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Thank you. I'll never understand why there's such a dominance of luddite thinking, bad takes and conspiracy theories on HN, when it comes to the topic of mental

Thank you. I'll never understand why there's such a dominance of luddite thinking, bad takes and conspiracy theories on HN, when it comes to the topic of mental health. Especially when it comes to drug treatments. Psychiatry no doubt has a lot of problems with it. But it's also the only game in town for a huge amount of people. What's the alternative? Prayer circles? Ayahuasca tourist traps? Cannabis? Homeopathy? Give me a break. Conventional medicine has always been imperfect, and has always improved over time. That's no less true of psychiatry than any other subfield. Whatever "alternative" therapies are truly effective tend to be incorporated into it eventually. In psychiatry we've seen this with meditation, and we're seeing it now with psychedelics.

afavour 3y ago
> I'll never understand why there's such a dominance of luddite thinking, bad takes and conspiracy theories on HN, when it comes to the topic of mental health I imagine there are many professional forums filled with people who know topic X inside out therefore assume they must also be an authority on unrelated topics Y and Z. But I also suspect there’s something about software engineering, perhaps the ability to succeed despite being deeply antisocial, or being very male dominated that means women’s mental health in particular is always going to be a dumpster fire discussion topic.
- haldujai 3y ago
  It's insane to me that a group of educated and seemingly intelligent people seem to think they understand more about drug safety and prescribing than the FDA, researchers and physicians. This is reminiscent of the Texas district judge who decided to controversially overrule the FDA on a medication safety decision that recently made the news, not good company one wants to have and I'm hoping is coincidental than suggestive of similar biases.
  - warbeforepeace 3y ago
    Its easy to figure out. Religion causes it.
    - specialist 3y ago
      I no longer believe that's the root, or even the primary, cause. I keep thinking about Michael Crichton. He transmorphed from reality-based to nutter. What happened? Religion wasn't a factor. So what radicalized him? Historian Joanna Radin's theory, paraphrasing, is that Crichton's full faith and trust in The System was so completely shattered, by the Vietnam War and other outrages, that he completely flipped. The Speculative Present - How Michael Crichton Colonized the Future of Science and Technology https://www.journals.uchicago.edu/doi/epdf/10.1086/704047 https://www.journals.uchicago.edu/doi/epdf/10.1086/704047 The theme of the second season of Jill Lepore's The Last Archive podcast is about skepticism ("What fed Doubt?") S01E06 "It Came From Outer Space" includes the example of Crichton's radicalization. https://www.thelastarchive.com/season-2-episodes https://www.thelastarchive.com/season-2-episodes Lepore has completely opened up my mind about anti-science, conspiracy, and other social pathogens. Made me a bit more empathetic. Highest recommendation.
  - NoZebra120vClip 3y ago
    [flagged]
    - haldujai 3y ago
      What black box warning are you talking about? The only one I see for Zurzuvae is: "IMPAIRED ABILITY TO DRIVE OR ENGAGE IN OTHER POTENTIALLY HAZARDOUS ACTIVITIES"[1] [1]https://documents.sage-biogen.com/us/zurzuvae/pi.pdf https://documents.sage-biogen.com/us/zurzuvae/pi.pdf
      - caeril 3y ago
        I haven't yet read the clinical trial results, but suicidal ideation has turned out to be a shockingly common side-effect of many other types of anti-depressants. The comment was unnecessarily inflammatory, but the concern is reasonable.
      - NoZebra120vClip 3y ago
        My bad - not a black box in this case. Just a regular box. Sorry for the confusion.
        haldujai 3y ago
        Black box (obsolete) and regular box are the same thing, they're simply called boxed warnings. In case you think this is semantics, boxed warnings are a determination by the FDA of a risk of adverse reaction so serious in proportion to the benefit of the drug it must be considered when assessing risks and benefits. The warning you are referring to is a regular warning which is used when there some evidence of a causal association but a causal relationship has not been definitively identified. In this specific instance it is based on an association of increased suicidality in a study looking at all antidepressants for all depressive indications and specifically in patients below the age of 25, not specific to this drug or drug class. This warning is accordingly present on all antidepressants. I won't go into the knowledge base behind this warning, its magnitude and variation between drugs but it is readily available online. Suffice it to say medical experts do not view the risk serious enough to merit a boxed warning and should the FDA have wanted to absolve themselves of blame as. you suggest it would be boxed.
  - staticman2 3y ago
    >>>"It's insane to me that a group of educated and seemingly intelligent people seem to think they understand more about drug safety and prescribing than the FDA, researchers and physicians." I'm currently on a psychiatrist prescribed drug which is illegal in Japan, which means I have to discontinue it before an upcoming trip. This is not a new drug, it's a generic. So is it "insane that a group of educated and seemingly intelligent doctors" in the U.S. are prescribing this drug or "insane that a group of educated and seemingly intelligent doctors" at the Japanese equivilent to the FDA are not authorizing this drug? I mean, it can't possibly be the case that neither group knows what it's doing, and that our scientific understanding of the brain is primitive, correct? One group has to be the insane one, right?
    - afavour 3y ago
      I think there’s a meaningful difference there. A disagreement between two highly qualified groups of doctors seems valid. A disagreement between a group of highly qualified doctors and someone who did some research on the internet does not.
      - staticman2 3y ago
        "A disagreement between two highly qualified groups of doctors seems valid." Well... if we're talking psychiatrists, they choose the thing they wanted to be highly qualified in. So, any potential "expert" that would disagree with their research methods was selected out so as to not become an expert in the first place. I guess if I have a point it's that I don't think shouting "trust the science" or "trust the experts" and beating one's chest is contributing much to the conversation.
        haldujai 3y ago
        What's insane is that seemingly intelligent people with zero medical training or research experience somehow think they have the capability to determine drug safety or whether a disease exists and merits treatment with pharmacotherapy. > So, any potential "expert" that would disagree with them was selected out so as to not become an expert in the first place. Anyone with some form of training or practical experience in an academic biomedical field (clinical or research) and has knowledge of how to synthesize and analyze evidence in order to make logical arguments may be considered a relevant expert, this is a much larger group than psychiatrists and is how FDA committees are constructed. Most notably this includes (and is not limited to) other physicians and providers, pharmacologists, pathologists, physiologists and epidemiologists. > I guess if I have a point it's that I don't think shouting "trust the science" or "trust the experts" and beating one's chest is contributing much to the conversation. One should absolutely "trust the experts" when it comes to determining safety of a therapeutic or definition of a disease. These are determined by scientific processes and debate based on evidence and not philosophical thoughts and feelings. Given how complex modern life is one has to defer to experts and regulators on many things beyond medicine. Some other examples: motor vehicles, aviation, building codes, financial institutions and encryption. > I'd also say that the more I've learned about psychiatry (including as a customer) the lower the opinion I have of it. The limitations in psychiatric medicine and research are widely acknowledged and not a novel insight that the FDA and medical community are ignorant of as many commenters here seem to believe.
NoZebra120vClip 3y ago
[flagged]
- tsimionescu 3y ago
  This is completely and utterly wrong. Psychiatric treatment varies in effectiveness, but there are drugs like lithium which have a fast and marked effect on the diseases they treat (e.g. Bipolar disorder, a crippling illness if left untreated). Depression drugs are less effective overall than other psychiatric illnesses, but even these have proven clinical effects in huge double-blind trials. You really should read up on the literature, or hang around some people with serious mental health problems before spewing such garbage.
zpeti 3y ago
It’s very easy to explain. By going straight to medication you are treating the symptom not the cause. And you don’t even know if it works. SSRIs don’t work for many people and we only found out 2-3 years ago. Opioids were prescribed to half of America for back pain. That gives scope for healthy scepticisms at least. Just because you might have some anecdotal evidence of some chemicals working, doesn’t mean it works for others or that it leads to a good place. Lastly - there are clearly lifestyle and even moral choices that people make or don’t make that can lead to mental health issues. Just from a common sense perspective it seems much healthier to try and deal with these first, with therapy, than just medicating. And not just therapy. Exercise, diet. We know these affect mental health, yet pills are easy, and they make doctors money. medicating is much easier than searching, finding and healing the cause. Therapy takes years, if not decades. I can understand why people pick the easier route, but easier is not always better. Also, are you just permanently going to be on pills then? I mean it’s a great subscription business, I can see that.
- haldujai 3y ago
  > By going straight to medication Initial treatment recommendations: For mild to moderate postpartum unipolar major depression, we suggest psychotherapy as initial treatment. This approach is consistent with multiple practice guidelines, and is especially useful for lactating patients who do not want to expose their infants to antidepressants. However, antidepressants (eg, selective serotonin reuptake inhibitors [SSRIs], serotonin-norepinephrine reuptake inhibitors, bupropion, and mirtazapine) are a reasonable alternative if psychotherapy is not available, not successful, or is declined, or if the patient has previously responded to antidepressants. In addition, combination treatment with pharmacotherapy plus psychotherapy is useful for some patients. Source: UpToDate. > And you don’t even know if it works. While evidence for SSRIs is weak in meta-analyses this is not one of them. I will also agree that a single trial (i.e. the original post and what led to approval) is not definitive but does in fact suggest it works and will continue to be assessed in post-market studies.
- mtlmtlmtlmtl 3y ago
  Look. It's not some earth shattering revelation that "SSRIs don't work for many people". This has been known since SSRIs first appeared on the scene. This is also true of any other treatment you can think of. The reason they became the first choice as far as antidepressants go is they were a lot safer and better tolerated than the older alternatives. Besides, there's a lot more to psychiatry than just SSRIs. But with people like you it's always about SSRIs. Can't shut up about the SSRIs. If you hadn't noticed, this new drug is not an SSRI! Psychiatrists recommend therapy, they recommend changes in diet and they recommend exercise. Clinical psychology, though technically a separate discipline from psychiatry, not being under the umbrella of medicine, is very much developed, researched and practiced in tandem and cooperation withpsychiatry, and vice versa. You're constructing an elaborate strawman here, where the only reason for using drugs is some evil financial motive. It's just not that simple. There bad apples, and perverse incentives, but not only bad apples. Most doctors do in fact care about helping their patients. Therapy can't fix everything. Therapy alone is not always sufficient and can be just as hit and miss as medication. Not everything is some deep personal issue that needs to be analysed and resolved. Mental disorder is often genetic, even neurological in nature. All the therapy in the world won't stop a bipolar person from cycling between mood disturbances, or someone with ADHD from being unable to concentrate. We can't throw the baby out with the bathwater. Medication, therapy, meditation, diet, exercise, sleep hygiene are all part of the psychiatric toolbox.
themitigating 3y ago
The compartmentilzation of intelligence
serf 3y ago
>What's the alternative? Prayer circles? Ayahuasca tourist traps? Cannabis? Homeopathy? Give me a break. PPD aside, if we're talking about the issues that psychiatry seeks to alleviate, every one of those 'solutions' has had thousands of advocates/adherents/patients that claim to have gained positive effect. and before I get considered a proponent of any of those; i'm not -- but I recognize the cohort of people who claim to have gained benefit just as I recognize the group who claim to have benefited from psychiatry. mental health needs not be a monopoly; many people go through issues that they fix through specific personal events or patterns that are specific only to them. You can complain about the style of thinking that you encounter on HN without disparaging the things that have helped people outside of clinical settings. Mental health and well-being is one of the most mysterious things that we study, if a suicide or otherwise bad decision is staved off by chanting in makeup and visiting exotic locations then so be it, that's what worked for them. And another aside : psychiatry will never incorporate extreme things that may help certain individuals, nor should they -- but that means that the breadth of things that are helpful is greater than the breadth of things that will ever fall within the umbrella of clinical mental health; so you should probably hold off on judging things based on whether or not the industry has adopted them.

afavour 3y ago

> I'll never understand why there's such a dominance of luddite thinking, bad takes and conspiracy theories on HN, when it comes to the topic of mental health I imagine there are many professional forums filled with people who know topic X inside out therefore assume they must also be an authority on unrelated topics Y and Z. But I also suspect there’s something about software engineering, perhaps the ability to succeed despite being deeply antisocial, or being very male dominated that means women’s mental health in particular is always going to be a dumpster fire discussion topic.

haldujai 3y ago
It's insane to me that a group of educated and seemingly intelligent people seem to think they understand more about drug safety and prescribing than the FDA, researchers and physicians. This is reminiscent of the Texas district judge who decided to controversially overrule the FDA on a medication safety decision that recently made the news, not good company one wants to have and I'm hoping is coincidental than suggestive of similar biases.
- warbeforepeace 3y ago
  Its easy to figure out. Religion causes it.
  - specialist 3y ago
    I no longer believe that's the root, or even the primary, cause. I keep thinking about Michael Crichton. He transmorphed from reality-based to nutter. What happened? Religion wasn't a factor. So what radicalized him? Historian Joanna Radin's theory, paraphrasing, is that Crichton's full faith and trust in The System was so completely shattered, by the Vietnam War and other outrages, that he completely flipped. The Speculative Present - How Michael Crichton Colonized the Future of Science and Technology https://www.journals.uchicago.edu/doi/epdf/10.1086/704047 https://www.journals.uchicago.edu/doi/epdf/10.1086/704047 The theme of the second season of Jill Lepore's The Last Archive podcast is about skepticism ("What fed Doubt?") S01E06 "It Came From Outer Space" includes the example of Crichton's radicalization. https://www.thelastarchive.com/season-2-episodes https://www.thelastarchive.com/season-2-episodes Lepore has completely opened up my mind about anti-science, conspiracy, and other social pathogens. Made me a bit more empathetic. Highest recommendation.
- NoZebra120vClip 3y ago
  [flagged]
  - haldujai 3y ago
    What black box warning are you talking about? The only one I see for Zurzuvae is: "IMPAIRED ABILITY TO DRIVE OR ENGAGE IN OTHER POTENTIALLY HAZARDOUS ACTIVITIES"[1] [1]https://documents.sage-biogen.com/us/zurzuvae/pi.pdf https://documents.sage-biogen.com/us/zurzuvae/pi.pdf
    - caeril 3y ago
      I haven't yet read the clinical trial results, but suicidal ideation has turned out to be a shockingly common side-effect of many other types of anti-depressants. The comment was unnecessarily inflammatory, but the concern is reasonable.
    - NoZebra120vClip 3y ago
      My bad - not a black box in this case. Just a regular box. Sorry for the confusion.
      - haldujai 3y ago
        Black box (obsolete) and regular box are the same thing, they're simply called boxed warnings. In case you think this is semantics, boxed warnings are a determination by the FDA of a risk of adverse reaction so serious in proportion to the benefit of the drug it must be considered when assessing risks and benefits. The warning you are referring to is a regular warning which is used when there some evidence of a causal association but a causal relationship has not been definitively identified. In this specific instance it is based on an association of increased suicidality in a study looking at all antidepressants for all depressive indications and specifically in patients below the age of 25, not specific to this drug or drug class. This warning is accordingly present on all antidepressants. I won't go into the knowledge base behind this warning, its magnitude and variation between drugs but it is readily available online. Suffice it to say medical experts do not view the risk serious enough to merit a boxed warning and should the FDA have wanted to absolve themselves of blame as. you suggest it would be boxed.
- staticman2 3y ago
  >>>"It's insane to me that a group of educated and seemingly intelligent people seem to think they understand more about drug safety and prescribing than the FDA, researchers and physicians." I'm currently on a psychiatrist prescribed drug which is illegal in Japan, which means I have to discontinue it before an upcoming trip. This is not a new drug, it's a generic. So is it "insane that a group of educated and seemingly intelligent doctors" in the U.S. are prescribing this drug or "insane that a group of educated and seemingly intelligent doctors" at the Japanese equivilent to the FDA are not authorizing this drug? I mean, it can't possibly be the case that neither group knows what it's doing, and that our scientific understanding of the brain is primitive, correct? One group has to be the insane one, right?
  - afavour 3y ago
    I think there’s a meaningful difference there. A disagreement between two highly qualified groups of doctors seems valid. A disagreement between a group of highly qualified doctors and someone who did some research on the internet does not.
    - staticman2 3y ago
      "A disagreement between two highly qualified groups of doctors seems valid." Well... if we're talking psychiatrists, they choose the thing they wanted to be highly qualified in. So, any potential "expert" that would disagree with their research methods was selected out so as to not become an expert in the first place. I guess if I have a point it's that I don't think shouting "trust the science" or "trust the experts" and beating one's chest is contributing much to the conversation.
      - haldujai 3y ago
        What's insane is that seemingly intelligent people with zero medical training or research experience somehow think they have the capability to determine drug safety or whether a disease exists and merits treatment with pharmacotherapy. > So, any potential "expert" that would disagree with them was selected out so as to not become an expert in the first place. Anyone with some form of training or practical experience in an academic biomedical field (clinical or research) and has knowledge of how to synthesize and analyze evidence in order to make logical arguments may be considered a relevant expert, this is a much larger group than psychiatrists and is how FDA committees are constructed. Most notably this includes (and is not limited to) other physicians and providers, pharmacologists, pathologists, physiologists and epidemiologists. > I guess if I have a point it's that I don't think shouting "trust the science" or "trust the experts" and beating one's chest is contributing much to the conversation. One should absolutely "trust the experts" when it comes to determining safety of a therapeutic or definition of a disease. These are determined by scientific processes and debate based on evidence and not philosophical thoughts and feelings. Given how complex modern life is one has to defer to experts and regulators on many things beyond medicine. Some other examples: motor vehicles, aviation, building codes, financial institutions and encryption. > I'd also say that the more I've learned about psychiatry (including as a customer) the lower the opinion I have of it. The limitations in psychiatric medicine and research are widely acknowledged and not a novel insight that the FDA and medical community are ignorant of as many commenters here seem to believe.

NoZebra120vClip 3y ago

[flagged]

tsimionescu 3y ago
This is completely and utterly wrong. Psychiatric treatment varies in effectiveness, but there are drugs like lithium which have a fast and marked effect on the diseases they treat (e.g. Bipolar disorder, a crippling illness if left untreated). Depression drugs are less effective overall than other psychiatric illnesses, but even these have proven clinical effects in huge double-blind trials. You really should read up on the literature, or hang around some people with serious mental health problems before spewing such garbage.

zpeti 3y ago

It’s very easy to explain. By going straight to medication you are treating the symptom not the cause. And you don’t even know if it works. SSRIs don’t work for many people and we only found out 2-3 years ago. Opioids were prescribed to half of America for back pain. That gives scope for healthy scepticisms at least. Just because you might have some anecdotal evidence of some chemicals working, doesn’t mean it works for others or that it leads to a good place. Lastly - there are clearly lifestyle and even moral choices that people make or don’t make that can lead to mental health issues. Just from a common sense perspective it seems much healthier to try and deal with these first, with therapy, than just medicating. And not just therapy. Exercise, diet. We know these affect mental health, yet pills are easy, and they make doctors money. medicating is much easier than searching, finding and healing the cause. Therapy takes years, if not decades. I can understand why people pick the easier route, but easier is not always better. Also, are you just permanently going to be on pills then? I mean it’s a great subscription business, I can see that.

haldujai 3y ago
> By going straight to medication Initial treatment recommendations: For mild to moderate postpartum unipolar major depression, we suggest psychotherapy as initial treatment. This approach is consistent with multiple practice guidelines, and is especially useful for lactating patients who do not want to expose their infants to antidepressants. However, antidepressants (eg, selective serotonin reuptake inhibitors [SSRIs], serotonin-norepinephrine reuptake inhibitors, bupropion, and mirtazapine) are a reasonable alternative if psychotherapy is not available, not successful, or is declined, or if the patient has previously responded to antidepressants. In addition, combination treatment with pharmacotherapy plus psychotherapy is useful for some patients. Source: UpToDate. > And you don’t even know if it works. While evidence for SSRIs is weak in meta-analyses this is not one of them. I will also agree that a single trial (i.e. the original post and what led to approval) is not definitive but does in fact suggest it works and will continue to be assessed in post-market studies.
mtlmtlmtlmtl 3y ago
Look. It's not some earth shattering revelation that "SSRIs don't work for many people". This has been known since SSRIs first appeared on the scene. This is also true of any other treatment you can think of. The reason they became the first choice as far as antidepressants go is they were a lot safer and better tolerated than the older alternatives. Besides, there's a lot more to psychiatry than just SSRIs. But with people like you it's always about SSRIs. Can't shut up about the SSRIs. If you hadn't noticed, this new drug is not an SSRI! Psychiatrists recommend therapy, they recommend changes in diet and they recommend exercise. Clinical psychology, though technically a separate discipline from psychiatry, not being under the umbrella of medicine, is very much developed, researched and practiced in tandem and cooperation withpsychiatry, and vice versa. You're constructing an elaborate strawman here, where the only reason for using drugs is some evil financial motive. It's just not that simple. There bad apples, and perverse incentives, but not only bad apples. Most doctors do in fact care about helping their patients. Therapy can't fix everything. Therapy alone is not always sufficient and can be just as hit and miss as medication. Not everything is some deep personal issue that needs to be analysed and resolved. Mental disorder is often genetic, even neurological in nature. All the therapy in the world won't stop a bipolar person from cycling between mood disturbances, or someone with ADHD from being unable to concentrate. We can't throw the baby out with the bathwater. Medication, therapy, meditation, diet, exercise, sleep hygiene are all part of the psychiatric toolbox.

themitigating 3y ago

The compartmentilzation of intelligence

serf 3y ago

>What's the alternative? Prayer circles? Ayahuasca tourist traps? Cannabis? Homeopathy? Give me a break. PPD aside, if we're talking about the issues that psychiatry seeks to alleviate, every one of those 'solutions' has had thousands of advocates/adherents/patients that claim to have gained positive effect. and before I get considered a proponent of any of those; i'm not -- but I recognize the cohort of people who claim to have gained benefit just as I recognize the group who claim to have benefited from psychiatry. mental health needs not be a monopoly; many people go through issues that they fix through specific personal events or patterns that are specific only to them. You can complain about the style of thinking that you encounter on HN without disparaging the things that have helped people outside of clinical settings. Mental health and well-being is one of the most mysterious things that we study, if a suicide or otherwise bad decision is staved off by chanting in makeup and visiting exotic locations then so be it, that's what worked for them. And another aside : psychiatry will never incorporate extreme things that may help certain individuals, nor should they -- but that means that the breadth of things that are helpful is greater than the breadth of things that will ever fall within the umbrella of clinical mental health; so you should probably hold off on judging things based on whether or not the industry has adopted them.