5 ms·

Adding to this article (I'm not a medical professional and not giving advice), the same inferior medical outcomes are attributed to most, if not all forms of ba

by arafa 10y ago

Adding to this article (I'm not a medical professional and not giving advice), the same inferior medical outcomes are attributed to most, if not all forms of back surgery. Physical therapy outperforms most or all back surgery with much fewer side effects, etc. This is covered extensively in the book How Doctors Think (https://www.amazon.com/How-Doctors-Think-Jerome-Groopman/dp/0547053649/ref=mt_paperback?_encoding=UTF8&me= https://www.amazon.com/How-Doctors-Think-Jerome-Groopman/dp/...) as well as articles like this Ars Technica one: https://arstechnica.com/science/2017/02/doctors-lower-back-pain-is-like-a-cold-minor-annoying-and-temporary/ https://arstechnica.com/science/2017/02/doctors-lower-back-p.... You see the same with exercise outperforming anti-depressants in most cases, again with much fewer side effects. (For example: https://www.theatlantic.com/health/archive/2014/03/for-depression-prescribing-exercise-before-medication/284587/ https://www.theatlantic.com/health/archive/2014/03/for-depre...) The kicker is that doctors will often refuse these same treatments when offered, which is not a good reflection on their efficacy (again covered in How Doctors Think). This is not an indictment of modern medicine (which is often very effective on acute care), just a recognition of the limitations.

seibelj 10y ago
Exercise helped reduce my depression and anxiety, and I tried to cure it without medication for 2 years. Finally I gave in and went on a low dose of lexapro, in addition to my usual exercise and healthy diet, and I recovered within weeks. Completely changed my life. I know this is just my anecdote, but when natural remedies fail, don't be afraid of medicine.
- tcj_phx 10y ago
  > but when natural remedies fail, don't be afraid of medicine. SSRIs frequently create their own problems. They are sometimes effective because of their effect on the neuroactive steroids: https://en.wikipedia.org/wiki/Neuroactive_steroid#Role_in_antidepressant_action https://en.wikipedia.org/wiki/Neuroactive_steroid#Role_in_an... Depressed people frequently have a metabolic problem, where they don't make enough ATP. This is caused by thyroid imbalances, poisoning with excess Omega-6 polyunsaturated oils, etc.
  - timrpeterson 10y ago
    I'd be curious to learn more about what you know about this. Could we have a conversation? I'm a professor at WashU can you email me? timrpeterson@wustl.edu
    - neurotech1 10y ago
      It seems that in a lot of cases of "unhelpful medical treatments" is a result of doctors forgetting the basics. If the doctor overlooks basics like lifestyle factors, electrolytes, vitamin deficiencies etc. then medications are of limited help in treating conditions like depression.
  - throaway343467 10y ago
    I've been on anti-depressants since I was 17. I'm 30 now. Buproprion works best for me, to which I later added lamictal. Prior to that, I'd been depressed since I could remember. In hindsight, I may have had mild aspergers like symptoms, mostly related to reading social cues. This wasn't "just growing up" despite shrinks for years telling me it was. Finding the right anti-depressant changed my life for the better. Absolutely changed my life. After college, I went off them for a year just to see if I "needed them" any more. Within 6 months, I noticed my thoughts slip into old patterns of hopelessness, counterproductivity, loneliness, and general loops of existential pain, and this outlook effected everything and everyone around me. I do need them, it turns out. So I wish people around me hadn't been so against drugs. In my case, they should have tried them earlier in treatment. That would have saved me some years of suffering. Also, I tried prosac, lexapro, and effexor before buproprion. If I'd listened to the many drug critics, I'd have stopped looking after prosac (side effects there included sexual disfunction and mania). I notice no notable side effects with my current cocktail. Also, I've exercised and been in good shape both pre and post taking anti-depressants. I feel better if I'm exercising than not, but it's not even in the same ballpark as what the drugs do for me. Everyone should exercise, not everyone benefits from anti-depressants. No exaggeration, I'd be dead without them.
    - tcj_phx 10y ago
      One of the mental hospitals gave my friend Wellbutrin. They took it away when they found her insufflating it. Thereafter they didn't care about her complaints of depression, and just forced her to take the suicide ideation pill ("anti-psychotic"). I guess Wellbutrin has mild stimulating properties. SSRI drugs were approved on the basis of fraudulent science. The MAOIs were reasonably effective, but caused high blood pressure when the patient also ate fine cheese.
- kirrent 10y ago
  It's probably worth giving some qualifiers on the grandparent comment. In short, the depressed population is bimodal with close to 2/3rds not responding to SSRIs and similar treatments satisfactorily and 1/3rd of people responding well. For the most part this is due to all of the different causes of depression being lumped in together. When the root cause of your depression is brain chemistry then you need the drugs, but if its secondary to environmental factors then it'll be less effective than lifestyle interventions. This leads to people saying that those lifestyle interventions are more effective in general, but that's due to them being appropriate for more patients, while there's a smaller population for which these interventions won't work well. Good doctors/psychologists will identify which patients are which over time.
  - arafa 10y ago
    I agree. If medical treatments make sense in specific cases, of course use them. And sometimes combination treatments are the best (as mentioned in this thread). But hopefully this is preceded by a talk about cost/benefit of all approaches and the weighted risks (including doing nothing), something that doesn't seem to be happening in a lot of cases in the US.
rsync 10y ago
"the same inferior medical outcomes are attributed to most, if not all forms of back surgery." I ran, not walked, to this thread without reading the article just to talk about back surgeries. It is stupefying and outrageous that people allow themselves to get butchered up (yes, butchered up - go read about spinal fusions, etc.) for an outcome that could easily be achieved by merely walking a few miles a few days per week.
- woliveirajr 10y ago
  Except when you are in a condition that you can barely walk more than 100 meters without having to stop giving the pain. Or when you try all kinds of physical interventions (physical therapy - pilates - yoga - quiropracty - osteopathy) that just makes you feel miserable in the end of the day. Or that you are taking so much painkillers (from all ranges, up to opiates) that you just have the side effects and not the benefits.

by arafa 10y ago

seibelj 10y ago

Exercise helped reduce my depression and anxiety, and I tried to cure it without medication for 2 years. Finally I gave in and went on a low dose of lexapro, in addition to my usual exercise and healthy diet, and I recovered within weeks. Completely changed my life. I know this is just my anecdote, but when natural remedies fail, don't be afraid of medicine.

tcj_phx 10y ago
> but when natural remedies fail, don't be afraid of medicine. SSRIs frequently create their own problems. They are sometimes effective because of their effect on the neuroactive steroids: https://en.wikipedia.org/wiki/Neuroactive_steroid#Role_in_antidepressant_action https://en.wikipedia.org/wiki/Neuroactive_steroid#Role_in_an... Depressed people frequently have a metabolic problem, where they don't make enough ATP. This is caused by thyroid imbalances, poisoning with excess Omega-6 polyunsaturated oils, etc.
- timrpeterson 10y ago
  I'd be curious to learn more about what you know about this. Could we have a conversation? I'm a professor at WashU can you email me? timrpeterson@wustl.edu
  - neurotech1 10y ago
    It seems that in a lot of cases of "unhelpful medical treatments" is a result of doctors forgetting the basics. If the doctor overlooks basics like lifestyle factors, electrolytes, vitamin deficiencies etc. then medications are of limited help in treating conditions like depression.
- throaway343467 10y ago
  I've been on anti-depressants since I was 17. I'm 30 now. Buproprion works best for me, to which I later added lamictal. Prior to that, I'd been depressed since I could remember. In hindsight, I may have had mild aspergers like symptoms, mostly related to reading social cues. This wasn't "just growing up" despite shrinks for years telling me it was. Finding the right anti-depressant changed my life for the better. Absolutely changed my life. After college, I went off them for a year just to see if I "needed them" any more. Within 6 months, I noticed my thoughts slip into old patterns of hopelessness, counterproductivity, loneliness, and general loops of existential pain, and this outlook effected everything and everyone around me. I do need them, it turns out. So I wish people around me hadn't been so against drugs. In my case, they should have tried them earlier in treatment. That would have saved me some years of suffering. Also, I tried prosac, lexapro, and effexor before buproprion. If I'd listened to the many drug critics, I'd have stopped looking after prosac (side effects there included sexual disfunction and mania). I notice no notable side effects with my current cocktail. Also, I've exercised and been in good shape both pre and post taking anti-depressants. I feel better if I'm exercising than not, but it's not even in the same ballpark as what the drugs do for me. Everyone should exercise, not everyone benefits from anti-depressants. No exaggeration, I'd be dead without them.
  - tcj_phx 10y ago
    One of the mental hospitals gave my friend Wellbutrin. They took it away when they found her insufflating it. Thereafter they didn't care about her complaints of depression, and just forced her to take the suicide ideation pill ("anti-psychotic"). I guess Wellbutrin has mild stimulating properties. SSRI drugs were approved on the basis of fraudulent science. The MAOIs were reasonably effective, but caused high blood pressure when the patient also ate fine cheese.
kirrent 10y ago
It's probably worth giving some qualifiers on the grandparent comment. In short, the depressed population is bimodal with close to 2/3rds not responding to SSRIs and similar treatments satisfactorily and 1/3rd of people responding well. For the most part this is due to all of the different causes of depression being lumped in together. When the root cause of your depression is brain chemistry then you need the drugs, but if its secondary to environmental factors then it'll be less effective than lifestyle interventions. This leads to people saying that those lifestyle interventions are more effective in general, but that's due to them being appropriate for more patients, while there's a smaller population for which these interventions won't work well. Good doctors/psychologists will identify which patients are which over time.
- arafa 10y ago
  I agree. If medical treatments make sense in specific cases, of course use them. And sometimes combination treatments are the best (as mentioned in this thread). But hopefully this is preceded by a talk about cost/benefit of all approaches and the weighted risks (including doing nothing), something that doesn't seem to be happening in a lot of cases in the US.

rsync 10y ago

"the same inferior medical outcomes are attributed to most, if not all forms of back surgery." I ran, not walked, to this thread without reading the article just to talk about back surgeries. It is stupefying and outrageous that people allow themselves to get butchered up (yes, butchered up - go read about spinal fusions, etc.) for an outcome that could easily be achieved by merely walking a few miles a few days per week.

woliveirajr 10y ago
Except when you are in a condition that you can barely walk more than 100 meters without having to stop giving the pain. Or when you try all kinds of physical interventions (physical therapy - pilates - yoga - quiropracty - osteopathy) that just makes you feel miserable in the end of the day. Or that you are taking so much painkillers (from all ranges, up to opiates) that you just have the side effects and not the benefits.