6 ms·

The reality is many drugs have long term effects, we just can't see them yet. But if you are close to someone who is a user, over the long run you will notice d

The reality is many drugs have long term effects, we just can't see them yet. But if you are close to someone who is a user, over the long run you will notice differences. Sometimes its just that they don't have the same spark. Regardless, 100 years down the line we will look back in horror at the state of pharmaceutical drugs. All it takes is going to a doctor, saying you have anxiety, and the doctor pops out a script. His "medical degree" and insurance demands that he "treats" his patient.

ZanyProgrammer 4y ago
The reality is that many doctors these days will not prescribe large amounts of benzos, certainly not just willy nilly.
- ldjkfkdsjnv 4y ago
  I'm not just talking about benzos, but also anti psychotics, amphetamines, statins, and basically the whole gamut. My brother is a pharmacist, and is constantly shocked by the prescriptions that healthy people bring in to get filled. The medical field has been unjustly given too much prestige.
  - cstejerean 4y ago
    And how does he know they are healthy?
    - anonymoushn 4y ago
      maybe my pharmacist can tell that I don't need methylphenidate because I have all my documents in order while I'm already on methylphenidate :)
      - sascha_sl 4y ago
        "You can't have ADHD, if you had ADHD, you could not have driven here for an hour" -- real thing that happened to someone I know.
        throwaway284534 4y ago
        This is a exactly the kind of puritanical catch-22 that entrenches every corner ADHD treatment. “Oh, your justification for access to the high-inducing, party drug of amphetamine is that it’ll cure your lack of focus? Well, if these dangerously addictive drugs so effective, then surely you can handle 30 day prescriptions with no refills.” God forbid your prescription runs out on a weekend or holiday when your doctor’s office is closed. And don’t even think about shopping around for multiple scripts because that’ll just label you as a drug addict. The only winning move is to take half-doses on down days and build up a small stash of emergency medication.
        opportune 4y ago
        100% this. The worst part about ADHD treatment is all the disruptions of care to prevent people trying to abuse it. I personally don't give a rat's ass if people want to take adderall to go out and party or masturbate either. They'd probably have fun with less negative health effects or risk of fights/belligerence compared to alcohol... But for some reason the government (the FDA) and medical field in general cares about abuse a lot. In the past few weeks, Cerebral got labelled a pill mill by the FDA/execs and as a result almost all ADHD telemedicine patients are having a hard time getting prescriptions filled. Sending a prescription to multiple places sequentially (because they keep refusing to fill it) or calling a pharmacy in advance to ask if they'd fill the prescription runs the risk of being labelled a drug seeker, and any power-tripping retail pharmacist - who doesn't know anything about you at all - can just refuse to fill your prescription if they want. Asking your provider for a higher dose is also anxiety-inducing for similar reasons. The worst part is, people with ADHD still build a dependence/tolerance on amphetamines/methylphenidate. So running out of your medicine is really disruptive - not only do your symptoms go untreated, but they become worse than they'd be if you were unmedicated for a long interval, plus you have to deal with things like not feeling fully awake, being hungrier, lethargic, sleeping more while your body adjusts back to being unmedicated. But for some reason that's acceptable as long as we prevent people from taking amphetamines for fun.
  - cwzwarich 4y ago
    > My brother is a pharmacist, and is constantly shocked by the prescriptions that healthy people bring in to get filled. While I definitely agree with your general point, how does your brother know that they’re healthy or don’t need to take the medication? I’ve never had any discussion with a pharmacist (in the US or Canada) where I’ve revealed this information.
    - ldjkfkdsjnv 4y ago
      What I mean is a mother of 4, with no medical history, is feeling stressed and worn out. Maybe she has trouble focussing. All of a sudden she comes in with an amphetamine prescription. A year later, she's a full blown dependent on a serious drug. She was actually just burned out and probably just needed a break from her kids and a vacation. Very common. There's no transparency, no public understanding of doctors who are prescribing like this. It's only in a pharmacy do you get a birds eye view.
      - anonymoushn 4y ago
        I sort of expect that the psychiatrist spends more time with the patient each month than the pharmacist.
        rhexs 4y ago
        It's sort of a sad indictment of our system, but odds are the pharmacist sees the patient far more than the psychiatrist does.
        tptacek 4y ago
        I have literally never had a discussion with a pharmacist. I drive up, hand them my script through the drawer thingy, and they hand me back my drugs. In fact, in the last couple years, I barely even do that anymore; our doctors just call in our scripts, and we get a text message when it's time to pick them up, and that's that. The idea that pharmacists have any meaningful diagnostic role in the US is risible.
  - ZanyProgrammer 4y ago
    Your brother is not a clinician, definitely not those people's clinician.
  - anonymoushn 4y ago
    antipsychotics are horrifying. do therapeutic doses of stimulants cause problems other than heart disease over the long term?
    - aaaaaaaaaaab 4y ago
      No, long-term stimulant use is totally A-ok! /s
      - mtlmtlmtlmtl 4y ago
        Actually, at therapeutic doses, it is.
    - maleldil 4y ago
      Antipsychotics are terrifying, but I'd rather deal with the physical side-effects than the disorder, and they're pretty effective at treating that.
      - deleted 4y ago
        [deleted]
    - matheusmoreira 4y ago
      Depends on how you define "problem". Amphetamines may cause a lot of side effects: lower appetite, agitation, insomnia, irritability, bruxism... The list goes on. Whether these risks are acceptable or not is an individualized choice. Some side effects may even be beneficial: lower appetite for weight loss, insomnia for narcolepsy.
  - sascha_sl 4y ago
    If your brother told you that with this exact framing, he's in the wrong industry. Health, and especially not mental health is very much not visible or even obvious. Just ask any disabled person that is not bound to a wheelchair 100 percent of the time.
  - cycomanic 4y ago
    I believe blaming this on doctors only is way to easy. I believe many people demand medication when they go to the doctor. If they go because of a cold they don't accept being told to rest for a week, but demand antibiotics, if they feel depressed they don't want to be told to exercise, but want a quick medication etc.. I definitely see this since coming to Sweden, where it's difficult for doctors to prescribe antibiotics and lots of expats complain that they went to the doctor and were told to rest for a week. They feel they are not taken seriously if they don't get medication (that is not to say that there are no problems with how healthcare is done here, but restrictive prescriptions of antibiotics is not one of them).
    - hombre_fatal 4y ago
      I'm sure you can find examples of failings on all sides, but doctors are the ones that pull the trigger. When I got an amphetamine prescription in uni (like everyone else), I felt like I was lucky to have a doctor that started me off on the lowest dose. Everyone I knew was on a much higher dose than me just starting out. People would get a dual prescription of XR capsules + IR tabs when they need a bump. Then when they couldn't sleep, the doc would just add another pill to the mix. And not just a mild one, but an extreme one like Seroquel. Your doctor just isn't a specialist, and certainly not someone specializing in you and your specific ailments despite what we seem to pretend in these threads. Best strategy is to be informed and meet them in the middle.
  - opportune 4y ago
    If they're healthy, couldn't that be because of the medicine? A lot of people have conditions that medicine treats so well you wouldn't even know they had a condition at all. I know many people who have taken antipsychotics, amphetamines, and statins for decades and it was perfectly fine for them. I also personally know some judgmental pharmacists too. All I'll say is, there's a reason pharmacists and doctors are distinct professions.
    - matheusmoreira 4y ago
      > If they're healthy, couldn't that be because of the medicine? It's very likely. This actually has to be explained to a lot of people with chronic diseases like hypertension and type 2 diabetes. Way too many of them just stop taking their medication after their condition improves.
heavyset_go 4y ago
SSRI-like drugs and drugs like buspirone are considered the gold standard for anxiety disorders now. They do not act like benzodiazepines at all in the brain.
- swayvil 4y ago
  You are speaking beside his point.
- symlinkk 4y ago
  How do they act? I just started taking buspirone for crippling social anxiety and I’m not sure if it’s helping or not.
  - deleted 4y ago
    [deleted]
  - heavyset_go 4y ago
    SSRIs are speculated to work via activation and downregulation of certain serotonin receptors, in particular 5HT1A, an autoreceptor responsible for regulating release of other neurotransmitters in the brain. Buspirone acts directly on 5HT1A as an agonist, I believe, which is more direct than the shotgun approach of SSRIs. In theory, activation of 5HT1A and its downregulation can help with depression and anxiety. Buspirone also blocks some dopamine receptors, but not any that are associated with dopamine blockade from antipsychotics, so their serious dopamine-related side effects aren't something to worry about, but the blocking might also contribute to anxiolytic effects. Newer SSRI-like drugs that block the serotonin transporter and activate 5HT1A also exist, combining the actions of both drugs. It typically takes serotonin receptors about two weeks to downregulate, and possibly even months to see any effects on depression and anxiety. Buspirone is not like benzodiazepines that work pretty much instantly, but it doesn't come with any of the risks benzodiazepines do.
ZanyProgrammer 4y ago
You're taking a very specific article about benzos and making unsubstantiated leaps about medicine in general.
openknot 4y ago
>"But if you are close to someone who is a user, over the long run you will notice differences. Sometimes its just that they don't have the same spark." The loss of a spark can happen regardless of drug use. Work in an unsupportive environment over a long period of time, a breakup, or the failure to achieve a long-sought goal can cause a person to change over time. In addition, the underlying condition that the medication is treating may cause the effect, which could have been worse had the medication not been prescribed. It's plausible that medications may have understudied long-term effects, but there are too many confounding causes to attribute a behavioral change to long-term medication use.
- mikercampbell 4y ago
  As someone who has had a long time relationship with Xanax, it quite literally saved my life. I was prescribed it for chronic nausea, and was 40lbs below my ideal weight. I've never been tempted to take any more than my prescribed dose, and so it's been a "healthy" relationship, but I'm working to discontinue my prescription for reasons other than this article. Not to be one of those "well, I use it and I'm fine and aren't tempted", on the contrary - I understand fully why people would feel the tugs of addiction. It's hard because I know I have an uphill battle to go. I use therapy and have seen benefits from psychedelics and medicinal cannabis, but it's literally a "pick your poison" battle. But also, it's hard to have a spark when you're not able to live a normal life without assistance. But in hindsight, I can see that this route has had it's costs and I'm excited to see who I am independent of it.
wit22145 4y ago
> His "medical degree" and insurance demands that he "treats" his patient. Completely lost me here. Why does the doctor have air quotes around their medical degree? And what’s wrong with treating disease? Or are you saying insurance requires unnecessary prescriptions? Because that’s definitely not the case, insurance would prefer no prescriptions financially at least and the doc is paid the same either way. Overall I think you just have an axe to grind against medicine for some reason. It’s not a perfect system but I don’t think you really know what you’re talking about and are concerned with the wrong things.
matheusmoreira 4y ago
Benzodiazepines are not even first line treatments for anxiety though. More like a last resort. They are very useful in aborting panic attacks and that says a lot about the intensity of symptoms necessary to justify their use. SSRIs and SNRIs have a much better risk/benefit profile. Sertraline in particular is a really effective drug. I don't really understand why other doctors prescribe benzodiazepines so frequently but I'm not doing it.
jotm 4y ago
If you look closer at others, you'll notice they have a new spark. But "new medication" won't be your first thought.
bcook 4y ago
You've got a dangerous level of confidence.

ZanyProgrammer 4y ago

The reality is that many doctors these days will not prescribe large amounts of benzos, certainly not just willy nilly.

ldjkfkdsjnv 4y ago
I'm not just talking about benzos, but also anti psychotics, amphetamines, statins, and basically the whole gamut. My brother is a pharmacist, and is constantly shocked by the prescriptions that healthy people bring in to get filled. The medical field has been unjustly given too much prestige.
- cstejerean 4y ago
  And how does he know they are healthy?
  - anonymoushn 4y ago
    maybe my pharmacist can tell that I don't need methylphenidate because I have all my documents in order while I'm already on methylphenidate :)
    - sascha_sl 4y ago
      "You can't have ADHD, if you had ADHD, you could not have driven here for an hour" -- real thing that happened to someone I know.
      - throwaway284534 4y ago
        This is a exactly the kind of puritanical catch-22 that entrenches every corner ADHD treatment. “Oh, your justification for access to the high-inducing, party drug of amphetamine is that it’ll cure your lack of focus? Well, if these dangerously addictive drugs so effective, then surely you can handle 30 day prescriptions with no refills.” God forbid your prescription runs out on a weekend or holiday when your doctor’s office is closed. And don’t even think about shopping around for multiple scripts because that’ll just label you as a drug addict. The only winning move is to take half-doses on down days and build up a small stash of emergency medication.
        opportune 4y ago
        100% this. The worst part about ADHD treatment is all the disruptions of care to prevent people trying to abuse it. I personally don't give a rat's ass if people want to take adderall to go out and party or masturbate either. They'd probably have fun with less negative health effects or risk of fights/belligerence compared to alcohol... But for some reason the government (the FDA) and medical field in general cares about abuse a lot. In the past few weeks, Cerebral got labelled a pill mill by the FDA/execs and as a result almost all ADHD telemedicine patients are having a hard time getting prescriptions filled. Sending a prescription to multiple places sequentially (because they keep refusing to fill it) or calling a pharmacy in advance to ask if they'd fill the prescription runs the risk of being labelled a drug seeker, and any power-tripping retail pharmacist - who doesn't know anything about you at all - can just refuse to fill your prescription if they want. Asking your provider for a higher dose is also anxiety-inducing for similar reasons. The worst part is, people with ADHD still build a dependence/tolerance on amphetamines/methylphenidate. So running out of your medicine is really disruptive - not only do your symptoms go untreated, but they become worse than they'd be if you were unmedicated for a long interval, plus you have to deal with things like not feeling fully awake, being hungrier, lethargic, sleeping more while your body adjusts back to being unmedicated. But for some reason that's acceptable as long as we prevent people from taking amphetamines for fun.
- cwzwarich 4y ago
  > My brother is a pharmacist, and is constantly shocked by the prescriptions that healthy people bring in to get filled. While I definitely agree with your general point, how does your brother know that they’re healthy or don’t need to take the medication? I’ve never had any discussion with a pharmacist (in the US or Canada) where I’ve revealed this information.
  - ldjkfkdsjnv 4y ago
    What I mean is a mother of 4, with no medical history, is feeling stressed and worn out. Maybe she has trouble focussing. All of a sudden she comes in with an amphetamine prescription. A year later, she's a full blown dependent on a serious drug. She was actually just burned out and probably just needed a break from her kids and a vacation. Very common. There's no transparency, no public understanding of doctors who are prescribing like this. It's only in a pharmacy do you get a birds eye view.
    - anonymoushn 4y ago
      I sort of expect that the psychiatrist spends more time with the patient each month than the pharmacist.
      - rhexs 4y ago
        It's sort of a sad indictment of our system, but odds are the pharmacist sees the patient far more than the psychiatrist does.
        tptacek 4y ago
        I have literally never had a discussion with a pharmacist. I drive up, hand them my script through the drawer thingy, and they hand me back my drugs. In fact, in the last couple years, I barely even do that anymore; our doctors just call in our scripts, and we get a text message when it's time to pick them up, and that's that. The idea that pharmacists have any meaningful diagnostic role in the US is risible.
- ZanyProgrammer 4y ago
  Your brother is not a clinician, definitely not those people's clinician.
- anonymoushn 4y ago
  antipsychotics are horrifying. do therapeutic doses of stimulants cause problems other than heart disease over the long term?
  - aaaaaaaaaaab 4y ago
    No, long-term stimulant use is totally A-ok! /s
    - mtlmtlmtlmtl 4y ago
      Actually, at therapeutic doses, it is.
  - maleldil 4y ago
    Antipsychotics are terrifying, but I'd rather deal with the physical side-effects than the disorder, and they're pretty effective at treating that.
    - deleted 4y ago
      [deleted]
  - matheusmoreira 4y ago
    Depends on how you define "problem". Amphetamines may cause a lot of side effects: lower appetite, agitation, insomnia, irritability, bruxism... The list goes on. Whether these risks are acceptable or not is an individualized choice. Some side effects may even be beneficial: lower appetite for weight loss, insomnia for narcolepsy.
- sascha_sl 4y ago
  If your brother told you that with this exact framing, he's in the wrong industry. Health, and especially not mental health is very much not visible or even obvious. Just ask any disabled person that is not bound to a wheelchair 100 percent of the time.
- cycomanic 4y ago
  I believe blaming this on doctors only is way to easy. I believe many people demand medication when they go to the doctor. If they go because of a cold they don't accept being told to rest for a week, but demand antibiotics, if they feel depressed they don't want to be told to exercise, but want a quick medication etc.. I definitely see this since coming to Sweden, where it's difficult for doctors to prescribe antibiotics and lots of expats complain that they went to the doctor and were told to rest for a week. They feel they are not taken seriously if they don't get medication (that is not to say that there are no problems with how healthcare is done here, but restrictive prescriptions of antibiotics is not one of them).
  - hombre_fatal 4y ago
    I'm sure you can find examples of failings on all sides, but doctors are the ones that pull the trigger. When I got an amphetamine prescription in uni (like everyone else), I felt like I was lucky to have a doctor that started me off on the lowest dose. Everyone I knew was on a much higher dose than me just starting out. People would get a dual prescription of XR capsules + IR tabs when they need a bump. Then when they couldn't sleep, the doc would just add another pill to the mix. And not just a mild one, but an extreme one like Seroquel. Your doctor just isn't a specialist, and certainly not someone specializing in you and your specific ailments despite what we seem to pretend in these threads. Best strategy is to be informed and meet them in the middle.
- opportune 4y ago
  If they're healthy, couldn't that be because of the medicine? A lot of people have conditions that medicine treats so well you wouldn't even know they had a condition at all. I know many people who have taken antipsychotics, amphetamines, and statins for decades and it was perfectly fine for them. I also personally know some judgmental pharmacists too. All I'll say is, there's a reason pharmacists and doctors are distinct professions.
  - matheusmoreira 4y ago
    > If they're healthy, couldn't that be because of the medicine? It's very likely. This actually has to be explained to a lot of people with chronic diseases like hypertension and type 2 diabetes. Way too many of them just stop taking their medication after their condition improves.

heavyset_go 4y ago

SSRI-like drugs and drugs like buspirone are considered the gold standard for anxiety disorders now. They do not act like benzodiazepines at all in the brain.

swayvil 4y ago
You are speaking beside his point.
symlinkk 4y ago
How do they act? I just started taking buspirone for crippling social anxiety and I’m not sure if it’s helping or not.
- deleted 4y ago
  [deleted]
- heavyset_go 4y ago
  SSRIs are speculated to work via activation and downregulation of certain serotonin receptors, in particular 5HT1A, an autoreceptor responsible for regulating release of other neurotransmitters in the brain. Buspirone acts directly on 5HT1A as an agonist, I believe, which is more direct than the shotgun approach of SSRIs. In theory, activation of 5HT1A and its downregulation can help with depression and anxiety. Buspirone also blocks some dopamine receptors, but not any that are associated with dopamine blockade from antipsychotics, so their serious dopamine-related side effects aren't something to worry about, but the blocking might also contribute to anxiolytic effects. Newer SSRI-like drugs that block the serotonin transporter and activate 5HT1A also exist, combining the actions of both drugs. It typically takes serotonin receptors about two weeks to downregulate, and possibly even months to see any effects on depression and anxiety. Buspirone is not like benzodiazepines that work pretty much instantly, but it doesn't come with any of the risks benzodiazepines do.

ZanyProgrammer 4y ago

You're taking a very specific article about benzos and making unsubstantiated leaps about medicine in general.

openknot 4y ago

>"But if you are close to someone who is a user, over the long run you will notice differences. Sometimes its just that they don't have the same spark." The loss of a spark can happen regardless of drug use. Work in an unsupportive environment over a long period of time, a breakup, or the failure to achieve a long-sought goal can cause a person to change over time. In addition, the underlying condition that the medication is treating may cause the effect, which could have been worse had the medication not been prescribed. It's plausible that medications may have understudied long-term effects, but there are too many confounding causes to attribute a behavioral change to long-term medication use.

mikercampbell 4y ago
As someone who has had a long time relationship with Xanax, it quite literally saved my life. I was prescribed it for chronic nausea, and was 40lbs below my ideal weight. I've never been tempted to take any more than my prescribed dose, and so it's been a "healthy" relationship, but I'm working to discontinue my prescription for reasons other than this article. Not to be one of those "well, I use it and I'm fine and aren't tempted", on the contrary - I understand fully why people would feel the tugs of addiction. It's hard because I know I have an uphill battle to go. I use therapy and have seen benefits from psychedelics and medicinal cannabis, but it's literally a "pick your poison" battle. But also, it's hard to have a spark when you're not able to live a normal life without assistance. But in hindsight, I can see that this route has had it's costs and I'm excited to see who I am independent of it.

wit22145 4y ago

> His "medical degree" and insurance demands that he "treats" his patient. Completely lost me here. Why does the doctor have air quotes around their medical degree? And what’s wrong with treating disease? Or are you saying insurance requires unnecessary prescriptions? Because that’s definitely not the case, insurance would prefer no prescriptions financially at least and the doc is paid the same either way. Overall I think you just have an axe to grind against medicine for some reason. It’s not a perfect system but I don’t think you really know what you’re talking about and are concerned with the wrong things.

matheusmoreira 4y ago

Benzodiazepines are not even first line treatments for anxiety though. More like a last resort. They are very useful in aborting panic attacks and that says a lot about the intensity of symptoms necessary to justify their use. SSRIs and SNRIs have a much better risk/benefit profile. Sertraline in particular is a really effective drug. I don't really understand why other doctors prescribe benzodiazepines so frequently but I'm not doing it.

jotm 4y ago

If you look closer at others, you'll notice they have a new spark. But "new medication" won't be your first thought.

bcook 4y ago

You've got a dangerous level of confidence.