Medications that change who we are

https://www.bbc.com/future/article/20200108-the-medications-that-change-who-we-are

by daveytea • 7 years ago

419 263 7 years ago

elil17• 7 years ago

I’d be curious to hear the experiences of people who take/have taken some of these drugs such as L-dopa. With alcohol, I feel different but I don’t feel like a different person. Is it like that, or is there a larger feeing of difference?

norepinephrine• 7 years ago

I've took various antidepressant (SSRI/SNRI/SARI) medications over the course of my life and some minor & major tranquilizers. Some alone, some in combination. Heck, during some time I even mixed them with psychoactive instances like LSD/amphetamines.

I doubt that it changed who I am, but it changed on how I act. Well, of course it depends on definition of who we are to start with. They certainly affect on how do you feel and how do you think, but when effects wear off, you typically return to your former ways. Maybe with new thoughts or new look at your life. But that's it.

I continue to see those kind of meds as a mere tools, which you can use to alter your thinking for a period of time to get yourself a fresh look at ordinary things. I think that therapeutic effect exists here only if you get some realization about your former ways.

Some meds made me worry less about my life when I've realized that worrying doesn't actual solve anything, it just makes you feel worse.

Some made me more emphatic towards people when I've realized that everyone is exactly as same as me, just with different life story.

rantwasp5• 7 years ago

the experiences you have make who you are. if a drug changes the way you behave it will change how you experience things. so depending to what you are exposed to, it can definitely change who you are.

an extreme example for environmental factors radically changing people’s behavior is lead poisoning.

cipher_314159• 7 years ago

For a lot of folks with epilepsy, this is nothing new. Plenty of medications that treat epilepsy are known to induce changes in mood, mental state, etc.

Probably the biggest one is levetiracetam (also known as Keppra). If you read the warning label, it says it can induce "mood changes", which is a euphemistic way of saying "it can turn you into an uncontrollable rage monster".

I've been there. Whatever you think you know about getting ticked off, you haven't felt angry until you've felt it on Keppra. There is no gradation of anger-- no "subtly annoyed", no "getting ticked off", no "this is really getting me angry". Just "zero" and "Incredible Hulk on a bad day". The stuff that annoys you may not be anything that annoyed you in the past, but now it's something that makes you want to bash somebody's skull against the pavement until it goes soft. And there is no warning, no ramp-up-- you just suddenly find yourself enraged beyond all human comprehension, and you're doing everything you can just to restrict yourself to yelling incoherently instead of resorting to physical violence.

There's even a cute nickname for this whole horror show: "Kepprage".

I'm off levetiracetam now (onto lamotrigine, which is also prescribed as an antidepressant). But it scared me pretty badly. I genuinely fear getting angry now-- because I worry that I'm going to wind up back where I was. I was single when I was on Keppra, but I'm in a relationship now-- it scares me to think what I might do if I ever get back to Kepprage levels of anger, because it could easily cost me my partner.

So, to your question: was I a different person on Keppra? I mean, I still responded to my name and worked the same job and had the same favorite foods and such. But I was a lot angrier, I was getting angry all the time, and there was no off switch. It's a valid philosophical question as to whether that makes me a "a different person". Looking to your example, consider that feeling that you have on alcohol, and its assorted side effects and behavioral changes. Now imagine that you were stuck in that mode, 24/7. Would you be "a different person"?

jotm2• 7 years ago

I've taken Levodopa, not prescribed, I do not have Parkinson's. Just had access to it and decided to try it as mood enhancement/anti depressant.

It did nothing noticeable. At higher dosages for 1 day I felt somewhat dizzy/nauseous, so I never tried that again (there is some research mentioning it can damage receptors irreparably). At the prescribed dosage, after a month I dropped it, as there was no improvement, no change.

Really, the only things I tried that had an actual effect were alcohol, cannabis, phenylethylamine (with nicotine! Does not work without it. And can probably kill you with alcohol, beware!), cocaine, aniracetam and sulbutiamine.

No wonder they're mostly banned, because they exhibit actual effects, but are not for any specific sickness. Sad, I'd say lack of alertness and a bad mood should be treated as sickness.

PragmaticPulp7• 7 years ago

I’d be curious to hear the experiences of people who take/have taken some of these drugs such as L-dopa.

L-DOPA's significant side effects and risks are very well known to doctors. No one should be prescribed L-DOPA unless they have severe Parkinson's disease, and even then the L-DOPA dose should be actively minimized.

The impulsive behavior side effect of L-DOPA is so well known that it has its own Wikipedia page: https://en.wikipedia.org/wiki/Dopamine_dysregulation_syndrom...

We should all be aware of potential side effects, but it's also important avoid the false dilemma fallacy. These patients aren't choosing between being healthy or taking L-DOPA. They're forced to choose between suffering from severe Parkinson's disease symptoms or risking the side effects of the medication. When the side effects outweigh the benefits, the medication should be discontinued. When the side effects are less than the underlying disease, the medication should be continued.

kshacker2• 7 years ago

First of all, not the same level of problems and not sure what I took. Could just be a fantasy.

Anyways, circa 1998, battling a serious fungal infection, an alternative treatments doctor (not homeopathy or something, this was in Seattle) put me on some kind of medication. I realized on my 3rd or 4th rage incident that the medicine triggered something which put me on the edge that even a small discomfort would trigger me. It was not the skin issues, it was just my mind on high. I have never been on (recreational) drugs before or after and barely drink alcohol, so not sure if any drugs cause similar behavior. I did not stop the medication once I realized it but I did try to be conscious of the effect and was able to control the rage better (but still not 100%).

[ Add: As I think more, the doctor was in sports medicine, so maybe he used somethings that he usually tried on athletes. ]

e40• 7 years ago

My brother was diagnosed with PD in his early 30's (mid 50's now). He was on a bunch of drugs, but the one that really fucked him was Mirapex. Turns out, there are huge numbers of people whose lives have been ruined by it. It is also used for restless leg syndrome and you can find forums on the internet where spouses of people taking Mirapex will recount how their partners lots fortunes to gambling and other addictions.

My brother went from being pretty wealthy to homeless in 7 years.

His personality was greatly changed by the meds or PD. It's not clear, but the side effects of Mirapex are very clear. It is criminal that that drug is handed out like candy, without any discussion of the potential problems it creates.

asimovfan• 7 years ago

Everything that happens to us changes who we are. Every conversation we make. Everything we think. We are not the same person in any given moment.

Also, because we are shaped by the things that happen to us, we are literally actually not ourselves but rather "everything else".

rantwasp5• 7 years ago

yes and this would not be contested. the same way we are not surprised when the drugs we take have the intended effect. this goes wrong is when the side effects are unexpected or undesirable. as a society we are conditioned to be entitled and to believe everything has an easy/quick fix.

banads3• 7 years ago

"No man ever steps in the same river twice, for it's not the same river and he's not the same man"

truth_be_told8• 7 years ago

I have long wondered about this. In the Asian world, traditional Systems of Medicine focus on "holistic" treatment and the general public often calls Western Medicine, "Allopathy with side-effects". I had intuitively felt that these medicines must have an overall effect on behaviour which may always not be obvious to the observer unless the difference between the before and after were stark and noticeable.

We really need a lot more research on this aspect of all commonly used medicines. A lot of our mood-swings, irritability, anger, anti-social behaviour etc. might be explained by this.

PragmaticPulp7• 7 years ago

In the Asian world, traditional Systems of Medicine focus on "holistic" treatment and the general public often calls Western Medicine, "Allopathy with side-effects". I had intuitively felt that these medicines must have an overall effect on behaviour which may always not be obvious to the observer unless the difference between the before and after were stark and noticeable.

Many traditional herbal medications also have significant side effects. It's not accurate or helpful to describe this as Eastern vs. Western medicine. All significant supplements and medications are bound to have side effects to some degree.

Good, evidence-based doctors don't care if the practice is Eastern or Western. If the practice or supplement has reasonable scientific evidence, a good doctor will incorporate it into their recommendations. I've had plenty of "western" doctors prescribe practices like acupuncture, yoga, meditation and traditional TCM supplements like ginger and turmeric.

The real problem with the Eastern vs. Western medicine false dichotomy is when it leads people to choose a side and stick with it. I've known a few people who suffered far too long with ineffective TCM or alternative medicine treatments before accepting proper, evidence-based treatment. The problem isn't limited to Eastern medicine, of course. For example, many depressed patients take Saint John's Wort for its herbal anti-depressant properties and are surprised to experience as many, if not more, side effects than highly targeted SSRI medications. Just because it's natural doesn't mean it's safer or more effective.

truth_be_told8• 7 years ago

You make some good points. However that is not what i meant when i said "holistic".

As an example, in Ayurveda/TCM, "prophylaxis" is given greater importance than symptomatic treatment.

We are what we eat and how we live.

The beauty of Western Medicine is that it is highly targeted and therefore provides immediate relief. However, people go overboard with no thought to other factors, consequences and ramifications. They look at it in isolation. Whereas in Eastern Medicine; controlled diet (with emphasis on stomach/gut cleansing), massage therapy (affecting the circulatory, lymphatic and nervous systems), change in environment(Summer/Winter) etc. are given more prominence. The organism and the environment in which it is embedded are looked at together.

With what we know today, both these approaches need to be harmoniously blended together for the best effect.

eivarv2• 7 years ago

There might be side effects to modern medicine, but there's no reason to assume that traditional beliefs re: health and medicine are more correct; The arguments behind them are usually epistemologically unsound, and they are often out-and-out superstitions.

truth_be_told8• 7 years ago

Somewhat True, but "don't throw the baby out with the bathwater".

Much of "traditional medicine" is empirically based. The models they came up with to explain the mechanisms may not be valid in light of today's Scientific Knowledge but they are instructive nevertheless (rungs in a ladder leading to better understanding etc.) As an example we still don't know how exactly Acupuncture works but do know that it works for many cases.

hhas013• 7 years ago

“In the Asian world, traditional Systems of Medicine focus on "holistic" treatment”

[rant on]

I believe the term you’re looking for here is “fabulist bullshit”.

“the general public often calls Western Medicine, "Allopathy with side-effects"”

Aaaand… No, it doesn’t. SCAM calls it that. Which is ironic, as “Allopathy” is a term coined by Hahnemann to mean “Everything BUT Homeopathy”, and that was in a day when “Western Medicine” was itself rank quackery still laboring under Galen’s “Four Humors” nonsense. Thus Chiropracty, Reiki, TCM, Acupuncture, etc are all “Allopathy” too.

Conversely, what you so casually misnomer “Western Medicine” (the term itself is borderline racist) is just “Medicine That Works†”.

(†“Within Limits”, as any sci fule kno.)

I mean, the only really significant difference between Traditional Chinese Medicine’s explanation of disease and Galen’s is that TCM believes in five humors while Galenites believed in only four. [Insert Emo Philips/Picard joke here.]

Otherwise “Chinese/Eastern Medicine” is the same mix of ungrounded herbalism and bloodletting that stalled out western healthcare for 2000 years. Until the Arab/Persian world, during its all-to-brief scientific golden age, came up with the brilliant idea that one should actually test one’s beliefs to find out if they’re bullshit or not… a process that Renaissance Europe finally distilled into modern scientific method 500 years later and determining Galen was full of it shortly after that.

Of course, getting the actual institutions to change took a lot longer; it wasn’t until Pasteur gave us a working model of disease that Galen’s bollocks and its attendant “worse than doing nothing at all” so-called treatments were finally buried down a very deep hole.

Germ Theory gave us sanitation, vaccination, and surgical hygene. Untested herbalism was usurped by pharmacognosy, modern chemistry, and reliable mass manufacturing. And so on.

Alas, China was been quite so lucky. Thanks to Mao and his vast “barefoot doctor” scam (which got around the problem of not having enough real doctors or money to provide everyone else with medicine that worked), TCM/Acupuncture is still around, not least as the CPC is now selling it for export as much as for use at home.

Incidentally, Mao himself (like most wealthier Chinese nowadays) had no truck with that homegrown crap and happily availed himself of your “Western Medicine”, thankyouverymuch. (You might want to take note of that.)

Incidentally #2, just as TCM was, and is, badly-tested herbalism marketing often poor-quality and fraudulent product, pre-Mao acupuncture was really just Galenic-style bloodletting sticking bloody great bamboo trocars into people. Worse, it had almost (rightly) died out until Mao reinvented it its modern form using fine steel needles, bad sterile practice, and total Qi bollox. “Distracting the patient while nature all does the work” as Voltaire used to say.

Incidentally #3—and considering that western researchers invested decades in figuring out how to reliably blind acupuncture studies before finally producing results showing it no better than placebo—every acupuncture study out of China is still positively glowing. Someone recently posted a FP link regarding China’s massive ongoing medical research crisis; I’m sure you can dig it up if you want.

TL;DR: You can take your “holistic treatment” and “traditional Systems of Medicine” and stick ’em where the pathologist’s light does shine, because that is where they all belong.

[rant off]

Real medicine does in fact study and treat the whole person. Unfortunately, it’s also a victim of its own and industrial nations’ success. General practices and hospitals are slammed with demand, increasingly with inevitable diseases of very old age (since so few of us die young now) and diseases of sedentary urban lifestyles.

And while doctors can tell us to eat less and exercise more till they’re blue in the face, they can’t make any of us do it; so it’s not surprising things like statins get widely (over?) prescribed as a workaround for our fat lazy butts.

I’ve no doubt too modern medicine desperately wishes more public would understand that all Medicines (that is, pharmacologically-active compounds) have multiple Effects; and that the only meaningful distinction is between Effects that are advantageous in treating a patient for a particular condition and Effects that are disadvantageous in that same patient. We commonly call the latter “side-effects” [not counting intolerance and allergies], but that’s misleading.

For instance, aspirin (descended from willow bark) is commonly used both as an NSAID and as an anticoagulant; thus what is a “side-effect” in pain patients is the therapy in those with blood disorders. (And vice-versa. And, of course, aspirin’s other common effect of giving you stomach ulcers isn’t a benefit in anyone. Although if you think aspirin is bad, just try original willow bark instead.)

Thus, we should not be surprised that modern pharmaceuticals have multiple effects across a wide range of biochemical and physiological systems; if anything, it’s a minor miracle they don’t have way more unwanted effects. Alas, familiarty does breed laxness, if not contempt, even in scientific and medical professionals; so it can never be re-stated enough that education, awareness, and due dilligence are essential to keeping that system operating as well as it can.

Think of it like this: Medicine [which works] is just a rolling bug-patching process of the most heinously complicated, tightly-coupled, under-documented Big Ball Of Mud known to man, and proceed accordingly. And that even that thing we call “self” is just a synthesized fiction, the product of countless biochemical and electrical interactions constantly occurring in just one[-ish] of numerous intricately interconnected organs, which together make up “Us”.

Dear Dog, I really need a drink now. Never been so glad I that crashed out of premed and landed up in software dev instead. :)

hhas013• 7 years ago

Ooh, and while I remember:

https://archive.org/details/thirtyyearsinmo00chrigoog

Written by this fellow:

https://en.wikipedia.org/wiki/Dugald_Christie_(missionary)

truth_be_told8• 7 years ago

WTH ? That is a nice rant but one with some validity :-)

First see my other responses in this thread so i don't have to repeat myself.

Real medicine does in fact study and treat the whole person.

In Theory; Current practice has all but forgotten this. That is why many Physicians themselves are looking at Yoga, Meditation, TCM, Ayurveda etc. to supplement their treatment.

Medicine [which works] is just a rolling bug-patching process of the most heinously complicated, tightly-coupled, under-documented Big Ball Of Mud known to man

Somewhat True but there are also multiple models/architectures within it all of which gives us a framework to hang everything else off of i.e. there is a method within the madness.

The point is not to throw away centuries of empirical evidence on what has worked regardless of theoretical models used to explain them. Two different examples, a) The importance of quieting/calming the mind using Meditation independent of any religious connotations. b) The importance attached to Turmeric which has been validated today by identification of the Curcumin active ingredient.

jiofih5• 7 years ago

You’re right, but I’m quite sure the “Asian world” doesn’t use that term, since homeopathy / allopathy / osteopathy are all western invented classifications.

chiefalchemist3• 7 years ago

Intra-system communication and control isn't limited to the brain. The gut for example, plays a part.

What's concerning about this article is that the researchers (?) we're not open to the possibility.

rantwasp5• 7 years ago

i believe this is taking a little bit too far. it’s about actually measuring/quantifying the effects. when this is hard/really expensive to do I’m sure the decision not to pursue it is made at several levels. in research (and especially in cutting edge research) you don’t get to explore everything and you have to carefully pick and choose what you do if you want to be around more than a few years.

chiefalchemist3• 7 years ago

The tests are done to look for such things. To deny them when presented is indefensible.

jiofih5• 7 years ago

Many modern studies have shown that not everything related to behavior is governed by the brain, some of it is offloaded to other subsystems. Seems to me that this should be considered when talking about the effect of medication on these behaviors, as the parent commenter pointed out.

julieswhites• 7 years ago

everything else

aszantu• 7 years ago

Probably all that's going through the stomach has one effect or another... Ever watched kids behaviour before and after sugary and non-sugary meals?

Zeratoss• 7 years ago

https://www.livescience.com/55754-does-sugar-make-kids-hyper...

There seem to be a bunch of studies indicating that it is not the sugar that affects the behavior

DailyHN4• 7 years ago

That link does little to disprove that sugar isn't the culprit.

And anecdotally, both my partner and I can recognize adverse psychological effects in myself after I consume too many high-glycemic carbs (ie, sugar).

copperx4• 7 years ago

Ever watched kids behaviour before and after sugary and non-sugary meals?

Yes, and I've never noticed a difference. I believe that "sugar rushes" are imaginary.

ChrisMarshallNY• 7 years ago

As the article mentions, this is a complicated, not-simple type of thing to filter out.

If it were anything other than the BBC reporting it, I would probably have a raised eyebrow.

One of the things that makes it difficult to develop a causative link, is things like someone may suddenly develop symptoms of heart disease or high blood pressure, but they are also going through a personally stressful time, and have taken to exercising less, worrying, and sitting around eating popcorn.

It may seem as if some medication or practice is the cause, but exercising less, and munching salt can throw the curve. Being worried about the future (or our own health -the reason we’re on the meds) can also have a fairly profound effect on things.

Animal testing will usually control for stuff, but real life is messy.

For example, alcohol is known to interact with all kinds of compounds. Rats don’t drink, so, unless the researchers deliberately introduce alcohol (in realistic dosage) in their regimen, they can be quite surprised, when unanticipated things start happening in human trials.

I’ve heard of unanticipated results manifesting, because a symptom only appeared within a certain dosage window, and testing had used extreme dosages.

Spoppys• 7 years ago

It's a worrying thought. My dad has become much less empathetic and more bitter over the past decade. I'd assumed it might have been the pain that was at least partially responsible, now I'm wondering if its actually the painkillers

malandrew• 7 years ago

It could also be the pain itself. My dad’s Parkinson’s and congestive heart failure did the same to him long before medicines were involved.

radmarshallb• 7 years ago

Chronic pain will chip away even the kindest person's ability to care about anything else.

blackbrokkoli• 7 years ago

An easy but not glamorous course of action to prevent this from happening on a large scale is flushing the notion that taking a pill for everything everytime is A-OK out of Western culture.

The average American is on ~1 prescribed pain killer and usually has access to several other over the counter opioids. People take incredibly potent whatevers against the mildest allergies to prevent having reddish eyes. A pill to take the edge off, a pill to calm down. Kids who are not firmly in the right area of every imaginable performance bell curve at age 7 get a whole palette of medicine against fictional anger issues, concentration issues, learning issues, anxiety issues.

I am glad that the topic of psychological side effects is gaining traction. Personally, I have always felt that taking any medicine is most likely going to be a trade-off against side effects we do not really understand yet. Keeping this in mind, one can make a much more sensible decision whether or not to take a pill. If we get this notion back into the head of people it would help a lot IMO.

ses1984• 7 years ago

What "other over the counter opioids"?

okusername• 7 years ago

That's not Western, but American. In Europe much weaker painkillers are prescribed due to risk of addiction, and in places like germany a lot of placebo (= overpriced homeopatic bullshit)

goblin892• 7 years ago

Tangentially (and anecdotally), not long ago I seem to have contracted what seems like a flu (or the like), and I remember feeling very healthy, social and unusually well—almost high—most of the day right until my brain went foggy and fever started.

In hindsight, I did not behave quite like myself that day, especially considering I felt somewhat overworked the preceding week.

This prompted me to first draw the analogy with taking and withdrawing from a substance, and then to imagine a possibility of some future human-made flu-like virus that preserves the incubation stage effects and lacks the “conventional” symptoms. Like a contagious mood boost, contractable for free by air!

travisjungroth• 7 years ago

A month ago I had an especially good workout then a few hours later the dengue fever that was incubating hit.

DailyHN4• 7 years ago

Similarly, I've learned to avoid running when I begin to feel any symptoms of a sinus infection or head cold.

Time and time again, I wake the next day will the full-blown illness.

Instead, a little rest goes a long way in letting my body heal itself.

thaumasiotes• 7 years ago

This prompted me to first draw the analogy with taking and withdrawing from a substance

The substance has no goals.

The flu specifically wants you to be social.

goblin892• 7 years ago

The action of taking the former is probably in alignment with some goals (even if potentially short-sighted), while contracting the latter alters your behavior so that it can spread more widely in accordance with the goals of its own DNA.

But yeah, I didn’t think my analogy through further than surface symptoms.

ImprovedSilence• 7 years ago

Yeah I always feel fantastic the day before I get sick. I don’t have any sources, but I remember reading that it’s due to your immune system ramping up and getting ready to fight. Not sure how much truth there is to that, but every time I’m sick, I can look back and see I felt great the day before.

m-i-l• 7 years ago

I've noticed exactly the same experience in recent years with common colds (which I've had slightly more often than normal thanks to young children). Like the parent post, the day before I feel "unusually well—almost high", and the next day the cold symptoms start, or I get a day of feeling especially unwell without any specific symptoms (the blearghs). Don't think I've read anything supporting this, but in my layperson's mind it is due to my immune system going into overdrive trying to fight the infection.

hrt_throw• 7 years ago

I am very curious about how transgender HRT affects personality. In a sense, HRT is supposed to change who one is, but the personality changes people undergo on it seem underappreciated and not really understood or studied clinically. At least I have not been able to find a published study specifically about about how HRT changes personality. I think not all of it can be attributed to decreased gender dysphoria or people "coming out of their shell" and being able to live and socialize as who they want to be after transition.

If I had to make a $100 bet today on what future research will find, I would wager that

1. FtM HRT reduces Big Five neuroticism despite increasing aggression. The effect is permanent and persists after the person's "second puberty" induced by HRT is over. It affects beliefs about how society should function. To a degree of approximation, it makes transmen more conservative or right-wing than they were before the treatment.

2. MtF HRT does not have the opposite effect to the above (but it may, and probably does, have other effects). Edit: The opposite effect on neuroticism and sociopolitical beliefs. It decreases aggression.

jiofih5• 7 years ago

I think most people don’t have the context to understand half of what’s being said there.

samcodes2• 7 years ago

This is a funny comment on HN, where it is very easy, for me at least, to be so far out of my element that I have no clue what is being discussed, such as any post about hardware!

cc813• 7 years ago

It could be but I used to look at studies about roid rage and found back then that there was not that much support for increased aggression, at least not when using testosterone and in moderate dosages for bodybuilding (which are very large dosages compared to replacement therapy).

On the other hand I'm pretty sure when we are talking really strong AAS such trendbolone there is so much anecdotal evidence that people get aggressive that I have no problem buying it in that case.

Never done any AAS but been prescribed corticosteroids (prednisone) which is an anti-inflammatory and that sure as hell changes the mood for me and many others. It is on the side-effects list as well I think and personally can get more irritated on it. Not always but it is noticable.

19963• 7 years ago

Are you blaming Trump on the trans? That's a funny new perspective!

But joke aside, why would hormones only work in one way?

And why couldn't you say the same about, say acetaminophen? Without a RCT your guess is as good as mine!

danbolt• 7 years ago

I think it’d be hard to isolate factors to test your hypothesis. You’re likely not wrong to some extent given that HRT changes the body (almost always for the betterment of voluntary trans individuals), but there’s so much activity going on in the song and dance of society it’d be hard to isolate.

klyrs• 7 years ago

...Big Five neuroticism...

It's gonna be really hard to deconvolve hormones from environment. Men and women are treated very differently in our culture; men's and women's behaviors are interpreted very differently; the former having a possible causal relationship with neuroticism, the latter having a possible causal relationship with diagnosis. You'd need a fairly large study involving a large number of trans people who aren't on hrt but pass as well as those who are.

boyadjian• 7 years ago

Medication is just a tool, it must be used with care and intelligence.

rantwasp5• 7 years ago

it is a tool. i don’t believe it’s a matter of care or intelligence. it’s just hard to synthesize something that targets one thing we don’t like (cholesterol in this case). sometimes it goes as far as not really understanding the underlying mechanism through which the drug actually works - i would say most times the full interaction of the drugs are not fully understood. if you add the desire to take a pill and just fix whatever issue you have i can see how, on a large scale, this can be problematic

tonyedgecombe• 7 years ago

The world is in the midst of a crisis of over-medication, with the US alone buying up 49,000 tonnes of paracetamol every year – equivalent to about 298 paracetamol tablets per person

Shocking, I knew it was bad but this is madness.

DailyHN4• 7 years ago

This Common Painkiller Does Some Interesting Things To Your Mind - VICE https://www.vice.com/en_us/article/gymgx7/tylenol-can-have-s...

truth_be_told8• 7 years ago

Very good article! Thanks for the link.

Some quotes;

There’s some imaging research that suggests that social and physical pain could have overlapping biological mechanisms, he tells me, so the parts of the brain that Tylenol affects to make your headache go away are the same parts that are involved in these other feelings as well; the same brain networks that allow us to feel and respond to physical pain may have been co-opted to also feel social pain.

He felt like the effects of Tylenol they were seeing were similar to mind wandering. People cared less about social rejection. They didn’t respond as much to existential anxiety; a similar kind of sensitivity reduction to the outside world.

“I think we should absolutely have a scientific concern to recognize the neurocognitive and neuro-affective consequences of substances that we've heretofore thought of as benign,” Handy says.

Ratner says there’s also the intriguing possibility that acetaminophen might be used therapeutically one day for people dealing with minor cases of depression or social anxiety.

The last point is the one which i had observed in my own behaviour and led me to suspect a correlation between acetaminophen/paracetamol and my "feeling good".

fhars• 7 years ago

As another illustration: that is enough paracetamol to reliably kill a quarter of the human population on earth.

TazeTSchnitzel• 7 years ago

I wonder how much of that paracetemol is actually consumed? Maybe a lot of it just sits on a shelf and expires?

PragmaticPulp7• 7 years ago

That was my first thought. My local Costco sells 1000 tablets of Paracetamol for $8.49.

I've bought several thousand pills of OTC pain relievers in the past year to keep a bottle in my car, my office, at home, and so on. I've only taken maybe 10 pills over the course of a year.

I do agree that the country is over-medicating in general, though. The focus on customer satisfaction and patient review scores for doctors has created bad incentives for doctors to "do something" by prescribing pills instead of pushing for natural interventions (diet changes, exercise, reducing screen time, going to bed earlier)

lifeisstillgood• 7 years ago

I am happy to accept that mass prescription of drugs will have unexpected side-effects, and the cholesterol/ anger / violence link seems plausible.

My question is has anyone studied voting intentions with this as well?

logicchains• 7 years ago

You mean studied whether mass prescription of drugs has an effect on how the people taking them vote?

Cougher• 7 years ago

“Then one day, she was chatting to a cholesterol expert about the potential link in the hallway at her work, when he brushed it off as obviously nonsense. “And I said ‘how do we know that?’,” she says.”

These are our “experts”, brushing off things about which they have no clue.

“How are all these medications affecting our brains? And should there be warnings on packets?”

Yet another warning in a list that makes people's eyes glaze over is not going to do much good. Additionally, people have a difficult time relating to just how bad these effects can really be. People also tend to overestimate their abilities to perceive the effects and endeavor to address them.

“But Golomb’s most unsettling discovery isn’t so much the impact that ordinary drugs can have on who we are – it’s the lack of interest in uncovering it. “There’s much more of an emphasis on things that doctors can easily measure,” she says,”

And what is it about medications that makes people willing to connect these dots? Money and a willingness to not want to know and even to deny what is known. The chemical industry is very good at this and we've known about that for a very long time. There are numerous studies that have found these same associations with various chemical products from artificial food colorings to laundry chemicals and more, with effects that include anxiety, depression, and rage. The ubiquity of chemicals with unknown physiological and psychological is staggering. It's gotten to the point where we can barely socialize without being inundated with the 21st version of passive smoking. People and places can't exist without dousing themselves and their spaces with chemical crap that also includes air "fresheners", candles, essential oils, etc. Road rage, infertility, anxiety, depression . . . all these psychological phenomena that have risen along with the public test lab that is our world. And chemical companies are using the tobacco industry's template of doubt and denial along with decades of honing the craft.

“But in order to minimise any undesirable effects and get the most out of the staggering quantities of medications that we all take each day, Mischkowski reiterates that we need to know more. Because at the moment, he says, how they are affecting the behaviour of individuals – and even entire societies – is largely a mystery.”

It's true. And if it's a problem for medications that are presumably scrutinized, what do we think is the case with the 10s of thousands of chemicals that are basically tested using the “honor system” of industry testing its own products for safety? These chemicals are not tested singly, nevermind in the near limitless combinations in which they exist in our daily lives.

“At this point it’s worth pointing out that no one is arguing that people should stop taking their medication. Despite their subtle effects on the brain, antidepressants have been shown to help prevent suicides, cholesterol-lowering drugs save tens of thousands of lives every year, and paracetamol is on the World Health Organisation’s list of essential drugs because of its ability to relieve pain. But it is important that people are informed about any potential psychological side-effects.”

And every one of these articles will include this boilerplate rationalization that's a lot more complicated – and different – than this.

LeonM• 7 years ago

This is basically the story of my mother.

About 15 years ago she was suffering from a panic disorder. Instead of trying to help her, her doctor prescribed a fairly high dose of benzodiazepines and be done with it.

These 'medicine' only made matters worse and changed her behavior radically. She became very closed up, never wanting to do anything, never leaving the house and always finding excuses not having to do anything. The stuff is also terrible for her memory, so she can't really remember anything since she has been taken these pills.

The worst part is that these medicine are highly addictive, and we have now passed to point where we had to accept that my mother will be on these pills for the rest of her life.

complex1314• 7 years ago

Highly recommend not giving up on getting off it. My grandmother thought she needed it to sleep for many years. But finally, after pressure from the family (several who are health care professionals), the doctor took her off it. She became so much better, even her sleep improved! Having worked as a health care professional myself, the rule was maximum 3 weeks, only for temporary treatment, long term need to find other solutions. Always some exceptions but then everything else had (or should have) been tried.

ohiovr• 7 years ago

I think benzodiazepines can be partially behind my friend, Jerold Haas' death especially the withdrawal from it. These drugs are really strong and it if it is strong in a way that doesn't help it leads to great distortions in thinking. Some drugs can help a lot but if it doesn't help it can hurt pretty bad. I take some drugs that help me tremendously but I won't last long without it because I can't get restful sleep without it anymore. In that case I have a dependency without addiction but I read that benzos can also be addicting.

It is a shame Darry did not get the kind of help I received. I believe he died because of a psychiatric system that doesn't take time to observe patients and make small adjustments. I pleaded that Darry get hospitalized and I think he was but it just didn't work out for him. They got him in and in a few days he was out. I was in for weeks. I've basically been on the same medicine regimen since then 14 years ago.

(Darry was Jerold's nick name)

jryan49• 7 years ago

I used the Ashton Manual to get off benzos. https://www.benzoinfo.com/wp-content/uploads/2019/08/Ashton-... It's probably best to find a doctor too who specializes in getting people off the stuff. It's worth trying, and it may take years to do it, but it's worth it in the long term.

aphextron• 7 years ago

"It turns out many ordinary medications don’t just affect our bodies – they affect our brains."

I feel like perpetuating this mindset is the ultimate sin of modern psychiatry and the entire industry of psychiatric pharmaceuticals - your brain is your body. It's not some special thing that sits apart from it. It is an integral part of the whole, no different than your kidneys or liver. People think they can take an antidepressant and it just "works" on their brain somehow. It affects absolutely everything.

kerkeslager19• 7 years ago

I think the problem goes at least as far back as Plato and the allegory of the cave. Plato spread this concept that there was a difference between the body and mind or soul, and Western culture has never really recovered from the stupidity of that idea.

There's really no evidence or justification for it. Your mind and your body are the same thing.

darkerside• 7 years ago

Modern philosophical thought and religion were built on that idea, and they were arguably inextricable from science in it's early stages. This is like someone people never fully recover from adolescence. Correct, it forms an integral part of who you eventually become.

ezequiel-garzon4• 7 years ago

Some people feel one’s essence is fundamentally different from one’s body, including the brain as part of the body. Not saying I support this notion, but to brush it aside as stupid or unjustified seems a bit hasty in view of the huge literature behind these issues. Moreover, doesn’t the notion of reincarnation in some parts of the Eastern world show it’s not restricted to Western culture? I’m sure there plenty more such notions outside the West.

fit2rule• 7 years ago

Metabolism. How the chemistry of your body interacts with itself.

I know for sure I have 'episodes' when I've got acid in the wrong parts of the gut. I also 'feel' the stages of stool composition, and there are definitely relics of unhealthy eating in my mood swings.

One thing though, is I never take pharmaceuticals, as I wish my body to be a picture of my life balance, which I believe are two separate realms completely (body/life). Instead I do everything I can to eat well, and give my body the sport it needs. This isn't easy, but everyone's got their own body, and its own needs. If you pay attention, it'll tell you what it needs.

The brain, or at least my brain, is a nice soft spongy joystick for controlling the rest of it. It feels good to throw around a bit, but you gotta take care of what its attached to, as well. A good day in the surf is how I charge my mind up, anyhoo...

jotm2• 7 years ago

I believe the mind, or soul, is indeed in the brain. But it's also separate. It's more like software controlling the hardware.

Take self control and attention. How many people struggle with it, procrastinating? You want to do something, you know you have to do it, you like doing it... But you don't.

Because your brain doesn't listen to your mind. Because the brain is mostly a primitive autonomous system and needs to be constantly motivated, coerced, trained to do things that it technically doesn't need to (why do anything besides eat, survive, reproduce?)

Take away what we call the mind/soul, and we're just a basic animal, running reactively on instinct and reflexes.

koheripbal• 7 years ago

Plato's allegory of the Cave is about the liberation provided by education, and self-awareness.

How gaining understanding of your environment freed you from the limited reality it presented you.

The initial usage of the story was to illustrate how political indoctrination could present a false reality to ardent followers "the shadows of cave fire for those raised in the cave", and how education could "open the eyes and show them the true light" (the fire in the sky/sun vs the fire in the cave). "...even if one was dragged out of the cave".

This was later extended to demonstrate that if humans learned about their own emotions, they could learn to reason decisions, rather than allow emotions to guide them exclusively.

Tangentially, this rough concept in early western philosophy evolved into the religion of the Sun, and had significant influence on early Christianity.

aldoushuxley0013• 7 years ago

Your mind and your body are the same thing.

That is incorrect, but unfortunately a very common misunderstanding.

The mind is highly correlated with the brain but it is not the brain. It’s easy to see this is the case because the brain is made up of a qualitatively different material than the mind. While the brain is composed of biological cells / chemistry / atoms, the mind is composed of things like sense-perceptions (like colours, smells, sounds, etc), emotions, etc.

Which is to say that the mind is composed of material that is fundamentally different from the brain. Of course they’re highly correlated but they are in fact separate entities composed of different materials.

You may say that the fundamental materials of the mind are reducible to the same things as the brain, but that would be confusing correlation for the thing itself.

Take for example the colour red, which is present in the mind but not the brain. Yes the brain enables the perception of red but it is not red itself. Eg a photon with a wavelength of approximately 620-750nm is often confused for red but in fact it’s just a photon which, when it hits the back of our eyes causes a chemical cascade from the relevant cone cells. So it’s abundantly clear this photon in itself is not red because it just causes a specific chemical cascade at back of our eyes. So is this chemical cascade red? No it’s just a chemical cascade that is highly correlated with red appearing in our mind.

The right answer, I believe, is simply that red is highly correlated with specific pathways of chemical cascades in our brain. The point remains that the brain and the mind are separate and distinct entities made up of qualitatively different material.

If you disagree with this assessment, please tell me what is red?

dr_dshiv7• 7 years ago

I like reading ignorant things like this because it helps show why we really need more classical education in society. If you'd actually read some Plato, as opposed to summaries, I'd be shocked if you could keep the same belief. It's just so damn good for thinking with.

But prior to Plato, the Pythagorean Philolaus wrote that sensation/experience comes from the interaction between the soul (greek: psyche) and the body. Soul, here, is not the experiencing thing but the immaterial forms. (Summary: an example of an immaterial form is the concept of a triangle — a real and meaningful form but separate from any material instance). This Pythagorean view of the soul is compelling and has similarities with the idea of computational logic being fundamentally separable from the media of computation. The same logic can run on silicon or some water pump computer.

So, from this, if mind is what we'd call the experience, then it isn't just the body. It is the material body interacting with the soul (the "computational" forms).

seisvelas• 7 years ago

My Python code ultimately runs on a circuit, but it feels lacking to say that my program is the circuitry. The program itself only has meaning inside of my mind, and in fact could exist equally well on paper. It exists conceptually even if it never manifests physically. So where do concepts like this exist, given that they don't exist as matter? What do we mean when we say that something like 1+1=2 is true - that that truth exists - and would exist even if there wasn't any matter to have 1 and 1 of?

The more you look at it, the more it looks like truths and ideas are even realer than the material world. After all, the only thing we know of the material world is what we experience of it in our mind. That was Plato's point, that the material world is a shadow of the real, immaterial world of thoughts, ideas, and truths.

Similar argument patterns permeate most ancient philosophies. The meme is that mind is the ultimate reality, of which the materialistic worldview is a surprisingly fragile inverse.

WilliamEdward• 7 years ago

True, and the rest of the body (particularly the gut and genitals) produces chemicals that function within your brain.

The brain and body inform eachother.

flavor8• 7 years ago

I mean making a distinction between mind/consciousness and body is one thing, and while I wouldn't, those of a religious bent might try to justify it. Making a distinction between brain and body is just sophomoric. The BBC unfortunately seems to have content-farm mistakes like this fairly frequently in their online writing.

xiphias22• 7 years ago

Even if the brain is not apart from the rest of the body, there is a special thing between the two: the blood-brain barrier, which is actually quite hard to cross with medications, and poses a real challange in curing brain diseases.

doitLP3• 7 years ago

Sure but the list of drugs that cross that barrier is long. Everything from antibiotics to statins.

And even if they didn’t, the body is a tightly interconnected system. Taking an antidepressant to “selectively affect serotonin” in the brain? Whoops, turns out your gut has at least as many serotonin receptors as the brain. Taking a statin to reduce cholesterol (which it does very well but with an NNT > 200 for heart attacks and NNT > 300 for stroke)? Whoops, it causes transient global amnesia and personality changes and diabetes in a lot of people. And 40% of the US Adult population we’re on statins in the mid 2000s.

jmvoodoo• 7 years ago

It seemed like the reduced cholesterol was what impacted personality. I don't know if statins cross the blood brain barrier but if cholesterol levels themselves drive behavior changes it doesn't seem like they would need to in order to have an impact. This was the most interesting take away for me because it means that crossing the barrier isn't always necessary as indirect effects can be powerful as well.

Balgair4• 7 years ago

To be fair, there are a lot of blood-XYZ barriers:

https://en.m.wikipedia.org/wiki/Blood%E2%80%93brain_barrier#...

derekp7• 7 years ago

I read that as They don't just affect our hardware, but also our software.

anamexis• 7 years ago

Right, but the point being made is that there is no distinction between the two.

hprotagonist3• 7 years ago

“I used to think that the brain was the most important part of the body. Then i realized who was telling me that...”

mikro2nd• 7 years ago

I used to think the brain was the most important part of the body. Then my arsehole clenched shut for a week...

dpark4• 7 years ago

It's not some special thing that sits apart from it. It is an integral part of the whole, no different than your kidneys or liver.

Except it is. The brain is a part of your body and the two are tightly integrated. Yet the brain is also not simply another organ. If you lose half of your liver, your personality might change due to the trauma, but you will still be you. If you lose a kidney, you’ll live on as if little happened (assuming modern medicine stops you from dying of infection). If you lose half your brain, you’re probably dead, and if not, you’ll be drastically impaired the rest of your life. You’ll also likely experience drastic personality changes.

The brain is part of the body but it is also special. To my knowledge it’s the only organ with a dedicated blood barrier. It’s also the only organ that modern medicine can’t keep “you” alive without. If your body is on life support but you are “brain dead”, then “you” are gone. Your heart can be replaced with a pump. Your kidneys can be replaced with dialysis. Your stomach can be replaced by a feeding tube. Yes, all of these are pretty poor alternatives but they affect quality of life. They don’t end life. If modern medicine could replace your brain with a computer, no one would consider this a lifesaving intervention.

No one says they’ve lost a parent to kidney failure while the parent is still alive. Many people have said they’ve lost a parent to dementia while the parent is still alive.

jp5552• 7 years ago

do you mean the brain as in what's contained in our skull or also the central nervous system which would include controlling (both automatically and consciously) everything else, as well as sensing all of what we define as reality?

dragonwriter• 7 years ago

If you lose half your brain, you’re probably dead, and if not, you’ll be drastically impaired the rest of your life. You’ll also likely experience drastic personality changes.

That's...not at all what the actual results of a hemispherectomy, in which you literally lose half of your brain, show.

_8ljf3• 7 years ago

“If you lose half your brain, you’re probably dead, and if not, you’ll be drastically impaired the rest of your life.”

Depends.

Patients who undergo hemispherectomy at a very young age can recover remarkably well; a testament to the incredible plasticity of the developing brain.

https://en.wikipedia.org/wiki/Hemispherectomy

In adult brains, yeah, it’s a very different story. See also: stroke.

Honestly, you’re both right. It is only one of a multitude of highly interconnected interdependent organs; but it can (and usually does) do some truly incredible stuff while running within that system.†

† Assuming, of course, that Descartes/Wachowskis aren’t right after all.<g>

Engineering-MD• 7 years ago

As an aside there is also the testis-blood-barrier, although this is not quite as tight as the blood brain barrier.

BurningFrog• 7 years ago

> It's not some special thing that sits apart from it.
Except it is

I'd half agree. It is a special thing, but it doesn't sit apart from the rest.

heavyset_go2• 7 years ago

If you lose half of your liver, your personality might change due to the trauma, but you will still be you.

If your thyroid is damaged, it effects who you are through depression, lethargy, anxiety and significant behavioral changes. If your adrenal glands are overactive, it effects who you are through chronic stress, psychological conditioning and panic. Disorders of the gut effect who you are similarly, as does removal of parts of the lymphatic system. Hormonal changes from disease, consequences of genetics or supplementation can drastically change a person's personality.

tbugrara• 7 years ago

You're taking that one line out of context in his post. Yes of course the brain is special because it's the only organ that makes you, you. Just like the heart is special because it's the only major organ that if you removed, blood would stop flowing.

GP's point was that in the context of how medication affects our bodies, the brain and body are more connected than we tend to think. Medication doesn't either only affect our body or our only affect our brain. It affects the entire system.

_8ljf3• 7 years ago

“perpetuating this mindset is the ultimate sin of modern psychiatry and the entire industry of psychiatric pharmaceuticals”

O-kaaaay.

But, as the science kids all say:

[Citation required]

(Please note Scopie’s Law is now in full effect.)

banads3• 7 years ago

Citation required

https://youtu.be/twhvtzd6gXA

"Depression may be related to an imbalance of natural chemicals between nerve cells in the brain. Prescription Zoloft works to correct this imbalance."

cassowary372• 7 years ago

"I feel like perpetuating this mindset is the ultimate sin of modern psychiatry and the entire industry of psychiatric pharmaceuticals"

Hmm. Modern psychiatry is usually accused of the opposite. Also interesting that leading comment on an article about how many (non-CNS) meds have CNS effects becomes yet another opportunity to criticize antidepressants. HN community's hostility to treating brain diseases (while emphatically supporting people with brain diseases) is perplexing.

robbiep• 7 years ago

The interesting bit here is that literally everything you do or eat affects this.

For example your diet is going to get broken down into micronutrients and for a lot of these molecules, while they are circulating, there are a lot of receptors that they are going to bind to and modify function on. And then there is exercise (or lack thereof) and all of the even-further away components (personal relationships, sleep etc) work on your brain and state of mind too.

When I was in Med school I came across this joke - apparently the effect size of antidepressants decreases with phase 3 trials, trending back to placebo. So the joke goes that as soon as a new antidepressant comes out, they need to use it before it stops working.

The deeper question here is whether the initial effect size was simply due to chance, and so the effect size of antidepressants is simply placebo and it was poor studies that let them get in the wild in the first place

joe_the_user2• 7 years ago

Certainly, "who" a person is, is a dynamic process. However, I strongly suspect that things like nutrition, social interactions and sleep are things we're adapted to self-modulating, so these are ways we can "consciously shape ourselves", give the old-us the opportunity to create the new-us. But a drug with an unexpected affect on personality seems like the opposite of this.

dr_dshiv7• 7 years ago

I take issue with the idea that we have some intrinsic essentialist self/soul/atman that constitutes "who we are" — such that it could be changed. If taking antidepressants makes one less neurotic, does that mean we have been fundamentally changed? Doubtful.

The illusion of the self is socially useful and pervasive, but there isn't much to support it.

noobdood• 7 years ago

Yes. The word "psychosomatic" exists for a reason.

colordrops• 7 years ago

To take it further, an even greater sin is perpetuating the idea there is a static "you". "You" are a conglomerate of coordinating and competing systems and are ever changing.

zzzeek• 7 years ago

actually a big chunk of this article is about cholesterol-lowering statins being linked to mood disorders, a medication which purportedly has no psychiatric impact at all. The reliance the medical industry has on statin drugs cannot die fast enough for me.

joe_the_user2• 7 years ago

Indeed, Statins seem to be handed out like by doctors as a fix for high colesteral. I recall that the final verdict is they increase life expectancy so they're effectively just a treatment for a disease marker.

Horseshoe• 7 years ago

I've been on high-dose statins since 1995. I still feed birds and squirrels in my yard, and most of my so-called neighbors are still alive and seemingly well. I must be doing something wrong :-)

jiofih5• 7 years ago

Your point being?

This is a very sad attempt at dismissing an entire study by personal anecdote, just to feel better about yourself. Truth is nobody cares, and you just made yourself another obnoxious commenter on the internet :-)

bsenftner• 7 years ago

Yeah, if you trust our "institutions" - still - you are in need of a serious, unsettling wake up. The 60's slogan of "Question authority" is needed more than ever. Our "institutions" are predators and we are all its prey. Your mindset is the most valued, because one they have that they can feed you anything: any foods, any drugs, any laws and any shitty orange politician they want.

I go out of my way to not take any medications, as well as maintain my body with healthy foods and regular exercise. This is a responsibility we need to respect to maintain clear heads in this psychological war period we live.

sugarkjube5• 7 years ago

Definitely 100% true, first hand experience here.

I had mild medication prescribed for regulating blood pressure. Supposedly without psychological side effects. I found out a year later that it dramatically affected my personality. More or less like in the article, but in the opposite way.

The frightening thing is, I didn't know !!!

I found out a year later when temporarily stopping the medication, my kids started to make remarks, alluding on my changed behaviour. Only that moment I started to realize what happened.

Also affected my profesional live: I heard years later that people / collegues had noticed (but never mentioned it). I'm pretty sure it impacted my career. All without me knowing. For medication without any known psychological effects.

I took this medication for a year without realizing anything was wrong, that will probably also be the case for other people, and I'm pretty sure in many cases psychological side effects won't show up in clinical trials.

I'm pretty sure if you take anything like anti anxiety / depressants, psycho-pharmaceuticals, or just anything with known side effects, the impact must be dramatic.

When I found out, discussed it with (several) docters : one said "impossible", another "interesting, tell me more". It assume most doctors are clueless here. When you break a leg, they can set it and it heals. When you have a headache, they look in their book to see if there is a pill. But anything out of the ordinary, it may be hard to find good medical help.

infradig• 7 years ago

Can I ask what medication it was?

jdietrich• 7 years ago

I'll wager it was a beta blocker.

https://en.wikipedia.org/wiki/Beta_blocker#Anxiety

netfl0• 7 years ago

Doctors are not always researchers. The mind of a good researcher is very curious. A good practitioner has to rely on heuristics for troubleshooting due to the high dimensionality of the decision space they deal with.

crimsonalucard6• 7 years ago

Usually doctors still operate by the book. All symptoms and deductions have to make sense in the "context" of the "book," if the book doesn't mention it, the doctor doesn't proceed any further.

For example, I slept on my bed with a heater blasting onto my face. Next day I developed sudden onset dry eye. Literally from eyes that had zero issues to dry eye. I think the heater was the causative agent, but the medical literature is blank on this, so the doctor is clueless as well. In fact the doctor literally ignores the fact that I had a heater blasting my eyes all night. I came in to the eye doctor and he assumed that my dry eye developed over a long time when in actually I "caught" it three days ago.

One perspective of this is that the patient is biased and assigning causative attributes to something that only happens to correlate with an outcome. Therefore all patient descriptions must be cut through and ignored if it's not relevant to the problem. It's largely true but I think doctors bias themselves towards this predisposition a little too much and dismiss many things that are actually important.

Either way though, if it's not in "the book" then treatment for it doesn't exist in any scientific form yet, so the doctor can't help you anyway.

PragmaticPulp7• 7 years ago

I found out a year later that it dramatically affected my personality. More or less like in the article, but in the opposite way.

So the blood pressure medication made you more calm? You didn’t specify the medication they prescribed, but that’s a common effect of certain types of blood pressure medication. In fact, certain blood pressure medications are prescribed off-label for their calming properties. One blood pressure medication is even approved for also treating ADHD (Guanfacine).

If you find that your doctor doesn’t acknowledge your side effects or dismisses your complaints, it’s time to get a second opinion or rotate doctors. I’ve never had a problem with my doctors not believing me.

I'm pretty sure if you take anything like anti anxiety / depressants, psycho-pharmaceuticals, or just anything with known side effects, the impact must be dramatic.

In my experience, the good doctors are well aware that all medications come with side effects. The best doctors strive to minimize medication exposure for this reason. Ironically, many patients disapprove of this because it feels like the doctors are withholding treatments, even when it may be the best choice for the patient.

The most common example is people demanding antibiotics for common colds. Doctors know antibiotics won’t help and that they come with significant risks, but they also know that patients might leave a bad review if they leave empty handed.

In the case of psychiatric medications: Yes, the differences can be significant. However, the side effects are worth the tradeoff for alleviating serious psychiatric issues. Being naturally healthy is obviously preferable to being medicated with side effects, but that’s not the choice that patients are making in these cases. Instead, they’re choosing between continuing to be unhealthy without medication or dealing with some side effects in order to relieve some of their pain.

This is also why many people get stuck in cycles of discontinuing their psychiatric medications. Someone who achieves remission from depression with anti-depressant medication might think that they don’t need the medication now that they’re “better”, and when all they can see are the side effects. This leads them to discontinue, which often results in relapse of the underlying disorder if not managed with the help of their doctors.

crimsonalucard6• 7 years ago

Blood pressure medicine does make you more calm and this is known anecdotally among the medical community.

I know this because I know of medical students taking it before giving a speech. Literally the medicine is well known for making you perfectly calm.

You know that magic pill that can get rid of your approach anxiety? I hear, this is it, though I never tried. I'm wondering if anyone more in the "know" can comment on it.

andruby• 7 years ago

In what way did your personality change?

sugarkjube5• 7 years ago

It's difficult to go into details, but lets say I became less focused and driven in both work and personal life, but also an easier person to work with. The kids perceived this evolution as very positive.

I'm on different medication now, but some effects appear to be irreversible.

kirstenbirgit• 7 years ago

Re: blood pressure meds; this is common knowledge. Look at beta blockers; they're commonly used for people with presentation anxiety for e.g. exams. Some people can barely speak without taking them.

bpizzi• 7 years ago

I took this medication for a year without realizing anything was wrong

Looks like you were also maybe not really paying attention to your behavior back in those times, as it looks like you would caught such a behavioral change sooner if you were to take medication again, don't you think?

sugarkjube5• 7 years ago

Indeed, in hindsight it should have been obvious. It's less obvious at the moment itself.

In life, many things are hidden in plain sight.

jczhang• 7 years ago

Why aren't you calling out the name of the medication given your story of warning?

GordonS2• 7 years ago

It's almost certainly propranolol, but it is odd they wouldn't just name it

lhuser123• 7 years ago

And I agree 100% with you. Also first hand experience here.

After that period, I started to read everything I could find about the subject, and it is pretty scary. You are spot on when assume that most doctors are clueless. Actually, I think is too complicated to understand for anyone.

Have you seen other people go through the same situation ? Have you tried to help them ? If you ever do, that's when you find out how complicated it is, because they look at you like you are crazy. Many times no one is able to figure out what's really going on. Not their family, not their friends, never mind their doctors, who sometimes just prescribe a stronger medication and all hell brake loose...

heavyset_go2• 7 years ago

Drugs like propranolol, clonidine, nitrates etc that are commonly prescribed for their effects on blood pressure, also exert action on the peripheral and central nervous system.

copperx4• 7 years ago

Do you mind sharing the name of the medication? Was it a beta blocker, which are known to have anti anxiety properties?

EamonnMR• 7 years ago

I'm interested that they did not touch on ADD medication there.

scottlocklin• 7 years ago

Pretty sure everyone knows speed changes your personality!

bemmu• 7 years ago

I've had trouble falling asleep for a long time, and at some point years ago started taking ambien for it. It took a long time to realize just how strong an impact it was having on me (could write a long blog post about it). Stopping wasn't easy, but now year+ later I'm basically back to normal, and feel like I have superpowers compared to the time when I was still on it.

bravura• 7 years ago

a) how often and for how long, and what impact?

and

b) yes, you should write a blog post on it

19963• 7 years ago

which effects? drowsy in the daytime? walrus in the nightime?

spodek• 7 years ago

Let's also consider the other direction -- how fresh vegetables and fruit, plus whole grains, beans, nuts, seeds, and herbs improve mood, behavior, resilience. Throw in some vigorous exercise, and for most people, drugs can't do better, without the drugs' side effects and cost.

For many people, switching from a standard American diet to largely those ingredients would register as changing who they are.

I just finished reading a chapter on it in Dr. Michael Greger's How Not to Die -- the chapter is "How Not to Die From Suicidal Depression" with plenty of footnotes to primary sources.

mcv• 7 years ago

You could argue that any kind of self-improvement, therapy, dealing with depression and other issues, changes who you are.

The big question is: do they change you for the better or for worse? If they make you happier, more balanced, more in control of your behaviour, then I'd argue that's a good think. If they make you angry, uncontrolled, a slave to your impulses, then that's bad.

A lot of the stuff we put in our bodies subtly or not-so-subtly influences our behaviour. I wonder if at some point we'll understand these processes well enough to allow us to influence our own behaviour in the direction we want.

lanstin5• 7 years ago

What if you are happier but become a sex pest (phrase I learned from TFA)?

maxerickson2• 7 years ago

If you look at health outcomes, this is sort of obviously not true. I don't mean the health benefits of the things you mention, I mean the "for most people" part.

Of course I realize that you are engaged in advocacy. I think it probably isn't good advocacy, people should be thinking about (and talking to their doctor about) the best way to approach their current health status, not imagining that they are going to eat well and get lots of vigorous exercise.

jdcaron2• 7 years ago

Are you really trying to say that promoting a nutritious diet supported by physical activity doesn't work for "most people"? You call that engaged advocacy?

What he claimed is true and backed by multiple studies. Doing a healthy dose of physical activity with a healthy diet can only be beneficial, no downside whatsoever. It's quite underrated I guess. Too many humans wish for a magic pill, they delude themselves into thinking that it must be better than healthy living habits, since it's more modern. People are looking for the lazy fix.

f_nachos• 7 years ago

this is sort of obviously not true... I mean the "for most people" part.
I think it probably isn't good advocacy

That's pretty strong, can you at least explain why you think that?

crimsonalucard6• 7 years ago

This is a biased conclusion.

The most logical answer is this: Anything we ingest can change our personality. Whether it's for the better or worse is an opinion.

The causative nature of how ingesting A causes a personality change of type B, must be investigated experimentally. You cannot just say eating veggies improves mood. Where is your data and what do you mean by "improve"?

PragmaticPulp7• 7 years ago

Throw in some vigorous exercise, and for most people, drugs can't do better, without the drugs' side effects and cost.

This is a dangerous generalization. I fully agree that exercise is more beneficial than most people realize for general health, but it's not good to treat exercise vs. drugs as a false dichotomy. They both have their place.

The key is to work with doctors who aren't afraid to recommend exercise and behavior changes when necessary. It's also important to signal to your doctors that you're willing to make lifestyle changes before jumping to drugs, if possible.

In my experience, doctors would always prefer to prescribe exercise, diet, and lifestyle changes before medications, but they're hesitant to do so in this world of patient satisfaction scores and demanding patients who self-diagnose their medication needs before they schedule the appointment.

iQuercus• 7 years ago

This sounds more like diet marketing. People have such varying success with different diets that one set of foods simply cannot fit all.

Exercise is a different story. The most likely to bring about the improvements you describe.

jdcaron2• 7 years ago

It's hard to believe you made such a comment without including more doubts in your claim. I will leave one link, I hope it changes your mind and people mind if they agree with your comment. But there's more science supporting that a good nutrition help the brain: https://www.health.harvard.edu/blog/nutritional-psychiatry-y...

anthony_doan• 7 years ago

You're advocating between drugs and the alternative you listed.

The problem is the alternative you've listed are usually for prevention not as a cure. At least all the papers I've seen are observational and retrospective. Drugs on the other hand are design experiment, clinical and casual.

You don't cure cancer with exercise and good diet.

m3kw9• 7 years ago

You are what you eat? But this is no different than hard drugs

dvfjsdhgfv• 7 years ago

Some of these examples given in the article are actually quite known. For example, many anti-asthma drugs available today have a leaflet informing the patient about possible side-effects, such as increased anxiety, nightmares, changes of mood and behavior, and even suicidal thoughts. Knowing this is extremely helpful as it allows the patient to distance oneself from these symptoms in case they occur.

JohnJamesRambo• 7 years ago

I had never heard of this link between statins and aggression and Tylenol and lack of empathy before. Interesting. Maybe this is why Boomers act so strange now. “Former flower children lost their empathy and caring for the world and the next generation when their doctors put them all on statins and they started gobbling Tylenol” would be quite an interesting story. Both my parents are on statins, it seems every person past a certain age is, the doctors think statins are something everyone should be on. I have my doubts.

“Should people at low risk of cardiovascular disease take a statin?”

https://www.bmj.com/content/347/bmj.f6123

PragmaticPulp7• 7 years ago

Both my parents are on statins, it seems every person past a certain age is, the doctors think statins are something everyone should be on.

In my experience, modern doctors are well aware of the risks of statin treatment. I'm sure you can find trigger-happy doctors who over prescribe statins, but that's definitely not the recommended best practices.

According to one of the first studies I found, only about 1 in 4 patients who fit the criteria for statin use are actually prescribed statin medications at followup: https://www.ahajournals.org/doi/full/10.1161/JAHA.118.010241

jiofih5• 7 years ago

only about 1 in 4 patients who fit the criteria for statin use are actually prescribed

That’s not of much help, when the criteria is very close to “everyone”.

kshacker2• 7 years ago

I take statins and my best self-analysis is that it gives me nightmares. I can't count the number of times I have woken up with bad dreams. However, I think it is my brain trying to regulate heart by causing it to beat harder. When I exercise, I usually do not have these nightmares, or maybe I am too tired to notice them.

copperx4• 7 years ago

I got prescribed Rosuvastatin and got extremely vivid nightmares to the point of waking up unrested. I thought I was the only one because I could find much online. The dreams and nightmares are so intense I have stopped the statin.

Thank you for recommending me exercixe. That might be the answer.

doitLP3• 7 years ago

Have them ask their doctor about the NNT of statins (number needed to treat). Statins reduce cholesterol, and boy do they do a good job. But what are the outcomes? Despite the hypothesis, Lowered cholesterol does not really reduce your chances for a heart attack (NNT 217) or stroke (NNT > 300). Which means 217 have to take the drug for 3 years for 1 person to avoid a non fatal heart attack!

Most of those statin studies were done on men. There is growing evidence for women but for decades it was almost non existent.

One of the problems with the Pharmaceutical industry is how long term effects/safety data are never available until decades later, after the industry has heavily pushed the drug On doctors and patients and made a ton of money. I’m not saying it is necessarily nefarious, just that the incentives are misaligned for positive patient outcomes. All patients should be aware of that.

dm03514• 7 years ago

When I was younger, I believed that my spirit and thoughts and personality were somehow separate from my body. Like something uniquely me that was put in my body to animate it.

As I get older I began to think the opposite; that our thoughts, personalities, and everything original about us are a product of our physical composition and brain structure.

I began to really notice this after reading Principles where Ray Dalio observes that the way people think and approach and solve problems are largely fixed. I notice this in myself and the people around me.

There was a sort of inflection point for me after getting my first massage. My body was completely relaxed, resulting in my mind being completely relaxed. After the massage I went to a trader joes in columbia maryland during a saturday. This trader joes is a logistic nightmare that always stresses me out, so much so that I would usually avoid going during peak shopping. But this time I was completely unbothered, nothing about the experience was bothering, my thoughts were completely at ease. At that moment I realized that it wasn't stress making me tight, it was tightness making me stressed. The dependency was completely backwards from the way I thought. Being self centered i thought my thoughts informing my physical, but it was actually my physical causing my thoughts.

I have genetically high blood pressure, and I have to consume low sodium in order to keep it under control. While I was learning this and my blood pressure was high, I was literally angry about everything. Road rage, meltdowns at home, being short and explosive with my wife and son. I thought it was stress or affect from work I thought it was thoughts/personality -> body. As soon as I experimented with reducing sodium, getting exercise and my blood pressure dropped, my mood completely rounded out and fixed itself. IT was actually my body -> thoughts.

The same thing happens with hiking spending time outside. I used to feel like a connected, or spiritual relationship with the outdoors. I enjoyed drinking and camping, I thought that there was a spiritual relationship with the outdoors (personality -> body) when, once again, it's actually just physical -> personality, dopamine is released, my blood pressure probably dropped my thoughts became more relaxed, my body was tired and relaxed from hiking.

I think that we really are a lot less conscious than we think we are, and that the way we think, our personalities, and pretty much everything about us is largely predetermined by our physical composition. I think we're just more complicated animals and our personalities are just a response to physical input and reactions.

elwell• 7 years ago

I think it goes both ways. The physical body affects the thoughts/emotions/personality, and the manifestations of the mind/fallacies/affects affect the physical body.

Regarding spirit, I still believe that that is somehow separate. It's one of the things though that I'm not sure can be proven in the physical realm (e.g., brain) to an undeniable degree.

cassowary372• 7 years ago

Ironic that folks who work in CNS drug discovery spend much of their time worrying about how to get our molecules /into/ the brain... and less energy thinking about keeping non-CNS meds out. For what it's worth, though, these 'off-target' CNS effects have also prompted a lot of enthusiasm for repurposing existing FDA-approved drugs for new indications, since their safety is already established.

davedx• 7 years ago

Wow, turns out there's a lot of studies into e.g. paracetamol out there too. e.g. https://www.ncbi.nlm.nih.gov/pubmed/31523834

More here: https://twitter.com/autismepi/status/1214388671752916992/pho...

hprotagonist3• 7 years ago

There were few associations with behavioural or neurocognitive outcomes after age 7-8 years, whether reported by the mother or the teacher.

If paracetamol use in mid-to-late pregnancy has an adverse effect on child neurocognitive outcome, it appears to mainly relate to the pre-school period. It is important that these results be tested using other datasets or methodologies before assuming that they are causal.

translation: "we studied it and no, tylenol doesn't cause autism; calm your pants."

carbocation2• 7 years ago

This article provides no meaningful references (but some useless ones).

This is a really interesting question, but essentially left unaddressed.

blithedale2• 7 years ago

You're a cardiology fellow, so you're likely much better versed in this than me, but take a look at the paper cited here:

Sure looks like they were doing multiple comparisons until they found a happenstance significant subgroup. : |

"Several studies have supported a potential link between irritability and statins, including a randomised controlled trial – the gold-standard of scientific research – that Golomb led, involving more than 1,000 people. It found that the drug increased aggression in post-menopausal women though, oddly, not in men."

https://journals.plos.org/plosone/article?id=10.1371/journal...

They adjusted for multiple comparisons, and after that even the post menopausal group wasn't significant. The bit about how that doesn't matter because testosterone mechanisms and independent chance seems very hand-wavey to me.

(Moved my broader comment on this from a reply here to it's own reply to the thread.)

carbocation2• 7 years ago

Yeah that sentence is very yikes:

“Among (postmenopausal) women, a borderline aggression-increase on statins became significant with exclusion of one younger, surgically-menopausal woman (N=310) β=0.70(SE=0.34)P=0.039.”

noir_lord• 7 years ago

I take gabapentin for a spinal issue (nerve damage in my spine) and it has a drastic and noticeable effect, I'm naturally quiet and introverted but when I take the higher prescribed dose that changes radically, I become outgoing and talkative, I have more confidence and I seem to be more creative (though that could just be the reduction in pain).

It definitely alters my mood and I can feel it happen.

sebazzz• 7 years ago

That's essentially what MDMA does too.

cc813• 7 years ago

It is quite different than MDMA in practice though I think and even despite its name it does not bind to GABA I would still more liken it to the positive/social feelings of alcohol than mdma (don't mix alcohol and gabapentin though, it can be dangerous).

jjjensen90• 7 years ago

Gabapentin has an off-label use as a mood stabilizer for those with bipolar disorder and other mood disorders. I've seen it turn manic lives into successful lives.

samcodes2• 7 years ago

I was on a large dose of gabapentin for anxiety for a few years. It felt similar to the flow of a beer, before the negative parts of the alcohol kicked in

hprotagonist3• 7 years ago

which is interesting, because the dosage range for gabapentin is, to put it mildly, all over the place: 100-3,600 mg/day

https://slatestarcodex.com/2019/07/18/know-your-gabapentinoi...

pkaye• 7 years ago

the US alone buying up 49,000 tonnes of paracetamol every year – equivalent to about 298 paracetamol tablets per person

I bet many of those expire and are never consumed. There is very little pricing difference based on quantity so people buy much more than needed.

blithedale2• 7 years ago

I suggest folks read the cited research. It's eye-opening here, in a way that's very irritiating. This does not seem like particularly good science journalism.

Because of the road rage story in the lede, a whole lot of people are going to walk away from that piece thinking Statins -> Aggression.

The author even repeats it in a troubling way by linking to Golomb's research (their main source for this article I imagine) on statins and aggression:

"Since then, more direct evidence has emerged. Several studies have supported a potential link between irritability and statins, including a randomised controlled trial – the gold-standard of scientific research – that Golomb led, involving more than 1,000 people. It found that the drug increased aggression in post-menopausal women though, oddly, not in men."

You can see right there - it's plain as day. Randomised controlled trial, gold standard. The really astute scientists now know statins make people aggressive!

Except, EXCEPT... the study that Golomb DID found that statins overall lowered aggression... in men, and did not raise it in pre-menopausal women.

Again, the paper the journalist linked to shows the OPPOSITE of what the BBC piece claims it does.

The only reason the author found a subset of people that statins increase aggression in: they sliced and dice their data a bajillion different ways. They looked at age strata, baseline aggression, sleep-status, serotonin status, until they found a group -- post meno-pausal women -- in which the statin appeared to increase aggression. And that was only significant when they excluded one participant who had medically induced menopause!

"Among (postmenopausal) women, a borderline aggression-increase on statins became significant with exclusion of one younger, surgically-menopausal woman (N=310) β=0.70(SE=0.34)P=0.039"

When you adjust for multiple comparisons done (otherwise pretty sure you're just p-hacking) the result for women becomes statistically insignificant --which, given the number of ways they sliced the data, is not at all surprising!

"The sample size for women is half that for men, calculations did not power separately for women, and significance of findings for women would not be sustained under multiple comparison adjustment."

The overall thrust of 'Be a medical conservative, it's easy to cause treatment related harms you're not aware of' is a good one - there are many pharma companies pushing product on iffy claims. And a lot of research that shows how pharma trials minimize side effects and maximize results by surreptitiously excluding unhealthy trial participants.

The research in this piece is neither brilliant, nor awful... but given that the author appears to happily be quoted in a way that takes their research out of context, and seems to be the main source in an article that makes claims that their research does not support, really concerns me that they have their own flawed biases on statins ...

specialist• 7 years ago

Along with other commenters -- thank you for sharing! -- I've also had psychoactive side effects.

TLDR: Self reporting simply doesn't work. We need better tools, strategies. We need before, during, and after assessments. We need to inform the people in our lives, so we can better monitor each other's mental state and keep each other accountable.

Most recently: Started bupropion after a surgery, in hopes of mitigating impact. Got caught in a rut. Took myself off (all of my meds), just to reset. I felt zero difference on or off the bupropion. The only way I knew something was different was the activity monitor on my Apple Watch. (Just to be sure, I resumed bupropion for a week, and I became lethargic again. Again, I felt zero difference mentally.)

Ages ago: I was very high dose prednisone for a long time. Completely changed my personality. I was more or less completely out of control, a human wrecking ball. I reported mania, suicidal thoughts, etc. My team of doctors completely dismissed such possibilities. Of course, none of them, nor any of their patients, had received as much prednisone as me. Even after stopping prednisone, it took years to find a new normal. I was active volunteering afterwards. I advised both patients and their families what the prednisone (and other drugs like chemo) was going to do to do. Strongly encouraged seeking professional counseling, with their eyes wide open.

droithomme2• 7 years ago

with the US alone buying up 49,000 tonnes of paracetamol every year – equivalent to about 298 paracetamol tablets per person

Commonly sold as the brand Tylenol. How is it possible that the average across the US population is nearly one per day, the entire year? Max dose is 3900mg per day. Tylenol is not recommended for children with fevers as it can have bad side effects (Reye's Syndrome). More popular than aspirin perhaps as less risk of ulcers. Not as safe as Advil/ibuprofen. Even for people regularly taking pain meds, not all will be on paracetamol. Those taking it every day (perhaps 5% of the population?) must be taking 10-20 tablets a day?

– and the average American consuming $1,200 worth of prescription medications over the same period.

I know there are people taking pills that cost tens or hundreds of thousands, but this is still a pretty amazing average number across the population. This year I spent just over $100 on meds and that was probably one of the most med-intensive years of my life. Most years I have spent perhaps $10 for one round of antibiotics and $2 on advil, which I buy a $6 bottle every 3 years or so. So under $20. I wonder if the numbers are significantly less for most other countries.

detaro• 7 years ago

Wonder at what rate that stuff gets bought and not used, either by institutions or consumers, but it's probably only a small part.

droithomme2• 7 years ago

Hey that's actually a really good point. First aid kits, hospitals, etc. Could half of it simply be trashed?

copperx4• 7 years ago

Reye's Syndrome is for Aspirin, not Tylenol.

nonbirithm• 7 years ago

All I can say is when I realized the only thing that prevents me from thinking negative thoughts about people and things around me, being frustrated at everything for petty reasons I end up forgetting shortly after and demolishing my productivity was whether or not I remember to take my medication, it became a major existential crisis for me. I felt powerless to actually change my situation through my own actions rather than chemical rebalancing which I can't just will into existence.

Of course I only have this crisis if I forget to take my medication.

teh_klev• 7 years ago

There's a wee bit of me feels I need to ask the question, is this years later, the Andrew Wakefield effect rearing its head again[0]?

Very small samples of and affected medicated population being used to push an agenda? Sure I realise the brain and body are deeply interconnected, but until we invest time and money in valid studies, how can we possibly know the outcomes of prescribing statins, paracetamol etc in terms of human behaviour.

For the vast majority of the population taking these drugs are generally safe (yes I know about drug allergies, which is a different thing), but I imagine there will be in a minuscule percentage of a population, long term, there may be side effects. I think this should be researched, but this sounds like a scare story.

[0] https://en.wikipedia.org/wiki/Andrew_Wakefield

wolfspider• 7 years ago

Well this is our modern “moldy rye bread” situation folks so what to do? Let’s not forget disruption of the basal ganglia is responsible for the formation of delusions which could be in the same ballpark here.

Dwarfield• 7 years ago

Damn, this really hits home for me. My brother got prescribed statins and one day the family had found out he'd stopped because he didn't believe in it and they didn't feel like they were doing anything.

He's one of the most scientific guys I know but began giving conspiracy theory/anti vaxx sort of answers of how you can't trust medical studies all the time. When asked why he still takes his hypertension meds and trusts the literature there, he couldn't answer and he said it's just a feeling. The family was pretty astounded. Honestly felt as if someone you know suddenly started believing antivax or say flat earth ideas is the closest way I can describe it.

I was explaining how inconsistent his thinking was, bordering on delusional. If the truth was that the statins affected him psychologically, I can see why he'd chose to hide it when his wife and parents are grilling him for it.

bvinc• 7 years ago

I just want to say that there is definitely a lot of misinformation around statins. All I want to say is that the debate among statins isn't settled like the debate about whether vaccines cause autism.

If you do a dive of only published medical research papers and professional opinions, you'll find nuanced arguments about what even causes heart attacks, how effective statins are, what the very real side effects are (eg: cancer), who all should be taking them, and what alternative treatments (eg: diet, exercise) should be tried first.

Medications that change who we are

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