14 ms·

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. Med

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.
      - FactoryReboot 4y ago
        “Every organ is the most complicated organ”. No, that’s blatantly untrue. The liver is one of the simpler ones as it’s all single cells, and the brain is definitely the most complex. I’ve never heard anyone say they are equally complex. That doesn’t mean we understand everything about the liver, but we are hell of a lot closer than the brain.
        knaik94 4y ago
        The liver itself might be simple but the complexity is in the enzyme pathways. The marker of "elevated liver enzymes" doesn't tell us much. Taking a step back, there is only one organ I will admit we understand better than the brain, the heart. It's the only organ where we know enough to replace it with a mechanical counterpart. We don't know enough to make it last a long time, but it's enough to prolong someone's life in a meaningful way.
  - blendergeek 4y ago
    That is weird. Diabetes can sometimes be treated with methods other than insulin [0]. I think that these dietary treatments are always a better option than insulin. The same way with high blood pressure. High blood pressure should always be managed by "diet and exercise" before meds are brought in. All of these drugs (diabetes drugs, high blood pressure drugs, heart medication) that are regularly being used to treat lifestyle diseases should be seen as a last resort with the main goal being to help people get to a point where they don't need them.
    - ggm 4y ago
      ... until you hit 55-60 and irreversible changes to your body's hormonal system mean diet and exercise alone cannot control your hypertension, or late onset diabetes. I mean sure. Try. I had 10 years on Hypertension meds, 15 off, and I am back on despite significant weightless and increased physical activity. Idiopathic can happen.
- 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.
        deleted 4y ago
        [deleted]
        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

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.
    - FactoryReboot 4y ago
      “Every organ is the most complicated organ”. No, that’s blatantly untrue. The liver is one of the simpler ones as it’s all single cells, and the brain is definitely the most complex. I’ve never heard anyone say they are equally complex. That doesn’t mean we understand everything about the liver, but we are hell of a lot closer than the brain.
      - knaik94 4y ago
        The liver itself might be simple but the complexity is in the enzyme pathways. The marker of "elevated liver enzymes" doesn't tell us much. Taking a step back, there is only one organ I will admit we understand better than the brain, the heart. It's the only organ where we know enough to replace it with a mechanical counterpart. We don't know enough to make it last a long time, but it's enough to prolong someone's life in a meaningful way.
- blendergeek 4y ago
  That is weird. Diabetes can sometimes be treated with methods other than insulin [0]. I think that these dietary treatments are always a better option than insulin. The same way with high blood pressure. High blood pressure should always be managed by "diet and exercise" before meds are brought in. All of these drugs (diabetes drugs, high blood pressure drugs, heart medication) that are regularly being used to treat lifestyle diseases should be seen as a last resort with the main goal being to help people get to a point where they don't need them.
  - ggm 4y ago
    ... until you hit 55-60 and irreversible changes to your body's hormonal system mean diet and exercise alone cannot control your hypertension, or late onset diabetes. I mean sure. Try. I had 10 years on Hypertension meds, 15 off, and I am back on despite significant weightless and increased physical activity. Idiopathic can happen.
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.
      - deleted 4y ago
        [deleted]
      - 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