6 ms·

I generally am supportive of people seeking psychiatric treatment, but wow, this woman's case seems, in retrospect, rather mismanaged. It is like her doctors t

I generally am supportive of people seeking psychiatric treatment, but wow, this woman's case seems, in retrospect, rather mismanaged. It is like her doctors tried to medicate away an epiphany. Realizing that "the glittering balls and designer clothing has no real underlying substance" and being depressed that one's life is limited to such things, is not a cause for medication. It sounds like she was struggling to be happy in a situation in which she was never going to find happiness. Finding purpose, the thing she said was missing so early on, seems to ultimately be what helped her. Her reason to get up every day is that she can now help others, instead of live just for herself. Some people look inward, they want to be the best dressed at the party, have a good career, and overall be successful in life. If that brings them happiness, then good for them! They have found what makes their life fulfilling. But different people need other forms of fulfillment, be it an artist completing their latest work, or someone who wants to have a daily positive impact on the world around them. Medication cannot make people happy. (Well at least not the legal drugs, and the illegal ones won't work long term!) They can only create the possibility for happiness for those who need some extra help. But, doctors need to do a better job of discovering if that extra help is just needed, or if the road their patient is going down is not going to lead to happiness no matter what is written on the prescription pad.

nerdponx 8y ago
Psychiatry should not be front-line treatment for most people. End of story.
- com2kid 8y ago
  For most people, psychiatry is overkill, sure sure. But heck, look at the diagnostic criteria for Bi-Polar, > The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. That line about "marked impairment in occupational functioning" is a common theme in the DSM. (Hypomania has a lower threshhold, but still involves risk to self) If someone is able to live their life, hold down a job, isn't a risk to themselves / others, then they should be directed to a psychologist or therapist. Bloody hell, the DSM says this, again and again and again. In the must be met criteria for ADHD: > There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning. Major depressive disorder, again, with this requirement: > Cause significant distress or severely impact social, occupational or other important life areas The diagnostic criteria is pretty on point. But even so, misdiagnosis is possible. If someone comes in and says that they hate their job and their spouse is abusive, the correct solution is a lawyer / career training (probably in that order?), not a pill! If someone comes in and says "my life has no meaning", maybe it isn't anhedonia, maybe the activities in their life legitimately aren't of interest to them! We all feel social pressure to fit in with the culture we grow up with. The great thing about America is, if we don't fit in with that culture, plenty of other culture's abound! But first people have to realize that they can leave the culture they are familiar with if it isn't bringing them happiness. We all know that one engineer who decided to be become a brick layer, and who is now super happy! Heck one of my friends and old co-workers went from being a preacher to coder! We all need to realize that laying bricks is just as fulfilling and meaningful as writing code[1] and not being judgmental about people's choice to leave one career behind and go into another. My masseuse used to be in the corporate world. One of the best Chocolatiers[2] alive used to work at Microsoft. Parents, if you kids aren't happy living the upper class lifestyle that you dreamed of when you were working your way up the ladder, then support them doing something else! Tell them that they don't have to live up to your dreams, or fit into the societal image of perfection created by the culture one is surrounded by. [1] Possibly more so, the bricks are going to outlive 99.9% of code that is ever written, and will likely be appreciated by far more people. [2] I've traveled to quite a few countries and found her equal, but none that surpass. http://bruggechocolates.com/ http://bruggechocolates.com/
  - SketchySeaBeast 8y ago
    The definitions can be more easily met when you consider "Cause significant distress" or "reduce the quality of, social, school, or work functioning" - that's much larger, and people can be visibly firing on all cylinders, but if they report reduced quality or distress, then it meets those criteria.
    - com2kid 8y ago
      But as the article made clear, the drugs were reducing her performance at school! This is one area where I think the ADHD community has pulled ahead, good doctors will, when someone starts a new treatment, do weekly check-ins[1] with how one's quality of life is going across multiple metrics. Mood, self image, social life, and work/school performance. The fact this isn't done for all forms of psychiatric treatment is shocking and sad. From a non-medical perspective, Cognitive Behavioral Therapy is good in that it tries to help people find fulfillment, or at least come to peace with themself. [1] Proper ADHD treatment is supposed to be provided by a psychiatrist and psychologist working in tandem and communicating with each other. Unfortunately the % of times this is actually done is most certainly way under 1%. Not even going to get into the insurance issues around this...
      - SketchySeaBeast 8y ago
        > But as the article made clear, the drugs were reducing her performance at school! She was by no means stable before the medication. In fact - Bipolar, if the hypomanic/manic states hit at the right time, could be a huge help with school. I'm not saying it's in any way right, I'm saying there are broad criteria for getting on medication, and there's no DSM criteria for when she should be coming off.
  - GuB-42 8y ago
    The article mentions talking about wanting to die, cutting oneself with razor blades, drinking through the night and doing cocaine. And that's before treatment, so it is not at fault. That's not something to take lightly, especially combined together. Also, that story somehow reminds me of someone I know who really is bipolar, she looked somewhat normal until she went completely bonkers, burning down most of her stuff at home, etc... It is serious. She now takes mood stabilizers (lithium) and lives a healthy life. So don't dismiss psychiatry.
- sixo 8y ago
  I think a decent cutoff for when to defer to medication is when the problem becomes self-sustaining. E.g. you get anxiety about your anxiety, or your mania leads to disastrous actions that can't be emotionally handled in a normal state, or your depression causes you to fail at goals in a way that contributes to your depression. At those points the cycle is the problem and needs to be broken.
- beenBoutIT 8y ago
  It should be a last resort for people who have been thoroughly screened by MDs and neurologists. According to sleep experts at Stanford at least 25% of people with ADHD/ADD are narcoleptics who've been misdiagnosed. That's a shitload of people who are currently living suboptimal lives because they went to a psychiatrist prior to being evaluated by a neurologist.
  - penagwin 8y ago
    Might not be the best example, as narcolepsy is usually treated with stimulants and antidepressants, so adding say ritalin may still improve symptoms regardless of if it's actual ADD/ADHD or narcolepsy
    - beenBoutIT 8y ago
      In this case psychiatry covers up the symptoms with stimulants (that further degrade sleep) while neurology can effectively fix the bad sleep. Psychiatry provides a poorly fitting bandage while neurology has something on par with a cure. There's no better example that I'm aware of.
  - Gibbon1 8y ago
    A good example is everyone I know with hypothyroidism, five out of five were put on a variety of psychiatric drugs for years before being properly diagnosed. Frankly I think MD's shouldn't be allowed to prescribe psychiatric drugs period.
    - nerdponx 8y ago
      How about my friend, whose "bipolar" disappeared when they got a positive test result for celiac and stopped eating gluten? Or myself for that matter, whose problems with sleep, gait, muscle weakness, mood instability, and difficulty paying attention all more or less evaporated when I went gluten free after my own celiac diagnosis? These weren't quack diagnoses either. We both saw traditional gastroenterologists, in different states, several years apart, both of us seeking treatment for different things. My diagnosis was confirmed with blood and endoscopy, as well as a follow-up DNA test to make sure I had the right mutation that makes it possible for celiac to arise.
stronglikedan 8y ago
> Medication cannot make people happy. But it can allow one to find happiness. Depression is a chemical imbalance, and not everyone can overcome it on their own - especially if left untreated for extended lengths of time. The medicine helps people get back into balance, so they can start to work on their happiness again, whatever that may be.
- com2kid 8y ago
  Literally the next sentence I wrote: > They can only create the possibility for happiness for those who need some extra help.
  - stronglikedan 8y ago
    Literally what I expounded upon.
    - bongo662 8y ago
      Literally
    - com2kid 8y ago
      True, apologizes for the rudeness on my part.
- Gibbon1 8y ago
  > Depression is a chemical imbalance That is literally drug company marketing propaganda.
  - pbhjpbhj 8y ago
    So, human bodies are perfectly self-regulating in brain chemistry?
    - Gibbon1 8y ago
      Define 'brain chemistry'
JamesBarney 8y ago
> Medication cannot make people happy. (Well at least not the legal drugs, and the illegal ones won't work long term!) They can only create the possibility for happiness for those who need some extra help. There are phase 3 randomized controlled trials that prove differently.
- KerryJones 8y ago
  And they are? Your statement is completely anecdotal and carries no weight without the references.
  - JamesBarney 8y ago
    Here is one trial there are 100's of others on the same website. https://clinicaltrials.gov/ct2/show/results/NCT01441440 https://clinicaltrials.gov/ct2/show/results/NCT01441440 P.S. My statement wasn't an anecdote.(I think you're using that word incorrectly)
    - com2kid 8y ago
      The outcome measures for that study are all related to decrease of depressive symptoms, they are not measuring increase in happiness. (Also no one is taking effexor to get high!) An SNRI isn't going to make people feel happy or joyous. It may lift the fog of depression and allow one to feel happiness, but it doesn't create it on its own. Joy in a pill, without long term side effects, doesn't yet exist.
      - YjSe2GMQ 8y ago
        > It may lift the fog of depression and allow one to feel happiness. Well if removing pain isn't happiness. It was for me. At least I don't think any more of how killing yourself is only a problem because of the people that will stay alive and suffer because of your suicide.
    - KerryJones 8y ago
      Anecdotal: "(of an account) not necessarily true or reliable, because based on personal accounts rather than facts or research" My comment was "without references...", ie. facts or research, it would make it anecdotal. As others commented, "lack of depressive symptoms" is very different from happiness. That's what "numbness" is.
plutonorm 8y ago
I'll just leave this here. https://en.m.wikipedia.org/wiki/Positive_disintegration https://en.m.wikipedia.org/wiki/Positive_disintegration

nerdponx 8y ago

Psychiatry should not be front-line treatment for most people. End of story.

com2kid 8y ago
For most people, psychiatry is overkill, sure sure. But heck, look at the diagnostic criteria for Bi-Polar, > The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. That line about "marked impairment in occupational functioning" is a common theme in the DSM. (Hypomania has a lower threshhold, but still involves risk to self) If someone is able to live their life, hold down a job, isn't a risk to themselves / others, then they should be directed to a psychologist or therapist. Bloody hell, the DSM says this, again and again and again. In the must be met criteria for ADHD: > There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning. Major depressive disorder, again, with this requirement: > Cause significant distress or severely impact social, occupational or other important life areas The diagnostic criteria is pretty on point. But even so, misdiagnosis is possible. If someone comes in and says that they hate their job and their spouse is abusive, the correct solution is a lawyer / career training (probably in that order?), not a pill! If someone comes in and says "my life has no meaning", maybe it isn't anhedonia, maybe the activities in their life legitimately aren't of interest to them! We all feel social pressure to fit in with the culture we grow up with. The great thing about America is, if we don't fit in with that culture, plenty of other culture's abound! But first people have to realize that they can leave the culture they are familiar with if it isn't bringing them happiness. We all know that one engineer who decided to be become a brick layer, and who is now super happy! Heck one of my friends and old co-workers went from being a preacher to coder! We all need to realize that laying bricks is just as fulfilling and meaningful as writing code[1] and not being judgmental about people's choice to leave one career behind and go into another. My masseuse used to be in the corporate world. One of the best Chocolatiers[2] alive used to work at Microsoft. Parents, if you kids aren't happy living the upper class lifestyle that you dreamed of when you were working your way up the ladder, then support them doing something else! Tell them that they don't have to live up to your dreams, or fit into the societal image of perfection created by the culture one is surrounded by. [1] Possibly more so, the bricks are going to outlive 99.9% of code that is ever written, and will likely be appreciated by far more people. [2] I've traveled to quite a few countries and found her equal, but none that surpass. http://bruggechocolates.com/ http://bruggechocolates.com/
- SketchySeaBeast 8y ago
  The definitions can be more easily met when you consider "Cause significant distress" or "reduce the quality of, social, school, or work functioning" - that's much larger, and people can be visibly firing on all cylinders, but if they report reduced quality or distress, then it meets those criteria.
  - com2kid 8y ago
    But as the article made clear, the drugs were reducing her performance at school! This is one area where I think the ADHD community has pulled ahead, good doctors will, when someone starts a new treatment, do weekly check-ins[1] with how one's quality of life is going across multiple metrics. Mood, self image, social life, and work/school performance. The fact this isn't done for all forms of psychiatric treatment is shocking and sad. From a non-medical perspective, Cognitive Behavioral Therapy is good in that it tries to help people find fulfillment, or at least come to peace with themself. [1] Proper ADHD treatment is supposed to be provided by a psychiatrist and psychologist working in tandem and communicating with each other. Unfortunately the % of times this is actually done is most certainly way under 1%. Not even going to get into the insurance issues around this...
    - SketchySeaBeast 8y ago
      > But as the article made clear, the drugs were reducing her performance at school! She was by no means stable before the medication. In fact - Bipolar, if the hypomanic/manic states hit at the right time, could be a huge help with school. I'm not saying it's in any way right, I'm saying there are broad criteria for getting on medication, and there's no DSM criteria for when she should be coming off.
- GuB-42 8y ago
  The article mentions talking about wanting to die, cutting oneself with razor blades, drinking through the night and doing cocaine. And that's before treatment, so it is not at fault. That's not something to take lightly, especially combined together. Also, that story somehow reminds me of someone I know who really is bipolar, she looked somewhat normal until she went completely bonkers, burning down most of her stuff at home, etc... It is serious. She now takes mood stabilizers (lithium) and lives a healthy life. So don't dismiss psychiatry.
sixo 8y ago
I think a decent cutoff for when to defer to medication is when the problem becomes self-sustaining. E.g. you get anxiety about your anxiety, or your mania leads to disastrous actions that can't be emotionally handled in a normal state, or your depression causes you to fail at goals in a way that contributes to your depression. At those points the cycle is the problem and needs to be broken.
beenBoutIT 8y ago
It should be a last resort for people who have been thoroughly screened by MDs and neurologists. According to sleep experts at Stanford at least 25% of people with ADHD/ADD are narcoleptics who've been misdiagnosed. That's a shitload of people who are currently living suboptimal lives because they went to a psychiatrist prior to being evaluated by a neurologist.
- penagwin 8y ago
  Might not be the best example, as narcolepsy is usually treated with stimulants and antidepressants, so adding say ritalin may still improve symptoms regardless of if it's actual ADD/ADHD or narcolepsy
  - beenBoutIT 8y ago
    In this case psychiatry covers up the symptoms with stimulants (that further degrade sleep) while neurology can effectively fix the bad sleep. Psychiatry provides a poorly fitting bandage while neurology has something on par with a cure. There's no better example that I'm aware of.
- Gibbon1 8y ago
  A good example is everyone I know with hypothyroidism, five out of five were put on a variety of psychiatric drugs for years before being properly diagnosed. Frankly I think MD's shouldn't be allowed to prescribe psychiatric drugs period.
  - nerdponx 8y ago
    How about my friend, whose "bipolar" disappeared when they got a positive test result for celiac and stopped eating gluten? Or myself for that matter, whose problems with sleep, gait, muscle weakness, mood instability, and difficulty paying attention all more or less evaporated when I went gluten free after my own celiac diagnosis? These weren't quack diagnoses either. We both saw traditional gastroenterologists, in different states, several years apart, both of us seeking treatment for different things. My diagnosis was confirmed with blood and endoscopy, as well as a follow-up DNA test to make sure I had the right mutation that makes it possible for celiac to arise.

stronglikedan 8y ago

> Medication cannot make people happy. But it can allow one to find happiness. Depression is a chemical imbalance, and not everyone can overcome it on their own - especially if left untreated for extended lengths of time. The medicine helps people get back into balance, so they can start to work on their happiness again, whatever that may be.

com2kid 8y ago
Literally the next sentence I wrote: > They can only create the possibility for happiness for those who need some extra help.
- stronglikedan 8y ago
  Literally what I expounded upon.
  - bongo662 8y ago
    Literally
  - com2kid 8y ago
    True, apologizes for the rudeness on my part.
Gibbon1 8y ago
> Depression is a chemical imbalance That is literally drug company marketing propaganda.
- pbhjpbhj 8y ago
  So, human bodies are perfectly self-regulating in brain chemistry?
  - Gibbon1 8y ago
    Define 'brain chemistry'

JamesBarney 8y ago

> Medication cannot make people happy. (Well at least not the legal drugs, and the illegal ones won't work long term!) They can only create the possibility for happiness for those who need some extra help. There are phase 3 randomized controlled trials that prove differently.

KerryJones 8y ago
And they are? Your statement is completely anecdotal and carries no weight without the references.
- JamesBarney 8y ago
  Here is one trial there are 100's of others on the same website. https://clinicaltrials.gov/ct2/show/results/NCT01441440 https://clinicaltrials.gov/ct2/show/results/NCT01441440 P.S. My statement wasn't an anecdote.(I think you're using that word incorrectly)
  - com2kid 8y ago
    The outcome measures for that study are all related to decrease of depressive symptoms, they are not measuring increase in happiness. (Also no one is taking effexor to get high!) An SNRI isn't going to make people feel happy or joyous. It may lift the fog of depression and allow one to feel happiness, but it doesn't create it on its own. Joy in a pill, without long term side effects, doesn't yet exist.
    - YjSe2GMQ 8y ago
      > It may lift the fog of depression and allow one to feel happiness. Well if removing pain isn't happiness. It was for me. At least I don't think any more of how killing yourself is only a problem because of the people that will stay alive and suffer because of your suicide.
  - KerryJones 8y ago
    Anecdotal: "(of an account) not necessarily true or reliable, because based on personal accounts rather than facts or research" My comment was "without references...", ie. facts or research, it would make it anecdotal. As others commented, "lack of depressive symptoms" is very different from happiness. That's what "numbness" is.

plutonorm 8y ago

I'll just leave this here. https://en.m.wikipedia.org/wiki/Positive_disintegration https://en.m.wikipedia.org/wiki/Positive_disintegration