3 ms·

> If it's just the symptom, who cares, as long as the drugs help people? Because for many, these symptoms are not adequately addressed through more conservativ

by kyro 13y ago

> If it's just the symptom, who cares, as long as the drugs help people? Because for many, these symptoms are not adequately addressed through more conservative means. There are numerous ways to attack an unusual disposition that do not involve medication -- exercising, weight loss, meditation, psychotherapy, cognitive behavioral therapy, rectifying family issues, finding a job. Many of these options are not adequately pursued. I have never seen a psychiatrist refer a patient to see a psychologist or a cognitive behavioral therapist, and they have no incentive to really.

randomknowledge 13y ago
> I have never seen a psychiatrist refer a patient to see a psychologist or a cognitive behavioral therapist, and they have no incentive to really. Plenty do, and there are questions about the efficacy of those techniques as well.
derefr 13y ago
On the other hand, where I live (a non-US country with public healthcare), you don't get in contact with a psychiatrist directly; you get referred to one from a therapist. The therapist decides which kind of treatment of your symptoms is best, where one of their options is to pass you off to a psychiatrist (who the therapist thinks of as "the guy who will mostly think of this in terms of prescribing medications.") Even when the therapist thinks medication is a good treatment regimen, they usually suggest combining it various forms of talk-therapy (in other words, to keep seeing them, as well as seeing the psychiatrist.) Those are some much more neatly-aligned incentives, I think. --- I have to say, though, as a separate issue: neuroaffective medications of all kinds (whether for chemical imbalances, or hormonal imbalances, or pain-management, etc.) are basically like crutches. Your problem might not be "just" a chemical imbalance, just like your problem might not be "just" pain. But even if the cause is external, and the "true solution" is external, the symptoms the external problem is causing in you might be too debilitating for you to pursue the external solution on your own, while you're still afflicted. That's when you need a crutch. If you break your leg, walking on it enough to get it to heal is usually far too painful to do all on your own. So, you get crutches. Now you can get some support to lessen the pain, while still walking on it to help it heal. If you lost your job while you were in the hospital for the leg-break, the crutch can let you go back to work before you otherwise would, which can give you the motivation to keep pushing yourself to heal, rather than just sitting around. Once your leg has healed, you don't need the crutch. If you're clinically depressed, going out and doing things you'd otherwise enjoy is hard. SSRIs and the like are a crutch that let you feel less pessimistic about your situation, so you can pursue real sources of happiness (getting a better job, finding a relationship, etc.) Once you've done those things, you might not need the crutch. Sometimes, though, we need crutches for life. Once you're old enough to need a cane or a walker, you're never going to not need a cane or a walker. Some people are born with conditions that put them in a wheelchair for their entire lives. If your problem is inherent to your physiology, there's no external problem to solve--so you'll always need the crutch. --- Here's the odd thing about neurotransmitter imbalances, though. I asked a psychiatrist friend of mine about whether, generally, his patients have obvious problems in their lives that could be possible causes of their symptoms, or whether they more often say things like "everything's great so I don't see why I'm so--". He said it was overwhelmingly the latter. My pure guess to explain this data, is that something happened to our brain chemistry that paralleled the rise of near-/farsightedness as a genetic trait. After the rise of agriculture, sharp near/far vision stopped being something we had natural selection pressuring us to keep--and, unlike traits like height, it's hard to tell how well your partner can see, so it wasn't sexually selected, either. So the likelihood of your vision staying perfectly "in tune" with the reference point became pretty much random chance, with near-/far-sighted people mating with other near-/far-sighted people with no concern for the consequences. So, just as our eyes have to be tuned to a certain reference point to work optimally, so do our neurotransmitter levels. And just like people don't much care if their partner can see well, people don't much care if their partner has strange moods sometimes (--in fact, some might prefer partners with a certain demeanor.) So we've let genetic drift and random crossovers take the place of selective pressure in determining our brain chemistry. A lot more people are born needing figurative wheelchairs than find themselves needing figurative crutches. But a wheelchair is a bad metaphor, here, isn't it? A wheelchair is for someone who can't walk at all without it. Whereas, being slightly off your reference point, and using something to bring you back in line? Why, that's a lot more like wearing glasses!
jen_h 13y ago
Can be as simple as a B12 deficiency, too, which is ridiculously common. http://www.health.harvard.edu/blog/vitamin-b12-deficiency-can-be-sneaky-harmful-201301105780 http://www.health.harvard.edu/blog/vitamin-b12-deficiency-ca...

by kyro 13y ago

randomknowledge 13y ago

> I have never seen a psychiatrist refer a patient to see a psychologist or a cognitive behavioral therapist, and they have no incentive to really. Plenty do, and there are questions about the efficacy of those techniques as well.

derefr 13y ago

On the other hand, where I live (a non-US country with public healthcare), you don't get in contact with a psychiatrist directly; you get referred to one from a therapist. The therapist decides which kind of treatment of your symptoms is best, where one of their options is to pass you off to a psychiatrist (who the therapist thinks of as "the guy who will mostly think of this in terms of prescribing medications.") Even when the therapist thinks medication is a good treatment regimen, they usually suggest combining it various forms of talk-therapy (in other words, to keep seeing them, as well as seeing the psychiatrist.) Those are some much more neatly-aligned incentives, I think. --- I have to say, though, as a separate issue: neuroaffective medications of all kinds (whether for chemical imbalances, or hormonal imbalances, or pain-management, etc.) are basically like crutches. Your problem might not be "just" a chemical imbalance, just like your problem might not be "just" pain. But even if the cause is external, and the "true solution" is external, the symptoms the external problem is causing in you might be too debilitating for you to pursue the external solution on your own, while you're still afflicted. That's when you need a crutch. If you break your leg, walking on it enough to get it to heal is usually far too painful to do all on your own. So, you get crutches. Now you can get some support to lessen the pain, while still walking on it to help it heal. If you lost your job while you were in the hospital for the leg-break, the crutch can let you go back to work before you otherwise would, which can give you the motivation to keep pushing yourself to heal, rather than just sitting around. Once your leg has healed, you don't need the crutch. If you're clinically depressed, going out and doing things you'd otherwise enjoy is hard. SSRIs and the like are a crutch that let you feel less pessimistic about your situation, so you can pursue real sources of happiness (getting a better job, finding a relationship, etc.) Once you've done those things, you might not need the crutch. Sometimes, though, we need crutches for life. Once you're old enough to need a cane or a walker, you're never going to not need a cane or a walker. Some people are born with conditions that put them in a wheelchair for their entire lives. If your problem is inherent to your physiology, there's no external problem to solve--so you'll always need the crutch. --- Here's the odd thing about neurotransmitter imbalances, though. I asked a psychiatrist friend of mine about whether, generally, his patients have obvious problems in their lives that could be possible causes of their symptoms, or whether they more often say things like "everything's great so I don't see why I'm so--". He said it was overwhelmingly the latter. My pure guess to explain this data, is that something happened to our brain chemistry that paralleled the rise of near-/farsightedness as a genetic trait. After the rise of agriculture, sharp near/far vision stopped being something we had natural selection pressuring us to keep--and, unlike traits like height, it's hard to tell how well your partner can see, so it wasn't sexually selected, either. So the likelihood of your vision staying perfectly "in tune" with the reference point became pretty much random chance, with near-/far-sighted people mating with other near-/far-sighted people with no concern for the consequences. So, just as our eyes have to be tuned to a certain reference point to work optimally, so do our neurotransmitter levels. And just like people don't much care if their partner can see well, people don't much care if their partner has strange moods sometimes (--in fact, some might prefer partners with a certain demeanor.) So we've let genetic drift and random crossovers take the place of selective pressure in determining our brain chemistry. A lot more people are born needing figurative wheelchairs than find themselves needing figurative crutches. But a wheelchair is a bad metaphor, here, isn't it? A wheelchair is for someone who can't walk at all without it. Whereas, being slightly off your reference point, and using something to bring you back in line? Why, that's a lot more like wearing glasses!

jen_h 13y ago

Can be as simple as a B12 deficiency, too, which is ridiculously common. http://www.health.harvard.edu/blog/vitamin-b12-deficiency-can-be-sneaky-harmful-201301105780 http://www.health.harvard.edu/blog/vitamin-b12-deficiency-ca...