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This really just feels like fearmongering because this is a threat to big pharma. I mean, several commonly prescribed antidepressants have black box warnings ab

This really just feels like fearmongering because this is a threat to big pharma. I mean, several commonly prescribed antidepressants have black box warnings about increased risk of suicide. When they trialed Prozac on people with no history of mental illness, someone committed suicide out of the blue. Fairly certain someone could cobble together a much more compelling meta analysis about even worse adverse effects of psych meds on similar populations, but due to NAMI and big pharma I think there's pressure not to draw those lines too clearly. I think there's a clear bias in cases of big pharma approved meds to jump to "Oh, it wasn't the medication, the condition just worsened" and with psychedelics/weed to jump to "The substance use is causing this". Even when there is proof of RX medication worsening mental health conditions, it's common to have these relationships straight up denied by the prescribing doctor. This isn't to say that there isn't a similar relationship in psychedelics, but it feels really disingenuous to me to be mentioning this outside of the wider context of psychiatric meds which somehow get a free pass for causing a much wider and dangerous range of side effects. If psychedelics cause less harm than commonly prescribed drugs in the same population, isn't that a good thing? We should understand these harms, but the bias of Big Pharma needs to be taken out of the picture.

swores 2y ago
> When they trialed Prozac on people with no history of mental illness, someone committed suicide out of the blue. I hadn't heard about this before, and while I'm sure it is possible for any drug that messes with brain chemicals to cause someone to decide to kill themselves, I've always been told & read a different explanation for the suicide warning that comes with most (or all?) antidepressants: Which is that a depressed person while at their lowest might think about suicide but not have the energy or willpower to do anything, but if they start taking a drug that partially fixes it, so they start having energy again, but doesn't fix their root problems so they still think that suicide would be preferable to life, and suddenly have energy to make that happen. Which is also the reason that modern guidance is for antidepressants to be co-prescribed with talk therapy, to try to use drugs to let the person be able to work on their issues, rather than just hoping the drug can fix all issues.
- cupcake-unicorn 2y ago
  I can understand why you would have that reasoning, but SSRIs are commonly prescribed off label to populations for non-mental health related reasons, for example ED or urinary incontinence, and in these populations the relationship holds, leading to some governments and regulatory bodies to recommend or warn against use for these conditions. "Although duloxetine reduced the symptoms of stress urinary incontinence and improved women’s quality of life, the harms related to suicidality and violence were 4 to 5 times more common with duloxetine than with a placebo, a meta analysis using patient level data by researchers from the Nordic Cochrane Centre showed." https://www.bmj.com/content/355/bmj.i6103 https://www.bmj.com/content/355/bmj.i6103
  - swores 2y ago
    Wow, TIL, thanks! Any idea if the logic I wrote about is also true? Or is it the same as how many doctors will talk about SSRIs working because depressed people "have too little serotonin", a myth that remains commonly believed despite research not backing it up?
    - skissane 2y ago
      It is possible multiple processes are at work-it is possible that SSRIs increase violence risks independently of their antidepressant effect, and simultaneously their antidepressant effect also increases it. The two explanations aren’t necessarily mutually exclusive
      - cupcake-unicorn 2y ago
        Sure, but if that's what's going on, it should be researched further and taken seriously during prescribing. 100% guarantee that when psychedelics hit the market, doctors will fall prey to overstating the harms from studies like this while turning a blind eye to the wealth of evidence of greater likelihood of harms in prescriptions they churn out without blinking an eye. I'm not anti medication, and I'm not saying that there are cases where the benefit doesn't outweigh the harm, but I do think the potential harms of each medication should be thoroughly investigated equally. Large companies with the ability to withhold damaging trials, sway the public opinion, and have a giant PR team and legal team at their disposal shouldn't be impacting our understanding of the real risks and science.
teh_infallible 2y ago
I always thought the “war on drugs” was a big pharma turf war. Nearly every school shooter was on an antidepressant, but somehow that never makes headlines.
- int_19h 2y ago
  In US, the original war on drugs was racial in nature (targeting blacks and Mexicans specifically). The particularly heavy-handed enforcement from 1970s onwards that spawned the term itself broadened into a war against the social and cultural opposition to the status quo - still partly racial in nature as various black civil rights and black power movements were a significant part of that, but also targeting anti-war protesters, "pinkos" etc.
- randomcarbloke 2y ago
  The tale of Qin Shi Huang

swores 2y ago

> When they trialed Prozac on people with no history of mental illness, someone committed suicide out of the blue. I hadn't heard about this before, and while I'm sure it is possible for any drug that messes with brain chemicals to cause someone to decide to kill themselves, I've always been told & read a different explanation for the suicide warning that comes with most (or all?) antidepressants: Which is that a depressed person while at their lowest might think about suicide but not have the energy or willpower to do anything, but if they start taking a drug that partially fixes it, so they start having energy again, but doesn't fix their root problems so they still think that suicide would be preferable to life, and suddenly have energy to make that happen. Which is also the reason that modern guidance is for antidepressants to be co-prescribed with talk therapy, to try to use drugs to let the person be able to work on their issues, rather than just hoping the drug can fix all issues.

cupcake-unicorn 2y ago
I can understand why you would have that reasoning, but SSRIs are commonly prescribed off label to populations for non-mental health related reasons, for example ED or urinary incontinence, and in these populations the relationship holds, leading to some governments and regulatory bodies to recommend or warn against use for these conditions. "Although duloxetine reduced the symptoms of stress urinary incontinence and improved women’s quality of life, the harms related to suicidality and violence were 4 to 5 times more common with duloxetine than with a placebo, a meta analysis using patient level data by researchers from the Nordic Cochrane Centre showed." https://www.bmj.com/content/355/bmj.i6103 https://www.bmj.com/content/355/bmj.i6103
- swores 2y ago
  Wow, TIL, thanks! Any idea if the logic I wrote about is also true? Or is it the same as how many doctors will talk about SSRIs working because depressed people "have too little serotonin", a myth that remains commonly believed despite research not backing it up?
  - skissane 2y ago
    It is possible multiple processes are at work-it is possible that SSRIs increase violence risks independently of their antidepressant effect, and simultaneously their antidepressant effect also increases it. The two explanations aren’t necessarily mutually exclusive
    - cupcake-unicorn 2y ago
      Sure, but if that's what's going on, it should be researched further and taken seriously during prescribing. 100% guarantee that when psychedelics hit the market, doctors will fall prey to overstating the harms from studies like this while turning a blind eye to the wealth of evidence of greater likelihood of harms in prescriptions they churn out without blinking an eye. I'm not anti medication, and I'm not saying that there are cases where the benefit doesn't outweigh the harm, but I do think the potential harms of each medication should be thoroughly investigated equally. Large companies with the ability to withhold damaging trials, sway the public opinion, and have a giant PR team and legal team at their disposal shouldn't be impacting our understanding of the real risks and science.

teh_infallible 2y ago

I always thought the “war on drugs” was a big pharma turf war. Nearly every school shooter was on an antidepressant, but somehow that never makes headlines.

int_19h 2y ago
In US, the original war on drugs was racial in nature (targeting blacks and Mexicans specifically). The particularly heavy-handed enforcement from 1970s onwards that spawned the term itself broadened into a war against the social and cultural opposition to the status quo - still partly racial in nature as various black civil rights and black power movements were a significant part of that, but also targeting anti-war protesters, "pinkos" etc.
randomcarbloke 2y ago
The tale of Qin Shi Huang