7 ms·

I'll tell you, with 100% conviction, that I would not be alive today without prescription antidepressants and mood stabilizers. Of course there are side effects

I'll tell you, with 100% conviction, that I would not be alive today without prescription antidepressants and mood stabilizers. Of course there are side effects, and it can take a while to find the right drug or combination of drugs for your particular brain chemistry. In most cases, I've considered the side effects worth the improvement to my life. Even with them, I'm still not completely "normal". These symptoms are with me for the rest of my life barring some amazing medical discovery. Mental health issues as a whole are difficult to bring up, even to a doctor. I actually worry about writing this on my real account. It's looked down on as if "you just can't handle life" so you "just feel sad". Chemotherapy is also a very unpleasant experience, but I don't think there would be much interest in an article about some imagined overprescription of chemotherapy.

frgtpsswrdlame 9y ago
>I don't think there would be much interest in an article about some imagined overprescription of chemotherapy Perhaps that's because it's possible to objectively know if someone has cancer? I'm not sure the same is true of depression. I was on an anti-depressant for about a year in college. It didn't save my life and looking back I didn't even need it.
- jakebasile 9y ago
  There are guidelines for determining if someone has depression and/or other mental health diseases, just like any other disease. You can't take an x-ray and see depression like a tumor, but you can talk to the patient and their family to gauge and track symptoms. see: https://www.nimh.nih.gov/health/topics/depression/index.shtml https://www.nimh.nih.gov/health/topics/depression/index.shtm... http://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_MajorDepressiveDisorder.pdf http://images.pearsonclinical.com/images/assets/basc-3/basc3...
  - frgtpsswrdlame 9y ago
    Sure, what I'm saying is that a doctor found that I met those guidelines (apparently) and prescribed me a drug. I don't think I ever needed it, I was just struggling with a transitional period in my life. It didn't really improve my life, in fact between the reduced appetite and hampered sexual performance I'd say it definitely was a negative. After reading some research about the performance of antidepressants vs placebos and the possibility of my sexual side effects becoming permanent I decided I was out. All of which is to say, are anti-depressants over prescribed? I can say yes, if only by my one case.
    - hackuser 9y ago
      In fairness, you don't know what your life would have been like without them. I'm not second guessing your personal judgment, which must include a million factors I have no idea about (and it's not my business), but I don't think that kind of comment is conclusive. > I was just struggling with a transitional period in my life Why shouldn't that cause serious depression, and why shouldn't someone need antidepressants for it?
      - frgtpsswrdlame 9y ago
        I guess... but you can get away with questioning my personal judgment. What if you went around to all the comments here saying "it definitely saved my life" and questioned their judgment? Maybe it's those people who don't realize their ability to beat depression without medication. To your second point I would say that a struggle shouldn't necessitate a clinical diagnosis. Life is full of struggle, and equating struggle to depression to medication is why we're in the overprescription business in the first place.
        hackuser 9y ago
        Again, I'm not questioning your judgment. Sorry if you feel that way; I'd delete the comment now if I could. I wouldn't question other people either, and especially, for obvious reasons, I wouldn't question the people you mention. > I would say that a struggle shouldn't necessitate a clinical diagnosis. Life is full of struggle, and equating struggle to depression to medication is why we're in the overprescription business in the first place. I know critics repeat that narrative often but I haven't seen evidence of it actually happening. That is, I haven't heard anyone say, 'struggle is a sufficient condition for the diagnosis of depression', and I'm almost certain that the standards for diagnosis in psychology/psychiatry are much higher than that. > overprescription I'm not sure that's true either. Certainly there are always some false positives, but what is the rate? The evidence does indicate there are very many false negatives, people who need help and are not getting it. I suspect the narrative of overprescription for psychological conditions is based in part on two things: 1) People with preconceived negative attitudes toward mental health care, and 2) variation from the norm they are accustomed to, which is that few or no people received mental health treatment. Regarding the latter reason, perhaps there was a problem with the old norm; perhaps many more people need mental health care than we knew. When there is a new treatment for cancer, we don't say 'it's overprescribed; in the old days we toughed it out.' We don't say that about lead in water. If it's helping people, it's a good thing, and I want to society to move forward, for people to be healthier and happier and not be stuck in the conditions of the 1970s (or whatever the baseline is).
  - wu-ikkyu 9y ago
    >There are guidelines for determining if someone has depression and/or other mental health diseases, just like any other disease. Psychiatric diagnoses are not "just like any other disease". Medical pathology is objective science, psychiatry is subjective postulation. >In 2013, Frances said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests". https://en.wikipedia.org/wiki/Allen_Frances https://en.wikipedia.org/wiki/Allen_Frances
    - pmyteh 9y ago
      Pain management, optometry, and many other non-psychiatric disciplines also rely on self-report. There's no bright line between the 'objective' and the 'postulation'.
      - Arizhel 9y ago
        >Pain management, optometry, and many other non-psychiatric disciplines also rely on self-report. That's just plain wrong on the optometry part. While there is a lot of self-reporting used in optometry because it's faster and easier, it's entirely possible to remove it, because you can't fake not being able to read stuff when your vision is too blurry. How do you think the DMV tests your vision? It's not self-reporting; they show you something that you don't know beforehand and you have to read it. Optometrists also use vision tests to gauge your vision as they try different lenses. If they really wanted to, they could move from static tests that you can memorize to dynamic ones to prevent "cheating", but why would anyone cheat on an optometry exam (like they really would for the DMV)?
        TylerE 9y ago
        Sure you can. There are only so many eye charts in use. It's possible to memorize them. Just being left in the exam room for 30 seconds unobserved would be enough.
        cowboysauce 9y ago
glenda 9y ago
Antidepressants are overprescribed (just like how Ritalin was like 15-20 years ago) because they work so well that doctors reach for a pill as their first course of action while ignoring other less life altering options. Some people also find themselves with side-effects like suicidal thoughts or loss of sexual functions that can be devastating, and in some cases will last beyond the use of the medicine.
- tptacek 9y ago
  They are also prescribed frequently because many people's first line of psychiatric care is their primary care physician, who is rarely trained in diagnosis or treatment of mental health issues, but is prepared to write a script. Serious psychiatrists combine multiple approaches; for instance, many are trained behaviorists. Additionally, psychiatrists are more careful about the scripts they write: you might find it hard to get much tuning and medication fitting done with your P.C.P., but a psychiatrist might carefully ramp you up and, later, down and off of a specific drug.
- _acme 9y ago
  Do you have any evidence for the efficacy of antidepressants that others, including their manufacturers, do not? In fact, SSRIs/SNRIs are not particularly effective -- at least no more effective than placebo.
  - glenda 9y ago
    My comment on the effectiveness of antidepressants is in reference to the way many doctors seem to view these drugs, not based on any particular studies or evidence.
hackuser 9y ago
> It's looked down on as if "you just can't handle life" so you "just feel sad". Loved ones have mental health problems and those reactions just piss me off. If someone has a broken bone sticking out of their leg, nobody questions why they have a hard time walking. If they have a heart attack, nobody questions that they can't go to work today and need medical attention. But when the most powerful, essential organ in the body has a problem - well, just buck up and get over it, which is similar to, 'just buck up and walk off that heart attack'. Or they say, 'I'm depressed sometimes too'; which is like telling someone who is paraplegic, 'my leg falls asleep sometimes too'. 'Why didn't I think of that? I'll just get up out of this wheelchair and walk it off!' In fact the symptoms of mental health problems sometimes can be just as obvious as broken legs and heart attacks. But because we don't understand the functioning of the brain on a physical level, IMHO people assume that what they don't know doesn't exist; and of course they fear what they don't understand, its implications for them, and don't know how to handle it, so they deny it or minimize it. I think these questions provide perspective to people: Would you rather be unable to walk the rest of your life, or live feeling true hopelessness the rest of your life? Would you rather be blind, or be unable to form relationships with people and be trapped in isolation? Of course, 'none of the above' is everyone's choice.
manmal 9y ago
Having a look at your genetics and microbiome might tell you more about why you have these impairments. Methylation issues or entire genea of microbes missing from the microbiome can easily cause neurotransmitter imbalances that the body cannot compensate for on its own.
pmcollins 9y ago
> It's looked down on as if "you just can't handle life" so you "just feel sad". I think that a large part of the problem is just the name, "antidepressant". If they were called Serotonin Stabilizers or something, maybe there wouldn't as much of a stigma.
- tptacek 9y ago
  The same is true, but more so, with "anti-psychotics".

frgtpsswrdlame 9y ago

>I don't think there would be much interest in an article about some imagined overprescription of chemotherapy Perhaps that's because it's possible to objectively know if someone has cancer? I'm not sure the same is true of depression. I was on an anti-depressant for about a year in college. It didn't save my life and looking back I didn't even need it.

jakebasile 9y ago
There are guidelines for determining if someone has depression and/or other mental health diseases, just like any other disease. You can't take an x-ray and see depression like a tumor, but you can talk to the patient and their family to gauge and track symptoms. see: https://www.nimh.nih.gov/health/topics/depression/index.shtml https://www.nimh.nih.gov/health/topics/depression/index.shtm... http://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_MajorDepressiveDisorder.pdf http://images.pearsonclinical.com/images/assets/basc-3/basc3...
- frgtpsswrdlame 9y ago
  Sure, what I'm saying is that a doctor found that I met those guidelines (apparently) and prescribed me a drug. I don't think I ever needed it, I was just struggling with a transitional period in my life. It didn't really improve my life, in fact between the reduced appetite and hampered sexual performance I'd say it definitely was a negative. After reading some research about the performance of antidepressants vs placebos and the possibility of my sexual side effects becoming permanent I decided I was out. All of which is to say, are anti-depressants over prescribed? I can say yes, if only by my one case.
  - hackuser 9y ago
    In fairness, you don't know what your life would have been like without them. I'm not second guessing your personal judgment, which must include a million factors I have no idea about (and it's not my business), but I don't think that kind of comment is conclusive. > I was just struggling with a transitional period in my life Why shouldn't that cause serious depression, and why shouldn't someone need antidepressants for it?
    - frgtpsswrdlame 9y ago
      I guess... but you can get away with questioning my personal judgment. What if you went around to all the comments here saying "it definitely saved my life" and questioned their judgment? Maybe it's those people who don't realize their ability to beat depression without medication. To your second point I would say that a struggle shouldn't necessitate a clinical diagnosis. Life is full of struggle, and equating struggle to depression to medication is why we're in the overprescription business in the first place.
      - hackuser 9y ago
        Again, I'm not questioning your judgment. Sorry if you feel that way; I'd delete the comment now if I could. I wouldn't question other people either, and especially, for obvious reasons, I wouldn't question the people you mention. > I would say that a struggle shouldn't necessitate a clinical diagnosis. Life is full of struggle, and equating struggle to depression to medication is why we're in the overprescription business in the first place. I know critics repeat that narrative often but I haven't seen evidence of it actually happening. That is, I haven't heard anyone say, 'struggle is a sufficient condition for the diagnosis of depression', and I'm almost certain that the standards for diagnosis in psychology/psychiatry are much higher than that. > overprescription I'm not sure that's true either. Certainly there are always some false positives, but what is the rate? The evidence does indicate there are very many false negatives, people who need help and are not getting it. I suspect the narrative of overprescription for psychological conditions is based in part on two things: 1) People with preconceived negative attitudes toward mental health care, and 2) variation from the norm they are accustomed to, which is that few or no people received mental health treatment. Regarding the latter reason, perhaps there was a problem with the old norm; perhaps many more people need mental health care than we knew. When there is a new treatment for cancer, we don't say 'it's overprescribed; in the old days we toughed it out.' We don't say that about lead in water. If it's helping people, it's a good thing, and I want to society to move forward, for people to be healthier and happier and not be stuck in the conditions of the 1970s (or whatever the baseline is).
- wu-ikkyu 9y ago
  >There are guidelines for determining if someone has depression and/or other mental health diseases, just like any other disease. Psychiatric diagnoses are not "just like any other disease". Medical pathology is objective science, psychiatry is subjective postulation. >In 2013, Frances said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests". https://en.wikipedia.org/wiki/Allen_Frances https://en.wikipedia.org/wiki/Allen_Frances
  - pmyteh 9y ago
    Pain management, optometry, and many other non-psychiatric disciplines also rely on self-report. There's no bright line between the 'objective' and the 'postulation'.
    - Arizhel 9y ago
      >Pain management, optometry, and many other non-psychiatric disciplines also rely on self-report. That's just plain wrong on the optometry part. While there is a lot of self-reporting used in optometry because it's faster and easier, it's entirely possible to remove it, because you can't fake not being able to read stuff when your vision is too blurry. How do you think the DMV tests your vision? It's not self-reporting; they show you something that you don't know beforehand and you have to read it. Optometrists also use vision tests to gauge your vision as they try different lenses. If they really wanted to, they could move from static tests that you can memorize to dynamic ones to prevent "cheating", but why would anyone cheat on an optometry exam (like they really would for the DMV)?
      - TylerE 9y ago
        Sure you can. There are only so many eye charts in use. It's possible to memorize them. Just being left in the exam room for 30 seconds unobserved would be enough.
        cowboysauce 9y ago

glenda 9y ago

Antidepressants are overprescribed (just like how Ritalin was like 15-20 years ago) because they work so well that doctors reach for a pill as their first course of action while ignoring other less life altering options. Some people also find themselves with side-effects like suicidal thoughts or loss of sexual functions that can be devastating, and in some cases will last beyond the use of the medicine.

tptacek 9y ago
They are also prescribed frequently because many people's first line of psychiatric care is their primary care physician, who is rarely trained in diagnosis or treatment of mental health issues, but is prepared to write a script. Serious psychiatrists combine multiple approaches; for instance, many are trained behaviorists. Additionally, psychiatrists are more careful about the scripts they write: you might find it hard to get much tuning and medication fitting done with your P.C.P., but a psychiatrist might carefully ramp you up and, later, down and off of a specific drug.
_acme 9y ago
Do you have any evidence for the efficacy of antidepressants that others, including their manufacturers, do not? In fact, SSRIs/SNRIs are not particularly effective -- at least no more effective than placebo.
- glenda 9y ago
  My comment on the effectiveness of antidepressants is in reference to the way many doctors seem to view these drugs, not based on any particular studies or evidence.

hackuser 9y ago

> It's looked down on as if "you just can't handle life" so you "just feel sad". Loved ones have mental health problems and those reactions just piss me off. If someone has a broken bone sticking out of their leg, nobody questions why they have a hard time walking. If they have a heart attack, nobody questions that they can't go to work today and need medical attention. But when the most powerful, essential organ in the body has a problem - well, just buck up and get over it, which is similar to, 'just buck up and walk off that heart attack'. Or they say, 'I'm depressed sometimes too'; which is like telling someone who is paraplegic, 'my leg falls asleep sometimes too'. 'Why didn't I think of that? I'll just get up out of this wheelchair and walk it off!' In fact the symptoms of mental health problems sometimes can be just as obvious as broken legs and heart attacks. But because we don't understand the functioning of the brain on a physical level, IMHO people assume that what they don't know doesn't exist; and of course they fear what they don't understand, its implications for them, and don't know how to handle it, so they deny it or minimize it. I think these questions provide perspective to people: Would you rather be unable to walk the rest of your life, or live feeling true hopelessness the rest of your life? Would you rather be blind, or be unable to form relationships with people and be trapped in isolation? Of course, 'none of the above' is everyone's choice.

manmal 9y ago

Having a look at your genetics and microbiome might tell you more about why you have these impairments. Methylation issues or entire genea of microbes missing from the microbiome can easily cause neurotransmitter imbalances that the body cannot compensate for on its own.

pmcollins 9y ago

> It's looked down on as if "you just can't handle life" so you "just feel sad". I think that a large part of the problem is just the name, "antidepressant". If they were called Serotonin Stabilizers or something, maybe there wouldn't as much of a stigma.

tptacek 9y ago
The same is true, but more so, with "anti-psychotics".