6 ms·

If you take an anti-depressant pill everyday and it solves your problem, why is that bad? Are you hostile to medication in general?

dTal 6y ago
Daily medication, which must be taken without fail in order to have a normal life, is a liability. It can be lost, stolen, or missed. It must be obtained on a regular basis, and carried around on trips. It can be expensive. It can stop working, from tolerance. It can have unpleasant side effects. A one-time, permanent cure is clearly superior. And your closing sentence was unnecessarily combative.
- deathgrips 6y ago
  >Daily medication, which must be taken without fail in order to have a normal life, is a liability. It can be lost, stolen, or missed. It must be obtained on a regular basis, and carried around on trips. I doubt these are a real problem for people who have a modicum of conscientiousness. >A one-time, permanent cure is clearly superior If you think that big bad pharma companies are keeping people from taking one-time cures for depression, by all means come up with a one-time cure on your own. How do you think one pill can create a permanent structural change in the brain that makes the just-so changes necessary to cure depression forever?
  - kranner 6y ago
    > I doubt these are a real problem for people who have a modicum of conscientiousness. What does conscientiousness have to do with it? You might need to travel or transit through a country which prohibits carrying them. Now you have to cancel the trip or go without the medicine. > by all means come up with a one-time cure on your own This is not helpful. People have the right to ask questions without being asked to devote a lifetime to develop some arbitrary authority (which would then in any case bias them to look for positive results).
    - joeberon 6y ago
      Are there any examples of medication other than ADHD medication that are have such restrictions in certain countries?
      - kranner 6y ago
        Opioid-based painkillers for sure, sleeping pills, apparently even decongestants like Sudafed because they contain pseudoephedrine.
      - GordonS 6y ago
        Yes. You need to get permission to take a vast number of medications into UAE, including opioids and even common antidepressants. I went through this process before COVID, with the intention of travelling to Dubai, and they knocked back my request about 10 times for spurious reasons, and were adament that I couldn't enter Dubai with a single pill more than was required for the duration of my time in Dubai. Which of course is completely unrealistic - I'd need some for travelling back, and a small buffer because of flight delays or whatever. Honestly, travelling with certain medications is a major PITA.
    - throwaway0a5e 6y ago
      > Now you have to cancel the trip or go without the medicine. International travel is a minuscule thing to give up if you get effective depression (or pretty much any chronic condition) treatment in exchange. Heck most people can't justify the expense of international travel in the first place and the number of people who do it regularly for work and have depression is very small compared to the number of people who have depression. Practically nobody is going to let a chronic condition that affects their daily life go untreated because there's a short list of countries they can't have that treatment in.
      - dTal 6y ago
        What exactly are you arguing? That people should be happy with the flaws of the status quo, and that we should not follow up on promising new treatments that don't have those flaws, because...?
  - PoachedSausage 6y ago
    >modicum of conscientiousness. Is that common in people suffering from mental ill health?
  - dTal 6y ago
    > How do you think one pill can create a permanent structural change in the brain that makes the just-so changes necessary to cure depression forever? From the article: "...clinical trials with psychedelic drugs suggest long-term anxiety relief in patients..." I'm not really sure what the context of your comments is, if you're not aware that this is what the entire thread is about.
  - harimau777 6y ago
    At least for controlled substances, it is definitely not that simple. Patients can run into situations where pharmacies refuse to tell them if they are able to fill a prescription until it is actually written for them. However, if they are not able to fill it, the doctor is hesitant to write a new prescription for a different pharmacy because it could look like they are writing the patient multiple prescriptions for the same drug.
  - bluntfang 6y ago
    >I doubt these are a real problem for people who have a modicum of conscientiousness. How insensitive of you.
  - klyrs 6y ago
    > I doubt these are a real problem for people who [have good mental health] Yeah. Funny thing about that. You're generally prescribed as low of a dose as is feasible, so by the time you're due to take your ADHD meds, antidepressants, antipsychotics, or whathaveyou, the last dose has worn off (especially first thing in the morning) and you're liable to miss a dose. So you get a pill minder, and fill it weekly, so at least you can check to make sure you don't forget and double-dose yourself. Chances are, you're taking several meds, so you have a highly detail-oriented chore you need to succeed at once a week on a specific day. If that's a bad day, you might not be able to muster the motivation and that throws off the whole week. Or you get most of the pills in but accidentally miss a day or a whole week's worth of a drug because you're juggling a handful of bottles and you're only human. Phone apps sound great, but depend on you being near your pills and your (charged) phone at a specific time of day, which has all sorts of failure modes. And then there's the uncontrollable shit. You pack for a trip out of town. You're only supposed to be gone for a week, so you diligently pack a week's meds. Your ride home flakes, flight gets cancelled or whatever, and suddenly you're S.O.L. Or, your bag gets rifled by luggage inspectors at the airport and they pocket the goods (I've lost a nice pocket knife that way), it's stolen by hotel cleaning staff, pickpockets, or whatever. Good luck getting your prescription filled in a different country. And once you miss a pill, you might hit a spiral that lasts a week or longer before you get back on track. It's a fucking liability.
  - at_a_remove 6y ago
    I found myself irritated enough to talk about conscientiousness. I have a permanent medical condition which calls for a somewhat antique medication. It is typically used "as needed," certainly not every day. I have had a regular prescription for over a decade and it has certainly improved my quality of life. I refill like clockwork, I am responsible about using it. It comes time for a refill and ... my pharmacist at Walgreens regrets to inform me that they cannot seem to get it, and that the manufacturer has stopped making it. This is worrisome. I remember life before the medication. I dig through the FDA databases, locating every organization which has applied to make the medication and been issued an NDC (National Drug Code) identifier. Each organization is tracked down: are they still in existence? Have they been bought out and if so, by what other company? I discover buyouts, shutdowns, press releases saying that they are "exiting" some market. I make phone calls, I send emails, and, when no other contact information is available, I send letters with self-addressed stamped envelopes. Almost everyone who has ever made it has stopped or been stopped in one fashion or another. Meanwhile, I begin to canvass the distributors: McKeeson, Cardinal, AmeriSourceBergen. Are there any remaining in stock? If so, which pharmacies in my area do they work with? Most pharmacies have a single distributor. These are organizations who do not like to be contacted by the hoi polloi, and I have quite a lot of "How did you get this number?" conversations. At last, a hit: someone has just started manufacturing it. Out of all of them, there's only one. I dutifully take this to Walgreens. After a few go-rounds, they cannot seem to get ahold of it. They suggest Walmart. I have to hassle my poor doctor's office, now in COVID-panic like everyone else, to move my script, which one required a special paper. Walmart swears they have it, they have contacted their distributor, they have bottles in stock. Wonderful. And it does not arrive, they call again, and it does not arrive, and they call again. Finally, they shrug and give up. Right! I call CVS; they are sure they can get it. I transfer the script, again. Off I go to CVS. CVS says that, yes, it is in stock at their distributor. Similar to Walmart, after a few weeks, they cannot get it. The pharmacist has called the corporate offices and only knows that there is a "corporate block" on it and that, despite being able to submit an order for a bottle of pills which are present at a distributor, they will never ever arrive. I am disappointed, and, out of a little curiosity, I submit a letter to CVS corporate (again with the self-addressed stamped envelope to remove barriers to reply) asking just what this block is ... not that I ever get a reply. I try a small, local shop. I wince at having to call my doctor to have the script transferred yet again. Surely they will try harder rather than giving me the brush-off you can so often get from large organizations. No dice. The dance is now familiar to me. Armed with yet more research and NDC codes and distributor phone numbers, I approach my original pharmacy again. Another script transfer, with all of the pain entertained in moving something with a low Schedule number around. With the new information I have gathered and a great deal of persistence, they manage to obtain it. The head pharmacist tells me that the sole other patient on it will be relieved, and that he has never had to work this hard to get a prescription before. By the end of this two month period, I had lost approximately twenty pounds and was clumsily knocking things over due to my coordination degrading. Finally, I managed to fall hard enough that I was still limping two months later. The moral of the story is this: being conscientious does not guarantee availability. One can do all of the right things and still not have it on hand. Being dependent on a medication, even weekly, can be a burden, even if you attend to the situation quite closely. I urge you not to be quite so flippant about it.
- luckylion 6y ago
  > A one-time, permanent cure is clearly superior. And your closing sentence was unnecessarily combative. So if we don't have a one-time, permanent cure, we shouldn't try to get a daily medication? Because ... why exactly?
- kortex 6y ago
  Psychedelic trips aren't a permanent cure for depression though. They have really good long-term effects on remission, but that still means nearly half won't remit. > At a follow-up appointment after three months, 5 out of 12 patients were still in remission and 7 out of 12 showed a continued response It often shines a light on the causes, but sometimes the causes are intractable/ongoing, or the only resolution is to learn to accept. [1] https://tidsskriftet.no/en/2018/11/oversiktsartikkel/psychedelic-drugs-treatment-anxiety-depression-and-addiction https://tidsskriftet.no/en/2018/11/oversiktsartikkel/psyched...
- PragmaticPulp 6y ago
  > A one-time, permanent cure is clearly superior. No research points to psychedelics being a one-time, permanent cure. That's an extreme misrepresentation of the science. In fact, the current psychedelic research revolves around a series of intense therapy sessions, a small number of which involve psychedelics. They aren't just giving people psychedelics to take at home and hoping for the best. And again, no serious researchers are suggesting that depression is cured permanently, let alone with a single ad-hoc dose. This should be common sense, as many people who used psychedelics recreationally still suffer from depression. Indeed, psychedelics can worsen depression for some people. Properly replicating these psychedelic-assisted therapy sequences is going to be expensive. I'm sure the vast majority of people would prefer a daily pill that has no cognitive distortions.
  - dTal 6y ago
    I never suggested that the dose be ad-hoc, nor implied that we should just give people psychedelics to take home and hope for the best. "One time cure" is indeed not accurate, today, but as a shorthand it captures the promise of psychedelic treatments. A single session can give benefits lasting many months, and some people may remit entirely. This is why more research is needed. >I'm sure the vast majority of people would prefer a daily pill that has no cognitive distortions. These don't exist. Existing psychological medication, not unsurprisingly, often comes with severe cognitive distortions - far worse than a single psychedelic trip every few months.
SuoDuanDao 6y ago
I would say if the symptoms reappear when you stop taking a medication, your problem isn't solved so much as the symptoms are being managed. Given that mood disorders can be due to some underlying conflict within the person's psyche, simply alleviating all negative symptoms seems at odds with the goal of getting as many people as possible to self-actualization.
- InfiniteRand 6y ago
  "Given that mood disorders can be due to some underlying conflict" - that is an interesting assumption. It is one of those things that is impossible to prove or disprove. My position is most complex organ systems have biological abnormalities that are prone to dysfunction, such as diabetes, albinoism, genetic predisposition to heart disease and cancers, I'm not sure why the brain would be different in that regard. Assuming there is an underlying conflict driving things, then medication might be simply masking the symptoms, which is a perfectly valid approach in dire situations, no use seeking out the underlying conflict if the symptoms kill you before you come to a conclusion. However, if there is no underlying conflict and this is just a twist of fate, searching for an underlying conflict can be aggravating and misleading. If waves of negative emotion occur randomly (or semi-randomly), as has been my experience, and you assume there is always some valid reason for these feelings, the tendency is to re-arrange your life searching for a solution, if that solution does not exist because there is no underlying problem, constant rearrangement can blow up your support system and the routines that help maintain your daily living.
  - SuoDuanDao 6y ago
    I did say 'can be'. The soldiers with PTSD whose depression has improved with small numbers of treatments did not simply suffer from a biological abnormality - their brains changed in response to stimulus, which is after all what we'd expect brains to do. I do think brains should be viewed as different from most organs when we describe medical intervention, they are plastic to a degree other organs are not. If a diabetic could simply 'mutate' their pancreas to function normally with a single intervention, I think most would prefer that to taking insulin all their lives, even if the one intervention was distressing. Brains actually can change in very dramatic ways. Most are for the worse of course, and we instinctively avoid any change in our mentality, but they are times when it is actually preferable.
new2628 6y ago
Most people I've met who solved their problem in this way seemed, as a side-effect, to have distorted their personalities in noticeable ways. (I am not claiming that this tradeoff is never worth it, but something rarely considered, and usually not noticed by the person taking the medication.) To be more specific in the kind of distortion I noticed: lack of empathy, shorter attention span, lowered curiosity.

dTal 6y ago

Daily medication, which must be taken without fail in order to have a normal life, is a liability. It can be lost, stolen, or missed. It must be obtained on a regular basis, and carried around on trips. It can be expensive. It can stop working, from tolerance. It can have unpleasant side effects. A one-time, permanent cure is clearly superior. And your closing sentence was unnecessarily combative.

deathgrips 6y ago
>Daily medication, which must be taken without fail in order to have a normal life, is a liability. It can be lost, stolen, or missed. It must be obtained on a regular basis, and carried around on trips. I doubt these are a real problem for people who have a modicum of conscientiousness. >A one-time, permanent cure is clearly superior If you think that big bad pharma companies are keeping people from taking one-time cures for depression, by all means come up with a one-time cure on your own. How do you think one pill can create a permanent structural change in the brain that makes the just-so changes necessary to cure depression forever?
- kranner 6y ago
  > I doubt these are a real problem for people who have a modicum of conscientiousness. What does conscientiousness have to do with it? You might need to travel or transit through a country which prohibits carrying them. Now you have to cancel the trip or go without the medicine. > by all means come up with a one-time cure on your own This is not helpful. People have the right to ask questions without being asked to devote a lifetime to develop some arbitrary authority (which would then in any case bias them to look for positive results).
  - joeberon 6y ago
    Are there any examples of medication other than ADHD medication that are have such restrictions in certain countries?
    - kranner 6y ago
      Opioid-based painkillers for sure, sleeping pills, apparently even decongestants like Sudafed because they contain pseudoephedrine.
    - GordonS 6y ago
      Yes. You need to get permission to take a vast number of medications into UAE, including opioids and even common antidepressants. I went through this process before COVID, with the intention of travelling to Dubai, and they knocked back my request about 10 times for spurious reasons, and were adament that I couldn't enter Dubai with a single pill more than was required for the duration of my time in Dubai. Which of course is completely unrealistic - I'd need some for travelling back, and a small buffer because of flight delays or whatever. Honestly, travelling with certain medications is a major PITA.
  - throwaway0a5e 6y ago
    > Now you have to cancel the trip or go without the medicine. International travel is a minuscule thing to give up if you get effective depression (or pretty much any chronic condition) treatment in exchange. Heck most people can't justify the expense of international travel in the first place and the number of people who do it regularly for work and have depression is very small compared to the number of people who have depression. Practically nobody is going to let a chronic condition that affects their daily life go untreated because there's a short list of countries they can't have that treatment in.
    - dTal 6y ago
      What exactly are you arguing? That people should be happy with the flaws of the status quo, and that we should not follow up on promising new treatments that don't have those flaws, because...?
- PoachedSausage 6y ago
  >modicum of conscientiousness. Is that common in people suffering from mental ill health?
- dTal 6y ago
  > How do you think one pill can create a permanent structural change in the brain that makes the just-so changes necessary to cure depression forever? From the article: "...clinical trials with psychedelic drugs suggest long-term anxiety relief in patients..." I'm not really sure what the context of your comments is, if you're not aware that this is what the entire thread is about.
- harimau777 6y ago
  At least for controlled substances, it is definitely not that simple. Patients can run into situations where pharmacies refuse to tell them if they are able to fill a prescription until it is actually written for them. However, if they are not able to fill it, the doctor is hesitant to write a new prescription for a different pharmacy because it could look like they are writing the patient multiple prescriptions for the same drug.
- bluntfang 6y ago
  >I doubt these are a real problem for people who have a modicum of conscientiousness. How insensitive of you.
- klyrs 6y ago
  > I doubt these are a real problem for people who [have good mental health] Yeah. Funny thing about that. You're generally prescribed as low of a dose as is feasible, so by the time you're due to take your ADHD meds, antidepressants, antipsychotics, or whathaveyou, the last dose has worn off (especially first thing in the morning) and you're liable to miss a dose. So you get a pill minder, and fill it weekly, so at least you can check to make sure you don't forget and double-dose yourself. Chances are, you're taking several meds, so you have a highly detail-oriented chore you need to succeed at once a week on a specific day. If that's a bad day, you might not be able to muster the motivation and that throws off the whole week. Or you get most of the pills in but accidentally miss a day or a whole week's worth of a drug because you're juggling a handful of bottles and you're only human. Phone apps sound great, but depend on you being near your pills and your (charged) phone at a specific time of day, which has all sorts of failure modes. And then there's the uncontrollable shit. You pack for a trip out of town. You're only supposed to be gone for a week, so you diligently pack a week's meds. Your ride home flakes, flight gets cancelled or whatever, and suddenly you're S.O.L. Or, your bag gets rifled by luggage inspectors at the airport and they pocket the goods (I've lost a nice pocket knife that way), it's stolen by hotel cleaning staff, pickpockets, or whatever. Good luck getting your prescription filled in a different country. And once you miss a pill, you might hit a spiral that lasts a week or longer before you get back on track. It's a fucking liability.
- at_a_remove 6y ago
  I found myself irritated enough to talk about conscientiousness. I have a permanent medical condition which calls for a somewhat antique medication. It is typically used "as needed," certainly not every day. I have had a regular prescription for over a decade and it has certainly improved my quality of life. I refill like clockwork, I am responsible about using it. It comes time for a refill and ... my pharmacist at Walgreens regrets to inform me that they cannot seem to get it, and that the manufacturer has stopped making it. This is worrisome. I remember life before the medication. I dig through the FDA databases, locating every organization which has applied to make the medication and been issued an NDC (National Drug Code) identifier. Each organization is tracked down: are they still in existence? Have they been bought out and if so, by what other company? I discover buyouts, shutdowns, press releases saying that they are "exiting" some market. I make phone calls, I send emails, and, when no other contact information is available, I send letters with self-addressed stamped envelopes. Almost everyone who has ever made it has stopped or been stopped in one fashion or another. Meanwhile, I begin to canvass the distributors: McKeeson, Cardinal, AmeriSourceBergen. Are there any remaining in stock? If so, which pharmacies in my area do they work with? Most pharmacies have a single distributor. These are organizations who do not like to be contacted by the hoi polloi, and I have quite a lot of "How did you get this number?" conversations. At last, a hit: someone has just started manufacturing it. Out of all of them, there's only one. I dutifully take this to Walgreens. After a few go-rounds, they cannot seem to get ahold of it. They suggest Walmart. I have to hassle my poor doctor's office, now in COVID-panic like everyone else, to move my script, which one required a special paper. Walmart swears they have it, they have contacted their distributor, they have bottles in stock. Wonderful. And it does not arrive, they call again, and it does not arrive, and they call again. Finally, they shrug and give up. Right! I call CVS; they are sure they can get it. I transfer the script, again. Off I go to CVS. CVS says that, yes, it is in stock at their distributor. Similar to Walmart, after a few weeks, they cannot get it. The pharmacist has called the corporate offices and only knows that there is a "corporate block" on it and that, despite being able to submit an order for a bottle of pills which are present at a distributor, they will never ever arrive. I am disappointed, and, out of a little curiosity, I submit a letter to CVS corporate (again with the self-addressed stamped envelope to remove barriers to reply) asking just what this block is ... not that I ever get a reply. I try a small, local shop. I wince at having to call my doctor to have the script transferred yet again. Surely they will try harder rather than giving me the brush-off you can so often get from large organizations. No dice. The dance is now familiar to me. Armed with yet more research and NDC codes and distributor phone numbers, I approach my original pharmacy again. Another script transfer, with all of the pain entertained in moving something with a low Schedule number around. With the new information I have gathered and a great deal of persistence, they manage to obtain it. The head pharmacist tells me that the sole other patient on it will be relieved, and that he has never had to work this hard to get a prescription before. By the end of this two month period, I had lost approximately twenty pounds and was clumsily knocking things over due to my coordination degrading. Finally, I managed to fall hard enough that I was still limping two months later. The moral of the story is this: being conscientious does not guarantee availability. One can do all of the right things and still not have it on hand. Being dependent on a medication, even weekly, can be a burden, even if you attend to the situation quite closely. I urge you not to be quite so flippant about it.
luckylion 6y ago
> A one-time, permanent cure is clearly superior. And your closing sentence was unnecessarily combative. So if we don't have a one-time, permanent cure, we shouldn't try to get a daily medication? Because ... why exactly?
kortex 6y ago
Psychedelic trips aren't a permanent cure for depression though. They have really good long-term effects on remission, but that still means nearly half won't remit. > At a follow-up appointment after three months, 5 out of 12 patients were still in remission and 7 out of 12 showed a continued response It often shines a light on the causes, but sometimes the causes are intractable/ongoing, or the only resolution is to learn to accept. [1] https://tidsskriftet.no/en/2018/11/oversiktsartikkel/psychedelic-drugs-treatment-anxiety-depression-and-addiction https://tidsskriftet.no/en/2018/11/oversiktsartikkel/psyched...
PragmaticPulp 6y ago
> A one-time, permanent cure is clearly superior. No research points to psychedelics being a one-time, permanent cure. That's an extreme misrepresentation of the science. In fact, the current psychedelic research revolves around a series of intense therapy sessions, a small number of which involve psychedelics. They aren't just giving people psychedelics to take at home and hoping for the best. And again, no serious researchers are suggesting that depression is cured permanently, let alone with a single ad-hoc dose. This should be common sense, as many people who used psychedelics recreationally still suffer from depression. Indeed, psychedelics can worsen depression for some people. Properly replicating these psychedelic-assisted therapy sequences is going to be expensive. I'm sure the vast majority of people would prefer a daily pill that has no cognitive distortions.
- dTal 6y ago
  I never suggested that the dose be ad-hoc, nor implied that we should just give people psychedelics to take home and hope for the best. "One time cure" is indeed not accurate, today, but as a shorthand it captures the promise of psychedelic treatments. A single session can give benefits lasting many months, and some people may remit entirely. This is why more research is needed. >I'm sure the vast majority of people would prefer a daily pill that has no cognitive distortions. These don't exist. Existing psychological medication, not unsurprisingly, often comes with severe cognitive distortions - far worse than a single psychedelic trip every few months.

SuoDuanDao 6y ago

I would say if the symptoms reappear when you stop taking a medication, your problem isn't solved so much as the symptoms are being managed. Given that mood disorders can be due to some underlying conflict within the person's psyche, simply alleviating all negative symptoms seems at odds with the goal of getting as many people as possible to self-actualization.

InfiniteRand 6y ago
"Given that mood disorders can be due to some underlying conflict" - that is an interesting assumption. It is one of those things that is impossible to prove or disprove. My position is most complex organ systems have biological abnormalities that are prone to dysfunction, such as diabetes, albinoism, genetic predisposition to heart disease and cancers, I'm not sure why the brain would be different in that regard. Assuming there is an underlying conflict driving things, then medication might be simply masking the symptoms, which is a perfectly valid approach in dire situations, no use seeking out the underlying conflict if the symptoms kill you before you come to a conclusion. However, if there is no underlying conflict and this is just a twist of fate, searching for an underlying conflict can be aggravating and misleading. If waves of negative emotion occur randomly (or semi-randomly), as has been my experience, and you assume there is always some valid reason for these feelings, the tendency is to re-arrange your life searching for a solution, if that solution does not exist because there is no underlying problem, constant rearrangement can blow up your support system and the routines that help maintain your daily living.
- SuoDuanDao 6y ago
  I did say 'can be'. The soldiers with PTSD whose depression has improved with small numbers of treatments did not simply suffer from a biological abnormality - their brains changed in response to stimulus, which is after all what we'd expect brains to do. I do think brains should be viewed as different from most organs when we describe medical intervention, they are plastic to a degree other organs are not. If a diabetic could simply 'mutate' their pancreas to function normally with a single intervention, I think most would prefer that to taking insulin all their lives, even if the one intervention was distressing. Brains actually can change in very dramatic ways. Most are for the worse of course, and we instinctively avoid any change in our mentality, but they are times when it is actually preferable.

new2628 6y ago

Most people I've met who solved their problem in this way seemed, as a side-effect, to have distorted their personalities in noticeable ways. (I am not claiming that this tradeoff is never worth it, but something rarely considered, and usually not noticed by the person taking the medication.) To be more specific in the kind of distortion I noticed: lack of empathy, shorter attention span, lowered curiosity.