4 ms·

It's the same deal for troublesome kids. For the old folks, why not morphine or heroin? That, I've heard, is at least pleasant. As long as the supply is assure

It's the same deal for troublesome kids. For the old folks, why not morphine or heroin? That, I've heard, is at least pleasant. As long as the supply is assured, anyway. Anti-psychotics aren't so much fun. And if that seems outrageous, please say why.

mayank 7y ago
How about dignity and care instead?
- mirimir 7y ago
  That should go without saying, as I see it. But the problem is that people with dementia can hurt themselves and each other.
- glangdale 7y ago
  Because people can't afford dignity and care, for the most part? It sounds good, but if you've ever cared for a severely demented person who can no longer safely walk, you will have to make the choice between (a) strapping someone to a bed or (b) paying for 24/7 care (or, to some pro-rated amount, giving up your own time) to ensure that they don't get up, fall, and break something.
  - mirimir 7y ago
    I do agree. I've been there, with an aged relative who lived with us. And my wife and I are headed there, with no kids. Me, I will die before going to a nursing home. And neither my wife nor I have life insurance, so suicide isn't problematic.
cookiecaper 7y ago
We're in a huge pickle in general because every simple, effective drug gets blacklisted pretty quickly, because people realize there's a simple, effective option for treatment that doesn't make them dependent on our horrifically broken medical system and start buying it without funneling through the racket. This upsets the racketeers and they work to clamp down on it. In the rare case where a simple, effective drug gets into medical practice, it magically ends up becoming "not recommended" about 20 years after it hits the market when the pharmaceutical company's patent runs out. MAOIs work much better for depression than SSRIs, for example, yet the clock runs down, a few widely-publicized cases of serotonin syndrome caused by careless ER doctors hit the press, and suddenly anyone prescribing those drugs comes under scrutiny, and we all need to switch to the newly-patented option.
- ghostbrainalpha 7y ago
  Maybe this is pessimistic but I think a lot of the reason for the switch from MAOIs to SSRIs comes from people not wanting to gain weight. SSRIs tend not to have that side effect and less side effects in general, even though they are definitely less effective.
  - InitialLastName 7y ago
    From my experience with loved ones' struggles with medicating mental illness, much of the difficulty is in finding a treatment regimen that's both effective enough to function normally and minimizes side effects. If SSRI's work well enough for some chunk of the depressed population and have fewer side effects than the alternatives, why would "lets try that first" be a pessimistic outcome?
    - cookiecaper 7y ago
      Because "fewer side effects" is such a massive overgeneralization that it's meaningless. Side effects are different for each drug and there's no reason to assume the patient would prefer the side effects of an ineffective SSRI to an effective MAOI right out of the gate. Additionally, each doctor wants you to try the less-effective drug for months at a time, each revision in the medication requires an expensive and time-consuming follow-up appointment at which point the doctor won't remember anything about you anyway, and SSRIs have their own non-trivial side effect profiles and withdrawal symptoms. It's just not as simple as -- or at least shouldn't be as simple as -- "oh, this one has fewer side effects!" It's especially bad in the case of SSRIs, because to switch from an SSRI to an MAOI or vice-versa, you have to "wash out" (that is, go unmedicated) for at least two weeks, during which time the person is unlikely to be functional regardless of their natural chemistry because they'll be withdrawing from the old medication.
- nradov 7y ago
  That's not how the process works. MAOIs may work better than SSRIs for some depressed patients, but certainly not everyone. Depression isn't a single disease; it has multiple causes and treatments. MAOIs have several serious side effects beyond just withdrawal syndrome so they shouldn't be prescribed lightly. But they absolutely are still prescribed when appropriate if safer treatments aren't effective.

mayank 7y ago

How about dignity and care instead?

mirimir 7y ago
That should go without saying, as I see it. But the problem is that people with dementia can hurt themselves and each other.
glangdale 7y ago
Because people can't afford dignity and care, for the most part? It sounds good, but if you've ever cared for a severely demented person who can no longer safely walk, you will have to make the choice between (a) strapping someone to a bed or (b) paying for 24/7 care (or, to some pro-rated amount, giving up your own time) to ensure that they don't get up, fall, and break something.
- mirimir 7y ago
  I do agree. I've been there, with an aged relative who lived with us. And my wife and I are headed there, with no kids. Me, I will die before going to a nursing home. And neither my wife nor I have life insurance, so suicide isn't problematic.

cookiecaper 7y ago

We're in a huge pickle in general because every simple, effective drug gets blacklisted pretty quickly, because people realize there's a simple, effective option for treatment that doesn't make them dependent on our horrifically broken medical system and start buying it without funneling through the racket. This upsets the racketeers and they work to clamp down on it. In the rare case where a simple, effective drug gets into medical practice, it magically ends up becoming "not recommended" about 20 years after it hits the market when the pharmaceutical company's patent runs out. MAOIs work much better for depression than SSRIs, for example, yet the clock runs down, a few widely-publicized cases of serotonin syndrome caused by careless ER doctors hit the press, and suddenly anyone prescribing those drugs comes under scrutiny, and we all need to switch to the newly-patented option.

ghostbrainalpha 7y ago
Maybe this is pessimistic but I think a lot of the reason for the switch from MAOIs to SSRIs comes from people not wanting to gain weight. SSRIs tend not to have that side effect and less side effects in general, even though they are definitely less effective.
- InitialLastName 7y ago
  From my experience with loved ones' struggles with medicating mental illness, much of the difficulty is in finding a treatment regimen that's both effective enough to function normally and minimizes side effects. If SSRI's work well enough for some chunk of the depressed population and have fewer side effects than the alternatives, why would "lets try that first" be a pessimistic outcome?
  - cookiecaper 7y ago
    Because "fewer side effects" is such a massive overgeneralization that it's meaningless. Side effects are different for each drug and there's no reason to assume the patient would prefer the side effects of an ineffective SSRI to an effective MAOI right out of the gate. Additionally, each doctor wants you to try the less-effective drug for months at a time, each revision in the medication requires an expensive and time-consuming follow-up appointment at which point the doctor won't remember anything about you anyway, and SSRIs have their own non-trivial side effect profiles and withdrawal symptoms. It's just not as simple as -- or at least shouldn't be as simple as -- "oh, this one has fewer side effects!" It's especially bad in the case of SSRIs, because to switch from an SSRI to an MAOI or vice-versa, you have to "wash out" (that is, go unmedicated) for at least two weeks, during which time the person is unlikely to be functional regardless of their natural chemistry because they'll be withdrawing from the old medication.
nradov 7y ago
That's not how the process works. MAOIs may work better than SSRIs for some depressed patients, but certainly not everyone. Depression isn't a single disease; it has multiple causes and treatments. MAOIs have several serious side effects beyond just withdrawal syndrome so they shouldn't be prescribed lightly. But they absolutely are still prescribed when appropriate if safer treatments aren't effective.