3 ms·

I find this argument interesting. Going through depression myself, waiting for an SSRI to be effective 6 - 8 weeks feels impossible if you want to end it all RI

I find this argument interesting. Going through depression myself, waiting for an SSRI to be effective 6 - 8 weeks feels impossible if you want to end it all RIGHT NOW. That's kinda the point of suicide, is to end the pain ASAP. Here's the thing, the SSRI didn't work out for me, now I'm going to try another medication, another 6 weeks before it's fully effective (It's not an SSRI though). I don't know if I can wait that long. I still haven't gotten to other tiers of treatment in terms of medication - Antipsychotics, rMAOIs, etc. Point is: I'm not sure a tiered approach for medication works well for everyone with depression, it's too time sensitive.

ineedasername 8y ago
I agree. I can imagine... well, I don't have to imagine, I've been there: the prospect of months or even years long carousel of medications, trying and discarding one after another, hoping to get lucky on the next try... It's awful. I'd like to see ketamine and some others in careful but wider use. (modafinil for example works wonders for me and is also fast acting, definitely keeps me functional during depressive periods)
freedomben 8y ago
Yes indeed. 6 to 8 weeks is an eternity for someone who is deeply suffering. I personally think we are way too stingy with medicines these days. I also had a friend commit suicide while suffering from intense depression. He would no doubt be alive today if he had been giving what he needed right away, instead of being made to start with Prozac and then worked through a bunch of different "starter" antidepressants. Just give people what they need. There are worse outcomes than over-prescribing (death at one's own hand, for example).
- nickbarnwell 8y ago
  Sadly, we don’t know enough about the brain to have any idea which medications are going to work or what it is people need right away. While you certainly could sedate people to the point of utter apathy by giving every shmiel who walks through the clinic doors high powered anti-psychotics it would be akin to treating a broken toe with amputation. First line treatments like sertraline and fluoxetine are used because they take time to work and have generally tolerable side-effect profiles. E.g. in the case of patients with undiagnosed bipolar disorder, you run a lower risk of triggering a manic episode.
  - TheAceOfHearts 8y ago
    Why shouldn't the person be allowed to make their own choice after being properly informed of their options and having received their doctor's suggestion?
    - monadgonad 8y ago
      It's unethical, just like if a patient demanded their leg be amputated for a broken toe.
      - fragmede 8y ago
        If the broken toe was inside a concrete cast that no one could see into, and there was no such thing as an X-ray machine, CT scan, MRI, or any other machine that could be used to verify the toe being the part that's broken. If the doctor didn't listen to, or at all believe at least half the the stuff the patient actually said, and didn't need to. If others had leg amputation performed and the leg grew back and on top of it we had evidence that leg amputation caused long-term damage when performed for other reasons. (Ketamine has long been used as an anesthetic precisely because the data we have suggests no long term damage from that dosage.) If the patient had suicidal ideation and intent, because something hurt so much and we had no way of doing anything other than leg amputation, then why shouldn't we? Until humanity manages to develop and deploy brain scanners that can actually see how much physical and emotional pain a person is actually in, then the leg amputation analogy is lazy and unhelpful because we simply don't have the same tools to address mental health because it's largely invisible. Most doctors are still humans who negatively judge patients who drink heavily, who frequently miss appointments, who can't manage to get lab work done, who self-medicate with street drugs; those patients are judged as degenerates, not deserving of their help because they can't manage to take a pill, that doesn't seem to work for 6-8 weeks. I mean, it's great that a hospital's ethic's board has reviewed the situation and determined that the best course of action is for people to suffer because they don't want the liability of, in this analogy, leg amputation, but in the meanwhile, people are being discarded by the mental health profession.
        8y ago
- monadgonad 8y ago
  How do you know what he needed? There aren't "starter" antidepressants and "high-strength" ones. Prescribing him prozac first was giving him what he needed. I'm sorry you lost your friend, but it's not because he was denied some wonder drug. Secondly, it's ridiculous to suggest we're underprescribing antidepressants. Completely the opposite. Mental health disorders require complex treatments involving therapy and lifestyle changes as well as medicines, but doctors will completely ignore that in favour of just writing a prescription after a 5-minute conversation. I say this with a lot of experience of mental health treatment: doctors hand out antidepressants far too easily.
sekh60 8y ago
I know it is trite, bit stay strong, things can get better. I have schizoaffective disorder and I did find a mix of medication that helps a lot, but it literally took 13 years to find the mix with a couple suicide attempts during that period. Check out some of the mental health subreddits, I am the founder of /r/schizoaffective.

ineedasername 8y ago

I agree. I can imagine... well, I don't have to imagine, I've been there: the prospect of months or even years long carousel of medications, trying and discarding one after another, hoping to get lucky on the next try... It's awful. I'd like to see ketamine and some others in careful but wider use. (modafinil for example works wonders for me and is also fast acting, definitely keeps me functional during depressive periods)

freedomben 8y ago

Yes indeed. 6 to 8 weeks is an eternity for someone who is deeply suffering. I personally think we are way too stingy with medicines these days. I also had a friend commit suicide while suffering from intense depression. He would no doubt be alive today if he had been giving what he needed right away, instead of being made to start with Prozac and then worked through a bunch of different "starter" antidepressants. Just give people what they need. There are worse outcomes than over-prescribing (death at one's own hand, for example).

nickbarnwell 8y ago
Sadly, we don’t know enough about the brain to have any idea which medications are going to work or what it is people need right away. While you certainly could sedate people to the point of utter apathy by giving every shmiel who walks through the clinic doors high powered anti-psychotics it would be akin to treating a broken toe with amputation. First line treatments like sertraline and fluoxetine are used because they take time to work and have generally tolerable side-effect profiles. E.g. in the case of patients with undiagnosed bipolar disorder, you run a lower risk of triggering a manic episode.
- TheAceOfHearts 8y ago
  Why shouldn't the person be allowed to make their own choice after being properly informed of their options and having received their doctor's suggestion?
  - monadgonad 8y ago
    It's unethical, just like if a patient demanded their leg be amputated for a broken toe.
    - fragmede 8y ago
      If the broken toe was inside a concrete cast that no one could see into, and there was no such thing as an X-ray machine, CT scan, MRI, or any other machine that could be used to verify the toe being the part that's broken. If the doctor didn't listen to, or at all believe at least half the the stuff the patient actually said, and didn't need to. If others had leg amputation performed and the leg grew back and on top of it we had evidence that leg amputation caused long-term damage when performed for other reasons. (Ketamine has long been used as an anesthetic precisely because the data we have suggests no long term damage from that dosage.) If the patient had suicidal ideation and intent, because something hurt so much and we had no way of doing anything other than leg amputation, then why shouldn't we? Until humanity manages to develop and deploy brain scanners that can actually see how much physical and emotional pain a person is actually in, then the leg amputation analogy is lazy and unhelpful because we simply don't have the same tools to address mental health because it's largely invisible. Most doctors are still humans who negatively judge patients who drink heavily, who frequently miss appointments, who can't manage to get lab work done, who self-medicate with street drugs; those patients are judged as degenerates, not deserving of their help because they can't manage to take a pill, that doesn't seem to work for 6-8 weeks. I mean, it's great that a hospital's ethic's board has reviewed the situation and determined that the best course of action is for people to suffer because they don't want the liability of, in this analogy, leg amputation, but in the meanwhile, people are being discarded by the mental health profession.
      - 8y ago
monadgonad 8y ago
How do you know what he needed? There aren't "starter" antidepressants and "high-strength" ones. Prescribing him prozac first was giving him what he needed. I'm sorry you lost your friend, but it's not because he was denied some wonder drug. Secondly, it's ridiculous to suggest we're underprescribing antidepressants. Completely the opposite. Mental health disorders require complex treatments involving therapy and lifestyle changes as well as medicines, but doctors will completely ignore that in favour of just writing a prescription after a 5-minute conversation. I say this with a lot of experience of mental health treatment: doctors hand out antidepressants far too easily.

sekh60 8y ago

I know it is trite, bit stay strong, things can get better. I have schizoaffective disorder and I did find a mix of medication that helps a lot, but it literally took 13 years to find the mix with a couple suicide attempts during that period. Check out some of the mental health subreddits, I am the founder of /r/schizoaffective.