3 ms·

Let's remember it was recently proven that there is little to no evidence that serotonin levels are linked to depression: https://www.nature.com/articles/s41380

Let's remember it was recently proven that there is little to no evidence that serotonin levels are linked to depression: https://www.nature.com/articles/s41380-022-01661-0 https://www.nature.com/articles/s41380-022-01661-0 It's pretty much likely to be the same deal here. Since there is no chemical or biological test one can do to confirm a schizophrenia diagnosis, it's a subjective diagnosis by practitioners, treating such subjective diagnosis with powerful brain-chemistry altering drugs. Worse, we do not yet know whether these new drugs will be easy to get off of. Some of the other anti-psychotic type medication is VERY hard to get off of, such as abilify, where most drug treatment centers will not deal with Abilify withdrawals or take on those patients because those are so severe (extreme violence, self harm, etc during withdrawal). Until Psychiatry can reform itself to become a real science, using the scientific method (repeatable, provable results and not just a "theory of how brain chemistry maybe works sorta but we're not sure"), it will continue to just be a big cash cow for Big Pharma while hooking many patients who do not need these drugs onto them for life, while failing to effect ANY cure on the things they are treating (Have you heard of someone getting "better" after taking anti-depressants and being able to come off them? No. They have to take them for life. That's not a cure.)

throw18376 2y ago
i'm curious what is the longest conversation you've ever had with an untreated schizophrenic person? it's so obviously a "real disease" even if we don't fully understand the biological basis. it's subjective but honestly, there are just a ton of completely obvious cases. abuses of the psychiatric system are very bad, but schizophrenia is so so clearly real.
crooked-v 2y ago
> Have you heard of someone getting "better" after taking anti-depressants and being able to come off them? No. They have to take them for life. That's not a cure. There is no medicine in the world that you can take for a limited time to fix problems forever. That's not how medicine works. That's not how the world works.
- catlikesshrimp 2y ago
  Antibiotics (Most of the time) Everything surgery, I would include gene replacement therapy and auto transplants in its viccinity.
- ClassyJacket 2y ago
  Yes there are? Antibiotics for one.
  - copperx 2y ago
    And those that change gene expression, like Accutane for acne.
Etheryte 2y ago
This is so misguided that it's hard to even know where to begin. People who develop high blood pressure without a known underlying cause take a pill for it every day for the rest of their life. You could say the same thing, they're not cured, but what actually matters is that they get to live a full life, unconstrained by the disease even if we don't know the underlying cause. Of course it would be better if we were more advanced of a civilization and figured it out, but the important thing is that these people get their lives back.
toast0 2y ago
> Have you heard of someone getting "better" after taking anti-depressants and being able to come off them? No. They have to take them for life. That's not a cure. Some people with acute depression can take the meds, work on the underlying issues and taper off, yes. People with chronic depression likely need to take the meds for life. People with type I diabetes can't get insulin one time either. People with allergies often take the allergy meds when exposed to allergens, which is always for some. That's not big pharma being greedy, that's a chronic condition requires chronic treatment.
- smeej 2y ago
  I'll raise my hand here. Took antidepressants for a year. Successfully weaned off of them. Have not had recurrence of symptoms. I needed the boost to be able to get out of bed often enough to do the work in therapy. That led to being able to take other actions that helped my brain chemistry too, like eating better food, which reduced inflammation, and getting outside more often. My doc said her experience was about half and half. Half of people were able to wean off successfully. Half ended up deciding it was better to stay on. Recovery does happen. For lots of us.
  - girvo 2y ago
    My experience was the same; they were like a bandage we put on to allow us to heal without infection, for me SSRIs were a mental bandage so I could heal enough to get to a psychologist. I came off them, and was fine. My situation is confounded by my buprenorphine script though, as it's known to be a reasonbly effective anti-depressant in it's own right, albeit via a completely different mechanism (it's an opioid-receptor agonist, partial agonist and antagonist. Weird drug)
toastau 2y ago
We don't have cures for diabetes, HIV/AIDS, allergies, plenty of ailments. Having treatments is totally valid even if they are taken forever. People with the guidance of their doctor stop taking antidepressants all the time. External factors aren't static and often these can change. (separately or because of the treatment) You do not need to stop treatment unless you and your doctor have decided it is going to be better for you. Another point I'd make is that we don't have exact mechanisms for action in other treatments like paracetamol. That doesn't make it invalid treatment.
- catlikesshrimp 2y ago
  What is your doubt about paracetamol? This drug's pharmacology is rather well understood. About the analgesic activity https://pubmed.ncbi.nlm.nih.gov/31734950/ https://pubmed.ncbi.nlm.nih.gov/31734950/ About the antipyretic activity https://pubmed.ncbi.nlm.nih.gov/29738273/ https://pubmed.ncbi.nlm.nih.gov/29738273/
nullindividual 2y ago
An enlarged salience network may be responsible for depression in some patients[0]. Some individuals are pre-disposed to being depressed and it may be a chronic condition, like any other chronic condition. For others, it could "simply" be a chemical imbalance that taking medication for a set period of time resolves (lucky them). [0]https://www.nih.gov/news-events/nih-research-matters/mapping-brain-network-involved-depression https://www.nih.gov/news-events/nih-research-matters/mapping...
jmcgough 2y ago
I work as an EM scribe and routinely see patients experiencing psychotic episodes. My background is in neuroscience and I'm interviewing for med school right now. > it was recently proven that there is little to no evidence that serotonin levels are linked to depression This has been the consensus of the psychiatric community for the last 20+ years. The serotonin hypothesis was heavily pushed in marketing as a way to medicalize depression and convince people to seek treatment for it. Probably a net positive when it comes to reducing stigma, but few people have been seriously arguing the serotonin hypothesis. As it takes about a month for effects to kick in, most people believe that it's compensatory changes to the brain that happen in response to upregulation of serotonin, such as downregulation of 5ht2a which has an overdensity in people with depression. > Since there is no chemical or biological test one can do to confirm a schizophrenia diagnosis, it's a subjective diagnosis by practitioners This is true to some degree - we don't have a blood test or an fmri scan that will definitively point to schizophrenia, the diagnosis is (for now) based on DSM criteria and by thoroughly ruling out other causes of schizophrenia. We do have tests for a number of other causes of psychosis, like lumbar punctures for NMDA-receptor encephalitis. I'd like to emphasize that there are MANY diseases and conditions that we treat empirically for based on subjective symptoms which are just as real as schizophrenia. There are no tests we can perform for concussions or migraines. The brain is very challenging to perform tests on because of the blood-brain barrier and the skull. > Worse, we do not yet know whether these new drugs will be easy to get off of. Cholinergic drugs are VERY well understood and used in the treatment of a number of diseases. This "new" drug is a drug that was discovered 20+ years ago and is being used in a creative way to mitigate its GI side effects. Everything so far points to this being more effective at treating the negative symptoms of schizophrenia (loss of motivation, cognitive impairment), with milder side effects (some mild GI issues which typically resolve after a few days), which is a huge deal considering how many people with schizophrenia quit dopaminergic drugs due to the side effects. One of the biggest problems with our for-profit system is that schizophrenia is comparatively rare and largely affects those with a lower socioeconomic status, so there isn't a huge financial incentive to work on schizophrenia drugs. This one was being developed for another purpose entirely. > Until Psychiatry can reform itself to become a real science, using the scientific method (repeatable, provable results and not just a "theory of how brain chemistry maybe works sorta but we're not sure"), it will continue to just be a big cash cow for Big Pharma while hooking many patients who do not need these drugs onto them for life, while failing to effect ANY cure on the things they are treating It sounds like you have an ax to grind against the profession, but I can assure you that there is a huge need for it and that people largely see benefits from medication. For me, SSRIs got me stable and functional so I could better address the root causes of my depression. Psychiatric drugs aren't perfect, but for many people they're truly life-saving. There is evidence to support kindling in some diseases such as bipolar as well - that if you remain unmedicated, manic episodes become progressively worse as the brain becomes more damaged. Additionally, psychiatrists treat more than just depression. Some specialize in sleep medicine, addiction medicine, toxicology. They are trained to tease apart primary depression from other non-psychiatric diseases masquerading as a psychiatric disease. I saw a patient once who had been treated with a number of antipsychotics by his PCP and mid-level providers for persistent visual hallucinations. He met with a psychiatrist who tried increasing his anti-seizure meds, which resolved what was likely a recurrent partial seizure. Every drug (sans some off-label use) goes through an FDA approval process and is, over the course of several years and millions of dollars, shown to be effective and relatively safe. I can assure you that psychiatry is as scientific as any other field of medicine. It's still in its infancy compared to some other specialties - the brain is a very complex organ and difficult to study - but we have as good of an understanding of most psychiatric illnesses as we do neurodegenerative diseases such as Alzheimer's, which have been equally as difficult to study and treat. Psychiatry is not even close to the most profitable area of American healthcare. Psychiatrists are one of the lower-earning specialties, and most people with mental illness never obtain treatment for it. Compare that to the 10% of all seniors who are on Eliquis to prevent blood clots, which costs a thousand dollars a month without insurance. Trust me, if there was a way to permanently cure a psychiatric disease with one procedure or pill, we would all be in favor of it. Just because a diabetic needs to take insulin for life doesn't make endocrinology a scam.

throw18376 2y ago

i'm curious what is the longest conversation you've ever had with an untreated schizophrenic person? it's so obviously a "real disease" even if we don't fully understand the biological basis. it's subjective but honestly, there are just a ton of completely obvious cases. abuses of the psychiatric system are very bad, but schizophrenia is so so clearly real.

crooked-v 2y ago

> Have you heard of someone getting "better" after taking anti-depressants and being able to come off them? No. They have to take them for life. That's not a cure. There is no medicine in the world that you can take for a limited time to fix problems forever. That's not how medicine works. That's not how the world works.

catlikesshrimp 2y ago
Antibiotics (Most of the time) Everything surgery, I would include gene replacement therapy and auto transplants in its viccinity.
ClassyJacket 2y ago
Yes there are? Antibiotics for one.
- copperx 2y ago
  And those that change gene expression, like Accutane for acne.

Etheryte 2y ago

This is so misguided that it's hard to even know where to begin. People who develop high blood pressure without a known underlying cause take a pill for it every day for the rest of their life. You could say the same thing, they're not cured, but what actually matters is that they get to live a full life, unconstrained by the disease even if we don't know the underlying cause. Of course it would be better if we were more advanced of a civilization and figured it out, but the important thing is that these people get their lives back.

toast0 2y ago

> Have you heard of someone getting "better" after taking anti-depressants and being able to come off them? No. They have to take them for life. That's not a cure. Some people with acute depression can take the meds, work on the underlying issues and taper off, yes. People with chronic depression likely need to take the meds for life. People with type I diabetes can't get insulin one time either. People with allergies often take the allergy meds when exposed to allergens, which is always for some. That's not big pharma being greedy, that's a chronic condition requires chronic treatment.

smeej 2y ago
I'll raise my hand here. Took antidepressants for a year. Successfully weaned off of them. Have not had recurrence of symptoms. I needed the boost to be able to get out of bed often enough to do the work in therapy. That led to being able to take other actions that helped my brain chemistry too, like eating better food, which reduced inflammation, and getting outside more often. My doc said her experience was about half and half. Half of people were able to wean off successfully. Half ended up deciding it was better to stay on. Recovery does happen. For lots of us.
- girvo 2y ago
  My experience was the same; they were like a bandage we put on to allow us to heal without infection, for me SSRIs were a mental bandage so I could heal enough to get to a psychologist. I came off them, and was fine. My situation is confounded by my buprenorphine script though, as it's known to be a reasonbly effective anti-depressant in it's own right, albeit via a completely different mechanism (it's an opioid-receptor agonist, partial agonist and antagonist. Weird drug)

toastau 2y ago

We don't have cures for diabetes, HIV/AIDS, allergies, plenty of ailments. Having treatments is totally valid even if they are taken forever. People with the guidance of their doctor stop taking antidepressants all the time. External factors aren't static and often these can change. (separately or because of the treatment) You do not need to stop treatment unless you and your doctor have decided it is going to be better for you. Another point I'd make is that we don't have exact mechanisms for action in other treatments like paracetamol. That doesn't make it invalid treatment.

catlikesshrimp 2y ago
What is your doubt about paracetamol? This drug's pharmacology is rather well understood. About the analgesic activity https://pubmed.ncbi.nlm.nih.gov/31734950/ https://pubmed.ncbi.nlm.nih.gov/31734950/ About the antipyretic activity https://pubmed.ncbi.nlm.nih.gov/29738273/ https://pubmed.ncbi.nlm.nih.gov/29738273/

nullindividual 2y ago

An enlarged salience network may be responsible for depression in some patients[0]. Some individuals are pre-disposed to being depressed and it may be a chronic condition, like any other chronic condition. For others, it could "simply" be a chemical imbalance that taking medication for a set period of time resolves (lucky them). [0]https://www.nih.gov/news-events/nih-research-matters/mapping-brain-network-involved-depression https://www.nih.gov/news-events/nih-research-matters/mapping...

jmcgough 2y ago

I work as an EM scribe and routinely see patients experiencing psychotic episodes. My background is in neuroscience and I'm interviewing for med school right now. > it was recently proven that there is little to no evidence that serotonin levels are linked to depression This has been the consensus of the psychiatric community for the last 20+ years. The serotonin hypothesis was heavily pushed in marketing as a way to medicalize depression and convince people to seek treatment for it. Probably a net positive when it comes to reducing stigma, but few people have been seriously arguing the serotonin hypothesis. As it takes about a month for effects to kick in, most people believe that it's compensatory changes to the brain that happen in response to upregulation of serotonin, such as downregulation of 5ht2a which has an overdensity in people with depression. > Since there is no chemical or biological test one can do to confirm a schizophrenia diagnosis, it's a subjective diagnosis by practitioners This is true to some degree - we don't have a blood test or an fmri scan that will definitively point to schizophrenia, the diagnosis is (for now) based on DSM criteria and by thoroughly ruling out other causes of schizophrenia. We do have tests for a number of other causes of psychosis, like lumbar punctures for NMDA-receptor encephalitis. I'd like to emphasize that there are MANY diseases and conditions that we treat empirically for based on subjective symptoms which are just as real as schizophrenia. There are no tests we can perform for concussions or migraines. The brain is very challenging to perform tests on because of the blood-brain barrier and the skull. > Worse, we do not yet know whether these new drugs will be easy to get off of. Cholinergic drugs are VERY well understood and used in the treatment of a number of diseases. This "new" drug is a drug that was discovered 20+ years ago and is being used in a creative way to mitigate its GI side effects. Everything so far points to this being more effective at treating the negative symptoms of schizophrenia (loss of motivation, cognitive impairment), with milder side effects (some mild GI issues which typically resolve after a few days), which is a huge deal considering how many people with schizophrenia quit dopaminergic drugs due to the side effects. One of the biggest problems with our for-profit system is that schizophrenia is comparatively rare and largely affects those with a lower socioeconomic status, so there isn't a huge financial incentive to work on schizophrenia drugs. This one was being developed for another purpose entirely. > Until Psychiatry can reform itself to become a real science, using the scientific method (repeatable, provable results and not just a "theory of how brain chemistry maybe works sorta but we're not sure"), it will continue to just be a big cash cow for Big Pharma while hooking many patients who do not need these drugs onto them for life, while failing to effect ANY cure on the things they are treating It sounds like you have an ax to grind against the profession, but I can assure you that there is a huge need for it and that people largely see benefits from medication. For me, SSRIs got me stable and functional so I could better address the root causes of my depression. Psychiatric drugs aren't perfect, but for many people they're truly life-saving. There is evidence to support kindling in some diseases such as bipolar as well - that if you remain unmedicated, manic episodes become progressively worse as the brain becomes more damaged. Additionally, psychiatrists treat more than just depression. Some specialize in sleep medicine, addiction medicine, toxicology. They are trained to tease apart primary depression from other non-psychiatric diseases masquerading as a psychiatric disease. I saw a patient once who had been treated with a number of antipsychotics by his PCP and mid-level providers for persistent visual hallucinations. He met with a psychiatrist who tried increasing his anti-seizure meds, which resolved what was likely a recurrent partial seizure. Every drug (sans some off-label use) goes through an FDA approval process and is, over the course of several years and millions of dollars, shown to be effective and relatively safe. I can assure you that psychiatry is as scientific as any other field of medicine. It's still in its infancy compared to some other specialties - the brain is a very complex organ and difficult to study - but we have as good of an understanding of most psychiatric illnesses as we do neurodegenerative diseases such as Alzheimer's, which have been equally as difficult to study and treat. Psychiatry is not even close to the most profitable area of American healthcare. Psychiatrists are one of the lower-earning specialties, and most people with mental illness never obtain treatment for it. Compare that to the 10% of all seniors who are on Eliquis to prevent blood clots, which costs a thousand dollars a month without insurance. Trust me, if there was a way to permanently cure a psychiatric disease with one procedure or pill, we would all be in favor of it. Just because a diabetic needs to take insulin for life doesn't make endocrinology a scam.