6 ms·

Has the Drug-Based Approach to Mental Illness Failed?

25 points by keiferski 5y ago

yung_steezy 5y ago
This is a really old debate in psychiatry. My father studied it in the 70s and said that the establishment of his day were suspicious of all medications and all the academic literature suggested drugs should only be used as a last resort. There was apparently a lot of animosity between the pro and anti-medication faction. Since then the pendulum has swung the other way and the pro-medication camp are now the establishment. The truth is probably somewhere in the middle but for better or worse academic literature always takes a thesis/antithesis approac.
- deleted 5y ago
  [deleted]
- kongolongo 5y ago
  A major reason for the rise of the medication side is because for many acute mental health episodes medicines, like lithium for example, are extremely effective at treating the episode. Even the most anti medication psychiatrist must acknowledge that for a lot of acute mental conditions, the evidence is overwhelmingly in support of medication even if we don't understand very well their mechanisms of action. The interesting push back that is happening against medication I think is because for more chronic and long term mental health conditions, the medications we have aren't as clearly effective for everyone and as a result of their chronic nature, the types of evidence we can collect and analyze will be further limited.
Aerroon 5y ago
The problem is that drugs are seen as a political issue. For some reason, other people think that it is their business what you put into your body, even when it's medicine. A side effect of this is that you get doctors that "don't believe in X illness" or "don't believe in treating X with medication Y". As a result lots of people are going to get inadequate treatment for their problems. When you read forums discussing ADHD you'll find plenty of stories where people were unable to get medication, because they had to change doctors and the new doctor was unwilling to prescribe it.[0][1] Many of those people will likely have their lives fall apart following that. Discouraging drug based treatments further is likely going to cause more situations like this. I think what would really help is if mental illness treatment became more specialized. You'd go to a doctor that really knows the illness you're dealing with. [0] https://www.reddit.com/r/ADHD/comments/antrln/doctor_refuses_to_continue_my_treatment_plan/ https://www.reddit.com/r/ADHD/comments/antrln/doctor_refuses... [1] https://www.reddit.com/r/ADHD/comments/lb5gq3/psychiatrist_wont_treat_me/ https://www.reddit.com/r/ADHD/comments/lb5gq3/psychiatrist_w...
- bwestergard 5y ago
  "For some reason, other people think that it is their business what you put into your body, even when it's medicine." Let's say we had a legal regime in which you could go to a pharmacy with a prescription your wrote yourself and get it filled. Opioids, stimulants, cannabis, ketamine, whatever. Wouldn't you still advise a friend that they should find a credentialed doctor and ask them to write a prescription before taking some of the more powerful substances? It's important to be able to get the advice of an expert, particularly when that advice goes against your intuitions.
  - Scoundreller 5y ago
    Issue is that your pharmacy is pretty much standardized. Walk into 100 pharmacies and ask for the same thing and you’ll walk out with the same thing from each one. Same inputs = same outputs. Credentialed doctors are all over the place. Go see 100 psychiatrists with the same issue and you’ll get as many treatments.
    - netizen-936824 5y ago
      This is because there is a disconnect between medication and our understanding of the underlying mechanisms driving mental health issues
  - Aerroon 5y ago
    I think that this a bit of a separate topic. I wasn't advocating for making all drugs freely available, but rather wanted to caution that there are already plenty of doctors who try to not prescribe drugs based on some moral feelings (or fear). However, on this topic I do think that there should be fewer restrictions on what you can buy. I have asthma. I would like to have an emergency inhaler for those rare situations where I have trouble breathing properly. But I can't have one, because asthma medications are prescription only here and I do not have health insurance. I am uncertain whether it's worth spending the likely €100-200 it would cost out of pocket to see the doctors and do the tests to get the prescription. So I make do with caffeine, wet blankets and sleeping upright on the rare occasion that I have a problem. I can afford the medicine, but the mandatory doctors visits are too much. As I said though, this is a bit of a different issue.
okareaman 5y ago
My bipolar disorder is managed quite nicely with a low dose of Quetiapine. It's been a life saver. Some people really have a problem with psychiatry and psychiatric meds. The following claim is suspect. > the pharmaceutical industry, has inflicted iatrogenic harm on millions of people What is verifiably true is psychiatric medications have helped millions of people. But you can't tell that to people who have an agenda against psychiatry and psychiatric meds.
- harvey9 5y ago
  I have permanent tinnitus as a side effect of taking a psych drug for 6 months a few years ago. On the other hand I might not have survived at all without the drug.
  - denhaus 5y ago
    how bad is your tinnitus?
  - puddingforears 5y ago
    I’m really happy you found something that worked. I’m sorry it still had a cost. My tinnitus started from having had to be on a high dose of a medication for a short term. This side effect I deal with now is far better than the alternative, and I don’t imagine I would be here to complain otherwise. The other side effects sucked as well, but same. I get pretty steamed when people try to blanket-statement their personal experience or lack thereof onto these deeply personal trade offs and issues and try to invalidate what does or does not work for the sake of sounding smart. Fuck those people.
  - egberts 5y ago
    Lost my hearing totally within 2 hours of taking Zyban. Tinnitus is all that I hear nowadays.
    - mickelsen 5y ago
      Chiming in late here, also had tinnitus with Bupropion, which remained for months even after I stopped taking it. Lowered my job performance because of it, never had any prior or posterior issues with other amphetamine-like medication (ritalin & vyvanse). I found relief in corticosteroids (combined pill of betametasone + chlorphenamine), which made the tinnitus disappear in a week. Now if it comes back it's very minor and I can ignore it, or go through a short course of medication again to make it go away for a couple of weeks. Oh, and keep out of some noise cancelling headphones, they make it worse for some reason.
Jerrrry 5y ago
Since I was 13, I was told it was a chemical imbalance, and that chemistry was to blame. I was lucky enough to live in the brief epoch where any substance can be delivered to any door, for a reasonable price. Having worked my way through the Erowid vault, through all the domains of types of drugs, it wasn't until external life changes outside of neurochemistry that the chemistry was "balanced" It wasn't internal chemistry that was at fault, but external social interactions, richer than what 3-MEO-PCP, 4-ACO-DMT, 25i/b/c, ketamine, or MDMA/MDA/MXE could achieve in isolation. We aren't just biological computers in a vat, we are social animals. Drugs have different interactions with people based on expectations, which is cultural. Sometimes it's not the drugs, it's the circumstances. We didn't evolve to stare, eat, and be entertained from a series of ever-rounding rectangles.
- netizen-936824 5y ago
  Correction: we are social biological computers
wydfre 5y ago
I used to take olanzapine religiously at 25 mg for Schizophrenia. I did exactly what the doctors asked because I wanted to be a good person and not the stereotypical person who doesn’t take their drugs. In my opinion drugs and therapy are useless. If they were actually rational pills everyone would be taking them recreationally. Antipsychotics are simply sedatives in my opinion. The idea of talking to a patient about their delusions is stupid to a degree I cannot comprehend. Therapists should instead say “You are full of nonsense, listen to Classical and read 2 Chapters of War and Peace for next time”. The goal of this beneficial technique is the same as brainwashing - to replace part of the brain, except in this case with a concrete and rational reality. If I could have a do-over, I would have gotten a dog instead of taking those pills. There is only one reality, as Murakami once wrote.

25 points by keiferski 5y ago

This is a really old debate in psychiatry. My father studied it in the 70s and said that the establishment of his day were suspicious of all medications and all the academic literature suggested drugs should only be used as a last resort. There was apparently a lot of animosity between the pro and anti-medication faction. Since then the pendulum has swung the other way and the pro-medication camp are now the establishment. The truth is probably somewhere in the middle but for better or worse academic literature always takes a thesis/antithesis approac.

deleted 5y ago
[deleted]
kongolongo 5y ago
A major reason for the rise of the medication side is because for many acute mental health episodes medicines, like lithium for example, are extremely effective at treating the episode. Even the most anti medication psychiatrist must acknowledge that for a lot of acute mental conditions, the evidence is overwhelmingly in support of medication even if we don't understand very well their mechanisms of action. The interesting push back that is happening against medication I think is because for more chronic and long term mental health conditions, the medications we have aren't as clearly effective for everyone and as a result of their chronic nature, the types of evidence we can collect and analyze will be further limited.

Aerroon 5y ago

The problem is that drugs are seen as a political issue. For some reason, other people think that it is their business what you put into your body, even when it's medicine. A side effect of this is that you get doctors that "don't believe in X illness" or "don't believe in treating X with medication Y". As a result lots of people are going to get inadequate treatment for their problems. When you read forums discussing ADHD you'll find plenty of stories where people were unable to get medication, because they had to change doctors and the new doctor was unwilling to prescribe it.[0][1] Many of those people will likely have their lives fall apart following that. Discouraging drug based treatments further is likely going to cause more situations like this. I think what would really help is if mental illness treatment became more specialized. You'd go to a doctor that really knows the illness you're dealing with. [0] https://www.reddit.com/r/ADHD/comments/antrln/doctor_refuses_to_continue_my_treatment_plan/ https://www.reddit.com/r/ADHD/comments/antrln/doctor_refuses... [1] https://www.reddit.com/r/ADHD/comments/lb5gq3/psychiatrist_wont_treat_me/ https://www.reddit.com/r/ADHD/comments/lb5gq3/psychiatrist_w...

bwestergard 5y ago
"For some reason, other people think that it is their business what you put into your body, even when it's medicine." Let's say we had a legal regime in which you could go to a pharmacy with a prescription your wrote yourself and get it filled. Opioids, stimulants, cannabis, ketamine, whatever. Wouldn't you still advise a friend that they should find a credentialed doctor and ask them to write a prescription before taking some of the more powerful substances? It's important to be able to get the advice of an expert, particularly when that advice goes against your intuitions.
- Scoundreller 5y ago
  Issue is that your pharmacy is pretty much standardized. Walk into 100 pharmacies and ask for the same thing and you’ll walk out with the same thing from each one. Same inputs = same outputs. Credentialed doctors are all over the place. Go see 100 psychiatrists with the same issue and you’ll get as many treatments.
  - netizen-936824 5y ago
    This is because there is a disconnect between medication and our understanding of the underlying mechanisms driving mental health issues
- Aerroon 5y ago
  I think that this a bit of a separate topic. I wasn't advocating for making all drugs freely available, but rather wanted to caution that there are already plenty of doctors who try to not prescribe drugs based on some moral feelings (or fear). However, on this topic I do think that there should be fewer restrictions on what you can buy. I have asthma. I would like to have an emergency inhaler for those rare situations where I have trouble breathing properly. But I can't have one, because asthma medications are prescription only here and I do not have health insurance. I am uncertain whether it's worth spending the likely €100-200 it would cost out of pocket to see the doctors and do the tests to get the prescription. So I make do with caffeine, wet blankets and sleeping upright on the rare occasion that I have a problem. I can afford the medicine, but the mandatory doctors visits are too much. As I said though, this is a bit of a different issue.

okareaman 5y ago

My bipolar disorder is managed quite nicely with a low dose of Quetiapine. It's been a life saver. Some people really have a problem with psychiatry and psychiatric meds. The following claim is suspect. > the pharmaceutical industry, has inflicted iatrogenic harm on millions of people What is verifiably true is psychiatric medications have helped millions of people. But you can't tell that to people who have an agenda against psychiatry and psychiatric meds.

harvey9 5y ago
I have permanent tinnitus as a side effect of taking a psych drug for 6 months a few years ago. On the other hand I might not have survived at all without the drug.
- denhaus 5y ago
  how bad is your tinnitus?
- puddingforears 5y ago
  I’m really happy you found something that worked. I’m sorry it still had a cost. My tinnitus started from having had to be on a high dose of a medication for a short term. This side effect I deal with now is far better than the alternative, and I don’t imagine I would be here to complain otherwise. The other side effects sucked as well, but same. I get pretty steamed when people try to blanket-statement their personal experience or lack thereof onto these deeply personal trade offs and issues and try to invalidate what does or does not work for the sake of sounding smart. Fuck those people.
- egberts 5y ago
  Lost my hearing totally within 2 hours of taking Zyban. Tinnitus is all that I hear nowadays.
  - mickelsen 5y ago
    Chiming in late here, also had tinnitus with Bupropion, which remained for months even after I stopped taking it. Lowered my job performance because of it, never had any prior or posterior issues with other amphetamine-like medication (ritalin & vyvanse). I found relief in corticosteroids (combined pill of betametasone + chlorphenamine), which made the tinnitus disappear in a week. Now if it comes back it's very minor and I can ignore it, or go through a short course of medication again to make it go away for a couple of weeks. Oh, and keep out of some noise cancelling headphones, they make it worse for some reason.

Jerrrry 5y ago

Since I was 13, I was told it was a chemical imbalance, and that chemistry was to blame. I was lucky enough to live in the brief epoch where any substance can be delivered to any door, for a reasonable price. Having worked my way through the Erowid vault, through all the domains of types of drugs, it wasn't until external life changes outside of neurochemistry that the chemistry was "balanced" It wasn't internal chemistry that was at fault, but external social interactions, richer than what 3-MEO-PCP, 4-ACO-DMT, 25i/b/c, ketamine, or MDMA/MDA/MXE could achieve in isolation. We aren't just biological computers in a vat, we are social animals. Drugs have different interactions with people based on expectations, which is cultural. Sometimes it's not the drugs, it's the circumstances. We didn't evolve to stare, eat, and be entertained from a series of ever-rounding rectangles.

netizen-936824 5y ago
Correction: we are social biological computers

wydfre 5y ago

I used to take olanzapine religiously at 25 mg for Schizophrenia. I did exactly what the doctors asked because I wanted to be a good person and not the stereotypical person who doesn’t take their drugs. In my opinion drugs and therapy are useless. If they were actually rational pills everyone would be taking them recreationally. Antipsychotics are simply sedatives in my opinion. The idea of talking to a patient about their delusions is stupid to a degree I cannot comprehend. Therapists should instead say “You are full of nonsense, listen to Classical and read 2 Chapters of War and Peace for next time”. The goal of this beneficial technique is the same as brainwashing - to replace part of the brain, except in this case with a concrete and rational reality. If I could have a do-over, I would have gotten a dog instead of taking those pills. There is only one reality, as Murakami once wrote.