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> In the course of a year, her doctors had created what’s known as “a prescription cascade”: the side effects of one medication are diagnosed as symptoms of ano
by tcj_phx 8y ago
> In the course of a year, her doctors had created what’s known as “a prescription cascade”: the side effects of one medication are diagnosed as symptoms of another condition, leading to a succession of new prescriptions.
This term, "prescription cascade", should be lesson #1 at medical school. It's the natural result of an incomplete diagnosis, and is present in every medical field.
> At the hospital, where she stayed for two weeks, she was put on a new combination of pills: Lamictal, a mood stabilizer; Lexapro, an antidepressant; and Seroquel, an antipsychotic that she was told to use as a sleep aid.
(emphasis added)
These descriptions -- mood stabilizer, antidepressant, antipsychotic -- are just marketing terms that don't actually describe the actual function of the drug. These marketing terms are most useful for tricking medical professionals into prescribing these products.
'Antibiotic' is the prototypical name for a class of drug that does what it describes: acts against bacteria.
> She saw her drugs as precision instruments that could eliminate her suffering, as soon as she and Dr. Roth found the right combination. “I medicated myself as though I were a finely calibrated machine, the most delicate error potentially throwing me off,” she later wrote.
I think this attitude is probably common for all the smart people who find themselves medicated into a downward spiral.
> “It is tempting to add a second drug just for the sake of ‘doing something,’ ” a 2004 paper in Current Medicinal Chemistry warns.
This is the trap the mental health system has fallen into: the professionals want to help. The drug industry has FDA-approved drugs for the various diagnosises.
Joel on Software said a re-write is something that shouldn't be done. But what other choice does the mental health industry have? Their system doesn't work. The modern industry is based on the flawed chemical imbalance theory of mental illness.
Little bits of progress have been made, in spite of the inertia to treat misunderstood behavioral problems with patent medicines. I have to conclude this comment before I can finish the article, so I'll link to my recent comment on the submission on the Szasz's book, the myth of mental illness: https://news.ycombinator.com/item?id=19243417 https://news.ycombinator.com/item?id=19243417
edit: shortened my first quote from the linked article
- azernik 8y ago"Mood stabilizer" is a quite accurate description of the usual function of the drug - in bipolar patients like me, it reduces the magnitude and stabilizes the period of mood swings. Mood stabilizers also tend to be anti-seizure meds, and have all kinds of off-label uses because of neurological phenomena we don't understand, but the label is a very useful one. Same for antidepressants - often the same drugs (especially SSRIs) are both antidepressants and anxiolytics, but both labels are useful descriptions of the meds' common effects. Antidepressants in particular happen to be fantastically idiosyncratic drugs, but on average they do what they say on the label. Part of the problem is that, due to the ill-understood nature of the brain, good psychiatrists need to know strange drug interactions and ill-studied minority reactions in order to serve the full range of their patients. This edges on art rather than science, which is always a recipe for cognitive biases to gain control.
- LyndsySimon 8y agoI think what the parent was trying to say was that "antibiotic" describes the drugs' method of action, while "antidepressant" describes the drugs' intended affect. > due to the ill-understood nature of the brain, I think this is exactly the problem. We have a bunch of drugs that seem to work, and we think we know how and why they work, but we're not able to directly measure the problem in those terms. If someone has a bacterial infection, we can culture it and prescribe the correct antibiotic. If someone has a mental health condition, we almost always have to consider the way that it's presenting and make an educated guess as to which drug is going to be effective. It's not at all uncommon for that first guess to be incorrect, which leads to either iteration or a "cascade" depending on the practitioner.
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- fraudsyndrome 8y agoI have a close friend with paranoid schizophrenia and also bipolar who, after an episode, underwent ECT. The medication that stopped him from hearing voices pre ECT/episode started again after ECT. After a year, the Psychiatrist is still trying to find the right combination of medication to stop it - they've (I think) more than tripled his current dosage of lithium along with others that I'm not aware of but it's unpredictable how much time the medication change actually takes effect, could be anywhere from 2 weeks to 2 months. I don't know where I was going with this, just sad to see him like this.
- tcj_phx 8y agoSometimes less treatment is better than more treatment. If your friend will let you go to his appointments, maybe you can advocate on your friend's behalf. If he's ordered to submit to involuntary mental health treatment, you can probably request judicial review on his behalf. This would be to let the court know that your friend was doing better before the ECT treatment, and that you are concerned that some of his problems are now caused by the treatment itself. Edit: I commented on lithium a few weeks ago: https://news.ycombinator.com/item?id=19299137 https://news.ycombinator.com/item?id=19299137