6 ms·

Is the history of psychiatry one of progress? Or is it one of damage and partial repair? I very well might not be alive if not for my SSRI prescription, but the

Is the history of psychiatry one of progress? Or is it one of damage and partial repair? I very well might not be alive if not for my SSRI prescription, but the side effects are brutal and lasting, and as a first-line treatment for kids too young to drive it really leaves a ton to be desired.

pyentropy 6y ago
I'm really angry at Pfizer and co for ditching MAOIs for SSRIs. All research shows that they are much more effective, have no emotional blunting effect and have less impact on libido, at the cost of not being allowed to eat cheese and some insomnia. SlateStarCodex wrote about it in his prescription perversity post. [1] [1] https://slatestarcodex.com/2015/04/30/prescriptions-paradoxes-and-perversities/ https://slatestarcodex.com/2015/04/30/prescriptions-paradoxe...
- cmehdy 6y ago
  I remember being told to watch out for side effects when switching from an SSRI (Trintellix) to a RIMA (Manerix), which is essentially a de-fanged MAOI. Younger psychiatrist kept pushing for the brand-new SSRI, I kept pushing back. Never mentioned anything else despite my attempts to open the discussion, and my own research (and in fact, experience thanks to darknet markets) over years. Eventually "agreed to disagree" (I hate this expression), I moved on from that place where I was stagnating in pain, and found a sensible knowledgeable psychiatrist who happens to be much older, and we made the switch. It's hard to understate how much of a change that was in my life. I try not to be bitter about any fresh new psychiatry grad on the block, but I really hope they get their shit together as a collective and observe what their own patients (and their older peers) seem to know better than them. No matter how much tyramine I ingest (which is supposed to be a no-no on MAOI/RIMA) the worst side effects I suffer can't even get anywhere near what the SSRI would TYPICALLY do to me. On Trintellix: morning headaches, being unable to have any caffeine, becoming lactose intolerant, frequent cramps and diarrhea. Depression very very mildly alleviated. Transition period when stopping the meds: 2 weeks. Cost of monthly refill: $110 CAD. On Manerix: some cramps if I ingest gigantic amounts of tyramine (I'm french, I'm talking cured meats+cheese plates and red wine bottles in the same meal). Could be back to coffee and milk with no headaches nor cramps within a couple weeks. Depression mostly alleviated. Transition period when stopping the meds: 2-4 days. Cost of monthly refill: $30 CAD. Oh and the kicker? Manerix is actually one of the few antidepressants that actually has a chance to "increase libido" as a side effect! I'm glad someone wrote a good article on what I've been hoping to articulate in different places over time, thanks for the share.
374yruruuru 6y ago
This seems like an arbitrary and unhelpful distinction to make. Better medicine can be made later, all that new medicine has to be in the present is better than what was previously available.
nvrspyx 6y ago
I'd say that it is one of progress, but one in which outdated or poor practices overshadow that progress. I can't speak of the prevalence of such practices, but rather I mean the result of mistreatment is apparent and rapid while relative success is subtle and gradual. It's generally understood that medication should be used as a backup after CBT or other forms of therapy and if you do need medication, it should be concurrent with that therapy. Psychiatric pharmacology is more complex and opaque than others, but there is progress being made on that front as well. The more apparent progression being made is in understanding the neural mechanisms for these disorders and thus, determining alternative methods of treatment as a result, such as transcranial magnetic stimulation targeting individualized neural correlates (e.g. stimulating areas near the surface of the brain that have functional connectivity with deeper parts of the brain to activate/inhibit areas like DLPFC) and discovering relationships between certain mechanisms and certain disorders to investigate other pharmacological avenues (e.g. ketamine loses antidepressant effects when opioid receptors are blocked with naltrexone). Another issue is that this progress in research takes awhile before you see results in practice and much longer for it to disseminate through the whole psychiatric community.
- Mirioron 6y ago
  >It's generally understood that medication should be used as a backup after CBT or other forms of therapy and if you do need medication, it should be concurrent with that therapy You say that, but from my experience medication is the first line treatment. Often there isn't even any other type of treatment that comes with it. You just try a whole bunch of different ones and hope for the best. >The more apparent progression being made is in understanding the neural mechanisms for these disorders and thus, determining alternative methods of treatment as a result, such as transcranial magnetic stimulation targeting individualized neural correlates Considering what happened the last time psychiatrists fiddled with people's brains I find it fascinating that anyone is willing to try this. Lobotomies were done for years by actual physicians, yet it was pretty much the worst possible horror show imaginable. Did they get it right this time? I think the greatest problem with it is its adjacency to psychology and patient care. It removes some of the rigor from the treatment that the patient gets, because most of the time the patient is not interacting with doctors or even nurses. It'll be social workers of some form that may or may not have some training in trying to help people with mental health issues.
walrus01 6y ago
> I very well might not be alive if not for my SSRI prescription, but the side effects are brutal and lasting The history of legal psychoactive medications is littered with dubious and ethically questionable choices. Here's some 1950s era psychiatric medication advertisements targeted at doctors: https://www.pinterest.ca/epomanic/psychiatric-ads/ https://www.pinterest.ca/epomanic/psychiatric-ads/
- konjin 6y ago
  The ones with women are jarring. I wonder if future generations will see how we treat children the same way. >Simone doesn't want to cook breakfast for her husband, a lobotomy and Thorazine fixed her right up. >Little Timmy doesn't want to do homework for his parents, Adderall and gender reassignment fixed her right up.
mahathu 6y ago
Let's not get ahead of ourselves here -- antidepressants don't really have an effect. If a person was feeling suicidal before, they would certainly not stop feeling this way after taking SSRIs. Symptoms of depression is our psyche showing us that something going on in our lives is not going well, and using drugs to suppress these feelings is the worst thing I can think of that modern medicine came up with.
- throw149102 6y ago
  My understanding of the research is that, compared to a placebo, antidepressants help as much as 20% more of the population (20% -> 40%), and the broader scope of drugs can help around 30% to 40%[1] of people. People routinely feel suicidal, take SSRIs, and later stop feeling suicidal. [1] https://youtu.be/NOAgplgTxfc?t=2294 https://youtu.be/NOAgplgTxfc?t=2294
- jhanschoo 6y ago
  As someone who has taken SSRIs they usually do have effects. You can take them as a healthy person and they also have usually effects. There is more diversity to people and their thoughts than your simple philosophy suggests; people may suffer from mental illnesses for no apparent reason, like how people may suffer from poor health in the same environment as a healthy person. And with antidepressants on a person with a condition stemming from a poor lifestyle, the effects can be what makes the difference that helps them transition to a more sustainable lifestyle. Ignorant, grandiose claims like these really don't help people suffering from mental illnesses.

pyentropy 6y ago

I'm really angry at Pfizer and co for ditching MAOIs for SSRIs. All research shows that they are much more effective, have no emotional blunting effect and have less impact on libido, at the cost of not being allowed to eat cheese and some insomnia. SlateStarCodex wrote about it in his prescription perversity post. [1] [1] https://slatestarcodex.com/2015/04/30/prescriptions-paradoxes-and-perversities/ https://slatestarcodex.com/2015/04/30/prescriptions-paradoxe...

cmehdy 6y ago
I remember being told to watch out for side effects when switching from an SSRI (Trintellix) to a RIMA (Manerix), which is essentially a de-fanged MAOI. Younger psychiatrist kept pushing for the brand-new SSRI, I kept pushing back. Never mentioned anything else despite my attempts to open the discussion, and my own research (and in fact, experience thanks to darknet markets) over years. Eventually "agreed to disagree" (I hate this expression), I moved on from that place where I was stagnating in pain, and found a sensible knowledgeable psychiatrist who happens to be much older, and we made the switch. It's hard to understate how much of a change that was in my life. I try not to be bitter about any fresh new psychiatry grad on the block, but I really hope they get their shit together as a collective and observe what their own patients (and their older peers) seem to know better than them. No matter how much tyramine I ingest (which is supposed to be a no-no on MAOI/RIMA) the worst side effects I suffer can't even get anywhere near what the SSRI would TYPICALLY do to me. On Trintellix: morning headaches, being unable to have any caffeine, becoming lactose intolerant, frequent cramps and diarrhea. Depression very very mildly alleviated. Transition period when stopping the meds: 2 weeks. Cost of monthly refill: $110 CAD. On Manerix: some cramps if I ingest gigantic amounts of tyramine (I'm french, I'm talking cured meats+cheese plates and red wine bottles in the same meal). Could be back to coffee and milk with no headaches nor cramps within a couple weeks. Depression mostly alleviated. Transition period when stopping the meds: 2-4 days. Cost of monthly refill: $30 CAD. Oh and the kicker? Manerix is actually one of the few antidepressants that actually has a chance to "increase libido" as a side effect! I'm glad someone wrote a good article on what I've been hoping to articulate in different places over time, thanks for the share.

374yruruuru 6y ago

This seems like an arbitrary and unhelpful distinction to make. Better medicine can be made later, all that new medicine has to be in the present is better than what was previously available.

nvrspyx 6y ago

I'd say that it is one of progress, but one in which outdated or poor practices overshadow that progress. I can't speak of the prevalence of such practices, but rather I mean the result of mistreatment is apparent and rapid while relative success is subtle and gradual. It's generally understood that medication should be used as a backup after CBT or other forms of therapy and if you do need medication, it should be concurrent with that therapy. Psychiatric pharmacology is more complex and opaque than others, but there is progress being made on that front as well. The more apparent progression being made is in understanding the neural mechanisms for these disorders and thus, determining alternative methods of treatment as a result, such as transcranial magnetic stimulation targeting individualized neural correlates (e.g. stimulating areas near the surface of the brain that have functional connectivity with deeper parts of the brain to activate/inhibit areas like DLPFC) and discovering relationships between certain mechanisms and certain disorders to investigate other pharmacological avenues (e.g. ketamine loses antidepressant effects when opioid receptors are blocked with naltrexone). Another issue is that this progress in research takes awhile before you see results in practice and much longer for it to disseminate through the whole psychiatric community.

Mirioron 6y ago
>It's generally understood that medication should be used as a backup after CBT or other forms of therapy and if you do need medication, it should be concurrent with that therapy You say that, but from my experience medication is the first line treatment. Often there isn't even any other type of treatment that comes with it. You just try a whole bunch of different ones and hope for the best. >The more apparent progression being made is in understanding the neural mechanisms for these disorders and thus, determining alternative methods of treatment as a result, such as transcranial magnetic stimulation targeting individualized neural correlates Considering what happened the last time psychiatrists fiddled with people's brains I find it fascinating that anyone is willing to try this. Lobotomies were done for years by actual physicians, yet it was pretty much the worst possible horror show imaginable. Did they get it right this time? I think the greatest problem with it is its adjacency to psychology and patient care. It removes some of the rigor from the treatment that the patient gets, because most of the time the patient is not interacting with doctors or even nurses. It'll be social workers of some form that may or may not have some training in trying to help people with mental health issues.

walrus01 6y ago

> I very well might not be alive if not for my SSRI prescription, but the side effects are brutal and lasting The history of legal psychoactive medications is littered with dubious and ethically questionable choices. Here's some 1950s era psychiatric medication advertisements targeted at doctors: https://www.pinterest.ca/epomanic/psychiatric-ads/ https://www.pinterest.ca/epomanic/psychiatric-ads/

konjin 6y ago
The ones with women are jarring. I wonder if future generations will see how we treat children the same way. >Simone doesn't want to cook breakfast for her husband, a lobotomy and Thorazine fixed her right up. >Little Timmy doesn't want to do homework for his parents, Adderall and gender reassignment fixed her right up.

mahathu 6y ago

Let's not get ahead of ourselves here -- antidepressants don't really have an effect. If a person was feeling suicidal before, they would certainly not stop feeling this way after taking SSRIs. Symptoms of depression is our psyche showing us that something going on in our lives is not going well, and using drugs to suppress these feelings is the worst thing I can think of that modern medicine came up with.

throw149102 6y ago
My understanding of the research is that, compared to a placebo, antidepressants help as much as 20% more of the population (20% -> 40%), and the broader scope of drugs can help around 30% to 40%[1] of people. People routinely feel suicidal, take SSRIs, and later stop feeling suicidal. [1] https://youtu.be/NOAgplgTxfc?t=2294 https://youtu.be/NOAgplgTxfc?t=2294
jhanschoo 6y ago
As someone who has taken SSRIs they usually do have effects. You can take them as a healthy person and they also have usually effects. There is more diversity to people and their thoughts than your simple philosophy suggests; people may suffer from mental illnesses for no apparent reason, like how people may suffer from poor health in the same environment as a healthy person. And with antidepressants on a person with a condition stemming from a poor lifestyle, the effects can be what makes the difference that helps them transition to a more sustainable lifestyle. Ignorant, grandiose claims like these really don't help people suffering from mental illnesses.