCalm, is touted as a relaxation aid that
helps users kick the smoking habit. The other, marketed under the name Liquid Trust, purports to improve users' social lives
Nowadays, however, the "love
drug" manufacturers don't seem to be feeling the love. Mike Delaney, a spokesman for OxyCalm, says pressure from the U.S.
Food and Drug Administration caused his suppliers to shut down oxytocin production. And a call to the makers of Liquid Trust
went quickly to voice mail.
But that hasn't stopped consumers
from seeking out what they believe is a miracle emotion potion.
Anatomy of a 'Love Potion'
Like certain other hormones,
oxytocin is produced naturally in the brain. While oxytocin's reputation as a love potion is relatively new, the hormone has
been the subject of study for decades.
In animal studies, researchers
have found that the hormone does play a role in social attachments and behavior. And in humans, oxytocin has been detected
in elevated levels in the bloodstream during orgasm, childbirth and breast-feeding. Some have suggested that this means the
hormone is instrumental in human trust and bonding as well.
Not all about oxytocin is
a matter of scientific speculation. Dr. John A. Seibel, past president of the American College of Endocrinology, notes that
the hormone is used as a medicine as well.
"It is a medicine that, traditionally,
we use to induce labor in women," he says. "But a lot of people feel that besides inducing labor in women, it may also lead
up to the nurturing nature of these women toward their children."
"I think this, in turn, has
been turned into a 'trust effect.' After all, who doesn't trust their mother?"
Research in the past several
years that looked into the possible connections between the hormone and levels of trust sparked a wave of interest in the
clinical community and the public alike.
First, a Swiss study published
in the journal Nature in 2005 -- in which Zak was a co-researcher -- suggested that the use of a nasal spray containing the
hormone could increase generosity in a game using imaginary money. In another study, published last year in the online Public
Library of Science journal PLoS ONE, Zak and his colleagues found that study subjects receiving the hormone were more generous
when asked to split a sum of make-believe money with a stranger.
Other research suggested the
hormone might have modest but positive effects in mitigating the repetitive behaviors seen in those with autism.
And animal studies continue
to suggest anti-anxiety effects of oxytocin. Larry J. Young, professor in the department of psychiatry at the Emory University
School of Medicine in Atlanta, has published many of these animal studies. But while the effects of the hormone when administered
to voles, mice and other creatures is quite well known, he notes, "the place it gets a little bit dicey is in humans."
Young says this is because
it is simply impossible to experiment on humans in the same way one would experiment on rodents. And the social behaviors
of humans -- the ones that everyone is interested in, anyway -- are far too complex to nail down without extensive research.
Seibel, too, urges caution
when it comes to interpreting the effects on humans.
"It is very difficult to quantify
how much of an effect this actually has," he says.
And while Zak says such excitement
over the potential of oxytocin is heartening, there are more ways than a nasal spray to increase the amount of the hormone
that courses through one's veins.
"Massage, for example, primes
the brain to release oxytocin," he says. "There are many more ways than having a drug to have trust behaviors develop …
there are lots of ways to get the brain to release this stuff."
Love Potion Biz Evaporating Online
Still, when studies on oxytocin
became common knowledge a few years ago, some companies couldn't resist marketing their versions of trust in a bottle. And many consumers couldn't resist trying it out.
Fast forward to today, and
the supposed wonder drug looks more like a formula for disaster. The root of the problem could be the fact that oxytocin is
already used as a drug in the medical setting, which makes it the object of scrutiny from federal regulators when marketed
for nonmedical purposes.
Companies selling a pharmaceutical
-- any drug with an application in a clinical setting -- off label and without permission to sell the drug, could be subject
to FDA penalties or sanctions, including forced shutdown.
"We haven't had any product
available this year," OxyCalm's Delaney says. "We can't find any contract manufacturers to make any more of it due to potential
Delaney says the troubles
began when the FDA contacted a seller of the product in Florida about two years ago. Soon, even Internet-based sales of his
vanilla-scented version of the oxytocin spray could not be sustained.
But in the year or so that
his product was available, Delaney says sales were "decent."
"We sold about 6,000 bottles,"
he recalls. "We always had a money-back guarantee. Only two to three customers asked for their money back. For one, it was
because he didn't like the vanilla scent."
Calls to the Vero Labs, the
Boca Raton, Fla.-based makers of Liquid Trust, were far less conclusive. As an automated voice in a distinctively clipped
British accent ushers callers through mailbox options, they learn that Liquid Trust is "The world's first and only trust-enhancing
spray, specially formulated to increase trust in you."
Messages left at the number
were not returned.
Zak says the last time he
encountered a representative of Vero Labs, it was on a morning news show on which he and a spokesperson for the company were
both guests. Zak says he took this opportunity to point out that the company could face trouble from the FDA for marketing
its product in the way it had.
"We really laid into them,"
No Magic Bullet for Trust
Could the time come when a
shot of oxytocin into the sinuses has therapeutic value? Some experts think it might. But even if such a treatment comes to
pass, experts agree that boosting the hormone can only go so far when it comes to treating such complex issues as social anxiety
and lingering psychological trauma.
"Social dysfunction and other
antisocial behaviors are often very difficult to treat," Zak says. "There is often some trauma in these people's lives; these are hard patients to treat."
Plus, Seibel notes, oxytocin
taken without a doctor's guidance can be harmful.
"You might be putting yourself
at a significant risk," he says, adding that the drug could lead to miscarriage in pregnant women or heart problems in those
predisposed to such conditions.
"I don't think that it's a
good idea for the public to go out and get oxytocin on their own," he says. "I don't think there's enough evidence for us
to know how powerful an effect this actually has."
So when it comes to Liquid
Trust, do people need a dose of liquid skepticism instead? Zak says perhaps.
"There's probably a big placebo
effect. ... It's not a crutch for people who are nervous," he notes. "Having said that, our findings are very exciting. Hopefully, people will just get the straight story and not the hype."
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