2 ms·

> None the less, I think the substantive point stands: the field is not in unity about the applicability of these drugs, and their use. Which field? You said h

> None the less, I think the substantive point stands: the field is not in unity about the applicability of these drugs, and their use. Which field? You said he was a psychologist. Your post was about psychiatry and neuroscience topics. I don't disagree that psychologists have a lot of opinions, but it's not really their domain. I think it's a mistake to think that a psychologist is better educated on psychiatry topics than actual psychiatrists or neuroscientists who actually study these things and understand the research.

ggm 4y ago
I think the gap between GPs, Psychologists and Psychiatrists lies at the heart of this. GPs can (and do) prescribe psychoactive drugs. What they do subsequently is subject to the constraints of the health economics which apply: In the UK (I am told) the delay to be seen by anyone other than your GP can be measured in YEARS because of the backlog in patents presenting. Many of these patients are young people. The GP has the determinant of the path. They can recommend something like CBT and a clinical psychologist, or they can recommend drugs and a psychiatrist. They can do either, for what is the same presentation of problem. They get seen by a GP, with limited time and tools. They are prescribed SSRIs, and booked in to see "some other health professional" and what emerges is a delay of some significant time, before they get that next stage of engagement. I was also triaged by my GP, in Australia, and was put into the non-drug path, and I am content. If my health practitioner prefers not to use drugs, and that is a bias, so be it. I can say that my mother in law was treated in other ways, became addicted to Xanax, and narrowly missed being placed in "deep sleep" therapy which wreaked havoc on many people, although it was "peak treatment" at the time. She was a deeply unhappy woman. I cannot say she would have been better off without drugs, but I do know the process of managing her drug regime was intense. Deep sleep therapy lasted a long time. It was credible for decades. Psychiatry is as capable as any other science of being led a long way down paths it subsequently walks back on. ECT, which is much more "confronting" in some ways, remains a useful tool. If you ask most people in the streets, They react with horror. I place great hopes in ketamine, and in psylocybin. Again, both require a context of use, and are still experimental. What I like about both, is that they appear to being considered as rapid-intervention therapies, not as sustained, long lived treatments. I like that because of the short duration. I guess I don't like the SSRI story precisely because of the long duration, and the consequences on young kids, especially on things like sexual dysfunction. (I'm not a young kid and that isn't an immediate concern for me)
- tptacek 4y ago
  This is for the most part a thread about SSRIs. Xanax is a benzodiazapine. There are no controversies on this thread, or really any ordinary place, about the dangers of benzodiazapines; they're scary drugs.
  - ggm 4y ago
    To stick to SSRI's I know one person who reacted badly to a change of meds, predicated on her personal dislike of the effects of the prior, but finding the replacement had extremely strong negative effect. I think had she been absent any support, this could have ended tragically, the effect was so strong and so sudden. This, coupled with the emerging reports of longterm sexual dysfunction in young women, I think represent pretty severe concerns. Obviously anecdata is not science, but this is what informs my own sense of place here. I am not anti drug in the wider sense. I think drugs of all kinds have been and are and will be beneficial. I am concerned with how SSRIs are being used in practice, with what longterm consequences, and short-term risks. There's a strong vibe of "butt out, stick to your knowledge" in responses to my posting here. I will take that advice. I'm off-piste, this isn't my area of work.
- klodolph 4y ago
  Agree that the system is a bit fucked, in pretty much every country (as far as I can tell). Unless you are involuntarily committed, you won't be put on the drug path if you don't want to. Psychiatric medications like SSRIs are generally awful. What I mean when I say "awful" is that the experience of taking them is awful. You may end up with symptoms that are under control, but you may still experience symptoms, or the symptoms can sometimes get worse, and the side effects are often just kind of shitty to deal with. These are generally not habit-forming drugs. These are nasty pills that you'll look at in the morning and dread taking. Non-compliance rates are already high, when you have patients who want to take the medication. There is no way you're going to prescribe antidepressants to somebody who says they don't want to take them. It's just a waste of time. Xanax is different. It's a benzodiazepine. The entire category of benzodiazepines is known to have a high rate of misuse, and Xanax in particular has a high rate of misuse. It's prescribed because it's an extremely effective and fast-acting. Very different from SSRIs.

ggm 4y ago

I think the gap between GPs, Psychologists and Psychiatrists lies at the heart of this. GPs can (and do) prescribe psychoactive drugs. What they do subsequently is subject to the constraints of the health economics which apply: In the UK (I am told) the delay to be seen by anyone other than your GP can be measured in YEARS because of the backlog in patents presenting. Many of these patients are young people. The GP has the determinant of the path. They can recommend something like CBT and a clinical psychologist, or they can recommend drugs and a psychiatrist. They can do either, for what is the same presentation of problem. They get seen by a GP, with limited time and tools. They are prescribed SSRIs, and booked in to see "some other health professional" and what emerges is a delay of some significant time, before they get that next stage of engagement. I was also triaged by my GP, in Australia, and was put into the non-drug path, and I am content. If my health practitioner prefers not to use drugs, and that is a bias, so be it. I can say that my mother in law was treated in other ways, became addicted to Xanax, and narrowly missed being placed in "deep sleep" therapy which wreaked havoc on many people, although it was "peak treatment" at the time. She was a deeply unhappy woman. I cannot say she would have been better off without drugs, but I do know the process of managing her drug regime was intense. Deep sleep therapy lasted a long time. It was credible for decades. Psychiatry is as capable as any other science of being led a long way down paths it subsequently walks back on. ECT, which is much more "confronting" in some ways, remains a useful tool. If you ask most people in the streets, They react with horror. I place great hopes in ketamine, and in psylocybin. Again, both require a context of use, and are still experimental. What I like about both, is that they appear to being considered as rapid-intervention therapies, not as sustained, long lived treatments. I like that because of the short duration. I guess I don't like the SSRI story precisely because of the long duration, and the consequences on young kids, especially on things like sexual dysfunction. (I'm not a young kid and that isn't an immediate concern for me)

tptacek 4y ago
This is for the most part a thread about SSRIs. Xanax is a benzodiazapine. There are no controversies on this thread, or really any ordinary place, about the dangers of benzodiazapines; they're scary drugs.
- ggm 4y ago
  To stick to SSRI's I know one person who reacted badly to a change of meds, predicated on her personal dislike of the effects of the prior, but finding the replacement had extremely strong negative effect. I think had she been absent any support, this could have ended tragically, the effect was so strong and so sudden. This, coupled with the emerging reports of longterm sexual dysfunction in young women, I think represent pretty severe concerns. Obviously anecdata is not science, but this is what informs my own sense of place here. I am not anti drug in the wider sense. I think drugs of all kinds have been and are and will be beneficial. I am concerned with how SSRIs are being used in practice, with what longterm consequences, and short-term risks. There's a strong vibe of "butt out, stick to your knowledge" in responses to my posting here. I will take that advice. I'm off-piste, this isn't my area of work.
klodolph 4y ago
Agree that the system is a bit fucked, in pretty much every country (as far as I can tell). Unless you are involuntarily committed, you won't be put on the drug path if you don't want to. Psychiatric medications like SSRIs are generally awful. What I mean when I say "awful" is that the experience of taking them is awful. You may end up with symptoms that are under control, but you may still experience symptoms, or the symptoms can sometimes get worse, and the side effects are often just kind of shitty to deal with. These are generally not habit-forming drugs. These are nasty pills that you'll look at in the morning and dread taking. Non-compliance rates are already high, when you have patients who want to take the medication. There is no way you're going to prescribe antidepressants to somebody who says they don't want to take them. It's just a waste of time. Xanax is different. It's a benzodiazepine. The entire category of benzodiazepines is known to have a high rate of misuse, and Xanax in particular has a high rate of misuse. It's prescribed because it's an extremely effective and fast-acting. Very different from SSRIs.