6 ms·

I'd say that it is one of progress, but one in which outdated or poor practices overshadow that progress.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

I'd say that it is one of progress, but one in which outdated or poor practices overshadow that progress.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.
- nvrspyx 6y ago
  > 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. I should have expanded on that particular point. It's widely understood in the research side that medicine should be a back up, but the practicing side of psychiatry is often completely detached from the current research, so it takes far too long for the body of knowledge to propagate into the practicing side. The impact of research on application is a far cry from where it should. > 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? The safety of TMS has been studied for a few decades now and its safety (and efficacy) is also being further understood with scanning someone with fMRI while simultaneously stimulating with TMS, which is pretty difficult since you're blasting a magnetic pulse at the same time that you're imaging using magnetism. As with most medical interventions, there is a risk. More specifically, there are two primary risks: triggering a seizure from an epileptic patient by using too high of a pulse near the motor cortex or exacerbating a patient's current hypomanic/manic symptoms. It's much less invasive and much safer than things like ECT and DBS. Once again, this is a last resort and used for people things like treatment-resistant depression or PTSD. It's used after trying multiple medications, not because it's riskier, but rather because its effects tend to be acute in lasting anywhere from a few months to a few days after a session. > 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. I agree that this where a lot of work needs to be done. In my opinion and in terms of widespread issues like depression and anxiety, psychiatric treatment should sought or referred after clinical psychologists have exhausted most or all of their options and should be taking on the brunt of those problems, not social workers and counselors. Too much rides on the latter's shoulders due to the barriers a lot of people face getting access to effective mental health professionals like clinical psychologists and psychiatrists. It doesn't help that a lot of general physicians will try to play the role of psychiatrist as well.
konjin 6y ago
>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. The problem is that when I was a teenager I could walk into any psychiatrists office and leave with whatever drug I had decided I wanted to get high off for that weekend. I memorized a list of symptoms, said I had them to a GP, got a referral to a specialist and repeated them there again. If I started on Monday I could get a prescription by Thursday. Having talked to "problem" kids of friends it that's still the case today. I never took the field seriously, and until I became an adult didn't realize anyone else did either. I just thought of them as legal drug dealers with good quality product, but not as fun as the unregulated product you could get on the street. Imagine my surprise when I found out people actually took prescriptions for decades at a time, something that is as horrifying to me as drinking yourself to sleep every night because someone told you to.
- nvrspyx 6y ago
  I totally forgot to elaborate on that sentence. I meant to say that it's widely understood within the research community and recently graduated psychiatrists. There's still a lot of bad practice, outdated methodology, and general laissez-faire that the field is still shaking off. It's lingering way too long and dissemination of the up-to-date knowledge is much less effective within psychiatry than other areas. This may be due to it not being readily apparent that you're harming the patient compared to say cardiology, but I can't say for sure. The field of mental health is definitely in a sorry state today, at least in the US. A lot of progress is being made in terms of research and knowledge, but it's not as impactful on the practicing community as it should be.
- afarrell 6y ago
  So your problem with the field of psychiatry is that psychiatrists can be lied to and they don't put more effort into second-guessing their patients' experiences? ... ... I think you might just be blaming other people for your unethical behaviour as a teenager. https://slatestarcodex.com/2018/10/24/nominating-oneself-for-the-short-end-of-a-tradeoff/ https://slatestarcodex.com/2018/10/24/nominating-oneself-for...
jokowueu 6y ago
>ketamine loses antidepressant effects when opioid receptors are blocked with naltrexone). . That was a small trial and another trial showed opposite results such as this one https://pubmed.ncbi.nlm.nih.gov/30624551/ https://pubmed.ncbi.nlm.nih.gov/30624551/ More details here https://www.tandfonline.com/doi/full/10.1080/17460441.2020.1781812 https://www.tandfonline.com/doi/full/10.1080/17460441.2020.1... I believe more research is required for r-ketamine (arketamine) I wonder if it has effects on the opiod system also They also thought that the mtor pathway was necessary but trials with human subjects and rapamycin showed that it potentiated the AD effects in humans . Which is sad to hear because it was the basis to the creation of NV-5138 that's heading towards phase 2 soon . It could very well work because the mtor pathway Is complicit In mood disorders . Also advances towards TMS is very interesting check out stanford's SAINT TMS trial Currently what I'm interested in is vistagen's pipeline of drugs . It works unlike any thing else and also the various FAAH inhibitors

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.

nvrspyx 6y ago
> 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. I should have expanded on that particular point. It's widely understood in the research side that medicine should be a back up, but the practicing side of psychiatry is often completely detached from the current research, so it takes far too long for the body of knowledge to propagate into the practicing side. The impact of research on application is a far cry from where it should. > 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? The safety of TMS has been studied for a few decades now and its safety (and efficacy) is also being further understood with scanning someone with fMRI while simultaneously stimulating with TMS, which is pretty difficult since you're blasting a magnetic pulse at the same time that you're imaging using magnetism. As with most medical interventions, there is a risk. More specifically, there are two primary risks: triggering a seizure from an epileptic patient by using too high of a pulse near the motor cortex or exacerbating a patient's current hypomanic/manic symptoms. It's much less invasive and much safer than things like ECT and DBS. Once again, this is a last resort and used for people things like treatment-resistant depression or PTSD. It's used after trying multiple medications, not because it's riskier, but rather because its effects tend to be acute in lasting anywhere from a few months to a few days after a session. > 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. I agree that this where a lot of work needs to be done. In my opinion and in terms of widespread issues like depression and anxiety, psychiatric treatment should sought or referred after clinical psychologists have exhausted most or all of their options and should be taking on the brunt of those problems, not social workers and counselors. Too much rides on the latter's shoulders due to the barriers a lot of people face getting access to effective mental health professionals like clinical psychologists and psychiatrists. It doesn't help that a lot of general physicians will try to play the role of psychiatrist as well.

konjin 6y ago

>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. The problem is that when I was a teenager I could walk into any psychiatrists office and leave with whatever drug I had decided I wanted to get high off for that weekend. I memorized a list of symptoms, said I had them to a GP, got a referral to a specialist and repeated them there again. If I started on Monday I could get a prescription by Thursday. Having talked to "problem" kids of friends it that's still the case today. I never took the field seriously, and until I became an adult didn't realize anyone else did either. I just thought of them as legal drug dealers with good quality product, but not as fun as the unregulated product you could get on the street. Imagine my surprise when I found out people actually took prescriptions for decades at a time, something that is as horrifying to me as drinking yourself to sleep every night because someone told you to.

nvrspyx 6y ago
I totally forgot to elaborate on that sentence. I meant to say that it's widely understood within the research community and recently graduated psychiatrists. There's still a lot of bad practice, outdated methodology, and general laissez-faire that the field is still shaking off. It's lingering way too long and dissemination of the up-to-date knowledge is much less effective within psychiatry than other areas. This may be due to it not being readily apparent that you're harming the patient compared to say cardiology, but I can't say for sure. The field of mental health is definitely in a sorry state today, at least in the US. A lot of progress is being made in terms of research and knowledge, but it's not as impactful on the practicing community as it should be.
afarrell 6y ago
So your problem with the field of psychiatry is that psychiatrists can be lied to and they don't put more effort into second-guessing their patients' experiences? ... ... I think you might just be blaming other people for your unethical behaviour as a teenager. https://slatestarcodex.com/2018/10/24/nominating-oneself-for-the-short-end-of-a-tradeoff/ https://slatestarcodex.com/2018/10/24/nominating-oneself-for...

jokowueu 6y ago

>ketamine loses antidepressant effects when opioid receptors are blocked with naltrexone). . That was a small trial and another trial showed opposite results such as this one https://pubmed.ncbi.nlm.nih.gov/30624551/ https://pubmed.ncbi.nlm.nih.gov/30624551/ More details here https://www.tandfonline.com/doi/full/10.1080/17460441.2020.1781812 https://www.tandfonline.com/doi/full/10.1080/17460441.2020.1... I believe more research is required for r-ketamine (arketamine) I wonder if it has effects on the opiod system also They also thought that the mtor pathway was necessary but trials with human subjects and rapamycin showed that it potentiated the AD effects in humans . Which is sad to hear because it was the basis to the creation of NV-5138 that's heading towards phase 2 soon . It could very well work because the mtor pathway Is complicit In mood disorders . Also advances towards TMS is very interesting check out stanford's SAINT TMS trial Currently what I'm interested in is vistagen's pipeline of drugs . It works unlike any thing else and also the various FAAH inhibitors