4 ms·

What's the advantage of labelled baskets of symptoms vs treating symptoms from first principles? Honest question

tediousdemise 5y ago
Misdiagnosing bipolar disorder as a purely depressive disorder can have disastrous consequences, especially if prescribed antidepressants instead of mood stabilizers. [1] [1] https://www.webmd.com/bipolar-disorder/news/20100601/bipolar-disorder-misdiagnosed-as-depression https://www.webmd.com/bipolar-disorder/news/20100601/bipolar...
- captainredbeard 5y ago
  > disastrous consequences, especially if prescribed antidepressants Viewed differently, this speaks to the extreme dangers of psychiatric drugs. They should be a tool (vital!) of last resort but are often used as a frontline therapy.
  - tediousdemise 5y ago
    I agree. It should go without saying that you only get one brain. Fundamentally, anything that modulates the brain should be used with extreme caution. Although the brain is remarkably resilient, sometimes drug-induced changes or side effects can be permanent. For some, this may come as relief, yet for others, they may find that the solution was worse than the problem. As they say, caveat emptor.
- treeman79 5y ago
  Everything is depression. Had major brain fog problems. But was generally happy and good natured. Spent years seeking help, at every stage was told it was depression. Turned out it was a horrible disease that was slowing killing me. I imagine a lot of “depressed” people have an underlying chronic condition that isn’t being addressed.
  - anonymouse008 5y ago
    Mind sharing how one could go about testing for this condition? (This sounds a bit familiar)
    - treeman79 5y ago
      Genetic testing for clotting. Autoimmune work up. Spinal tap for pressure. Make a list every symptom, and what affects your symptoms. Take it to every kind of specialist. Then keep repeating. Take an advocate. I would explain stuff, could see they had mentally written me off. The wife would start bawling. This would wake them up, and they would dig further. A neuro-ophthalmologist was reading my list. Looked up and declared I had Sjogrens. He was right. Now he missed the clotting disorder. Then have a clot in your lungs. Then you get taken seriously. That’s when they found factor 5 Leiden. So between the two my body and mind were trashed.
      - spicybright 5y ago
        Crying wife is a good lifehack!
whalesalad 5y ago
I wish more people thought like this. Treating from first principles should be the way - but lately it is not.
bosie 5y ago
do you mind expanding on what 'treating symptoms from first principles' means? I have a hard time visualising how that works in medicine
- deleted 5y ago
  [deleted]
- ludamad 5y ago
  I guess first principles here just meant whatever you might do without the other symptoms in consideration
LatteLazy 5y ago
The theory has been that if you could find a single underlying cause, you could just treat that, and then all the symptoms would disappear in one go. This would also let you treat symptoms that can't be treated directly (you can tranquilise away anxiety, you can't do much about hearing voices). That theory has largely failed as we can't even really agree which groups of symptoms make which diseases. Hence the constant changes to systems like the DSM. Full disclosure, I may be bias and I'm also an example: I have Major Mood Disorder. I used to have Severe Clinical Depression. Before that, I had Treatment Resistant Depression. Before that it was just Clinical Monopolar Depression (It's still called monopolar sometimes to differentiate it from Bipolar). My symptoms haven't changed. Nor has the treatments offered. But in the last 10y we've repeatedly renamed, recategorised, reshuffled etc just common depression. God knows what it's like in more complex, less common symptom sets... The BBCs Life Scientific podcast discusses this very question in this episode if you're interested: https://www.bbc.co.uk/programmes/m000sj7c https://www.bbc.co.uk/programmes/m000sj7c The wider series is also very good imho.
- tediousdemise 5y ago
  It amazes me how complex the brain is. We are barely equipped with the tools to understand its complexity. An article I read earlier today on HN stated that the brain contains up to 11-dimensional neural networks. [1] I think we’ve been incredibly lucky to have the fields of psychology and psychiatry to fill the medical role, especially when the quantitative gaps in our understanding of the brain seem to be widening. [1] https://bigthink.com/paul-ratner/our-brains-think-in-11-dimensions-discover-scientists https://bigthink.com/paul-ratner/our-brains-think-in-11-dime...
- hpoe 5y ago
  This kind of constant relabeling and recategorizing along with everyone I know who works in mental health fields constantly diagnosing everyone around them is why I am skeptical of the entire field of psychology/psychiatry.
  - tediousdemise 5y ago
    Look at it this way. Turbulence is an observable phenomenon that you may have experienced while riding an airplane. Modern fluid dynamics cannot adequately explain turbulence. Richard Feynman has described turbulence as the most important unsolved problem in classical physics.[1] We don’t dismiss fluid dynamics because turbulence is ill-defined, and we also don’t deny that turbulence exists just because we lack a thorough mathematical understanding of it. This is analogous to psychology/psychiatry and mental illnesses. If we had magical brain oscilloscopes that we could hook up to visualize every mental disorder, we’d use them. Until those exist, we must rely on qualitative and statistical approaches to provide treatment. [1] https://en.wikipedia.org/wiki/Turbulence https://en.wikipedia.org/wiki/Turbulence
cpach 5y ago
Good question. A unipolar depression is very different from a bipolar depression in many regards. E.g. likeliness to eat less vs. likeliness to eat more. And a unipolar depression can possibly be treated and then be gone. (If the treatment works out.) If one has bipolar disorder, it won’t go away. One has to live with it the the whole life.

Misdiagnosing bipolar disorder as a purely depressive disorder can have disastrous consequences, especially if prescribed antidepressants instead of mood stabilizers. [1] [1] https://www.webmd.com/bipolar-disorder/news/20100601/bipolar-disorder-misdiagnosed-as-depression https://www.webmd.com/bipolar-disorder/news/20100601/bipolar...

captainredbeard 5y ago
> disastrous consequences, especially if prescribed antidepressants Viewed differently, this speaks to the extreme dangers of psychiatric drugs. They should be a tool (vital!) of last resort but are often used as a frontline therapy.
- tediousdemise 5y ago
  I agree. It should go without saying that you only get one brain. Fundamentally, anything that modulates the brain should be used with extreme caution. Although the brain is remarkably resilient, sometimes drug-induced changes or side effects can be permanent. For some, this may come as relief, yet for others, they may find that the solution was worse than the problem. As they say, caveat emptor.
treeman79 5y ago
Everything is depression. Had major brain fog problems. But was generally happy and good natured. Spent years seeking help, at every stage was told it was depression. Turned out it was a horrible disease that was slowing killing me. I imagine a lot of “depressed” people have an underlying chronic condition that isn’t being addressed.
- anonymouse008 5y ago
  Mind sharing how one could go about testing for this condition? (This sounds a bit familiar)
  - treeman79 5y ago
    Genetic testing for clotting. Autoimmune work up. Spinal tap for pressure. Make a list every symptom, and what affects your symptoms. Take it to every kind of specialist. Then keep repeating. Take an advocate. I would explain stuff, could see they had mentally written me off. The wife would start bawling. This would wake them up, and they would dig further. A neuro-ophthalmologist was reading my list. Looked up and declared I had Sjogrens. He was right. Now he missed the clotting disorder. Then have a clot in your lungs. Then you get taken seriously. That’s when they found factor 5 Leiden. So between the two my body and mind were trashed.
    - spicybright 5y ago
      Crying wife is a good lifehack!

whalesalad 5y ago

I wish more people thought like this. Treating from first principles should be the way - but lately it is not.

bosie 5y ago

do you mind expanding on what 'treating symptoms from first principles' means? I have a hard time visualising how that works in medicine

deleted 5y ago
[deleted]
ludamad 5y ago
I guess first principles here just meant whatever you might do without the other symptoms in consideration

LatteLazy 5y ago

The theory has been that if you could find a single underlying cause, you could just treat that, and then all the symptoms would disappear in one go. This would also let you treat symptoms that can't be treated directly (you can tranquilise away anxiety, you can't do much about hearing voices). That theory has largely failed as we can't even really agree which groups of symptoms make which diseases. Hence the constant changes to systems like the DSM. Full disclosure, I may be bias and I'm also an example: I have Major Mood Disorder. I used to have Severe Clinical Depression. Before that, I had Treatment Resistant Depression. Before that it was just Clinical Monopolar Depression (It's still called monopolar sometimes to differentiate it from Bipolar). My symptoms haven't changed. Nor has the treatments offered. But in the last 10y we've repeatedly renamed, recategorised, reshuffled etc just common depression. God knows what it's like in more complex, less common symptom sets... The BBCs Life Scientific podcast discusses this very question in this episode if you're interested: https://www.bbc.co.uk/programmes/m000sj7c https://www.bbc.co.uk/programmes/m000sj7c The wider series is also very good imho.

tediousdemise 5y ago
It amazes me how complex the brain is. We are barely equipped with the tools to understand its complexity. An article I read earlier today on HN stated that the brain contains up to 11-dimensional neural networks. [1] I think we’ve been incredibly lucky to have the fields of psychology and psychiatry to fill the medical role, especially when the quantitative gaps in our understanding of the brain seem to be widening. [1] https://bigthink.com/paul-ratner/our-brains-think-in-11-dimensions-discover-scientists https://bigthink.com/paul-ratner/our-brains-think-in-11-dime...
hpoe 5y ago
This kind of constant relabeling and recategorizing along with everyone I know who works in mental health fields constantly diagnosing everyone around them is why I am skeptical of the entire field of psychology/psychiatry.
- tediousdemise 5y ago
  Look at it this way. Turbulence is an observable phenomenon that you may have experienced while riding an airplane. Modern fluid dynamics cannot adequately explain turbulence. Richard Feynman has described turbulence as the most important unsolved problem in classical physics.[1] We don’t dismiss fluid dynamics because turbulence is ill-defined, and we also don’t deny that turbulence exists just because we lack a thorough mathematical understanding of it. This is analogous to psychology/psychiatry and mental illnesses. If we had magical brain oscilloscopes that we could hook up to visualize every mental disorder, we’d use them. Until those exist, we must rely on qualitative and statistical approaches to provide treatment. [1] https://en.wikipedia.org/wiki/Turbulence https://en.wikipedia.org/wiki/Turbulence

cpach 5y ago

Good question. A unipolar depression is very different from a bipolar depression in many regards. E.g. likeliness to eat less vs. likeliness to eat more. And a unipolar depression can possibly be treated and then be gone. (If the treatment works out.) If one has bipolar disorder, it won’t go away. One has to live with it the the whole life.