Psychiatrists Must Face Possibility That Medications Hurt More Than They Help

https://blogs.scientificamerican.com/cross-check/psychiatrists-must-face-possibility-that-medications-hurt-more-than-they-help/

by aburan28 • 10 years ago

245 179 10 years ago

blogs.scientificamerican.com

youdontknowtho• 10 years ago

Their over-prescription is no doubt a problem. That being said, I have family members that are verteran's from the Vietnam era. Anti-depressants made their existence possible. They all had so much trouble adjusting and maintaining relationships. The change was night and day different.

Anecdotal evidence isn't really evidence, I know that. And the pharma companies are really just the worst. I have seen these things really work though.

EDIT: It's funny, but people never seem to question if modern American life actually, you know, is good for mental health. Maybe people are mentally ill because the world is super effing weird and hard to adjust to?

Alex39173• 10 years ago

I have seen these things really work though.

The argument (based on some large scale trials and other data) is that after 2+ years, those on SSRIs are worse off than they would have been without them.

The issue is that by taking SSRIs, you may be getting a few weeks of negligible benefits in exchange for a lifetime of being disabled, when otherwise you'd have been better after a few months using other interventions.

falcolas2• 10 years ago

are worse off than they would have been without them

With, or without continuing monitored dosage to account for the body's corrections towards what it perceives as equilibrium? If without a continued dosage, is this before or after a "withdrawl" phase?

Leon• 10 years ago

Can you cite this?

Broken_Hippo• 10 years ago

That means there is more to figure out, not that people shouldn't be taking them. It could be that a combination of therapy and SSRI's are the answer, or they only work with certain blood chemistry and we develop a test for such a thing so we'll know.

Someone with a major mental illness might just do worse after a couple of years, despite medication. Some folks with bi-polar disorder truly can't work, despite the medications, for example. They'd definitely be doing "worse" after starting their medications, some of which might easily include SSRIs, but it isn't really because they started medications.

None of this means we shouldn't use them, just use them responsibly with a bit more medical oversight. After all, for some people these really do help.

GuiA• 10 years ago

It's funny, but people never seem to question if modern American life actually, you know, is good for mental health. Maybe people are mentally ill because the world is super effing weird and hard to adjust to?

http://www.vanityfair.com/news/2015/05/ptsd-war-home-sebasti...

themgt2• 10 years ago

Agreed for sure. As someone who's lived or spent time in a number of other cultures I do think there's something excessively (if not uniquely) toxic about American life, which if I had to summarize (and agree with Sebastian Junger), would be: lack of community.

rubicon332• 10 years ago

As much as I want to believe things are over prescribed, and that medications don't actually help, my anecdotal experience is very similar to yours. I've heard nothing but extremely positive things. Comments like "I have my life back". And "I finally feel okay in my own skin".

I've been long skeptical of the pharma industry, and those drugs... But the more I hear personal accounts like that, it's hard to remain skeptical.

funnyfacts3652• 10 years ago

Who would say getting high on drugs could fix lifes instead of destroying them...

masterDepressor2• 10 years ago

Well, in my case, the result of me taking antidepressants was gaining 120lb, stopping leaving the house, and spending hours a day posting on 4chan and jacking off to porn since I no longer cared about the negative emotions such actions would have previously inspired in me. I also felt like I was going crazy when I stopped taking the medecine. The result now is that I'm very high performing in all areas of my life, and I have lost over 120lb and achieved a nornal weight, but I believe that my stint with antidepressants have permanently taken several years off my life span. They also contributed to significant delays in my economic, intellectual, and social development, as they seemed to bring me from relatively poorly functioning (but functioning) human being to out of control explosion of self-destruction and shit. But maybe it's different for older people who take them.

wu-ikkyu3• 10 years ago

Placebos have been shown to be nearly as effective as anti depressants.

komali212• 10 years ago

I've been attacked before, even by employers, for claiming I need Adderall to work. I'm told ADHD isn't real, I just need to suck it up and focus, that I'm an addict, etc.

I've never really found an apt metaphor to describe what ADHD is and why I need to medicate it. To many people, disease is on or off - you either have the virus or pathogen or missing chromosome, or you don't. The sliding scale of mental illnesses is hard to describe. So if I say I can't focus , they say "lots of people can't focus ." I try to use obesity as a metaphor, like, lots of people are fat, most people can become not fat by eating right and working out, but a rare selection of people genuinely have a disease that make it difficult to the point of needing medication to aid their weight loss. They could still lose weight by doing the stuff other people do to lose weight, but it will be way harder and they'll never be able to achieve what other people can without medication.

That's me and Adderall. Yea, I can work without it. I can meditate and suck it up and drink coffee or whatever. But I'm hamstringing myself, and I'm exerting way more energy than the average person does to do the "simple" thing of staying focused. Better if I just pop 5mg (I stay at the lowest possible dosage) of Adderall and actually be a functional member of society.

mjburgess5• 10 years ago

ADHD is a horribly misnamed condition. It's caused by a delay in the development of the frontal cortex which puts people about 30% behind their peers in many higher order cognitive functions.

If depression is like the flu, ADHD is like missing a leg. You can't regrow or cure a missing leg, all you can do is use a prosthesis -- for ADHD stimulants are the prosthesis for the missing development of the higher order brain functions.

ADHD is a serious impairment to normal cognitive functioning. However everything a person with ADHD experience is a part of everyone's ordinary rational expectations: things forgotten, things missing, a lack of motivation, difficulty focusing, emotional dis-regulation, lack of social awareness. And that makes popular perception very difficult to correct -- because it isn't that these things happen, its that they happen to an extreme because of a significant neurological impairment.

LordHumungous4• 10 years ago

Other side of the coin: I have a friend who went to a psychiatrist and was given an Adderall prescription. A couple years later he was hopelessly addicted, taking over 90 mg at a time. He may well have had ADHD but the drug ended up being worse than the condition. Amphetamine is not something to take lightly.

pmoriarty2• 10 years ago

As I got older, I've had more and more trouble focusing. I also started to suffer from confusion. The scariest part was when I was talking to someone about a technical subject, and suddenly what they were saying literally stopped having any meaning. I just couldn't understand a single word they were saying. I saw and heard them speaking, but didn't understand any of it. This lasted only a short time, but it happened a couple of times.

I then started taking DHA and CDP Choline, and all of the above symptoms went away. I was back to "normal". Through experimentation with stopping and restarting both DHA and CDP Choline, I figured out that it was the latter which was responsible for the change. There were days when I'd forget to take the CDP Choline and then later in the day notice that I felt I had trouble focusing and then realised, "oh yeah, I forgot to take the CDP". Starting to take it again would relieve the symptoms. This happened more than once. I also went for months without taking either supplement, where I'd run out and procrastinate on getting a refill, and sure enough, I'd go back to having trouble concentrating. Then I'd finally get a refill of CDP and I'd be able to focus well again. All of this has convinced me that CDP really is working for me.

Later, due to some other health issues (not related to cognition) that I've had, I took a good hard look at my diet, and found out that many health issues that I have and have had in the past could very likely be due to various vitamin and mineral deficiencies. Though I've always known that my diet wasn't really healthy, I never realized how much of a profound effect the lack of proper vitamins and minerals could have on my mental and physical health.

I started eating a lot more healthily (in particular, eating lots of fruits and vegetables, which were almost completely missing from my diet in the past), and taking supplements for some of the nutrients which I was still not getting adequate amounts of from my diet.

As a result, I feel much better, have a ton more energy, feel in a better mood, and have no problems concentrating.

I strongly encourage you to take a hard look at your diet to see if you're missing or low on any essential nutrients, and consider supplementing those (or, better yet, getting them through eating more nutritious food). It can really make a world of difference.

engx• 10 years ago

I've had ten friends take Adderall and all of them exhibited the same characteristics as a person on meth. They are not fun to be around. Sometimes they would be highly productive, other times they just bounce around the house, doing nothing. My current roommate takes Vyvanse and it's incredibly difficult to deal with.

To me, it's okay to say it's a performance enhancing drug and that some people need more energy (e.g. coffee) to get going. But I find it incredibly dangerous to suggest a person needs to take an amphetamine every single day to be normal.

I am open to change my opinion, especially if things like EEGs can conclusively establish ADHD. But all the troubles you describe, are universally human. If Adderall helps you overcome them, I'm all for your ability to take it. I'm just cautious about labeling everything a disorder or disease.

aeze• 10 years ago

Genuinely curious, and hopefully this doesn't come across as inflammatory. When you say you can't focus, and they say "lots of other people can't focus" - you mean that they don't know what it's like for you - but how do you know what it's like for them?

carlisle_• 10 years ago

The only way I can describe it to people is by identifying how disruptive distractions are, and how powerless I am to stop being distracted.

My go to example, being in an open office, is to point out how every time somebody walks by my desk in eye shot it is very difficult for me to not immediately look over at them. I would really not like to, I trust our building's security to keep me safe, people who walk by are quiet and polite, and I know the things I'm trying to focus on are more important.

My brain does not let me do it. I have to look over every time.

I tend to leave out the hyperfocus thing b/c it's hard to describe what it's like to somebody who's never had it, because to some people it directly contradicts the other point: "See? You can focus!"

Diederich4• 10 years ago

I have ADHD as well, and I started treating it with meds quite a few years ago.

Before I took meds, I was generally very productive, but it was a huge strain.

I've always been pretty religious about getting enough sleep, and so back then I was consistently getting more than 8 hours of sleep every night. And I would wake up refreshed, and I'd feel great.

Then after a work day containing a fair share of intense concentration, I would be absolutely exhausted. Most days, I'd take a 90 minute nap as soon as I got home, so I could have some kind of useful evening.

I've always been, for myself, extremely reluctant to take any kinds of medication. I don't put that on anyone else, but it's just my own personal perspective. So I resisted getting the ADHD treated for a long time.

I finally went in and got a scrip for Adderall.

My blood pressure and pulse rate were, at the time, in the normal range, but slightly high. So I did some experiments, tracking my BP and pulse rates at various intervals after taking the meds.

Even though Adderall is speed, for me, it clearly lowered my pulse rate and blood pressure after I took it. My mind wasn't racing around in many directions at once, which I assume allowed my BP and pulse rate to go down further into the normal range.

Further, I no longer needed to take a nap in the afternoon after work.

Note: this wasn't because the meds were keeping me awake. I never take them after noon, so their levels are very, very low when I go to bed. Sleep is still important to me.

I manage my consumption of the ADHD meds pretty rigorously. My doctors have always given me that flexibility by giving me many tablets of small dose, so that I can slice and dice the dose as I see fit. This has been quite useful, since I'll actually dose myself based on what's expected during the day. And on days off, I'll almost never take the meds.

One last point: I don't think ADHD is a mental illness per se. I know that people who have it might not fit as well into some parts of our modern society, but more than anything, I think it's just a personality trait, one that provided evolutionary advantages at some point in our past.

Moshe_Silnorin2• 10 years ago

The fact that it is enhancing your performance and you are able to tolerate it is reason enough to not judge you for using it. If I could take a drug that made me significantly smarter, I would be willing to pay vast percentages of my income for it, like up to 50%. We must pathologize to justify enhancement. But there really should be no need. We all wish to improve ourselves. If responsible use of amphetamines betters you, that's enough to justify its use.

maxxxxx• 10 years ago

"It's funny, but people never seem to question if modern American life actually, you know, is good for mental health. Maybe people are mentally ill because the world is super effing weird and hard to adjust to?"

American Life is very harsh and unforgiving without doubt. There are upsides to everything being competitive and everybody supposed to make his own luck. But when you have a problem you are in a very unfriendly environment.

gdulli• 10 years ago

Prescription drugs save lives (or one's quality of life) all the time, and it sounds obvious but people forget or don't recognize that.

It doesn't always work because it's not an exact thing, two bodies can have different reactions to the same prescription. The same body can different reactions to the same prescription at different times. And some doctors make mistakes and some exercise poor judgment. But too many people latch onto the negative anecdotes and the narrative of us vs. the evil drug companies.

It's like with police. You can see them as fundamentally your enemy, or else fundamentally on your side but since they're just people like all of us, many are below average at their job and some outliers are incompetent or truly evil. The way you choose to see it says more about you than about law enforcement.

joe_the_user• 10 years ago

Well,

What you are ultimately saying that drug X made the person's existence possible under the current circumstances and given the current options.

My anecdotal evidence is a friend who went for years working a night shift and playing RPGs during the day, wracking a massive sleep deficit and engaging in other irresponsible behavior. Antidepressants made his existence possible. Until they finally stopped working and he reached full psychological disability.

It is extremely difficult to say this means. My reflex is to give the "folk psychology" explanation that he'd pushed away the "real problem" for so long that when it "caught up to him", he couldn't deal with it. But it could just as well be the chemicals gave him a few more years.

Now if I suspect, chemicals or not, if he'd had job/leisure activity combo that satisfied him more and didn't produce sleep deficits, he would have at least lasted longer.

TeMPOraL• 10 years ago

EDIT: It's funny, but people never seem to question if modern American life actually, you know, is good for mental health. Maybe people are mentally ill because the world is super effing weird and hard to adjust to?

Anecdote: my mother told me that when she was young and they could - living in Poland - finally get to watch some American movies, they were perplexed by one thing: it seemed that every other American goes to a shrink. They used to laugh at the western lifestyle because of that. Fast-forward ~30 years, and every other person in Poland also visits a psychiatrist...

tn13• 10 years ago

It's funny, but people never seem to question if modern American life actually, you know, is good for mental health. Maybe people are mentally ill because the world is super effing weird and hard to adjust to?

Clearly these people have not been to India, China or some place like that. At least in India mental issues are not even diagnosed and people suffer from mental issues rest of their lives unable to cope and sometimes disowned by family. Modern american life might have its issues but I think it is probably the best kind of life humans are living compared to past or elsewhere on earth.

vinay4272• 10 years ago

I agree with the first part that India does not handle mental issues well, but I disagree with the latter part. The US as some have pointed out here is quite exceptionalist in that it's unforgiving to those who are not the highest achievers. This is certainly not the case to the same extent in India, where in my (limited) experience an average honest middle-class lifestyle is more admirable in and of itself. This leads the US to have an entrepreneurial spirit at the cost of some other aspects of life.

vacri2• 10 years ago

It's funny, but people never seem to question if modern American life actually, you know, is good for mental health

Speaking as an outsider, it seems to me that the US lionises some mental illnesses. For example, someone gets up on stage and gets passionately frothy about 1776, and they get accolades. In other countries that person would be treated as a nutter.

Florin_Andrei• 10 years ago

It's funny, but people never seem to question if modern American life actually, you know, is good for mental health. Maybe people are mentally ill because the world is super effing weird and hard to adjust to?

To me this is self-evident.

Our lives have become more and more comfortable physically, less challenging, less stressful.

But from a mental perspective, we are doing FAR more deliberate, conscious effort than any of our ancestors. Emphasis on conscious. Being a hunter-gatherer surely required a lot of processing power, but over time we've adapted so that a lot of that effort is not conscious. And we don't seem to have a problem processing a heck of a lot of data unconsciously.

It's this newfangled, forced-conscious processing that we are not adapted for, and is very stressful.

kps• 10 years ago

One part of ‘American life’ is the intense Puritan/Calvinist streak that holds that suffering is necessary for redemption: using mere science to make people feel better is evil. Among those that would claim to reject Puritanism the appeal to nature is a search-and-replace copy. Then you have Chernyshevsky's “the worse the better”: the proles need to be kept miserable so they'll revolt.

gozur88• 10 years ago

One part of ‘American life’ is the intense Puritan/Calvinist streak that holds that suffering is necessary for redemption: using mere science to make people feel better is evil.

I've been living in the US for five decades, and I've never, ever run into someone who articulated that belief.

DanBC3• 10 years ago

Good doctors are fully aware of the bio-psycho-social factors to "illness", and they recognise the strength of multidisciplinary teams that work across all these things.

But mental health tends to be underfunded, and employment support or drug and alcohol rehab or whatnot even more so.

randomgyatwork• 10 years ago

You are right about the modern life being the problem for most of us.

themgt2• 10 years ago

Fascinating to watch a brief video from Robert Whitaker [1]

The core of his argument appears to be that because the brain tends to compensate for disequilibrium, psych drugs in the long-term paradoxically have the opposite effect that they do short-term - anti-depressants are depressogenic, anti-psychotics increase long-term psychosis, etc

[1] https://www.youtube.com/watch?v=5VBXWdhabuQ

falcolas2• 10 years ago

This makes a certain amount of sense; its something we see in drug addicts. But this doesn't account for cases where there already exists a disequilibrium. Also, the body's ability to correct a disequilibrium is not infinite; it can be overwhelmed and the effects retained (see alcohol, for example).

heisenbit• 10 years ago

This argument assumes a healthy biology. The body seeks equilibrium - that much is true and messing with it is generally not wise.

But that view is limited and assumes some linear or at least monotonic relationship of cause and effect. The bodies myriad biochemical pathways are anything but. As soon as one has non-linear relationships the door is open to latching up etc..

There are ways a person can either through genetic variations or through extreme experiences (chemical, psychological see also epi-genetics) not exhibit a "normal" bio-chemistry. In such cases targeted intervention can help to restore or long term maintain a state that is closer to "normal".

concinds5• 10 years ago

Would the psyche be better modeled as a complex system, then? Where mental health isn't an equilibrium but almost an "accident", where everything has to be in alignment?

The idea of "decompensation" seems to support psyche-as-a-complex-system theory.

Still I don't think that that invalidates Whitaker's point, since pills or other external treatments only add yet another subelement to the psyche "system", rather than fixing those subelements or making the relationships between subelements more functional. Pills only make the system more complex, and compensate for the dysfunction in other subelements of the system, rather than fixing anything at all.

Overtonwindow• 10 years ago

Many years ago I was given citalopram to help with severe anxiety. The big difference between this, and the other times I'd been given paxil, stratera, wellbutrin, Lexapro, and others, was that I had a therapist who was adamant that drugs alone will not help. You must combine drug therapy with closely monitored, regular one-on-one therapy. That year of therapy and the meds changed my life. Now I'm off the meds and doing very well. Just two cents but maybe others have similar experience?

amorphid• 10 years ago

It sounds like therapy is learning to run, and medication is a good pair of running shoes.

Sanddancer4• 10 years ago

I'd compare them more to orthotics than running shoes. Some people only need them temporarily until their legs get better, some people need them for the rest of their lives. You still need a doctor, but they help with day to day activities.

johnward• 10 years ago

Wellbutrin for anxiety? That drug made me more anxious and wired.

gwbas1c• 10 years ago

Ritalin and Adderal are good examples of how incorrectly prescribing medication will have devastating effects.

Adderal is indistinguishable from methamphetamine, and Ritalin has similar effects. Prescribing too high of a dose will result in effects that are very similar to abusing illegal methamphetamine.

wincy2• 10 years ago

I was taking 60mg of adderall daily. It made me a monster. My doctor kept upping my dose so I could "feel it" and I got meaner and meaner toward my wife. Eventually she gave me an ultimatum: her and my daughter or the adderall.

The three weeks after stopping adderall were awful. Eventually I got productive but not nearly as productive as I had been at work. I was ashamed at how difficult it was for me to accomplish simple tasks, not because I couldn't do them but because I'd do literally anything but my job as often as possible.

After a few months and having a long heart to heart with my wife, we agreed to try adderall again but very differently. The main rule is that she's the ultimate decider if I can take it. I take 5mg twice a day and feel so much better. I'm productive without totally destroying my life.

lfowles• 10 years ago

FWIW, a lot of people on /r/ADHD report having less anger issues on Vyvanse. It is pretty expensive if your insurance won't help you out though.

LordHumungous4• 10 years ago

The stuff is not a joke, especially for people who are prone to addiction. A friend of mine was in a similar situation to you and I started buying it off him for work. After a while I found myself calling psychiatrists telling them about my adult ADHD symptoms. Luckily they all saw through my bs. It totally fucks with your brain chemistry so that once you remove it, you cannot function. It's a real drug for sure.

When I read people online talking about how amazing it is and talking as if there's no downside, red flags go up in my head. It sounds like what every early stage addict says.

kolinko2• 10 years ago

On the other hand, when they are used properly, they have an absolutely aazing impact.

Show me any other medicine that removes almost all the symptoms, has so few side-effects, works within 30 min of taking it, and is effective in 90% of cases.

LordHumungous4• 10 years ago

To be precise, adderall is amphetamine salt, which is different and slightly less potent than methamphetamine.

sharkweek2• 10 years ago

Here's my take, as someone diagnosed with OCD/Anxiety.

Life can get to a point where it's miserable with OCD. It is exactly like a frog in water that's slowly boiling, that you don't recognize things are getting as bad as they are until one day you just kind of feel REALLY shitty and recognize something is wrong.

Medication can really help get over that hump in treatment, and honestly has made it possible for me to accept the problems for what they are. This allows me to move into a "better" place in my own head and be more open and ready for therapy, which I believe gives the far more valuable tools to overcome problems.

I have seen a few different doctors in my life, and NEVER has one of them only recommended medication. In fact most have said exactly the above, that medicine should be an enabler to make other therapy more helpful. Maybe I've just gotten lucky with good doctors, but I kind of think this is a common suggestion.

A lot of people on here are complaining about big pharma, but my generics cost like 2-3 bucks a month. I don't think GSK and Pfzier are exactly making bank off my mental conditions...

gph• 10 years ago

A lot of people on here are complaining about big pharma, but my generics cost like 2-3 bucks a month. I don't think GSK and Pfzier are exactly making bank off my mental conditions...

Not that I disagree with most of your post, but this statement is a bit disingenuous. The fact that there are cheap generics is because Big Pharma already made their money pushing those drugs for 20 years. They might not at this point have a huge profit motive to push these drugs, but the damage is already done. SSRIs are now the standard treatment, and Big Pharma is one of the main reasons that's the case. Given the questionable efficacy of SSRIs, I think it's only right to question the role of Big Pharma in setting our standard practices in medicine/psychiatry.

iamatworknow3• 10 years ago

And "small pharma" (or whoever is making the generics) is still making more money than the $2-3 per month because it's subsidized by insurance.

I'm on a generic prescription now that with insurance is $5/month, and without was $1400/month. Even if the pharma company accepts less than $1400 through insurance negotiation, I find it difficult to believe that my insurance company haggles well enough to knock the price down to just $5. The profit that even a generic pharmaceutical company makes comes from somewhere.

nylonstrung• 10 years ago

Antidepressants are a 15B market globally.

That definitely seems like "making bank" to me, specifically considering it is a pretty consolidated space where that value is being shared by a relatively small number of players.

They certainly are not selling them for charitable reasons.

komali212• 10 years ago

When I went through a bout of depression, I didn't want to medicate because I was convinced I could just "tough it out." Maybe I could have, but over the course of months I never managed it, because the nature of depression is that it depresses your ability to think, act, motivate yourself, etc. A couple months on SSRIs and I was in a place where I could motivate myself to dig out of that hole. That was years ago and the things I learned while I was on SSRIs are enough to help me fight off the random upticks of depression I occasionally get, but now without medication.

sharkweek2• 10 years ago

There was honestly no better day in this process for me than having the self-realization that I COULDN'T tough it out on my own; what a liberating feeling, knowing that you're now open to getting help.

op00to• 10 years ago

Are you comfortable sharing what drugs you have tried? What is your experience with them?

khalilravanna• 10 years ago

...Americans’ mental health has, according to some measures, deteriorated.

I wonder if these "measures" tried to account for the fact that the idea of "mental health" is something that we as a society have only recently tried to destigmatize and normalize. Seems to me that even just a decade or two ago many mental health issues were something you brushed under the rug or something that "other people" had to deal with but "never me". Could it just be the case that many more people are finally coming forward with issues that they had all along?

concinds5• 10 years ago

Do you really think we've even begun destigmatizing mental health issues? I don't think the current situation is any better than it ever was.

Being able to find like-minded people on internet communities to discuss mental issues they're also facing isn't the same as mental health issues being "normalized" and "destigmatized" at the cultural level.

Wouldn't it be fairer to say that global mental health has deteriorated because there are several factors favoring that, and fewer (I would say no) factors acting in the opposite direction?

Sanddancer4• 10 years ago

Or it could be that medication keeps people from hiding from their problems. I know people who have stopped going to therapy and thus, according to stats, are "cured", however, they still have all the problems they had before. Conversely, because you need to see a doctor regularly while on psychiatric medications, it makes it a lot harder for one to hide from their situation. Over prescribed meds are definitely an issue, but there is more at play than just that.

Edit:

One of the data points describes the amount of people taking antipsychotics. The article fails to tell how a lot of psych meds, like antipsychotics, have off-label used. For example, seroquel is a sleep medication in low doses. That would count as taking an antipsychotic even though the dosage is a tenth of that needed for an antipsychotic effect. This article fails to describe how psychiatric medications really are complicated.

VLFBERHT• 10 years ago

I came here to make a Scientology joke but I can't think of anything funny.

0x4d464d48• 10 years ago

I've worked in the mental health field for years and remember believing that a sense of purpose and good social support was more important than the medication and that the medication was not necessary and harmful. Knowing what I know now, there are some diseases, mostly those involving psychosis e.g. schizophrenia, where med adherence is vital to a person learning how to cope with their disease otherwise they can't function and it is certainly not a character failing.

I haven't read the book in this piece and not to knock on journalists but there are things about mental illness you just won't learn without exposure to it and actually working to help people recover. There is a massive problem with over prescription and this idea that mental illness can be 'cured' with medications and medications alone which is absolute flummery (but if you look at what medications bring in the most revenue, the fact this persists shouldn't surprise you).

Biggest take away is that you shouldn't view drugs as necessarily bad as this piece implies. They aren't. When you have a patient who is so depressed they can't get out of bed or another whose auditory hallucinations intensify to the point of violence the drugs are necessary but they aren't a cure. Getting over mental illness requires social support but it does at times also require psychotropic meds.

And don't get me started on the bullshit pushed by pharma a few years ago that people in pain can't get addicted to opiates. I loose it almost every time.

DanBC3• 10 years ago

And don't get me started on the bullshit pushed by pharma a few years ago that people in pain can't get addicted to opiates. I loose it almost every time.

Watch out though. Pain comes in broadly two types - long term and short term pain.

Opiates are great for short term pain and the risk of addiction is low.

It's when opiates are misused for long term pain that they become a problem.

tomquin• 10 years ago

Prescription drugs may be necessary but only after all other therapies have been exhausted. There are many ways to treat mental issues that do not require nuking the brain with powerful pharmaceuticals. Yes they are needed, sometimes.

cannonpr2• 10 years ago

The brain isn't 'badly' designed as much as people often claim and it also shows a remarkable amount of neuroplasticity and ability to alter it's cognative abilities based the demands and situations that it is placed in. I have reservations on the focus that our society places on magic pills versus training your mind... At some point I would love to be able to modify and edit my mind and cognition, but honestly the chemicals we peddle now are akin to fixing a CPU with a butane torch.

Sanddancer4• 10 years ago

I feel it's more complicated than that. The problem seems to be more that psychiatric medication is being prescribed without therapy being prescribed as well. I don't feel I could be able to discuss the things I do in therapy without the psychiatric medications I'm on helping with the healing process -- blocking adrenal response due to social anxiety is one example. While I try to gain the confidence needed to socialize at all, having a medication to help me not run and hide is definitely a good thing.

Regarding your last statement, sometimes you do fix a CPU with a butane torch. There are techs that use butane solder irons so they don't have to worry about cords getting in the way while repairing bad solder joints. Sometimes there really is a mechanical problem, and not just a logic error.

cannonpr2• 10 years ago

I have some experience with therapy under medication for exactly the same reasons you describe, and it was the right choice for me at the time, so I agree, sometimes they buy you time and space to do the work. I also have fixed solder joints/BGA's via last ditch attempts such as the towel technique for xbox 360, and a few variations for certain Nvidia chipsets in certain cough cough apple crap. So I did choose the example for a reason, however, I eventually bought a soldering oven and a desoldering hot air gun lol.

pc2g4d2• 10 years ago

Blame the environment.

It's difficult for me to believe that traits prevalent in 10% or more of the population are actually "disorders". They must have been advantageous in some past situations in order to be passed on so much, or at least not selected against. Right?

So what is it about our environment that makes these traits disadvantageous? Or is that even true? Maybe "mental illness" is an appropriate response to the injustices and impossibilities of modern life. How could we _not_ be having an epidemic of "mental illness" right now given the profound disruptions our society has endured in the last fifty years?

Psych drugs seem to me like a case of "you can't get enough of what you don't really need". An alternate view is that they're like a shoehorn---they're there to help normal people conform to the impossible expectations of society. But maybe we don't really need shoehorns for 10% of the population---maybe instead we need to learn to wear sandals or go barefoot.

Sorry, I know it's a stretched metaphor. And now I'm done.

kolinko2• 10 years ago

Well, perhaps we don't meed prosthetics either - these people should just find jobs that don't need fully functioning arms.

concinds5• 10 years ago

Blaming culture is way too easy. Anxiety or depression have nothing to do with how "unjust" the culture is. Many people live in the exact same society as you, and had worse starting conditions (socioeconomics, family) but excel, mostly because of social support and strong mindset skills (which can both be acquired through reasonable effort), and because they likely had a healthier childhood and more nurturing parents than others who don't end up doing as well.

Jordan Peterson (psychiatrist) says the default state for animals is not calm, but anxiety. An animal only becomes calm in a given environment once he sees and smells that no predators are around to get him, and that they are not in danger. Someone who is chronically anxious will often have grown up in a dysfunctional family and been emotionally neglected. Society didn't do that to them.

Traits prevalent in 10+% of the population can still be disorders. In any given society, you'll have the rich, the middle, and the poor. You'll have the psychologically healthy, the average, and the psychologically unhealthy (the 10+%).

These traits aren't "selected for" or "advantageous" in some situations. In this society, most people with low self-esteem will die with low self-esteem, since, when it comes to the psyche and emotions, most people only improve superficially, they learn to cope rather than fixing for good. They'll obviously pass that low self-esteem down to their children. No selection involved. Would you say low self-esteem is "advantageous"? Is it an "appropriate response"?

pc2g4d2• 10 years ago

I guess I consider dysfunctional families to be part of the injustice of our society. As you say, anxiety is the default state, it's there to keep us alive. So we should blame the family for not being nurturing or the culture for not helping individuals learn how to deal with life, rather than blaming the individual or saying they have some disorder.

Low self-esteem isn't advantageous. But getting anxious or depressed when life isn't working out I would suggest actually is advantageous. Being at the lower end of a bell curve doesn't make something a disorder.

vacri2• 10 years ago

They must have been advantageous in some past situations in order to be passed on so much, or at least not selected against. Right?

No. Evolution only requires that you get to breeding age and have viable offspring. It doesn't care about how you feel, or what happens to you after you've bred. As long as the general population of an organism can get their offspring to a viable independent status, it doesn't matter what happens to you. As a results, traits don't have to be beneficial to be passed on; they just need to allow successful breeding.

Look at the male insects that are devoured by their females on mating. Once they've mated, they're not necessary to getting the offspring viable, so it doesn't matter to the continuance of the species that they immediately die.

broahmed• 10 years ago

"You're depressed? Here: instead of fixing the problem that's causing your sadness, take this pill and it'll all be fine!"

I find this attitude perplexing. Instead of facing the problem(s), drug your mind so you're less aware of the sadness it's causing you. Reminds me of the soma in Aldous Huxley's Brave New World.

And yes, I recognize that there are certain people who suffer from major clinical depression. By all means, prescribe then anti-depressants. I just think that our brains experience sadness for a reason: it's a signal that something is wrong in our life and that we need to change it.

DanBC3• 10 years ago

Doctors (should) know the difference between situational depression and regular depression.

Many people have depression and there's nothing particularly in their life causing it.

duderific• 10 years ago

I wonder if it has to do with the difference between expectation and reality.

If you expect your life to be like that of an attractive and successful character on a TV show or movie, or a celebrity, then chances are you'll be disappointed and possibly depressed. Technically, nothing in your life is "causing it" other than unrealistic expectations.

elihu• 10 years ago

This isn't an area I'm an expert in, so take this with a grain of salt, but my understanding is that one of the symptoms of depression is the inability to feel certain emotions, and that antidepressants will in some cases restore your ability to feel those things.

(The reverse may be true for some people as well, but it's not generally true that the purpose of antidepressants is to make you numb to your problems.)

jokoon• 10 years ago

You can't always change the things in your life, or change yourself. It's easy to say "I should be more motivated, change job, get that degree". Anti depressants help people to feel less bad, but it won't change them. It's not a magic pill but it's welcome.

Psychiatry is about medicine, it's not about changing the world or changing people.

rev_bird2• 10 years ago

I just think that our brains experience sadness for a reason: it's a signal that something is wrong in our life and that we need to change it.

Forgive me, but I don't understand how someone can just decide to come up with alternate explanations of attentively studied medical conditions. While there's still a long way to go in understanding clinical depression, we know for sure that particular chemical imbalances in the brain, or the inability to process those chemicals, cause the most commonly recognized symptoms and behavior. This is like telling someone with diabetes, "I just think your pancreas is trying to tell you that your life is missing something."

stevewillows• 10 years ago

this is long winded.. tldr; was on a drug that didn't work, got into group therapy that was far more effective.

---

I've tried a several anti-depressants over the past twenty-two years with no long-term success.

My GP's approach to severe depression was to 'change my outlook.' A few years ago when I saw a psychiatrist, they were quick with the drugs, and, at the time, I was thankful.

This was mirtazapine / remeron.

The first two or three months were fine -- a slight improvement that was enough to give me hope. It wasn't until about two years of constant suicidal thoughts (to an obsessive / fantasy level) that I realized that this wasn't the drug for me.

With the mirtazapine and the thoughts, the suggestion was that I add another drug to fight the suicidal / obsessive side. Seeing as these thoughts were the reason I was taking the drug to begin with, I turned down that idea. I was also aware of how easy it is to get into the balancing act of multiple medications, and I didn't want to swing that again. That's when I decided (against the wishes of everyone) to go drug-free.

It was suggested that I take close to a year to ween myself off of the little pills -- but I figured I could do it in two months. While I was able to do it, I had an extra two months of cold sweats, extremely believable nightmares, and general withdrawal. It was much worse than anything I've ever experienced.

When I first expressed the feeling that the medication had stopped working, the response was to up the dosage. This wouldn't be a bad thing if I weren't exhibiting a good portion of the side effects.

The best solution for me was a ten-week group therapy CBT 'course' provided by the local hospital's outpatient care. We watched clips from 'What About Bob?', focused on 4-7-8 breathing techniques (also fantastic for those with anxiety), and discussed the aspects of the illness that we felt were most shameful.

In externalizing the depression and suicidal thoughts, there was an amazing transformation that came through the validation from the others that I wasn't alone in the struggle. For me, this has been far more effective than any drug I've tried over the past twenty-two years, and I'd suggest it to anyone -- either standalone or in combination with medication.

I'm not completely free of these thoughts or desires, but when they do come up, I now have rational, logical tools to address them and move on. For anyone in the struggle, look into what your local hospital has to offer.

aj0strow• 10 years ago

For any parents out there: Please think long and hard before getting your kid prescribed. Get 2nd opinions, try nature or counselling, reflect if it's actually you who is the instigator. If you do go that route, know that your kid might not make it to 18, and if they do, might resent you deeply.

When experts in the same field looking at the same case can't agree even a little bit on best course of action, maybe it's not really science.

evo_9• 10 years ago

My ex has PTSD and was prescribed Adderal; it wrecked our lives for years before I figured out what a horrible substance it is. After much trial and error I switched her to a specific type of Fish-Oil that has the DHA and EPA inverted (aka usually you have a very high DHA versus lower EPA). For whatever reason this stuff was the only thing that really seemed to help.

She also in recent years added medical mj bars (thankfully we live in Denver) and she would carefully cut up bars into smaller dosages (around 10mg each I believe) and take one of those every 3 hours roughly.

Ultimately this was the combo, along with a good multi-vitiman that really helped her regain a normal life.

yarou2• 10 years ago

A lot of people underestimate the anti-inflammatory and neuroprotective effects of cannabinoids like CBD and CBN.

cjlars• 10 years ago

Suicide rates are up, which is perhaps the best measure of the quality of mental health care people are receiving. However, there are at least few plausible explanations not mentioned in the article:

1. We have an older population -- suicide rates increase with age. [1]

2. We have a less religious population -- Christians, Buddhists and Muslims all have lower suicide rates than Atheists. [1]

3. We have a lower worker participation rate -- Unemployment is associated with higher suicide rates. Although most of the decrease in work in the US is voluntary, there is still a plausible link. [2]

[1] https://www.journals.uio.no/index.php/suicidologi/article/do... [2] https://www.cambridge.org/core/journals/psychological-medici...

tptacek2• 10 years ago

4. It became much easier and more fashionable for people in middle America to acquire and use opiates and methamphetamine.

5. We've had a slow collapse in the markets for routine manual labor, which were the backbone of small/mid-market middle America, which drew people into the cities set up a vicious cycle of depopulation and market decline in middle America.

Maybe some of the linked research decouples the suicide rate from these phenomenon, but I don't see enough meat in this article to make the case that psychiatric medication is the likeliest cause.

tptacek2• 10 years ago

I'm not sure I understand how substance abuse --- which appears to be correlated with suicide --- would be caused by psychiatry, rather than on socio-economic circumstances. How many rural Ohio opiate addicts do we think first worked their way through antidepressants?

anigbrowl4• 10 years ago

Drugs can help, but really I've had greater and more lasting benefit from proscribed ones than prescribed. Also, psychiatrists really need to grow out of being licensed pill pushers and make more of an effort to be therapists. Every psychiatrist I've worked with sees themselves primarily as a diagnostician and invests only rudimentary effort in the caregiving or investigatory aspects of treating mental illness. I think the compartmentalization of health delivery functions is bad for patients.

rev_bird2• 10 years ago

I'm inclined to agree with you, but I think this might be an unfair demand -- you're describing two jobs that are closely related but entirely different. I've had lots of doctors recommend therapy; I never expected any to be my therapist -- it seems a little like if you went to a restaurant and were disappointed by the waiter because he wasn't a very good cook.

matheusmoreira• 10 years ago

The evidence in favor of psychotropic medications is vast. Any medical treatment may very well "cause more harm than good" -- the physician must weigh the risks and benefits and inform the patient.

They are not the only approach to treatment. There are many others we know may provide a benefit such as cognitive behavioral therapy and many others. It depends on the patient.

I think it's useful to review the medical practice guidelines; they collect the relevant evidence in one place and recommend treatments based on them. American Psychiatric Association guidelines can be found here:

http://psychiatryonline.org/guidelines

For example, lets take the Major Depressive Disorder 2010 Guidelines¹ since it covers the most prevalent mental health issue. It is divided in three sections:

Treatment Recommendations
Background Information and Review of Available Evidence
Future Research Needs

Many treatment modalities for the acute phase are suggested: pharmacotherapy, electroconvulsive therapy, psychotherapy and association of pharmaco- and psychotherapies.

The discussion of the efficacy of antidepressants starts on page 33. Here's a few important lines:

A large body of literature supports the superiority of SSRIs compared with placebo in the treatment of major depressive disorder
Each of these medications [SNRIs] is efficacious (i.e., superior to placebo in controlled studies and meta-analyses)
Mirtazapine has comparable efficacy to SSRIs
Although trazodone is an effective antidepressant, relative to placebo, in contemporary practice it is much more likely to be used in lower doses as a sedative-hypnotic than as an antidepressant
Despite widespread use of trazodone as a hypnotic, few data support its use for this indication
In comparative trials versus SSRIs, nefazodone showed comparable efficacy and overall tolerability
Tricyclic antidepressants are effective treatments for major depressive disorder and have comparable efficacy to other classes of antidepressants, including SSRIs, SNRIs, and MAOIs
MAOIs have comparable efficacy to other antidepressants for outpatients with major depressive disorder and may be appropriate for patients with major depressive disorder who have not responded to safer and more easily used treatments

It's well-established that modern psychotropic medications are effective treatments. Choosing among them and offering the patient the most appropriate medication is a complex process. In particular, the appearance of side effects and how well they are tolerated must be monitored.

Of course, general health advice applies. Regular exercise is likely to improve mental condition. However, I've never had the experience where a severely depressed person suddenly got motivated, started exercising regularly and got better. In fact, reduced energy and decreased activity is one of many signs² of depression.

¹ http://psychiatryonline.org/pb/assets/raw/sitewide/practice_...

² https://www.ncbi.nlm.nih.gov/books/NBK64063/

DubiousPusher• 10 years ago

I was writing something that got way too ranty so I'll confine myself to this.

While over prescribing may be a real problem, I think they mischaracterize how psych meds are prescribed. I've had several people in my life who suffer from severe mental illness and finding the right meds for these people has been a long and difficult process. I've sat in on many an appointment and never have I seen the flippant attitudes towards prescribing these meds that this article implies are widespread.

warfangle3• 10 years ago

Ah, the old 'more people are being prescribed medication over time, which is clearly causing more people to be prescribed medication.'

It's not at all tenable for other externalities to bring underlying mental illnesses to the forefront, nope, not at all.

What lazy thinking.

StanislavPetrov• 10 years ago

Unfortunately the problem here is a serious one, and it isn't limited to psychiatrists - hubris. Those in positions of power, whether psychiatrists or presidents, virtually always prefer to err on the side of "doing something" rather then "doing nothing" regardless of the risk/benefit ratio. Intrinsic in the psyche of powerful people is the feeling of control. To these people, inaction is a sign of powerlessness, an admission of defeat, of their lack of control, and control is what they value above all else (whether consciously or subconsciously).

projektfu• 10 years ago

The author of the article basically states that they are suffering from the Baader-Meinhof phenomenon. They recently read, or read about the book, and all of a sudden lots of studies come out of the woodwork that he thinks agree. This is why systematic reviews are done instead of relying on opinion pieces.

disposablezero• 10 years ago

Nuance/evidence-free claims. There are pluses and minuses to every situation which must be weighed with common-sense. Also, psychiatrists spend very little time on patient, use little or no evidence-based medicine and rarely act as social workers.

lyle_nel• 10 years ago

Could someone explain to me how this is not a correlation implies causation fallacy?

I don't where a causal relation is demonstrated.

Psychiatrists Must Face Possibility That Medications Hurt More Than They Help

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