9 ms·

Thanks to everyone for their heartfelt responses and interesting viewpoints! Some have pushed back regarding the notion of serotonin imbalance. I would point yo

by pc2g4d 9y ago

Thanks to everyone for their heartfelt responses and interesting viewpoints! Some have pushed back regarding the notion of serotonin imbalance. I would point you to literature that strongly challenges the idea of straightforward neurochemical imbalance as the cause of depression. This is a good place to start: http://kellybroganmd.com/depression-serotonin/ http://kellybroganmd.com/depression-serotonin/ From that article: > "The most applicable analogy is that of the woman with social phobia who finds that drinking two cocktails eases her symptoms. One could imagine, how, in a 6 week randomized trial, this “treatment” could be found efficacious and recommended for daily use and even prevention of symptoms. How her withdrawal symptoms after 10 years of daily compliance could lead those around her to believe that she “needed” the alcohol to correct an imbalance. This analogy is all too close to the truth." I believed in the chemical imbalance theory for many years, but now I am persuaded that it's more marketing slogan than scientific reality. This is not to say that antidepressants cannot have beneficial effects. Just that it's not clear that they are correcting any naturally occurring imbalance. As far as the interesting point that emotions and neurochemical brain states may be equivalent, I grant that this may be true. I guess it was more my way of referring to two approaches to emotional problems: the first, which sees the problems originating in the brain chemistry, internalizing the dysfunction within the sufferer. The second, which sees the brain chemistry mostly as a reaction to the life and environment of the sufferer, wherein the true dysfunction lies. This points people in the direction of their relationships, the congruence of their values and choices, their life philosophy, etc. which I find a more productive pursuit.

hosh 9y ago
This is exactly why I've been trying to get my step-daughter off of the meds. She is on the autism spectrum, and her previous guardian solved behavior problems by pushing more and more meds. We've weaned her off of the anti-psychotic and in the process of weaning her off of the anti-anxiety. We'll see if we can do the same for the vyvanse or adderall. I have worked with a lot of intense emotions and pain within myself. I have faced them in life and in meditative, psychedelic, and dream states. There are not a lot of darkness and intense emotions that faze me much anymore -- though it isn't as if I've become invulnerable to emotions. If anything, I've become to be more sensitive to emotions, and being OK with that vulnerability. Whatever the emotional state or the narrative, the way it dissolves generally remains the same. In all the things I have tried, the key ingredient has always been mindfulness. I have found that surfacing up deeply-buried emotions don't do much if one becomes mindless and intoxicated by those emotions. At the same time, I have also tried suppression and repression. Numbing oneself or cutting oneself off from the emotions at best, defers the emotional work you end up doing. Instead, it usually causes more damage. Mood-altering drugs can help _if_ they are taken along with therapy that necessarily includes mindfulness. The therapy helps change and shift deeply-held beliefs, and it is the mindfulness that lets one unwind the damage from root cause. The drugs in question can help if they support such a process, to be able to help face the scary things within you. If they are taken as a way to _avoid_ this kind of work, yeah, I too also hear they can freeze you at that emotional maturity level.
- lawnchair_larry 9y ago
  Those are mighty strong assertions from someone with a sample size of 1.
  - hosh 9y ago
    Feel free to ignore it.
  - vic-traill 9y ago
    Personal experience isn't Science, but it is a powerful influence on one's beliefs. I'm okay with that. I do hear you that it shouldn't be generalised to a broader experience.
- wincy 9y ago
  Adderall and vyvanse are a lot different in my experience than anti anxiety and anti depressants. The anxiety and depression seemed to be caused by my environment. Now that I have a happy family and a well paying job that I love anxiety is rare and I'm not depressed. I tried going completely off the Adderall completely and was miserable. I found myself not completing goals, and having a really hard time doing any sort of long term planning for about six months. I now take an extremely low dose which is consciously barely perceptible but helps me immensely. Obviously everyone is different but I don't think I could work as a software engineer without 5-10mg of adderall on weekdays.
  - hosh 9y ago
    Keep in mind, adderall and vyvanse work different for someone on ASD than someone with ADD. My daughter, who is on the spectrum, has trouble completing goals and having a hard time doing any sort of long-term planning on vyvanse ... even for the things she is highly-motivated to work on. She is currently on 15mg of Adderall. I am only now just teaching her how to organize and plan. It required building a lot of more fundamental skills first: unwinding the entitlement attitude (that seems common in this current generation), getting her used to checking a list of tasks, day by day, teaching her how to use her visualization skills for both planning and for shaping and solidifying intent. (She is very good at visualization. She doesn't use her skill wisely). We're now just getting her working with a planner and weaning her off of direct supervision. Today was the first day she woke up on her own with the alarm clock. This was months in building her to this point since she first started living with my wife and I during the custody transitional phase. My daughter had somehow trained her brain to ignore the alarm clock with her previous guardian, and the entrenched entitlement attitude did not help. We have had to do a lot to get to this point. The final bit was, in each of the past three nights, I had her visualize (using both sight and auditory modalities) the clock turning to 7:15, hearing the exact sound, and then seeing herself get up. Last night, I introduced to her "intent" and how to shape and form an intention to get up. (And man, I wished I had someone teach me how to shape and focus intent when I was a kid... not that I would have been in the right mindset to take that in back then). Will there be a regression? Likely. Stuff like this takes time and persistence. This milestone is still one step in many. My intention is to teach her how to use her mind and how to use it well. If we wean her off of Adderall, it would come after a lot of intense, ongoing coaching on how to shape and solidify intent, how to use visualization to accomplish what she chooses rather than to sabotage herself, how to organize, how to reason, and a solid basis for morality, ethics, and values. The hardest part will be learning how come into focus and gather will without the use of a consciousness-modifying substance.
nradov 9y ago
I hope you realize that Kelly Brogan is a complete quack. She posts all sorts of feel-good nonsense memes on Facebook without a shred of scientific evidence. For example: "Saying no to pharmaceuticals is an act of feminism. Every time you open that pill bottle, you are saying 'nope you don't got this' to your body, and you are instilling a message of oppression by a system that says feeling anything is dangerous."
- pc2g4d 9y ago
  I was a little worried linking there since I can't vouch for the rest of her output. But that particular article seems solid to me. This anti-establishment part of psychiatry certainly attracts fringe views. But I find the core criticisms of neurochemical imbalances and psych drugs to be convincing.
- tptacek 9y ago
  I have no idea who Kelly Brogan is and would not be especially receptive to crossing these particularly ideological streams the way they have, but the logic they're employing here isn't that dissimilar from the logic underpinning Cognitive Behavioral Therapy, which has been subjected to serious testing.
  - nradov 9y ago
    How are you reaching that conclusion? The unsupported and unscientific assertions made by Dr. Brogan have no relation to evidence-based medicine techniques such as CBT.
    - tptacek 9y ago
      I am only responding to that one quoted paragraph. I am not claiming that it is scientifically rigorous, but if you told me that was a pop-sci writeup of ideas based in CBT, I would not be surprised.
  - Bartweiss 9y ago
    Click the provided link, though. It's bad. The biggest warning sign is that it pitches a serotonin-deficiency model as standard and claims mainstream doctors are "breaking ranks" to oppose it. That's absurd. Knowledgeable doctors don't claim serotonin deficiency causes depression, only that SSRIs can help address depression. The serotonin-deficit hypothesis was advanced because SSRIs treated depression, and discarded when depressed patients proved not to have lowered serotonin levels. Brogan is pretending serotonin deficiency is a crumbling conspiracy, when it's actually a tested-and-discarded hypothesis. I don't especially object to the pull quote about alcoholism. It's a standard clinical observation that antidepressants don't treat simple serotonin shortages, and work equally well on 'clinical' depression and 'normal' depression like the loss of a loved one. I just object to implying that this isn't commonly recognized.

by pc2g4d 9y ago

hosh 9y ago

This is exactly why I've been trying to get my step-daughter off of the meds. She is on the autism spectrum, and her previous guardian solved behavior problems by pushing more and more meds. We've weaned her off of the anti-psychotic and in the process of weaning her off of the anti-anxiety. We'll see if we can do the same for the vyvanse or adderall. I have worked with a lot of intense emotions and pain within myself. I have faced them in life and in meditative, psychedelic, and dream states. There are not a lot of darkness and intense emotions that faze me much anymore -- though it isn't as if I've become invulnerable to emotions. If anything, I've become to be more sensitive to emotions, and being OK with that vulnerability. Whatever the emotional state or the narrative, the way it dissolves generally remains the same. In all the things I have tried, the key ingredient has always been mindfulness. I have found that surfacing up deeply-buried emotions don't do much if one becomes mindless and intoxicated by those emotions. At the same time, I have also tried suppression and repression. Numbing oneself or cutting oneself off from the emotions at best, defers the emotional work you end up doing. Instead, it usually causes more damage. Mood-altering drugs can help _if_ they are taken along with therapy that necessarily includes mindfulness. The therapy helps change and shift deeply-held beliefs, and it is the mindfulness that lets one unwind the damage from root cause. The drugs in question can help if they support such a process, to be able to help face the scary things within you. If they are taken as a way to _avoid_ this kind of work, yeah, I too also hear they can freeze you at that emotional maturity level.

lawnchair_larry 9y ago
Those are mighty strong assertions from someone with a sample size of 1.
- hosh 9y ago
  Feel free to ignore it.
- vic-traill 9y ago
  Personal experience isn't Science, but it is a powerful influence on one's beliefs. I'm okay with that. I do hear you that it shouldn't be generalised to a broader experience.
wincy 9y ago
Adderall and vyvanse are a lot different in my experience than anti anxiety and anti depressants. The anxiety and depression seemed to be caused by my environment. Now that I have a happy family and a well paying job that I love anxiety is rare and I'm not depressed. I tried going completely off the Adderall completely and was miserable. I found myself not completing goals, and having a really hard time doing any sort of long term planning for about six months. I now take an extremely low dose which is consciously barely perceptible but helps me immensely. Obviously everyone is different but I don't think I could work as a software engineer without 5-10mg of adderall on weekdays.
- hosh 9y ago
  Keep in mind, adderall and vyvanse work different for someone on ASD than someone with ADD. My daughter, who is on the spectrum, has trouble completing goals and having a hard time doing any sort of long-term planning on vyvanse ... even for the things she is highly-motivated to work on. She is currently on 15mg of Adderall. I am only now just teaching her how to organize and plan. It required building a lot of more fundamental skills first: unwinding the entitlement attitude (that seems common in this current generation), getting her used to checking a list of tasks, day by day, teaching her how to use her visualization skills for both planning and for shaping and solidifying intent. (She is very good at visualization. She doesn't use her skill wisely). We're now just getting her working with a planner and weaning her off of direct supervision. Today was the first day she woke up on her own with the alarm clock. This was months in building her to this point since she first started living with my wife and I during the custody transitional phase. My daughter had somehow trained her brain to ignore the alarm clock with her previous guardian, and the entrenched entitlement attitude did not help. We have had to do a lot to get to this point. The final bit was, in each of the past three nights, I had her visualize (using both sight and auditory modalities) the clock turning to 7:15, hearing the exact sound, and then seeing herself get up. Last night, I introduced to her "intent" and how to shape and form an intention to get up. (And man, I wished I had someone teach me how to shape and focus intent when I was a kid... not that I would have been in the right mindset to take that in back then). Will there be a regression? Likely. Stuff like this takes time and persistence. This milestone is still one step in many. My intention is to teach her how to use her mind and how to use it well. If we wean her off of Adderall, it would come after a lot of intense, ongoing coaching on how to shape and solidify intent, how to use visualization to accomplish what she chooses rather than to sabotage herself, how to organize, how to reason, and a solid basis for morality, ethics, and values. The hardest part will be learning how come into focus and gather will without the use of a consciousness-modifying substance.

nradov 9y ago

I hope you realize that Kelly Brogan is a complete quack. She posts all sorts of feel-good nonsense memes on Facebook without a shred of scientific evidence. For example: "Saying no to pharmaceuticals is an act of feminism. Every time you open that pill bottle, you are saying 'nope you don't got this' to your body, and you are instilling a message of oppression by a system that says feeling anything is dangerous."

pc2g4d 9y ago
I was a little worried linking there since I can't vouch for the rest of her output. But that particular article seems solid to me. This anti-establishment part of psychiatry certainly attracts fringe views. But I find the core criticisms of neurochemical imbalances and psych drugs to be convincing.
tptacek 9y ago
I have no idea who Kelly Brogan is and would not be especially receptive to crossing these particularly ideological streams the way they have, but the logic they're employing here isn't that dissimilar from the logic underpinning Cognitive Behavioral Therapy, which has been subjected to serious testing.
- nradov 9y ago
  How are you reaching that conclusion? The unsupported and unscientific assertions made by Dr. Brogan have no relation to evidence-based medicine techniques such as CBT.
  - tptacek 9y ago
    I am only responding to that one quoted paragraph. I am not claiming that it is scientifically rigorous, but if you told me that was a pop-sci writeup of ideas based in CBT, I would not be surprised.
- Bartweiss 9y ago
  Click the provided link, though. It's bad. The biggest warning sign is that it pitches a serotonin-deficiency model as standard and claims mainstream doctors are "breaking ranks" to oppose it. That's absurd. Knowledgeable doctors don't claim serotonin deficiency causes depression, only that SSRIs can help address depression. The serotonin-deficit hypothesis was advanced because SSRIs treated depression, and discarded when depressed patients proved not to have lowered serotonin levels. Brogan is pretending serotonin deficiency is a crumbling conspiracy, when it's actually a tested-and-discarded hypothesis. I don't especially object to the pull quote about alcoholism. It's a standard clinical observation that antidepressants don't treat simple serotonin shortages, and work equally well on 'clinical' depression and 'normal' depression like the loss of a loved one. I just object to implying that this isn't commonly recognized.