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As an outsider, that American obsession with prescripted medication seems maddening. Many of these conditions are caused by underlying societal factors and are

As an outsider, that American obsession with prescripted medication seems maddening. Many of these conditions are caused by underlying societal factors and are nowhere near as widespread outside the US. The American solution is to throw more pills at the problem, or ostracise the patients not willing to take that route. Even children are offered an ever larger number of pills, and are constantly challenged about their self-identification.

thomastjeffery 4y ago
If a treebranch falls on me, should I limit treatment to wind-based therapy?
nkozyra 4y ago
My views have changed about this a lot over the years. I've gone from feeling that medication is largely unnecessary and that there are alternative routes to feeling that carefully directed medications can and often should be used along with alternative therapies, when applicable. Just throwing medication at a problem and calling it a day will never be useful, but seeing a lot of people find success with a mix of medications (amphetamines, ketamine, mushrooms, etc.) with therapy has been kind of eye opening. A lot of this stems from blanket stigmatization of some drugs versus others. Fixing society is a much larger (and ultimately fluid, unsolvable) problem so I feel like whatever people can do to find contentment should be on the table.
- chiefalchemist 4y ago
  > Fixing society is a much larger (and ultimately fluid, unsolvable) problem so I feel like whatever people can do to find contentme But why is it unsolvable? As the parent comment noted, these issues aren't as prevalent in other cultures. So why here? Why is these so much pain that needs to be medicated? I'm not anti-meds. I think the re-introduction of MDMA and other formerly alternative meds is a good thing as they are more effective. And there will always going to be some people who need such assistance. However, we can still ask why? Why are so many suffering so much that they need meds?
  - nkozyra 4y ago
    > Why is it unsolvable? Because as we solve societal problems new ones will arise. There's no utopian ideal. > As the parent comment noted, these issue dont They don't what?
    - chiefalchemist 4y ago
      So we are content and complicit and stick with the status quo? That mindset itself is a problem. A problem that would still have us living in caves.
      - nkozyra 4y ago
        > So we are content and complicit and stick with the status quo? Why can't we be content but not "complicit" and still address issues? I'd argue having a growing population with mental health issues is less prepared to functionally address larger problems. This feels like it's piggy backing off of a caricature of a zoned out druggie who doesn't care what's happening around them.
    - themitigating 4y ago
      Perfection isn't required and as others have noted there are countries with far less problems so obviously it is possible
      - nkozyra 4y ago
        > Perfection isn't required and as others have noted there are countries with far less problems so obviously it is possible Never said it was impossible to improve. I said it was impossible to "fix" society.
        themitigating 4y ago
        Fix doesn't mean perfection either. Come on, it means bring things to a level consistent with other similar countries. Your absolute take on this is a deflection to avoid any change
- 0xcde4c3db 4y ago
  It's important to keep in mind that while the combination of drugs+psychotherapy works better than either alone on average across a population, this doesn't mean that everyone should be pursuing both. Some people do not respond (or even respond negatively) to psychotherapy, just like with drug therapy. Psychotherapy as an industry also has some pretty serious problems with professional and scientific standards that tend to get swept under the rug because so many people lean into psychotherapy triumphalism (e.g. declaring that drugs are only good for enabling psychotherapy, or that everyone should be seeing a therapist).
mettamage 4y ago
Also, this is mentioned with the book: The Body Keeps The Score by Bessel van der Kolk
ValentineC 4y ago
I am amazed that seemingly-American Redditors (and some other acquaintances I've made in real life) really know their medication brands. I'm guessing it has a bit to do with pharmaceutical advertising targeted directly at consumers too.
- deleted 4y ago
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SV_BubbleTime 4y ago
I don’t think we have any idea how bad it really is. I have anecdotes, but only Pharma companies have real numbers, they’ll never release them. I was surprised at how many HN users happily talk about which SSRIs they are on.
Simulacra 4y ago
underlying societal factors I'm glad you brought that up. I always found it amusing that the best medicine for depression is to go out, meet people, engage with the world around you, but depression keeps you from doing that. American culture is very individualistic and there's very little pushing communities together, which would seem to exacerbate depression once it takes its hold..
- hammyhavoc 4y ago
  As an anecdotal counterpoint, I find mingling with others to be excruciating when I'm depressed.
cnity 4y ago
I think it's more nuanced. If anything, MDMA therapy goes _hand in hand_ with dealing with the societal factors, because as an empathogen it enables you to deal with trauma in a loving and caring way. This is not about "correcting" imbalances in the brain or brushing issues under the rug, it's about dealing with them directly.
timcobb 4y ago
What you're saying may or may not be true, but it is orthogonal to the idea of exploring the role MDMA might have in improving the human condition and helping us understand existence.
LapsangGuzzler 4y ago
I generally agree with the sentiment that American culture tends to over-prescribe medication. That said, I've had a lot of incredibly positive experiences with psychedelics and I think taking a substance under the supervision of a trained therapist is different than just handing out bottles of pills. The other great thing about psychedelics is that they're typically only used temporarily as opposed to many other kinds of prescription antidepressants, which often need to be taken for extended periods or for life. The pharma industry has tended to favor solutions that incentivize the latter and I think we desperately need alternatives that don't require long-term intervention.
toddmorey 4y ago
Depression and anxiety are complicated. For some patients, taking medication can be transformative, especially when combined with other modalities of treatment. In my experience, you still have to put in the work, but the right medication can make it possible. If you are worried about patients being ostracized for declining medication, worry too about ostracizing patients for whom it could be really effective.
- starkd 4y ago
  But many times the medication are so good in the short term, it is very easy to forego doing the work.
  - JAlexoid 4y ago
    That's why people use(and abuse) all kinds of substances. It's just your social acceptance of a certain substance is deemed "acceptable"(alcohol), while others are deemed "bad"(THC).
Glench 4y ago
> As an outsider, that American obsession with prescripted medication seems maddening. Totally sympathize with that viewpoint, but I'm not sure if this commenter knows that MDMA will not be a prescription medication — no one is prescribed or goes home with MDMA. The treatment in the trials is only 3 medication-assisted therapy sessions with normal preparation and integration therapy sessions before and after. After those 3 MDMA sessions, the patient doesn't take MDMA again. It's been clear since the beginning that it's psychedelic-assisted therapy — not just psychedelics — that makes the treatment effective.
- toddmorey 4y ago
  This is a really good point. It's a therapy, not a prescription per se.
- starkd 4y ago
  People will use it as justification to buy it illegally.
  - nordsieck 4y ago
    > People will use it as justification to buy it illegally. People already buy it illegally. I don't see how this will meaningfully change the supply or demand.
  - meepmorp 4y ago
    Because without that justification MDMA hasn't been popular with people buying drugs illegally?
  - JAlexoid 4y ago
    MDMA is no less popular in Europe, than it is in US. You should read up on harm reduction.
  - KyeRussell 4y ago
    And? MDMA very realistically shouldn’t be lumped in with cocaine, heroin, etc. Hell, opiates as a whole! Just based on the effect profile and typical usage patterns, I baselessly posit that one is more likely to be a daily marijuana user than a daily MDMA user, even taking into account the number of people that use each drug in the first place. Nobody is holding you up with a knife or gun, or stealing the coins out of your car, to get their next fix of MDMA. Nobody is acting aggressively on the street or in a nightclub because they’ve had MDMA, or not gotten enough of it. MDMA is certainly not without its risks / dangers. Someone can easily irresponsibly take too much and end up in hospital or dead. Someone can easily take the right amount of the right stuff and end up in hospital or dead just because they had an adverse reaction. You could ruin your relationships, throw your brain off-balance such that you never really enjoy anything again. There’s the whole ‘gateway drug’ argument. Blah blah blah. Let’s really stop and think very carefully about whether these risks (which unlike say…meth, heroin, etc, have an absolutely negligible societal impact per capita compared to alcohol, tobacco, etc) should even show up on the radar when weighed up against the increasingly proven positive effects of MDMA-assisted psychotherapy.
starkd 4y ago
The success in these studies is largely short term. There are many drugs that will help - even cure - depression over the short term. The risk is that people will interpret the short term success as an excuse to always dose whenever they experience a hurdle. I remember well the claims of SSRI's when they first came out. It was nothing short of a wonder drug. The article gives away perhaps the big underlying motivation to get these to market: its a potential billion dollar industry.
- JAlexoid 4y ago
  > its a potential billion dollar industry And that is fine. It's a good motivator to provide a great product. I will never see anyone here complaining about the video game industry... The whole video games industry is pretty much a drug for a lot of mental issues. In fact all of the recreational activities have similar mental condition boosting effects.
deleted 4y ago
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fasterik 4y ago
I see a few issues with your argument. Just because something has underlying social factors doesn't mean that it shouldn't also be treated with drugs and therapy. The latest wave of psychedelic research is not simply pushing a prescription drug; all of the research on MDMA, psilocybin, etc. is finding that these drugs work within a clinical setting paired with therapy. Also, I wasn't able to find a source saying that PTSD is less prevalent outside of the US. I found one study [1] that says that treatment seeking is higher in high-income countries. However, this doesn't imply that the US has higher rates than Europe, for example. It could also be the case that the disorder is just as prevalent or higher in lower income populations without access to mental healthcare. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034513/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034513/
- themitigating 4y ago
  I think his argument is that the US should focus on trying to solve the underlying issues, either first or at least concurrently
  - BurningFrog 4y ago
    This argument implies that approving MDMA therapy is one of the biggest efforts in the country, consuming huge resources that could go to solving big societal issues.
  - galangalalgol 4y ago
    A good starting place might be the inability to afford the very treatments and medications being studied by a large portion of the population.
    - notch898c 4y ago
      I would also revoke all the mandatory reporting and other reporting laws for therapists, and remove the ability for government to use therapy/medical records for considering licensing or security clearances. These are barriers that keep people that need therapy most from seeking it.
JAlexoid 4y ago
Take it from someone that's not from US - your comment is ignorant and toxic. In US mental conditions are undertreated, while outside of US they are underdiagnosed and self medicated. I'm from Lithuania, one of the "leaders" in suicide... which are easily preventable by normalizing mental healthcare. The stigmatization of mental conditions in Europe is sky high, to the point that it's barely possible to be seen as sane if you're just seeing a therapist. However, comments like your, are widespread amongst many in Europe and farther stigmatize accessible mental healthcare. A lot of cases prescription medication is what people need to live with their mental issues, and should not be seen as "obsession". It's no more an obsession, than chemotherapy is an obsession to a person with cacner.
- martopix 4y ago
  > The stigmatization of mental conditions in Europe is sky high, to the point that it's barely possible to be seen as sane if you're just seeing a therapist. I think this is just not true. I've never seen so many people talk openly about seeing a therapist as in the last few years. I'm almost surprised by how mainstream it has become.
  - JAlexoid 4y ago
    Not my experience. You can have someone with cancer openly talk about it, but any psychological issue is treated like it's your own personal fault.
    - BurningFrog 4y ago
      "Europe" is many very different countries.
      - augment002 4y ago
        The US is many different states. If you think California and Kentucky are the same, I invite you to visit.
      - JAlexoid 4y ago
slibhb 4y ago
Leaving aside the important fact there's no broad agreement about which "underlying societal factors" cause mental illness, individuals taking pills is much more realistic than overhauling society.
syndacks 4y ago
This same system brought COVID vaccines to the rest of the world in warp speed.
VoodooJuJu 4y ago
1. Friends and family helping each other with their issues isn't profitable, but selling drugs to "help" with their issues is. 2. Similarly, unbroken families aren't profitable, but split up ones are: divorce proceedings, 2x apartments/houses/taxes, higher dependency on the state for assistance, no family to help through issues which may beget drugs (see #1).
outlace 4y ago
I agree but it’s hard to navigate out of it organically. The mental health crisis is quite similar in origin as the obesity epidemic. In the latter it is largely caused by the food environment and we could avoid the vast majority of cases of diabetes by changing our societal food environment, but how does one do that? A politician that bans or regulates sugar is not going to be popular. People want their sweets, or at least the option to have sweets. So what is the medical system to do if it can’t modify the food environment? It generates drugs that treat the diseases caused by the food environment. Similar with mental health. There are society-wide environmental factors likely contributing to huge rates of depression and anxiety, but how is any one person or organization supposed to change that? So what does the medical system do? It generates drugs to treat the mental health conditions caused by environmental factors. It’s a bad equilibrium but it’s hard to see a path out. Otherwise if you decide drugs are bad you have still have the environmental causes there and a bunch of untreated diabetes and suicidal people.
systemtest 4y ago
I am not sure if medication is due to societal factors. The list of countries with high antidepressant consumption is topped by Iceland, Australia, Portugal, UK, Canada and Sweden. All countries with a high quality of life, good safety nets, universal healthcare. Australia, Sweden and Iceland are exemplary progressive countries that are in the top 10 of the Human Development Index.
AmericanChopper 4y ago
I don’t think that’s a uniquely American problem at all. When you go to a doctor with a problem, the only tool they have available to help you is medical treatments. If you go to a doctor with a psychological problem, or a lifestyle problem, the only way they can help you is with a medical treatment. Any place you go in the world you’ll find huge amounts of mental health or lifestyle-related physical health problems, and they’ll either be untreated, or medicated. With the only factor that influences the ration between those two being how economically developed that place is. The only thing unique about the US is the amount of money put into healthcare. But they’re pumping the kids full of drugs in Australia too…
mardifoufs 4y ago
Ok but this isn't really true. The country with the most anti-depressant intake is Iceland, the US is around second or third place, yet the other countries in the "top ten" of antidepressant usage per capita are almost all european nations. The USA isn't an outlier, but I guess we really can't escape the "do americans really, really do X?" even when it is trivially easy to verify. The funny thing is that the reason Americans know the names of their medications is almost the exact same reason people seem to think the USA are always some sort of outlier; they hear about it more in the media! Branding for drugs is much more emphasized in the US.
- nwoli 4y ago
  Antidepressants and adderall are very different beasts
  - augment002 4y ago
    It’s not clear how this is relevant.
  - Spivak 4y ago
    Yeah, antidepressants are way more complicated, they have more side effects, and have to be monitored carefully to not make the underlying issues that caused the patient to take them worse. Suicidal thoughts plus antidepressants that give you energy can give you the motivation to go through it. And despite not being categorized as addictive you can't stop taking them without wrecking your mental health until your body readjusts. If you don't refill your Rx of antidepressants your doctor will be notified and reach out to you because stopping has such pronounced effects. While at the same time despite being a controlled substance because they're supposedly so addictive people with ADHD forget to take adderall and with normal use you don't take it every day. We got this this shit so unbelievably backwards because we haven't shook the puritanical bullshit of "oh no someone might experience euphoria if they go out of their way to abuse it." Like bro, people with real medical issues shouldn't suffer because of this crap. If everyone who is buying cocaine from their dealer switched to medically supervised stimulants we would be unquestionably better off.
say_it_as_it_is 4y ago
The problem begins with the organizations who govern curriculum and expectations of those who are licensed to practice mental health services.
dimal 4y ago
Normally, I’d agree with you, but in this case, I think the medication is warranted. While PTSD may be caused by societal factors, healing large numbers of individuals from it is not going to happen without medication. Speaking as someone who is recovering from PTSD, I can tell you that no amount of talk therapy can heal it. It can help, but never heal it. If MDMA is effective as it appears to be, we must utilize it. If we heal people from PTSD, then we have a chance to heal society.
cactusplant7374 4y ago
> nowhere near as widespread outside the US Except they are but they are just ignored because of lack of knowledge and money. Many countries don't even recognize ADHD so the kid never goes to college and doesn't reach their full potential.
goodpoint 4y ago
> that American obsession with prescripted medication seems maddening Yes but don't confuse short term use of medication to help with therapy with long-term to help sell pills. The first can be beneficial, the latter is very profitable. And because of the profit motive, millions of poor people with serious conditions go untreated. What is really bad is the complete absence of any public debate about prevention. Individuals are completely blamed for mental health issues and society gets a pass. > and are constantly challenged about their self-identification. Huh? What are you talking about??
KyeRussell 4y ago
The classic Gen X parent “over-medicated child” scapegoat is stimulant medication for ADHD. It needs to be said that the reality for better or worse is that compared to other psych meds the efficacy is pretty damn high, and the entirely justified popular opinion in the ADHD community is that dealing with ADHD without stimulants is often like pushing a rock up a hill. And, sure, argue that ADHD’s mere categorisation as a ‘bad thing’ is a reflection of society’s expectations of a person. But…so what? I’d love a socialist utopia. This is a big part of the reason I’d never ever move to the US in the first place. But I damn well still take my Vyvanse and don’t look down on anyone else that does so because we are all still cogs, even me as a fairly privileged tech worker. Stroking your chin and saying “yeah, but we live in a society!” belongs right at the top of the metaphorical food pyramid. If you do it any more than rarely, you’re going to quite rightfully come across as a privileged dick. This is notwithstanding the wider point that this whole thing is about using MDMA as a short-term therapy aid.
wmeredith 4y ago
I rarely downvote, but this take is just straight-up factually incorrect and it is the top comment as of now. The facts and assumptions here are rebutted in other replies, so I'll leave them to it.
repler 4y ago
The societal factors you mention are due to - unfortunately - freedom. Humans are innately horrible. Freedom also means freedom to be horrible. Unfortunately.
- rootusrootus 4y ago
  > Humans are innately horrible. You're even more pessimistic than me ;-). I think that most humans are good or at least neutral, but the horrible ones are a lot more visible. And a lot of what we call horrible is just rhetoric -- when the shit hits the fan, people pull together, even when they're ideologically opposed. At least in my experience. There are outliers, of course.
dang 4y ago
"Eschew flamebait. Avoid generic tangents." https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html

thomastjeffery 4y ago

If a treebranch falls on me, should I limit treatment to wind-based therapy?

nkozyra 4y ago

My views have changed about this a lot over the years. I've gone from feeling that medication is largely unnecessary and that there are alternative routes to feeling that carefully directed medications can and often should be used along with alternative therapies, when applicable. Just throwing medication at a problem and calling it a day will never be useful, but seeing a lot of people find success with a mix of medications (amphetamines, ketamine, mushrooms, etc.) with therapy has been kind of eye opening. A lot of this stems from blanket stigmatization of some drugs versus others. Fixing society is a much larger (and ultimately fluid, unsolvable) problem so I feel like whatever people can do to find contentment should be on the table.

chiefalchemist 4y ago
> Fixing society is a much larger (and ultimately fluid, unsolvable) problem so I feel like whatever people can do to find contentme But why is it unsolvable? As the parent comment noted, these issues aren't as prevalent in other cultures. So why here? Why is these so much pain that needs to be medicated? I'm not anti-meds. I think the re-introduction of MDMA and other formerly alternative meds is a good thing as they are more effective. And there will always going to be some people who need such assistance. However, we can still ask why? Why are so many suffering so much that they need meds?
- nkozyra 4y ago
  > Why is it unsolvable? Because as we solve societal problems new ones will arise. There's no utopian ideal. > As the parent comment noted, these issue dont They don't what?
  - chiefalchemist 4y ago
    So we are content and complicit and stick with the status quo? That mindset itself is a problem. A problem that would still have us living in caves.
    - nkozyra 4y ago
      > So we are content and complicit and stick with the status quo? Why can't we be content but not "complicit" and still address issues? I'd argue having a growing population with mental health issues is less prepared to functionally address larger problems. This feels like it's piggy backing off of a caricature of a zoned out druggie who doesn't care what's happening around them.
  - themitigating 4y ago
    Perfection isn't required and as others have noted there are countries with far less problems so obviously it is possible
    - nkozyra 4y ago
      > Perfection isn't required and as others have noted there are countries with far less problems so obviously it is possible Never said it was impossible to improve. I said it was impossible to "fix" society.
      - themitigating 4y ago
        Fix doesn't mean perfection either. Come on, it means bring things to a level consistent with other similar countries. Your absolute take on this is a deflection to avoid any change
0xcde4c3db 4y ago
It's important to keep in mind that while the combination of drugs+psychotherapy works better than either alone on average across a population, this doesn't mean that everyone should be pursuing both. Some people do not respond (or even respond negatively) to psychotherapy, just like with drug therapy. Psychotherapy as an industry also has some pretty serious problems with professional and scientific standards that tend to get swept under the rug because so many people lean into psychotherapy triumphalism (e.g. declaring that drugs are only good for enabling psychotherapy, or that everyone should be seeing a therapist).

mettamage 4y ago

Also, this is mentioned with the book: The Body Keeps The Score by Bessel van der Kolk

ValentineC 4y ago

I am amazed that seemingly-American Redditors (and some other acquaintances I've made in real life) really know their medication brands. I'm guessing it has a bit to do with pharmaceutical advertising targeted directly at consumers too.

deleted 4y ago
[deleted]

SV_BubbleTime 4y ago

I don’t think we have any idea how bad it really is. I have anecdotes, but only Pharma companies have real numbers, they’ll never release them. I was surprised at how many HN users happily talk about which SSRIs they are on.

Simulacra 4y ago

underlying societal factors I'm glad you brought that up. I always found it amusing that the best medicine for depression is to go out, meet people, engage with the world around you, but depression keeps you from doing that. American culture is very individualistic and there's very little pushing communities together, which would seem to exacerbate depression once it takes its hold..

hammyhavoc 4y ago
As an anecdotal counterpoint, I find mingling with others to be excruciating when I'm depressed.

cnity 4y ago

I think it's more nuanced. If anything, MDMA therapy goes _hand in hand_ with dealing with the societal factors, because as an empathogen it enables you to deal with trauma in a loving and caring way. This is not about "correcting" imbalances in the brain or brushing issues under the rug, it's about dealing with them directly.

timcobb 4y ago

What you're saying may or may not be true, but it is orthogonal to the idea of exploring the role MDMA might have in improving the human condition and helping us understand existence.

LapsangGuzzler 4y ago

I generally agree with the sentiment that American culture tends to over-prescribe medication. That said, I've had a lot of incredibly positive experiences with psychedelics and I think taking a substance under the supervision of a trained therapist is different than just handing out bottles of pills. The other great thing about psychedelics is that they're typically only used temporarily as opposed to many other kinds of prescription antidepressants, which often need to be taken for extended periods or for life. The pharma industry has tended to favor solutions that incentivize the latter and I think we desperately need alternatives that don't require long-term intervention.

toddmorey 4y ago

Depression and anxiety are complicated. For some patients, taking medication can be transformative, especially when combined with other modalities of treatment. In my experience, you still have to put in the work, but the right medication can make it possible. If you are worried about patients being ostracized for declining medication, worry too about ostracizing patients for whom it could be really effective.

starkd 4y ago
But many times the medication are so good in the short term, it is very easy to forego doing the work.
- JAlexoid 4y ago
  That's why people use(and abuse) all kinds of substances. It's just your social acceptance of a certain substance is deemed "acceptable"(alcohol), while others are deemed "bad"(THC).

Glench 4y ago

> As an outsider, that American obsession with prescripted medication seems maddening. Totally sympathize with that viewpoint, but I'm not sure if this commenter knows that MDMA will not be a prescription medication — no one is prescribed or goes home with MDMA. The treatment in the trials is only 3 medication-assisted therapy sessions with normal preparation and integration therapy sessions before and after. After those 3 MDMA sessions, the patient doesn't take MDMA again. It's been clear since the beginning that it's psychedelic-assisted therapy — not just psychedelics — that makes the treatment effective.

toddmorey 4y ago
This is a really good point. It's a therapy, not a prescription per se.
starkd 4y ago
People will use it as justification to buy it illegally.
- nordsieck 4y ago
  > People will use it as justification to buy it illegally. People already buy it illegally. I don't see how this will meaningfully change the supply or demand.
- meepmorp 4y ago
  Because without that justification MDMA hasn't been popular with people buying drugs illegally?
- JAlexoid 4y ago
  MDMA is no less popular in Europe, than it is in US. You should read up on harm reduction.
- KyeRussell 4y ago
  And? MDMA very realistically shouldn’t be lumped in with cocaine, heroin, etc. Hell, opiates as a whole! Just based on the effect profile and typical usage patterns, I baselessly posit that one is more likely to be a daily marijuana user than a daily MDMA user, even taking into account the number of people that use each drug in the first place. Nobody is holding you up with a knife or gun, or stealing the coins out of your car, to get their next fix of MDMA. Nobody is acting aggressively on the street or in a nightclub because they’ve had MDMA, or not gotten enough of it. MDMA is certainly not without its risks / dangers. Someone can easily irresponsibly take too much and end up in hospital or dead. Someone can easily take the right amount of the right stuff and end up in hospital or dead just because they had an adverse reaction. You could ruin your relationships, throw your brain off-balance such that you never really enjoy anything again. There’s the whole ‘gateway drug’ argument. Blah blah blah. Let’s really stop and think very carefully about whether these risks (which unlike say…meth, heroin, etc, have an absolutely negligible societal impact per capita compared to alcohol, tobacco, etc) should even show up on the radar when weighed up against the increasingly proven positive effects of MDMA-assisted psychotherapy.

starkd 4y ago

The success in these studies is largely short term. There are many drugs that will help - even cure - depression over the short term. The risk is that people will interpret the short term success as an excuse to always dose whenever they experience a hurdle. I remember well the claims of SSRI's when they first came out. It was nothing short of a wonder drug. The article gives away perhaps the big underlying motivation to get these to market: its a potential billion dollar industry.

JAlexoid 4y ago
> its a potential billion dollar industry And that is fine. It's a good motivator to provide a great product. I will never see anyone here complaining about the video game industry... The whole video games industry is pretty much a drug for a lot of mental issues. In fact all of the recreational activities have similar mental condition boosting effects.

deleted 4y ago

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fasterik 4y ago

I see a few issues with your argument. Just because something has underlying social factors doesn't mean that it shouldn't also be treated with drugs and therapy. The latest wave of psychedelic research is not simply pushing a prescription drug; all of the research on MDMA, psilocybin, etc. is finding that these drugs work within a clinical setting paired with therapy. Also, I wasn't able to find a source saying that PTSD is less prevalent outside of the US. I found one study [1] that says that treatment seeking is higher in high-income countries. However, this doesn't imply that the US has higher rates than Europe, for example. It could also be the case that the disorder is just as prevalent or higher in lower income populations without access to mental healthcare. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034513/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034513/

themitigating 4y ago
I think his argument is that the US should focus on trying to solve the underlying issues, either first or at least concurrently
- BurningFrog 4y ago
  This argument implies that approving MDMA therapy is one of the biggest efforts in the country, consuming huge resources that could go to solving big societal issues.
- galangalalgol 4y ago
  A good starting place might be the inability to afford the very treatments and medications being studied by a large portion of the population.
  - notch898c 4y ago
    I would also revoke all the mandatory reporting and other reporting laws for therapists, and remove the ability for government to use therapy/medical records for considering licensing or security clearances. These are barriers that keep people that need therapy most from seeking it.

JAlexoid 4y ago

Take it from someone that's not from US - your comment is ignorant and toxic. In US mental conditions are undertreated, while outside of US they are underdiagnosed and self medicated. I'm from Lithuania, one of the "leaders" in suicide... which are easily preventable by normalizing mental healthcare. The stigmatization of mental conditions in Europe is sky high, to the point that it's barely possible to be seen as sane if you're just seeing a therapist. However, comments like your, are widespread amongst many in Europe and farther stigmatize accessible mental healthcare. A lot of cases prescription medication is what people need to live with their mental issues, and should not be seen as "obsession". It's no more an obsession, than chemotherapy is an obsession to a person with cacner.

martopix 4y ago
> The stigmatization of mental conditions in Europe is sky high, to the point that it's barely possible to be seen as sane if you're just seeing a therapist. I think this is just not true. I've never seen so many people talk openly about seeing a therapist as in the last few years. I'm almost surprised by how mainstream it has become.
- JAlexoid 4y ago
  Not my experience. You can have someone with cancer openly talk about it, but any psychological issue is treated like it's your own personal fault.
  - BurningFrog 4y ago
    "Europe" is many very different countries.
    - augment002 4y ago
      The US is many different states. If you think California and Kentucky are the same, I invite you to visit.
    - JAlexoid 4y ago

slibhb 4y ago

Leaving aside the important fact there's no broad agreement about which "underlying societal factors" cause mental illness, individuals taking pills is much more realistic than overhauling society.

syndacks 4y ago

This same system brought COVID vaccines to the rest of the world in warp speed.

VoodooJuJu 4y ago

1. Friends and family helping each other with their issues isn't profitable, but selling drugs to "help" with their issues is. 2. Similarly, unbroken families aren't profitable, but split up ones are: divorce proceedings, 2x apartments/houses/taxes, higher dependency on the state for assistance, no family to help through issues which may beget drugs (see #1).

outlace 4y ago

I agree but it’s hard to navigate out of it organically. The mental health crisis is quite similar in origin as the obesity epidemic. In the latter it is largely caused by the food environment and we could avoid the vast majority of cases of diabetes by changing our societal food environment, but how does one do that? A politician that bans or regulates sugar is not going to be popular. People want their sweets, or at least the option to have sweets. So what is the medical system to do if it can’t modify the food environment? It generates drugs that treat the diseases caused by the food environment. Similar with mental health. There are society-wide environmental factors likely contributing to huge rates of depression and anxiety, but how is any one person or organization supposed to change that? So what does the medical system do? It generates drugs to treat the mental health conditions caused by environmental factors. It’s a bad equilibrium but it’s hard to see a path out. Otherwise if you decide drugs are bad you have still have the environmental causes there and a bunch of untreated diabetes and suicidal people.

systemtest 4y ago

I am not sure if medication is due to societal factors. The list of countries with high antidepressant consumption is topped by Iceland, Australia, Portugal, UK, Canada and Sweden. All countries with a high quality of life, good safety nets, universal healthcare. Australia, Sweden and Iceland are exemplary progressive countries that are in the top 10 of the Human Development Index.

AmericanChopper 4y ago

I don’t think that’s a uniquely American problem at all. When you go to a doctor with a problem, the only tool they have available to help you is medical treatments. If you go to a doctor with a psychological problem, or a lifestyle problem, the only way they can help you is with a medical treatment. Any place you go in the world you’ll find huge amounts of mental health or lifestyle-related physical health problems, and they’ll either be untreated, or medicated. With the only factor that influences the ration between those two being how economically developed that place is. The only thing unique about the US is the amount of money put into healthcare. But they’re pumping the kids full of drugs in Australia too…

mardifoufs 4y ago

Ok but this isn't really true. The country with the most anti-depressant intake is Iceland, the US is around second or third place, yet the other countries in the "top ten" of antidepressant usage per capita are almost all european nations. The USA isn't an outlier, but I guess we really can't escape the "do americans really, really do X?" even when it is trivially easy to verify. The funny thing is that the reason Americans know the names of their medications is almost the exact same reason people seem to think the USA are always some sort of outlier; they hear about it more in the media! Branding for drugs is much more emphasized in the US.

nwoli 4y ago
Antidepressants and adderall are very different beasts
- augment002 4y ago
  It’s not clear how this is relevant.
- Spivak 4y ago
  Yeah, antidepressants are way more complicated, they have more side effects, and have to be monitored carefully to not make the underlying issues that caused the patient to take them worse. Suicidal thoughts plus antidepressants that give you energy can give you the motivation to go through it. And despite not being categorized as addictive you can't stop taking them without wrecking your mental health until your body readjusts. If you don't refill your Rx of antidepressants your doctor will be notified and reach out to you because stopping has such pronounced effects. While at the same time despite being a controlled substance because they're supposedly so addictive people with ADHD forget to take adderall and with normal use you don't take it every day. We got this this shit so unbelievably backwards because we haven't shook the puritanical bullshit of "oh no someone might experience euphoria if they go out of their way to abuse it." Like bro, people with real medical issues shouldn't suffer because of this crap. If everyone who is buying cocaine from their dealer switched to medically supervised stimulants we would be unquestionably better off.

say_it_as_it_is 4y ago

The problem begins with the organizations who govern curriculum and expectations of those who are licensed to practice mental health services.

dimal 4y ago

Normally, I’d agree with you, but in this case, I think the medication is warranted. While PTSD may be caused by societal factors, healing large numbers of individuals from it is not going to happen without medication. Speaking as someone who is recovering from PTSD, I can tell you that no amount of talk therapy can heal it. It can help, but never heal it. If MDMA is effective as it appears to be, we must utilize it. If we heal people from PTSD, then we have a chance to heal society.

cactusplant7374 4y ago

> nowhere near as widespread outside the US Except they are but they are just ignored because of lack of knowledge and money. Many countries don't even recognize ADHD so the kid never goes to college and doesn't reach their full potential.

goodpoint 4y ago

> that American obsession with prescripted medication seems maddening Yes but don't confuse short term use of medication to help with therapy with long-term to help sell pills. The first can be beneficial, the latter is very profitable. And because of the profit motive, millions of poor people with serious conditions go untreated. What is really bad is the complete absence of any public debate about prevention. Individuals are completely blamed for mental health issues and society gets a pass. > and are constantly challenged about their self-identification. Huh? What are you talking about??

KyeRussell 4y ago

The classic Gen X parent “over-medicated child” scapegoat is stimulant medication for ADHD. It needs to be said that the reality for better or worse is that compared to other psych meds the efficacy is pretty damn high, and the entirely justified popular opinion in the ADHD community is that dealing with ADHD without stimulants is often like pushing a rock up a hill. And, sure, argue that ADHD’s mere categorisation as a ‘bad thing’ is a reflection of society’s expectations of a person. But…so what? I’d love a socialist utopia. This is a big part of the reason I’d never ever move to the US in the first place. But I damn well still take my Vyvanse and don’t look down on anyone else that does so because we are all still cogs, even me as a fairly privileged tech worker. Stroking your chin and saying “yeah, but we live in a society!” belongs right at the top of the metaphorical food pyramid. If you do it any more than rarely, you’re going to quite rightfully come across as a privileged dick. This is notwithstanding the wider point that this whole thing is about using MDMA as a short-term therapy aid.

wmeredith 4y ago

I rarely downvote, but this take is just straight-up factually incorrect and it is the top comment as of now. The facts and assumptions here are rebutted in other replies, so I'll leave them to it.

repler 4y ago

The societal factors you mention are due to - unfortunately - freedom. Humans are innately horrible. Freedom also means freedom to be horrible. Unfortunately.

rootusrootus 4y ago
> Humans are innately horrible. You're even more pessimistic than me ;-). I think that most humans are good or at least neutral, but the horrible ones are a lot more visible. And a lot of what we call horrible is just rhetoric -- when the shit hits the fan, people pull together, even when they're ideologically opposed. At least in my experience. There are outliers, of course.

dang 4y ago

"Eschew flamebait. Avoid generic tangents." https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html