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Fascinating story. Thanks for sharing. > Ray’s mother asked the Lodge to give him antidepressants. But to the Lodge psychiatrists the premise of this form of t

Fascinating story. Thanks for sharing. > Ray’s mother asked the Lodge to give him antidepressants. But to the Lodge psychiatrists the premise of this form of treatment – to be cured without insight into what had gone wrong – seemed superficial and cheap. Drugs “might bring about some symptomatic relief”, Ross, Ray’s psychiatrist, acknowledged, “but it isn’t going to be anything solid in which he can say, ‘Hey, I’m a better man. I can tolerate feelings.’” I remember a HN comment from trained pharmacist (https://news.ycombinator.com/item?id=32103546 https://news.ycombinator.com/item?id=32103546) that argues the same thing: “I promise you that no drug that you can take can make any permanent changes to edit your mind” Ray looked at two different stories about his illness, the psychoanalytic and the neurobiological, but both "failed him". I would say that the psychoanalytic story has a better chance of explaining his case, but for some reason he wasn't receptive to it. Relatedly, the chemical imbalance theory of depression was disproved in a popular study published two months ago. Here is a good summary: https://youtu.be/TZhgvr2rbwE https://youtu.be/TZhgvr2rbwE. But SSRI are still effective, at least in reducing symptoms. We basically don't understand why and how they work.

98codes 4y ago
While what they're saying is true, to me it rings just as misguided as not taking pain medicine when you have a broken leg until it has properly set first. Medication for neurological issues isn't and shouldn't be the end-all-be-all but can indeed be a way to manage the issues at hand while teaching the tools needed to deal with the symptoms via therapy if possible.
- e40 4y ago
  There are always side effects and there is a real fear by many that they will be dependent on those drugs and have to live with the real side effects.
  - knaik94 4y ago
    It's weird that we treat psychoactive drugs differently than other drugs. We don't have a fear of a diabetic becoming dependent on insulin or someone with high blood pressure becoming addicted to beta blockers. There are side effects is a bad generalization of all drugs used to treat mental health issues. When I say I am taking beta blockers, most people comment on how I am a bit young to be taking them, but when I was prescribed benzos for the same condition, everyone decided to become my doctor and tell me what I should and shouldn't take. Endless stories about how then knew someone who got addicted to pain killers and became homeless and how they heard benzos are just as bad. I chose to switch off benzos to beta blockers. Doctors and the patient are the best judge for the benefits and risks of living with certain conditions vs being medicated for them. In most cases there aren't side effects.
    - anotherman554 4y ago
      "It's weird that we treat psychoactive drugs differently than other drugs. We don't have a fear of a diabetic becoming dependent on insulin or someone with high blood pressure becoming addicted to beta blockers." It not that weird. The brain is the most complicated organ in the human body. Science understands how the kidneys work but largely doesn't understand how the brain works. If you think these drugs are worth trying, I think you should make the argument without these sorts of analogies. "Doctors and the patient are the best judge for the benefits and risks of living with certain conditions vs being medicated for them." Okay, but if you were to follow this advise you should scold anyone who says "People with mental health problems should take drugs..." That's for the doctor and patient to decide, right? But you only scolded the person pushing back at this statement.
      - knaik94 4y ago
        I do. I equally scold anyone that says MDMA or LSD is the cure all of depression. It's not an analogy. There is no mechanical difference between someone using Amphetamines to treat their ADHD and someone using insulin to treat their diabetes. There are just as many external as internal factors that go into how someone can get diabetes and what dosage of insulin they need at a specific moment in time. Science has advanced to a point where diabetes specifically can be monitored easily by a patient. The same is true of hypertension. The difference for mental health issues is that there is no easy quantifiable way to diagnose someone. Every organ is the most complicated organ in the human body, at a certain level every organ has a mechanism science doesn't understand yet. That's not a valid argument. The same is true for pain management. And Multiple Sclerosis. I would suggest you look into the modern state of neurophysiology and neuropsychopharmacology. The "we don't understand" is not true anymore. The reality is that there are so many factors affecting a certain visible outcome that it's hard to specify a root cause. I am not a medical professional, I have only taken some 300 and 400/grad level courses in psychology.
        ButterBiscuits 4y ago
        > The "we don't understand" is not true anymore. The reality is that there are so many factors affecting a certain visible outcome that it's hard to specify a root cause. That sounds like "we don't understand" except now we slightly better understand how little we understand. We don't even know how Tylenol works.
  - hutzlibu 4y ago
    You can also get addicted to pain killers. They still can help, but are surely no long term solution. Antidepressants fall in the same category for me, even though I always avoided them. But if things are really dark, I would use any tool.
    - haswell 4y ago
      I would place antidepressants under a different umbrella - closer to insulin or other chronically required "maintenance" medicine required to sustain life. Anti-depressants don't take pain away. In some cases, they make it possible to even feel pain. I'm ~6 years into my therapy journey at this point and I'm not on antidepressants at the moment, but I have been in the past when I needed them. I'm fortunate that I was able to stop, and that was partly because I put my work life on hold to go on sabbatical and use all of my capacity on myself for awhile. But that doesn't mean everyone can or should. I think it's also worth noting that especially now, mental health issues are increasingly caused by advancements in technology we don't yet know how to cope with, and from which there's very little escape. Meds allow one to do the hard internal work that would be significantly harder to achieve if they don't have the capacity to keep a well functioning life up and running. I think only embracing one or the other exclusively is where things start to go wrong, and what I took from the article.
  - themitigating 4y ago
    Then it's a balance between side effects and the original issue. Isn't this common knowledge and accepted? I feel like debate makes no sense unless your motive is create more mistrust in science
  - seti0Cha 4y ago
    Psychiatric treatment is not without its dangers either. A bad psychiatrist can fuck you up. I know several people that experienced this. I also know a couple of people who were messed up by poorly prescribed psychopharmaceuticals. The ugly truth is, there's no safe solution.
  - yamrzou 4y ago
    I have read an interesting thought the other day about the side effects of those drugs from a psychoanalytic poit of view. It's just a psychoanalyst's thought, nothing scientific: “Recently the thought occurred to me that we have antidepressants back-to-front, as it were. The listed side-effects of these drugs (mostly SSRI’s) is really the main action, and the advertised effect is the real side effect. In other words antidepressants reduce anxiety and depression as a side effect of reducing libido – in the more inclusive sense of ‘life force’. Perhaps the relief of depression occurs because anxiety and depression are symptoms of libido or life energy hitting up against an obstacle or difficulty either in the internal or external world. This obstruction interferes with the ability of libido to express itself. Reduce libido and the unpleasant effects (depression and anxiety) of libido encountering an “obstruction” are correspondingly also reduced.” https://aucklandpsychotherapy.co.nz/antidepressants/ https://aucklandpsychotherapy.co.nz/antidepressants/
    - karencarits 4y ago
      Thank you for sharing this. Psychoanalysis is often heavily criticized but it has this nice tendency to be curious and open about things and produce intriguing and interesting thoughts
    - projektfu 4y ago
      That doesn't really match my experience of depression unless you somehow redefine all those terms to mean something else. It's hard to see where the libido is in someone who doesn't want to get out of bed, even to eat. Or in the case from the article, someone who feels like a piece of wood, and who paces the hospital like a Roomba. All effects of drugs are effects and they become side effects when they are undesirable. You used to be able to buy the same medication as either a decongestant and an appetite suppressant. In either case, the other effect is a side effect. On the other hand, if you took an antacid every day for your depression, and had no effect on it, for years, you might consider that it didn't work. However, the analysts didn't think that was possible to say about analysis.
- pessimizer 4y ago
  Nobody is doing studies to prove that morphine works better than placebo.
  - knaik94 4y ago
    Studies to show morphine is better than placebo in treating what? Here is a link for Study protocol for a randomised, placebo-controlled, single-blind phase II study of the efficacy of morphine for dyspnoea in patients with interstitial lung disease (JORTC-PAL 15) https://bmjopen.bmj.com/content/11/5/e043156 https://bmjopen.bmj.com/content/11/5/e043156 . I would suggest you look into the drug approval process in the US, I think you will learn a lot.
  - themitigating 4y ago
    The effects of morphine are profound and obvious. It's like asking for a study to prove crack does something.
    - knaik94 4y ago
      I think it's valid to want a reproducible study done, regardless of how obvious it seems. The studies have already been done.
- dleslie 4y ago
  Taking pain killers can exacerbate injuries by masking the pain caused by behaviours that cause additional trauma. I've seen a child's broken arm go from a scheduled intervention to an emergency surgery because the xray techs manipulated it poorly. The kid felt nothing thanks to the opioids she was given, and so didn't protest when they made a further mess of it.
  - DangitBobby 4y ago
    What's the takeaway here? We all know physical pain serves a purpose.
    - infogulch 4y ago
      Maybe you're depressed because your life and environment is actually shit and you don't know how to fix it. Maybe taking happy pills just eliminates the only signal telling you to take your hand off the hot stove.
      - scotty79 4y ago
        I don't think depression is like that. Depression is not being sad but rather just blank and those are not happy pills, those are feel a bit something again pills. Which enabled you to take the hand of the stove albeit imperfectly.
        raydiatian 4y ago
        Is that really how it is for you? The blank days in my opinion are the good ones, the level and balanced ones where I can just be in the zone or frankly even just zoned out. The depressing days are the ones where my brain decides to sample from its wine cellar of my past mistakes without my permission.
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        4y ago
- skissane 4y ago
  > to me it rings just as misguided as not taking pain medicine when you have a broken leg This is a bad analogy in so many ways. Most pain medications are short-acting, so one knows pretty quickly whether they work. People prescribed antidepressants are told to wait weeks to see positive results, and a large percentage of them won’t actually see any-and even those who do see positive results, it is often unclear if the improvement is actually due to the medication, or due to something else instead (therapy, lifestyle changes, self-limiting disease course, etc). If someone out there is taking antidepressants, and they feel it works for them-great. But having tried a range of antidepressants over the years (SSRIs, MAOIs, SNRIs), I’ve reached the conclusion that for me, they are pointless-I’ve never got any benefit from any of them. Some people will swear that they’ve saved their life - I see no reason to argue with that, it could well be true - but I’m sure there are many other people out there just like me. It’s a game of chance, and deciding not to play (or to stop playing) can be a rational and informed decision (at least for some people in some circumstances.)
  - luckylion 4y ago
    To stop playing that game of chance can certainly be a rational and informed decision. If you've tried multiple drugs of multiple categories and none of them work, chances are good that the next one won't work either. But not even trying? I don't think that's a rational and informed decision. Sure, it might take two weeks, and sure, there are side effects, but if it works, it'll greatly improve your condition. If your condition is serious, taking a pill every day and waiting for two weeks isn't a huge investment. It's like betting at roulette, you don't have to pay to bet $10000, but you'll get the full win if you're lucky. And you have to wait two weeks after each bet to know whether you won.
    - skissane 4y ago
      > But not even trying? I don't think that's a rational and informed decision. My GP told me that for mild to cases of mild to moderate depression, he’s hesitant about introducing antidepressants-be said they can worsen concentration at work, impairing performance, thereby introducing additional life stressors, leading to more depression not less. A person seeking antidepressants who was dissuaded from doing so by that advice is arguably making a much more informed choice than if he’d just given them what they wanted from the start. Of course, there comes a degree of severity (drawing that line is sometimes a subjective judgement call) when he doesn’t have these qualms any more. Although (this is my view, don’t know whether he agrees), if one’s situation is severe enough to warrant trying antidepressants, they might not be enough. While I’m no great fan of antipsychotics, if I was in a real crisis situation, I’d much rather something that delivers noticeable results right away, than something which might take 2-4 weeks to do nothing.
- bongoman37 4y ago
renewiltord 4y ago
- haswell 4y ago
  First, I fully support the use of drugs, and I've been on antidepressants. I've also had surgeries, and have had the "good stuff" on a few occasions. Drugs are a necessary part of modern healthcare. > People are pointlessly scared of drugs ... I exercise zero willpower to avoid them People are appropriately scared of drugs. You are very fortunate to have that willpower. I exercise no willpower when I think about the bottles of Bourbon and Scotch in my liquor cabinet. Our anecdotes don't change the reality of addiction. We're lucky.
  - renewiltord 4y ago
    But that's the point. I have no willpower. I just don't need it for opiates. And it's quite clear that the effect varies for people. Some people experience addiction and others don't. I'm glad the present system doesn't have holier than thou doctors sitting around lecturing you while your vision whites out in pain. And you know what? I'm glad that there are medical staff out there intelligent enough to be aware of this for physical pain. The mental guys haven't quite figured it out yet - mostly because their studies don't replicate so they have very little knowledge.
- vore 4y ago
  Wow, if only opioid addicts did the same thing, we wouldn't be having this opioid crisis!
  - renewiltord 4y ago
    Well, clearly the 3% of people who get addicted on exposure should sit it out and just live in pain but for me that helped me recover quickly. Fortunately for me, my doctors and nurses weren't obsessive ideologues and worked with me on a pain management program that involved opiates. Can you imagine having to sit in that bloody bed unable to move unless you hit the button to call the nurse all while in mind blowing pain? I'll pass! You can keep your sanctimonious doctors giving you lectures. I'll keep my professionals. Big ups for the folks at Zuck SF Gen.
7952 4y ago
I take SSRIs for anxiety and feel like the opportunity cost of trying to survive without them is too great. The good things in my life would be too disrupted by the extra load of tolerating those feelings. And those good things are protective against anxiety.
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webmobdev 4y ago
I have faced the opposite problem in India - psychiatrists insisting that they won't treat me without pills and even disparaging therapy as it "takes a long time and 'unreasonable' commitment from both patient and doctor"!
- urthor 4y ago
  This is a core problem with all of medicine. When the treatment involves the patient changing their behavior, most doctors give up and don't bother. And yet, the majority of diseases are rooted in patient behavior.
  - webmobdev 4y ago
    True, a patient's ignorance or belief system can be an issue. There's also two other factors - (1) some doctors often don't update themselves on the medical advances in their field and (2) doctors who treat mental health problems are also the most suspicious about trusting what their patients say (which is somewhat understandable when you consider the kind of mental health issues there are where patients do lie or can be delusional and all that isn't easy to ascertain in one or two sitting). So dealing with new therapists is always a pain as they want to do their own evaluations and insist on medicating you even if you don't need it. More so when you can't find therapists well versed with newer therapies like CT, DBT.
daniel-cussen 4y ago
c4ptnjack 4y ago
Worth noting that understanding why a problem occurs is not the same as treating that underlying condition. And moreover, you can treat and even cute something without fully understanding the precise mechanics of its attack vector, per say.
woojoo666 4y ago
Drugs can give you the insight to change your perspective though. From my understanding, depression is a deadly spiral of mental state leading to chemical imbalance which further reinforces the mental state, making it impossible to see outside that worldview. Thus drugs can take you out of that cycle and give a glimpse outside, and then even after the drug wears off the change in perspective is persistent.
- skissane 4y ago
  > From my understanding, depression is a deadly spiral of mental state leading to chemical imbalance There has never been any good scientific evidence that depression (or any other mental health issue for that matter) involves a “chemical imbalance”. It is, at the very best, a debatable and unproven hypothesis - yet many think it is some proven fact. To pick out just a couple of the numerous sources which confirm this, see https://www.nature.com/articles/s41380-022-01661-0 https://www.nature.com/articles/s41380-022-01661-0 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1277931/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1277931/
  - scotty79 4y ago
    My personal belief is that depression is a deadly spiral stemming from and exacerbating damage to neurons.
  - gjvnq 4y ago
    > There has never been any good scientific evidence that depression (or any other mental health issue for that matter) involves a “chemical imbalance”. Transfem here. Gender Dysphoria is a hell of a condition and it usually improves massively as soon as people start taking cross-sex hormonal replacement therapy (HRT). In my personal experience, it was almost like magic how quickly and how much I improved when my testosterone finally fell to zero.
    - skissane 4y ago
      You’ve wanted something for years and now at last you are getting it - that fact alone has to make a person feel happier and feel like the trajectory of their life is turning in a more positive direction. It is near impossible to determine what consequences of cross-sex HRT are due to its direct biochemical effects, and which are due to those kinds of psychological factors.
bsder 4y ago
> “I promise you that no drug that you can take can make any permanent changes to edit your mind” I don't agree. I know a couple people with mental illness that seems to be due to runaway "feedback loops". Drugs seem to reduce the "gain" on those loops and enable them to actually live life. Besides, most research I have seen seems to indicate that the people who get appropriate amounts of both medication and therapy seem to have the best outcomes.
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ohbleek 4y ago
As a trained pharmacist, the previous pharmacist is wrong in their interpretation and in their explanation. Specifically the way they explain the duration and mechanisms of the drugs is incorrect. While the main focus of discussion tends to center around the “serotonin” aspect of SSRIs, this is akin to discussing a road trip and only talking about turning the ignition before you leave the drive way. Serotonin receptors in the prefrontal cortex are the beginning of the signaling pathways that are to a greater extent controlled by glutamate, nmda receptors, and GABA. Not to be forgotten are also the dopamine and epi/norepi. All of which are affected downstream from the initial signaling of 5ht1a/b and 5ht2a receptors. Changes in concentrations of these neurotransmitters, their receptors, and reuptake vesicles, lead to system level changes in mood and behavior. The idea that some “small changes” in serotonin levels for a few weeks is all that occurs with an SSRI is just plain incorrect. The resulting fluctuations from baseline in neurotransmitters and receptors translate to slow changes in plasticity and “direction” as pathways are reshaped. Depression stems from a “negative cognitive bias” that deepens and is self-reinforcing over time. Changing that bias by reshaping pathways takes time. For some people, a very long time, and for others (arguably most) the drugs alone cannot accomplish this change in direction toward s more positive cognitive bias without cognitive behavioral therapy, rebuilding social support systems, and a change of environment. It’s true that everyone has different chemical concentrations, different levels of enzymes for breaking down neurotransmitters, and differences in receptor availability and that has been reduced to an idea of “chemical imbalance” which is not only too simplistic but also it treats a person like a baking recipe that would be turn out well with just more baking powder. That PharmD in the comment did the same kind of reduction here. At a molecular level, permanent changes absolutely can and do happen. That is essentially what the mechanisms at work in ketamine therapy have demonstrated providing strong evidence for thr neuro plastic theory of depression.
tsol 4y ago
>Relatedly, the chemical imbalance theory of depression was disproved in a popular study published two months ago. It hasn't been an accepted explanation for years in academia. It's only accepted bc of pharmaceutical commercials and word of mouth

98codes 4y ago

While what they're saying is true, to me it rings just as misguided as not taking pain medicine when you have a broken leg until it has properly set first. Medication for neurological issues isn't and shouldn't be the end-all-be-all but can indeed be a way to manage the issues at hand while teaching the tools needed to deal with the symptoms via therapy if possible.

e40 4y ago
There are always side effects and there is a real fear by many that they will be dependent on those drugs and have to live with the real side effects.
- knaik94 4y ago
  It's weird that we treat psychoactive drugs differently than other drugs. We don't have a fear of a diabetic becoming dependent on insulin or someone with high blood pressure becoming addicted to beta blockers. There are side effects is a bad generalization of all drugs used to treat mental health issues. When I say I am taking beta blockers, most people comment on how I am a bit young to be taking them, but when I was prescribed benzos for the same condition, everyone decided to become my doctor and tell me what I should and shouldn't take. Endless stories about how then knew someone who got addicted to pain killers and became homeless and how they heard benzos are just as bad. I chose to switch off benzos to beta blockers. Doctors and the patient are the best judge for the benefits and risks of living with certain conditions vs being medicated for them. In most cases there aren't side effects.
  - anotherman554 4y ago
    "It's weird that we treat psychoactive drugs differently than other drugs. We don't have a fear of a diabetic becoming dependent on insulin or someone with high blood pressure becoming addicted to beta blockers." It not that weird. The brain is the most complicated organ in the human body. Science understands how the kidneys work but largely doesn't understand how the brain works. If you think these drugs are worth trying, I think you should make the argument without these sorts of analogies. "Doctors and the patient are the best judge for the benefits and risks of living with certain conditions vs being medicated for them." Okay, but if you were to follow this advise you should scold anyone who says "People with mental health problems should take drugs..." That's for the doctor and patient to decide, right? But you only scolded the person pushing back at this statement.
    - knaik94 4y ago
      I do. I equally scold anyone that says MDMA or LSD is the cure all of depression. It's not an analogy. There is no mechanical difference between someone using Amphetamines to treat their ADHD and someone using insulin to treat their diabetes. There are just as many external as internal factors that go into how someone can get diabetes and what dosage of insulin they need at a specific moment in time. Science has advanced to a point where diabetes specifically can be monitored easily by a patient. The same is true of hypertension. The difference for mental health issues is that there is no easy quantifiable way to diagnose someone. Every organ is the most complicated organ in the human body, at a certain level every organ has a mechanism science doesn't understand yet. That's not a valid argument. The same is true for pain management. And Multiple Sclerosis. I would suggest you look into the modern state of neurophysiology and neuropsychopharmacology. The "we don't understand" is not true anymore. The reality is that there are so many factors affecting a certain visible outcome that it's hard to specify a root cause. I am not a medical professional, I have only taken some 300 and 400/grad level courses in psychology.
      - ButterBiscuits 4y ago
        > The "we don't understand" is not true anymore. The reality is that there are so many factors affecting a certain visible outcome that it's hard to specify a root cause. That sounds like "we don't understand" except now we slightly better understand how little we understand. We don't even know how Tylenol works.
- hutzlibu 4y ago
  You can also get addicted to pain killers. They still can help, but are surely no long term solution. Antidepressants fall in the same category for me, even though I always avoided them. But if things are really dark, I would use any tool.
  - haswell 4y ago
    I would place antidepressants under a different umbrella - closer to insulin or other chronically required "maintenance" medicine required to sustain life. Anti-depressants don't take pain away. In some cases, they make it possible to even feel pain. I'm ~6 years into my therapy journey at this point and I'm not on antidepressants at the moment, but I have been in the past when I needed them. I'm fortunate that I was able to stop, and that was partly because I put my work life on hold to go on sabbatical and use all of my capacity on myself for awhile. But that doesn't mean everyone can or should. I think it's also worth noting that especially now, mental health issues are increasingly caused by advancements in technology we don't yet know how to cope with, and from which there's very little escape. Meds allow one to do the hard internal work that would be significantly harder to achieve if they don't have the capacity to keep a well functioning life up and running. I think only embracing one or the other exclusively is where things start to go wrong, and what I took from the article.
- themitigating 4y ago
  Then it's a balance between side effects and the original issue. Isn't this common knowledge and accepted? I feel like debate makes no sense unless your motive is create more mistrust in science
- seti0Cha 4y ago
  Psychiatric treatment is not without its dangers either. A bad psychiatrist can fuck you up. I know several people that experienced this. I also know a couple of people who were messed up by poorly prescribed psychopharmaceuticals. The ugly truth is, there's no safe solution.
- yamrzou 4y ago
  I have read an interesting thought the other day about the side effects of those drugs from a psychoanalytic poit of view. It's just a psychoanalyst's thought, nothing scientific: “Recently the thought occurred to me that we have antidepressants back-to-front, as it were. The listed side-effects of these drugs (mostly SSRI’s) is really the main action, and the advertised effect is the real side effect. In other words antidepressants reduce anxiety and depression as a side effect of reducing libido – in the more inclusive sense of ‘life force’. Perhaps the relief of depression occurs because anxiety and depression are symptoms of libido or life energy hitting up against an obstacle or difficulty either in the internal or external world. This obstruction interferes with the ability of libido to express itself. Reduce libido and the unpleasant effects (depression and anxiety) of libido encountering an “obstruction” are correspondingly also reduced.” https://aucklandpsychotherapy.co.nz/antidepressants/ https://aucklandpsychotherapy.co.nz/antidepressants/
  - karencarits 4y ago
    Thank you for sharing this. Psychoanalysis is often heavily criticized but it has this nice tendency to be curious and open about things and produce intriguing and interesting thoughts
  - projektfu 4y ago
    That doesn't really match my experience of depression unless you somehow redefine all those terms to mean something else. It's hard to see where the libido is in someone who doesn't want to get out of bed, even to eat. Or in the case from the article, someone who feels like a piece of wood, and who paces the hospital like a Roomba. All effects of drugs are effects and they become side effects when they are undesirable. You used to be able to buy the same medication as either a decongestant and an appetite suppressant. In either case, the other effect is a side effect. On the other hand, if you took an antacid every day for your depression, and had no effect on it, for years, you might consider that it didn't work. However, the analysts didn't think that was possible to say about analysis.
pessimizer 4y ago
Nobody is doing studies to prove that morphine works better than placebo.
- knaik94 4y ago
  Studies to show morphine is better than placebo in treating what? Here is a link for Study protocol for a randomised, placebo-controlled, single-blind phase II study of the efficacy of morphine for dyspnoea in patients with interstitial lung disease (JORTC-PAL 15) https://bmjopen.bmj.com/content/11/5/e043156 https://bmjopen.bmj.com/content/11/5/e043156 . I would suggest you look into the drug approval process in the US, I think you will learn a lot.
- themitigating 4y ago
  The effects of morphine are profound and obvious. It's like asking for a study to prove crack does something.
  - knaik94 4y ago
    I think it's valid to want a reproducible study done, regardless of how obvious it seems. The studies have already been done.
dleslie 4y ago
Taking pain killers can exacerbate injuries by masking the pain caused by behaviours that cause additional trauma. I've seen a child's broken arm go from a scheduled intervention to an emergency surgery because the xray techs manipulated it poorly. The kid felt nothing thanks to the opioids she was given, and so didn't protest when they made a further mess of it.
- DangitBobby 4y ago
  What's the takeaway here? We all know physical pain serves a purpose.
  - infogulch 4y ago
    Maybe you're depressed because your life and environment is actually shit and you don't know how to fix it. Maybe taking happy pills just eliminates the only signal telling you to take your hand off the hot stove.
    - scotty79 4y ago
      I don't think depression is like that. Depression is not being sad but rather just blank and those are not happy pills, those are feel a bit something again pills. Which enabled you to take the hand of the stove albeit imperfectly.
      - raydiatian 4y ago
        Is that really how it is for you? The blank days in my opinion are the good ones, the level and balanced ones where I can just be in the zone or frankly even just zoned out. The depressing days are the ones where my brain decides to sample from its wine cellar of my past mistakes without my permission.
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        4y ago
skissane 4y ago
> to me it rings just as misguided as not taking pain medicine when you have a broken leg This is a bad analogy in so many ways. Most pain medications are short-acting, so one knows pretty quickly whether they work. People prescribed antidepressants are told to wait weeks to see positive results, and a large percentage of them won’t actually see any-and even those who do see positive results, it is often unclear if the improvement is actually due to the medication, or due to something else instead (therapy, lifestyle changes, self-limiting disease course, etc). If someone out there is taking antidepressants, and they feel it works for them-great. But having tried a range of antidepressants over the years (SSRIs, MAOIs, SNRIs), I’ve reached the conclusion that for me, they are pointless-I’ve never got any benefit from any of them. Some people will swear that they’ve saved their life - I see no reason to argue with that, it could well be true - but I’m sure there are many other people out there just like me. It’s a game of chance, and deciding not to play (or to stop playing) can be a rational and informed decision (at least for some people in some circumstances.)
- luckylion 4y ago
  To stop playing that game of chance can certainly be a rational and informed decision. If you've tried multiple drugs of multiple categories and none of them work, chances are good that the next one won't work either. But not even trying? I don't think that's a rational and informed decision. Sure, it might take two weeks, and sure, there are side effects, but if it works, it'll greatly improve your condition. If your condition is serious, taking a pill every day and waiting for two weeks isn't a huge investment. It's like betting at roulette, you don't have to pay to bet $10000, but you'll get the full win if you're lucky. And you have to wait two weeks after each bet to know whether you won.
  - skissane 4y ago
    > But not even trying? I don't think that's a rational and informed decision. My GP told me that for mild to cases of mild to moderate depression, he’s hesitant about introducing antidepressants-be said they can worsen concentration at work, impairing performance, thereby introducing additional life stressors, leading to more depression not less. A person seeking antidepressants who was dissuaded from doing so by that advice is arguably making a much more informed choice than if he’d just given them what they wanted from the start. Of course, there comes a degree of severity (drawing that line is sometimes a subjective judgement call) when he doesn’t have these qualms any more. Although (this is my view, don’t know whether he agrees), if one’s situation is severe enough to warrant trying antidepressants, they might not be enough. While I’m no great fan of antipsychotics, if I was in a real crisis situation, I’d much rather something that delivers noticeable results right away, than something which might take 2-4 weeks to do nothing.
bongoman37 4y ago

renewiltord 4y ago

haswell 4y ago
First, I fully support the use of drugs, and I've been on antidepressants. I've also had surgeries, and have had the "good stuff" on a few occasions. Drugs are a necessary part of modern healthcare. > People are pointlessly scared of drugs ... I exercise zero willpower to avoid them People are appropriately scared of drugs. You are very fortunate to have that willpower. I exercise no willpower when I think about the bottles of Bourbon and Scotch in my liquor cabinet. Our anecdotes don't change the reality of addiction. We're lucky.
- renewiltord 4y ago
  But that's the point. I have no willpower. I just don't need it for opiates. And it's quite clear that the effect varies for people. Some people experience addiction and others don't. I'm glad the present system doesn't have holier than thou doctors sitting around lecturing you while your vision whites out in pain. And you know what? I'm glad that there are medical staff out there intelligent enough to be aware of this for physical pain. The mental guys haven't quite figured it out yet - mostly because their studies don't replicate so they have very little knowledge.
vore 4y ago
Wow, if only opioid addicts did the same thing, we wouldn't be having this opioid crisis!
- renewiltord 4y ago
  Well, clearly the 3% of people who get addicted on exposure should sit it out and just live in pain but for me that helped me recover quickly. Fortunately for me, my doctors and nurses weren't obsessive ideologues and worked with me on a pain management program that involved opiates. Can you imagine having to sit in that bloody bed unable to move unless you hit the button to call the nurse all while in mind blowing pain? I'll pass! You can keep your sanctimonious doctors giving you lectures. I'll keep my professionals. Big ups for the folks at Zuck SF Gen.

7952 4y ago

I take SSRIs for anxiety and feel like the opportunity cost of trying to survive without them is too great. The good things in my life would be too disrupted by the extra load of tolerating those feelings. And those good things are protective against anxiety.

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webmobdev 4y ago

I have faced the opposite problem in India - psychiatrists insisting that they won't treat me without pills and even disparaging therapy as it "takes a long time and 'unreasonable' commitment from both patient and doctor"!

urthor 4y ago
This is a core problem with all of medicine. When the treatment involves the patient changing their behavior, most doctors give up and don't bother. And yet, the majority of diseases are rooted in patient behavior.
- webmobdev 4y ago
  True, a patient's ignorance or belief system can be an issue. There's also two other factors - (1) some doctors often don't update themselves on the medical advances in their field and (2) doctors who treat mental health problems are also the most suspicious about trusting what their patients say (which is somewhat understandable when you consider the kind of mental health issues there are where patients do lie or can be delusional and all that isn't easy to ascertain in one or two sitting). So dealing with new therapists is always a pain as they want to do their own evaluations and insist on medicating you even if you don't need it. More so when you can't find therapists well versed with newer therapies like CT, DBT.

daniel-cussen 4y ago

c4ptnjack 4y ago

Worth noting that understanding why a problem occurs is not the same as treating that underlying condition. And moreover, you can treat and even cute something without fully understanding the precise mechanics of its attack vector, per say.

woojoo666 4y ago

Drugs can give you the insight to change your perspective though. From my understanding, depression is a deadly spiral of mental state leading to chemical imbalance which further reinforces the mental state, making it impossible to see outside that worldview. Thus drugs can take you out of that cycle and give a glimpse outside, and then even after the drug wears off the change in perspective is persistent.

skissane 4y ago
> From my understanding, depression is a deadly spiral of mental state leading to chemical imbalance There has never been any good scientific evidence that depression (or any other mental health issue for that matter) involves a “chemical imbalance”. It is, at the very best, a debatable and unproven hypothesis - yet many think it is some proven fact. To pick out just a couple of the numerous sources which confirm this, see https://www.nature.com/articles/s41380-022-01661-0 https://www.nature.com/articles/s41380-022-01661-0 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1277931/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1277931/
- scotty79 4y ago
  My personal belief is that depression is a deadly spiral stemming from and exacerbating damage to neurons.
- gjvnq 4y ago
  > There has never been any good scientific evidence that depression (or any other mental health issue for that matter) involves a “chemical imbalance”. Transfem here. Gender Dysphoria is a hell of a condition and it usually improves massively as soon as people start taking cross-sex hormonal replacement therapy (HRT). In my personal experience, it was almost like magic how quickly and how much I improved when my testosterone finally fell to zero.
  - skissane 4y ago
    You’ve wanted something for years and now at last you are getting it - that fact alone has to make a person feel happier and feel like the trajectory of their life is turning in a more positive direction. It is near impossible to determine what consequences of cross-sex HRT are due to its direct biochemical effects, and which are due to those kinds of psychological factors.

bsder 4y ago

> “I promise you that no drug that you can take can make any permanent changes to edit your mind” I don't agree. I know a couple people with mental illness that seems to be due to runaway "feedback loops". Drugs seem to reduce the "gain" on those loops and enable them to actually live life. Besides, most research I have seen seems to indicate that the people who get appropriate amounts of both medication and therapy seem to have the best outcomes.

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ohbleek 4y ago

As a trained pharmacist, the previous pharmacist is wrong in their interpretation and in their explanation. Specifically the way they explain the duration and mechanisms of the drugs is incorrect. While the main focus of discussion tends to center around the “serotonin” aspect of SSRIs, this is akin to discussing a road trip and only talking about turning the ignition before you leave the drive way. Serotonin receptors in the prefrontal cortex are the beginning of the signaling pathways that are to a greater extent controlled by glutamate, nmda receptors, and GABA. Not to be forgotten are also the dopamine and epi/norepi. All of which are affected downstream from the initial signaling of 5ht1a/b and 5ht2a receptors. Changes in concentrations of these neurotransmitters, their receptors, and reuptake vesicles, lead to system level changes in mood and behavior. The idea that some “small changes” in serotonin levels for a few weeks is all that occurs with an SSRI is just plain incorrect. The resulting fluctuations from baseline in neurotransmitters and receptors translate to slow changes in plasticity and “direction” as pathways are reshaped. Depression stems from a “negative cognitive bias” that deepens and is self-reinforcing over time. Changing that bias by reshaping pathways takes time. For some people, a very long time, and for others (arguably most) the drugs alone cannot accomplish this change in direction toward s more positive cognitive bias without cognitive behavioral therapy, rebuilding social support systems, and a change of environment. It’s true that everyone has different chemical concentrations, different levels of enzymes for breaking down neurotransmitters, and differences in receptor availability and that has been reduced to an idea of “chemical imbalance” which is not only too simplistic but also it treats a person like a baking recipe that would be turn out well with just more baking powder. That PharmD in the comment did the same kind of reduction here. At a molecular level, permanent changes absolutely can and do happen. That is essentially what the mechanisms at work in ketamine therapy have demonstrated providing strong evidence for thr neuro plastic theory of depression.

tsol 4y ago

>Relatedly, the chemical imbalance theory of depression was disproved in a popular study published two months ago. It hasn't been an accepted explanation for years in academia. It's only accepted bc of pharmaceutical commercials and word of mouth