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I am a doctor. ALL conversations in HN about mental health go overboard due to two reasons: either generalisation of a N=1 case or trying to apply in practice l

I am a doctor. ALL conversations in HN about mental health go overboard due to two reasons: either generalisation of a N=1 case or trying to apply in practice large scale statistics. Reality lies somewhere in the middle, that is ADs are neither garbage nor life saving for all. It is absolutely personalized

n8henrie 4y ago
I would broaden this to "conversations about health" in general on HN. (Does HN support ~strikethrough~? On mobile or I'd try to find the official documentation.)
- nmarinov 4y ago
  I don't think so, it's not listed in the docs: https://news.ycombinator.com/formatdoc https://news.ycombinator.com/formatdoc
bilsbie 4y ago
I think every person is in charge of their own health. We can’t blindly follow advice based on credentials of others.
- jstx1 4y ago
  Sure, you're responsible for your health but don't use that as an excuse to ignore or dismiss scientific evidence. I guess you could ignore it, as long as you aren't harming anyone else, but it still seems like a bad idea.
  - anikom15 4y ago
    I think that’s part of the problem. We have very little understanding of the mechanisms of depression and how ADs can help or harm that.
- mellosouls 4y ago
  No, of course not - by definition, advice is advisory only. But we can and should default to trusting advice from reputable people over hearsay; credentials inform our assessment of how reputable they are.
  - bilsbie 4y ago
    > advice is advisory only. The last three years would like a word. > But we can and should default to trusting advice from reputable people over hearsay; credentials inform our assessment of how reputable they are. Tell that to the doctor 50 years ago that recommended his favorite brand of cigarettes. Or the experts that made the food pyramid.
    - amanaplanacanal 4y ago
      > The last three years would like a word. There is nothing unusual about the last three years. Public health measures have frequently come with stiff penalties, since the beginning. “Sin taxes”, drug prohibition, water quality and vaccine mandates, etc.
- falcolas 4y ago
  Yes, and no. If your health issues can impact the health other people, it's no longer just your problem to be in charge of. And without proper training, you can't manage your bigger health problems without help, either mental or physical.
wincy 4y ago
Antidepressants were weird for me because they just made me temporarily satisfied with my life going nowhere and working a terrible job that I hated. Also when I got off of Paxil I felt like I was being dropped down an elevator shaft for months. Turns out I just needed to succeed in life and suddenly I’m not depressed anymore. I was keenly aware of what a loser I was and through marriage and a small amount of amphetamines am doing pretty well now.
- cnity 4y ago
  Chiming in with an anecdote that aligns with yours. I've never used antidepressants but my sense of self-confidence and "happiness" is so highly correlated with my level of mastery and control on my life progression that I now ask myself the same question when I'm feeling vaguely bad: "what is going on in my life that I have the ability to improve that I do not like?", and I fix the first thing that comes to mind as soon as possible.
  - missingrib 4y ago
    What if it is something that is impossible for you to improve?
    - cnity 4y ago
      Yes, that is where acceptance is required for sure. I found that for me, I was using mindfulness and acceptance as an excuse to avoid dealing with the things I _did_ have the power to control. It's better for me, my wife, and the world around me for me to manage my sphere of influence and use it to make a space that is comfortable and fun for my family. Learning that I have the power to change some things I don't like is gratifying.
- vorpalhex 4y ago
  "I found Jesus and meth-amp-hetamines!" (I realize you almost certainly mean adhd medication) I do worry that practicioners jump too quickly to antidepressents versus attempting other interventions, but I've also seen practitioners fail to have even basic alternatives. To quote one MD, "Oh that sounds bad... uhm, maybe therapy?" No referral, nothing. We are starting to see Cognitive Behavioral Therapy take flight not just as a guided therapy but also something where the patient can just work through a workbook solo and try exercises on their own.
mattpallissard 4y ago
> Reality lies somewhere in the middle HN struggles with this concept in general.
- aliqot 4y ago
  HN is made of people. IT'S PEEEOOOPLLE!!!!
- JimtheCoder 4y ago
  Reality?
travoltaj 4y ago
The good old "Statistics don't apply to an individual"
dennis_jeeves1 4y ago
Not targeted do you in particular. I generally have a very poor opinion of doctors. According to the article: "In around 15% of cases, they offer large benefits". If this figure is accurate, then I would somewhat speculate that this figure would drop to less than 5% just by fixing diet alone. I'm not sure how many doctors would actually suggest a _correct_ dietary change. (the general advises avoid junk food , eat your greens and lots of fiber: while the former is correct the latter two is not, and can even be a disaster)
ChrisRR 4y ago
But I have an anecdotal story about how they affected a single person!
weakfortress 4y ago
[dead]
chayesfss 4y ago
How are we all not n=1? If we don’t share the same fingerprint how are we supposed to have the same chemistry? And you’re a DR? Sorry but scary. Like me saying all Dr’s are killers or all pigs are cops no? Must be nice weather over there
- cjbgkagh 4y ago
  Same chemistry different DNA. Based on the 1000 genome each person has roughly 150 known pathogenic rare mutations. And vastly more currently unknown pathogenic. People inherit ~2 to 3 million SNPs from a collection of 700m SNPs. So doctors are looking for rare conditions in 1 of 10 people, where we all have rare conditions and a lot of them. We are walking bags of rare conditions. Thankfully there are direct to consumer While Genome Sequencing which is pretty easy to find your SNPs and look up which ones are attached to studies about being pathogenic. I figured out that I have pathogenic TNXB mutation myself despite the gaslighting of many doctors for many years and WGS confirmed it. It’s a totally different way of doing medicine that bypasses doctors. Interestingly enough one of the treatments for my specific mutation is one sub class of anti depressant.
- WastingMyTime89 4y ago
  I have trouble making sense of your comment. You are replying to someone explaining that their professional experience shows that the answer can be neither generalising anecdote because what works for one will not necessarily work for another nor simply broadly applying statitics because, to oversimplify, something which works perfectly for 20% and not at all for 80% as a terrible average rate of success but is indeed what you want if you are amongst the lucky 20%. What are you complaining about in this take exactly?
  - chayesfss 4y ago
    My favorites, all doctors are small and nobody knows you’re a dog on the internet!!! Yeeeee hawwww, sorry, just retired yesterday and feeling lively:)
- DaftDank 4y ago
  I'm not following. Why is being a doctor scary? And why do you believe or suggest doctors are killers?
jokoon 4y ago
Thanks for defending AD. They help a little but it's better than nothing. The new problem is how internet people encourage others to self medicate with psychedelics. Everytime there is a trial study, you can read a lot of them.
- tredre3 4y ago
  > The new problem is how internet people encourage others to self medicate with psychedelics. This is a seriously annoying and recurring issue on HN. It's the "just hit the gym, bro" equivalent of silicon valley.
- mtlmtlmtlmtl 4y ago
  Agreed. It's so idiotic because psychedelics only have an effect in the right setting, and clinical psychedelic therapy is all about establishing that setting. Doing it alone, or with some burnt out druggie friend is not likely to work except by pure accident, and making it worse is just as likely.
  - PartiallyTyped 4y ago
    This claim needs some data to back it up.
    - mtlmtlmtlmtl 4y ago
      Which one, the part that set and setting matter? Read basically any paper on psychedelic therapy. That psychedelics can worsen mental disorder? Psychedelics can help you process bad experiences, and it can generate new ones. You can unlearn unhealthy biases or gain new ones. The papers tend to discuss this.
      - PartiallyTyped 4y ago
        > Doing it alone, or with some burnt out druggie friend is not likely to work except by pure accident, and making it worse is just as likely. This claim, that doing it alone is unlikely to work, or likely to worsen your situation. > That psychedelics can worsen mental disorder? That sentence is not the same as the previous claim.

n8henrie 4y ago

I would broaden this to "conversations about health" in general on HN. (Does HN support ~strikethrough~? On mobile or I'd try to find the official documentation.)

nmarinov 4y ago
I don't think so, it's not listed in the docs: https://news.ycombinator.com/formatdoc https://news.ycombinator.com/formatdoc

bilsbie 4y ago

I think every person is in charge of their own health. We can’t blindly follow advice based on credentials of others.

jstx1 4y ago
Sure, you're responsible for your health but don't use that as an excuse to ignore or dismiss scientific evidence. I guess you could ignore it, as long as you aren't harming anyone else, but it still seems like a bad idea.
- anikom15 4y ago
  I think that’s part of the problem. We have very little understanding of the mechanisms of depression and how ADs can help or harm that.
mellosouls 4y ago
No, of course not - by definition, advice is advisory only. But we can and should default to trusting advice from reputable people over hearsay; credentials inform our assessment of how reputable they are.
- bilsbie 4y ago
  > advice is advisory only. The last three years would like a word. > But we can and should default to trusting advice from reputable people over hearsay; credentials inform our assessment of how reputable they are. Tell that to the doctor 50 years ago that recommended his favorite brand of cigarettes. Or the experts that made the food pyramid.
  - amanaplanacanal 4y ago
    > The last three years would like a word. There is nothing unusual about the last three years. Public health measures have frequently come with stiff penalties, since the beginning. “Sin taxes”, drug prohibition, water quality and vaccine mandates, etc.
falcolas 4y ago
Yes, and no. If your health issues can impact the health other people, it's no longer just your problem to be in charge of. And without proper training, you can't manage your bigger health problems without help, either mental or physical.

wincy 4y ago

Antidepressants were weird for me because they just made me temporarily satisfied with my life going nowhere and working a terrible job that I hated. Also when I got off of Paxil I felt like I was being dropped down an elevator shaft for months. Turns out I just needed to succeed in life and suddenly I’m not depressed anymore. I was keenly aware of what a loser I was and through marriage and a small amount of amphetamines am doing pretty well now.

cnity 4y ago
Chiming in with an anecdote that aligns with yours. I've never used antidepressants but my sense of self-confidence and "happiness" is so highly correlated with my level of mastery and control on my life progression that I now ask myself the same question when I'm feeling vaguely bad: "what is going on in my life that I have the ability to improve that I do not like?", and I fix the first thing that comes to mind as soon as possible.
- missingrib 4y ago
  What if it is something that is impossible for you to improve?
  - cnity 4y ago
    Yes, that is where acceptance is required for sure. I found that for me, I was using mindfulness and acceptance as an excuse to avoid dealing with the things I _did_ have the power to control. It's better for me, my wife, and the world around me for me to manage my sphere of influence and use it to make a space that is comfortable and fun for my family. Learning that I have the power to change some things I don't like is gratifying.
vorpalhex 4y ago
"I found Jesus and meth-amp-hetamines!" (I realize you almost certainly mean adhd medication) I do worry that practicioners jump too quickly to antidepressents versus attempting other interventions, but I've also seen practitioners fail to have even basic alternatives. To quote one MD, "Oh that sounds bad... uhm, maybe therapy?" No referral, nothing. We are starting to see Cognitive Behavioral Therapy take flight not just as a guided therapy but also something where the patient can just work through a workbook solo and try exercises on their own.

mattpallissard 4y ago

> Reality lies somewhere in the middle HN struggles with this concept in general.

aliqot 4y ago
HN is made of people. IT'S PEEEOOOPLLE!!!!
JimtheCoder 4y ago
Reality?

travoltaj 4y ago

The good old "Statistics don't apply to an individual"

dennis_jeeves1 4y ago

Not targeted do you in particular. I generally have a very poor opinion of doctors. According to the article: "In around 15% of cases, they offer large benefits". If this figure is accurate, then I would somewhat speculate that this figure would drop to less than 5% just by fixing diet alone. I'm not sure how many doctors would actually suggest a _correct_ dietary change. (the general advises avoid junk food , eat your greens and lots of fiber: while the former is correct the latter two is not, and can even be a disaster)

ChrisRR 4y ago

But I have an anecdotal story about how they affected a single person!

weakfortress 4y ago

[dead]

chayesfss 4y ago

How are we all not n=1? If we don’t share the same fingerprint how are we supposed to have the same chemistry? And you’re a DR? Sorry but scary. Like me saying all Dr’s are killers or all pigs are cops no? Must be nice weather over there

cjbgkagh 4y ago
Same chemistry different DNA. Based on the 1000 genome each person has roughly 150 known pathogenic rare mutations. And vastly more currently unknown pathogenic. People inherit ~2 to 3 million SNPs from a collection of 700m SNPs. So doctors are looking for rare conditions in 1 of 10 people, where we all have rare conditions and a lot of them. We are walking bags of rare conditions. Thankfully there are direct to consumer While Genome Sequencing which is pretty easy to find your SNPs and look up which ones are attached to studies about being pathogenic. I figured out that I have pathogenic TNXB mutation myself despite the gaslighting of many doctors for many years and WGS confirmed it. It’s a totally different way of doing medicine that bypasses doctors. Interestingly enough one of the treatments for my specific mutation is one sub class of anti depressant.
WastingMyTime89 4y ago
I have trouble making sense of your comment. You are replying to someone explaining that their professional experience shows that the answer can be neither generalising anecdote because what works for one will not necessarily work for another nor simply broadly applying statitics because, to oversimplify, something which works perfectly for 20% and not at all for 80% as a terrible average rate of success but is indeed what you want if you are amongst the lucky 20%. What are you complaining about in this take exactly?
- chayesfss 4y ago
  My favorites, all doctors are small and nobody knows you’re a dog on the internet!!! Yeeeee hawwww, sorry, just retired yesterday and feeling lively:)
DaftDank 4y ago
I'm not following. Why is being a doctor scary? And why do you believe or suggest doctors are killers?

jokoon 4y ago

Thanks for defending AD. They help a little but it's better than nothing. The new problem is how internet people encourage others to self medicate with psychedelics. Everytime there is a trial study, you can read a lot of them.

tredre3 4y ago
> The new problem is how internet people encourage others to self medicate with psychedelics. This is a seriously annoying and recurring issue on HN. It's the "just hit the gym, bro" equivalent of silicon valley.
mtlmtlmtlmtl 4y ago
Agreed. It's so idiotic because psychedelics only have an effect in the right setting, and clinical psychedelic therapy is all about establishing that setting. Doing it alone, or with some burnt out druggie friend is not likely to work except by pure accident, and making it worse is just as likely.
- PartiallyTyped 4y ago
  This claim needs some data to back it up.
  - mtlmtlmtlmtl 4y ago
    Which one, the part that set and setting matter? Read basically any paper on psychedelic therapy. That psychedelics can worsen mental disorder? Psychedelics can help you process bad experiences, and it can generate new ones. You can unlearn unhealthy biases or gain new ones. The papers tend to discuss this.
    - PartiallyTyped 4y ago
      > Doing it alone, or with some burnt out druggie friend is not likely to work except by pure accident, and making it worse is just as likely. This claim, that doing it alone is unlikely to work, or likely to worsen your situation. > That psychedelics can worsen mental disorder? That sentence is not the same as the previous claim.