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This is a hard topic to communicate in depression treatment. It's easy to mistake substances that temporarily boost your mood or calm your nerves for effective

This is a hard topic to communicate in depression treatment. It's easy to mistake substances that temporarily boost your mood or calm your nerves for effective treatments for an underlying condition. There was a brief period of time before the opioid prescribing backlash when some fringe psychiatrists were proposing weaker opioids as adjunctive treatments for treatment resistant depression. It's hard to fathom now, but opioids were more casually prescribed a few decades ago. I recall some discussion where one of them said they were seeing good initial results but the effects faded, and then it was hard to get the patients off of the opioids when they were no longer helping. Not surprising to anyone now, but remember there was a period of time where many seemingly forgot about their addictive properties. I feel like I've seen a weaker version of this in some friends who turned to THC to "treat" their depression: Initial mood boost, followed by dependency, then eventually into a protracted period where they know it's not helping but they don't want to stop because they feel worse when they discontinue. This wasn't helped by the decades of claims that claimed THC was basically free of dependency problems.

wahern 8mo ago
> but remember there was a period of time where many seemingly forgot about their addictive properties. There was also quite alot of talk about how doctors, by being reticent to prescribe opioids, were inhumanely forcing patients to live in pain, and not being sufficiently deferential to patient autonomy. Moreover, the rhetoric was incorporated into discussions about racist disparities in treatment, given there was some evidence doctors were less likely to prescribe opioids to black patients, suggesting doctors were systematically being cruel. Naturally, the easiest way to dodge those accusations was to simply prescribe opioids as a matter of course. Even in the absence of Purdue Pharma pushing their claims about lack of significant addictive potential, there was already significant pressure to discount the risk of addiction.
- jounker 8mo ago
  As an aside, it is a well established fact that doctors, as a whole, take the the pain of black people much less seriously than the pain of non-black people.
  - readthenotes1 8mo ago
    Even black doctors? Does this finding hold across different nations?
    - jounker 8mo ago
      As far as I know just the USA, and yes, even black doctors.
  - Hobadee 8mo ago
    > it is a well established fact [Citation Needed]
    - shakna 8mo ago
      One of many, many citations: [0]. This is not something surprising, it's been ongoing since before the USA was a country. [0] https://www.mayoclinicproceedings.org/article/S0025-6196%2821%2900322-0/fulltext https://www.mayoclinicproceedings.org/article/S0025-6196%282...
    - perfmode 8mo ago
      In emergency departments, Black patients are prescribed opioids for acute pain at a lower rate than White patients with matched chief concerns.4 Discrepancies in prescriptions for chronic pain therapies have also been identified in Veterans Administration and Medicaid payer databases, and several retrospective cohort studies have shown persistent underprescribing of analgesics to Black patients.6,7 White medical trainees, reflecting the general population, can have false beliefs about biologic differences between Black and White patients (eg, “Black patients feel less pain”), and this racial bias leads to inaccurate pain diagnoses and treatment recommendations.8 In anesthesiology and pain medicine, use of regional anesthesia for joint replacement surgery is applied less frequently in Black patients and the underinsured.9 This also holds true in the implantation of spinal cord stimulation for the treatment of postlaminectomy syndrome.10 Among patients with occupational low back injuries, Black patients incur lower treatment costs than their White counterparts and are provided fewer health care interventions, including surgery.11 Perceived discrimination results in psychological distress, and a US population–based study has demonstrated a dose-response relationship between psychological distress and chronic pain. from the mayo link
andoando 8mo ago
This point of view makes no sense to me. If you take it and you feel your anxiety is lessened, that's the greatest proof you can ask for. All the psychiatric studies are already based on self assessment. Second, a lot of psychatric treatments are temporary, ending whenever the medication is stopped or wears off so I dont see how this would be any different
- Aurornis 8mo ago
  > If you take it and you feel your anxiety is lessened, that's the greatest proof you can ask for. This mistake has been made many time throughout history. Cocaine was originally believed to be a viable treatment for depression. Opioids and amphetamines too. You take them and you feel good for a while, which was mistakenly equated with treating depression. Many drugs will make you feel good temporarily by blocking certain feelings or tricking your brain into feeling good. This is not the same as treating a condition. You can think of actual treatments as working closer to the source to reduce the problem, not temporarily overriding it with a powerful drug-induced sensation.
  - noosphr 8mo ago
    Alcohol too. It's not a cure. It's a high.
    - mapontosevenths 8mo ago
      Im unaware of any frequently medicated psychiatric disorder for which there is a cure. Are all psych meds just "a high"?
  - mikkupikku 8mo ago
    > Cocaine was originally believed to be a viable treatment for depression. Is it not?? Sure there's the addiction and harm from abuse that make it less than ideal for long term use, to put it mildly, but weed isn't coke so what's really the argument here?
    - 8mo ago
trinsic2 8mo ago
Yeah this has been my experience with THC. I never took it for depression, but it was always a temporary thing. I doesn't treat anything IMHO. its a symptom relief at best. it works pretty good as a temporary relief from anxiety.
cineticdaffodil 8mo ago
Isn't the problem with psychological dependency that drugs generate basically a artifical depression, so more drugs are needed to basically feel normal again? Thus saddling a already existing problem with the same on top?
lll-o-lll 8mo ago
Yes. Rather it is the reverse that helps. Exercise is the biggest one, but essentially “pain that will stop” seems to help in general. Ice showers, fasting, new challenging activity, giving up caffeine/alcohol. All these things suck in the short term, and make you feel more good in the medium term. Maybe because your default becomes “not in so much pain”, rather than “feeling worse than when briefly enhanced by substance X” Edit: I’m referring more to the “self medication” approach. Please don’t take any of this as medical advice.
fdgfikgfv 8mo ago
Sadly, I have witnessed three of my friends who started THC product to deal with anxiety, developed paranoia. Two of them quit THC and got better but one got way worse and now is in process of divorce. His personality is completely different, he was pretty chill guy but now he is talking way too much, easily distracted, and always worried about macro events.
lukan 8mo ago
"This wasn't helped by the decades of claims that claimed THC was basically free of dependency problems." But did anyone professional made these claims? I was pretty much told since a child, no physical dependency (unlike alcohol and nicotin) but potentially strong psychological withdraw symptoms.
LocalH 8mo ago
> It's easy to mistake substances that temporarily boost your mood or calm your nerves for effective treatments for an underlying condition. Perhaps the temporary boost can be used in such a way to effect change that lasts? Sometimes all a person needs is something small to change how their brain is processing things, and with structure perhaps that can be leveraged. But then again, many people think that all brains work the same, and this underlies 99% of the failings of mental health care.

wahern 8mo ago

> but remember there was a period of time where many seemingly forgot about their addictive properties. There was also quite alot of talk about how doctors, by being reticent to prescribe opioids, were inhumanely forcing patients to live in pain, and not being sufficiently deferential to patient autonomy. Moreover, the rhetoric was incorporated into discussions about racist disparities in treatment, given there was some evidence doctors were less likely to prescribe opioids to black patients, suggesting doctors were systematically being cruel. Naturally, the easiest way to dodge those accusations was to simply prescribe opioids as a matter of course. Even in the absence of Purdue Pharma pushing their claims about lack of significant addictive potential, there was already significant pressure to discount the risk of addiction.

jounker 8mo ago
As an aside, it is a well established fact that doctors, as a whole, take the the pain of black people much less seriously than the pain of non-black people.
- readthenotes1 8mo ago
  Even black doctors? Does this finding hold across different nations?
  - jounker 8mo ago
    As far as I know just the USA, and yes, even black doctors.
- Hobadee 8mo ago
  > it is a well established fact [Citation Needed]
  - shakna 8mo ago
    One of many, many citations: [0]. This is not something surprising, it's been ongoing since before the USA was a country. [0] https://www.mayoclinicproceedings.org/article/S0025-6196%2821%2900322-0/fulltext https://www.mayoclinicproceedings.org/article/S0025-6196%282...
  - perfmode 8mo ago
    In emergency departments, Black patients are prescribed opioids for acute pain at a lower rate than White patients with matched chief concerns.4 Discrepancies in prescriptions for chronic pain therapies have also been identified in Veterans Administration and Medicaid payer databases, and several retrospective cohort studies have shown persistent underprescribing of analgesics to Black patients.6,7 White medical trainees, reflecting the general population, can have false beliefs about biologic differences between Black and White patients (eg, “Black patients feel less pain”), and this racial bias leads to inaccurate pain diagnoses and treatment recommendations.8 In anesthesiology and pain medicine, use of regional anesthesia for joint replacement surgery is applied less frequently in Black patients and the underinsured.9 This also holds true in the implantation of spinal cord stimulation for the treatment of postlaminectomy syndrome.10 Among patients with occupational low back injuries, Black patients incur lower treatment costs than their White counterparts and are provided fewer health care interventions, including surgery.11 Perceived discrimination results in psychological distress, and a US population–based study has demonstrated a dose-response relationship between psychological distress and chronic pain. from the mayo link

andoando 8mo ago

This point of view makes no sense to me. If you take it and you feel your anxiety is lessened, that's the greatest proof you can ask for. All the psychiatric studies are already based on self assessment. Second, a lot of psychatric treatments are temporary, ending whenever the medication is stopped or wears off so I dont see how this would be any different

Aurornis 8mo ago
> If you take it and you feel your anxiety is lessened, that's the greatest proof you can ask for. This mistake has been made many time throughout history. Cocaine was originally believed to be a viable treatment for depression. Opioids and amphetamines too. You take them and you feel good for a while, which was mistakenly equated with treating depression. Many drugs will make you feel good temporarily by blocking certain feelings or tricking your brain into feeling good. This is not the same as treating a condition. You can think of actual treatments as working closer to the source to reduce the problem, not temporarily overriding it with a powerful drug-induced sensation.
- noosphr 8mo ago
  Alcohol too. It's not a cure. It's a high.
  - mapontosevenths 8mo ago
    Im unaware of any frequently medicated psychiatric disorder for which there is a cure. Are all psych meds just "a high"?
- mikkupikku 8mo ago
  > Cocaine was originally believed to be a viable treatment for depression. Is it not?? Sure there's the addiction and harm from abuse that make it less than ideal for long term use, to put it mildly, but weed isn't coke so what's really the argument here?
  - 8mo ago

trinsic2 8mo ago

Yeah this has been my experience with THC. I never took it for depression, but it was always a temporary thing. I doesn't treat anything IMHO. its a symptom relief at best. it works pretty good as a temporary relief from anxiety.

cineticdaffodil 8mo ago

Isn't the problem with psychological dependency that drugs generate basically a artifical depression, so more drugs are needed to basically feel normal again? Thus saddling a already existing problem with the same on top?

lll-o-lll 8mo ago

Yes. Rather it is the reverse that helps. Exercise is the biggest one, but essentially “pain that will stop” seems to help in general. Ice showers, fasting, new challenging activity, giving up caffeine/alcohol. All these things suck in the short term, and make you feel more good in the medium term. Maybe because your default becomes “not in so much pain”, rather than “feeling worse than when briefly enhanced by substance X” Edit: I’m referring more to the “self medication” approach. Please don’t take any of this as medical advice.

fdgfikgfv 8mo ago

Sadly, I have witnessed three of my friends who started THC product to deal with anxiety, developed paranoia. Two of them quit THC and got better but one got way worse and now is in process of divorce. His personality is completely different, he was pretty chill guy but now he is talking way too much, easily distracted, and always worried about macro events.

lukan 8mo ago

"This wasn't helped by the decades of claims that claimed THC was basically free of dependency problems." But did anyone professional made these claims? I was pretty much told since a child, no physical dependency (unlike alcohol and nicotin) but potentially strong psychological withdraw symptoms.

LocalH 8mo ago

> It's easy to mistake substances that temporarily boost your mood or calm your nerves for effective treatments for an underlying condition. Perhaps the temporary boost can be used in such a way to effect change that lasts? Sometimes all a person needs is something small to change how their brain is processing things, and with structure perhaps that can be leveraged. But then again, many people think that all brains work the same, and this underlies 99% of the failings of mental health care.