Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Friday, September 12, 2014


I'm addicted to chocolate. When I tell this to people, they usually smile, and I get that it's kinda cute. After all, chocolate doesn't impair my judgment, or make it hazardous for me to drive or operate heavy machinery. I won't go to prison for selling or using chocolate. Chocolate won't put me in rehab, or in danger of dying from overdose or withdrawal. And I won't spend my life's savings on chocolate.

It just tastes great and makes you feel good. But truly, I'm addicted. My longest clean time is one year, but I'm more typically on the wagon for a month or two.

Please understand, I am not making light of addiction. I genuinely have a problem with chocolate. I go on chocolate benders. I experience withdrawal with intense cravings and mood swings. In fact, probably the worst thing chocolate does to me is affect my mood. Or maybe it's the severe GERD. Either way, it gives me tremendous empathy for people suffering from addictions, and I'm just grateful that my substance of choice is legal and relatively benign.

Granted, some of it is about the taste. Because I won't consume just any chocolate. I'm extremely fussy. My favorite chocolate to just munch on or bake with is Callebaut. I'm particularly partial to their semisweet. And my favorite hot chocolate (not cocoa, NEVER cocoa-you can barely taste the chocolate) is the single origin Venezuela source by L.A. Burdick, which has stores in Boston, Cambridge, New York City (unfortunately, right across the street from my old office), New Hampshire, and nowhere else, as far as I know. I'm also partial to a store in the West Village called, The Meadow, which sells small batch chocolates, salt, bitters, and flowers. The guy working there told me he likes to eat dark chocolate ice cream out of a pink himalayan salt bowl, which sounds magnificently indulgent.

There's no question, at least for me, that eating chocolate feels good. It's soothing. It's calming, and it's mildly euphoric. Is it possible to isolate the elements in chocolate that cause those effects, and turn them into an antidepressant? Is it possible to keep those effects from wearing off quickly?

A paper by Parker et al (Summary) claims that while eating chocolate is a pleasurable experience, if eaten to help with a negative mood, it may provide short-lived relief, but then perpetuate the negative mood.

An article in How Stuff Works claims that chocolate contains caffeine, cannabinoids, and Pheylethylamine, the "love drug", technically classified as a hallucinogen. It also causes the release of dopamine and serotonin. The article goes on to claim that these chemicals are present in chocolate in amounts to which we've become habituated in things like coffee, so they don't have much effect on people. I don't smoke, I don't use any illegal drugs, I drink maybe a glass of wine a month, and I don't consume caffeine, except in the form of chocolate. Maybe that's why it effects me so intensely.

Anandamide is an endogenous cannabinoid also found in chocolate. Its effects are mediated by the central CB1 cannabinoid receptors, and the peripheral CB2 receptors. A metabolite of acetaminophen, AM404 is a weak CB1 and CB2 agonist, as well as an anandamide reuptake inhibitor. This may explain some of the analgesic effects of acetaminophen.

Anandamide is degraded by the fatty acid amide hydrolase (FAAH) enzyme, as is AM404. However, an analogous, synthetic compound, AM1172, also inhibits anandamide reuptake, and is not degraded by FAAH. AM1172 is a candidate for the treatment of anxiety and depression (Royal Society of Chemistry, Fegley et al).

Phenylethylamine is sold as a dietary supplement for its purported mood effects. However, it undergoes extensive first pass metabolism by MAO-B, and as such, would need to be ingested in extremely high doses to have any significant effect on mood.

In writing this, I've pretty much exhausted everything I remember from Chemistry, so I'm gonna stop with the technical stuff. But with all the talk about there being nothing in the pipeline in antidepressant development, what happened to these guys? Does anyone know?

I'll leave you with a recipe for the world's best brownies. It's my adaptation of a fantastic recipe from Smitten Kitchen. In my opinion, they taste best frozen.

3 ounces unsweetened chocolate, roughly chopped
1 stick unsalted butter, plus extra for pan
1 cup (packed) dark brown sugar
2 large eggs
1 teaspoon vanilla extract
1/2 teaspoon flaky sea salt
2/3 cup all-purpose flour

Heat oven to 350°F. Line an 8×8-inch square baking pan with parchment, extending it up two sides, or foil. Butter the parchment or foil or spray it with a nonstick cooking spray.

In a medium heatproof bowl over gently simmering water, melt chocolate and butter together until only a couple unmelted bits remain. Off the heat, stir until smooth and fully melted. You can also do this in the microwave in 30-second bursts, stirring between each. Whisk in sugar, then eggs, one at a time, then vanilla and salt. Stir in flour with a spoon or flexible spatula and scrape batter into prepared pan, spread until even. Bake for 25 to 30 minutes, or until a toothpick inserted into the center comes out batter-free.

Let cool and cut into desired size. If desired, dust the brownies with powdered sugar before serving.

*non-linked info from Wikipedia