The use of these anti-depressants is extremely irresponsible. Most people who use them dont even have an inherant chemical problem. This will all be looked back upon as very stupid indeed.
> Most people who use them dont even have an inherant chemical problem.
Which leads to another issue that worries me: this kind of thing will end up with a backlash that likely screws over those who really do need the medication.
I take Wellbutrin and Lamictal (a mood stabilizer) every single day for PTSD and I wouldn’t really be able to function without them. I really wouldn’t call myself or the psychiatrist who prescribed them irresponsible. I’d say it’s equally irresponsible to make a blanket statement about something that does actually help people in certain circumstances.
That being said, there are a number of GPs out there who prescribe things without fully understanding the consequences. I’ve always had a GP refer me to a psychiatrist for any mental health issues, however.
I think the "irresponsibility" was aimed at the medical field, not at the patients. At least that was how I decided to read it.
EDIT: Also, I think that even for the patients where the cause of the depression is not "chemical" in origin, that does not reduce the severity of the illness in the slightest. It just means that the causes may lie elsewhere (for example externally). I have been depressed as an indirect result of the troubles I got myself into due to undiagnosed ADD. In my case, yes, I needed medication to treat my condition, as well as therapy. But I did not need antidepressants, I needed medication for ADHD (and I just checked: lisdexamfetamine is currently not considered an effective anti-depressant[0]).
Ah, that does make sense. I just tend to be a little on the defensive about it because often the response I get is that I’m taking the “easy” way out through medication.
> I just tend to be a little on the defensive about it
Completely understandable! Most people seem to have such a frustrating inability to understand that other people can have very different experiences of the world to their own, and that those experiences aren't wrong.
I am lucky enough that most of my friends do understand mental illnesses a bit better than the average person out there. Some of them who confided their mental health problems with me about the kind of reaction they tend to get, and it's just amazing how ignorant the natural state of the human mind is.
> that I’m taking the “easy” way out through medication.
Call me crazy, but I partially blame the dualist world view of the Western world for that, even if most people aren't even aware that they have been raised with a dualist mindset. This whole mind/matter division makes people think that mental problems have to be solved by thinking.
> Call me crazy, but I partially blame the dualist world view of the Western world for that, even if most people aren't even aware that they have been raised with a dualist mindset. This whole mind/matter division makes people think that mental problems have to be solved by thinking.
SSRIs help even if the causes are psycho-social. Obviosuly the person also needs the other stuff too in those cases - fixing the situation; some talking therapy - but meds aren't useless.
No-one credible talks about a chemical imbalance anymore.
Yep, though its the most common reason, SSRIs are not only prescribed for depression be it mild or severe. Anxiety is another rather common reason SSRIs get prescribed, and in my case Fluoxetine for ASD.
Its anecdotal but I know that in my specific case it helps.. a lot! I can focus better, I am less anxious, I'm happier (though that is not my main complaint at all), and most of all I get less agitated. That doesn't just help me; it helps my significant other, our newborn, my co-employees, and my family in general (don't have friends).
Oh, hmm thats kind of you. I understand that reaction. That probably sounded rather sad, so I reflected whilst writing this response.
First and foremost I have one very good friend (my partner!), and a rather good relation with my mother (my father passed away, alas). I consider my mother like a friend, who given her age needs me more and more and this will increase. Same with my mother-in-law. That's both OK, but also a burden of stress.
It appears difficult to become friends as you grow older compared to being young. I burned ships with my old friends because the relations were no longer mutual; no longer developmental ("stuck" or "grown different paths") or downright parasitic. Ironically, my last major friendship was my best friend wanting to use mushrooms with me at my place while I was no longer interested in recreational drugs. I was an avid gamer, but no longer have time to play games so all friends who I had who were into gaming I no longer have that in common with. That's a big blow in my social network and friendship list.
The gist is, I find individuals inherently boring and basically I don't want [new] friends; they're a hassle and nuisance. Friends are a distraction, just like this very forum. At best, they're interesting, like this forum. At worst, its annoying to waste a Sunday on a birthday (with mindless chit-chat, annoying opinionated people, eating crap I could better buy/cook myself, and travel time/cost), just like you can waste an Sunday on this forum. Heck, like Facebook, rather. OTOH, you reap what you sow. I still got like 100 movies to watch if not more, 20 books to read, etc.
My family and partner's friends and our newborn is more than enough. I need to focus on improving those connections first and foremost since my autism does put those relations under pressure both generally as well as incidentally more so. That plus integrating my autism diagnosis with my career which isn't easy in mid 30s. You could argue I'm not ready for it yet but I didn't start taking SSRIs to become more social. I do want to meet more people with autism, but that's out of self-interest, and a long-term project since right now I still feel overburdened due to the above (mostly our newborn).
Thank you for sharing your story. You seem to have a good idea of what are the most important issues to tackle for now, I hope you'll be successful at dealing with them!
I am actually going through something that is in some aspects the same, yet as a whole kind of the opposite. I have close friends, but they no longer live in the same city as I do. I emigrated for work two years ago. I didn't really like the city much, and at the time I also felt kind of heartbroken to say goodbye to my friends.
As a result I too did not feel like making new friends, but for opposite reasons: I did not want to root down in this new city, and then break my heart all over again when work finished (I knew it was a temporary thing). So in the last couple of years I have spent most of my time on work, and only "mildly" socialised. Slowly and almost unnoticeably, the relative social isolation has worn me down.
Last year while travelling I met the woman that I want to share my life with. As she lives in another country, we have been in a long-distance relationship (despite both of us having bad experiences with that before and swearing we'd never repeat that). In some sense this made the social isolation worse: we spent so much time on Skyping every day that we forget to meet our friends.
My contract is nearly ending, and our plan was that I would move in with her soon. I am really looking forward to this, and to end this period of solitude. However, she has lived in her city for nearly a decade, is "settled in" and has a network of friends. By comparison, I'm moving to for her - while the city she lives in is nice, I would not have thought of moving there if not for her. I will also have to build up yet another network of friends (like you, I am in my thirties, and I too notice how this is getting harder).
This created an unbalance in our relationship: I "need" her much more than she "needs" me, as I would have noone else in that city when I arrive. This asymmetrical dependency resulted in a a strange kind of tension, making me hyper-oriented towards her to the point where it resulted in me becoming unstable.
So now we changed the plan: I'm looking for a temporary place to live, in some kind of shared appartment arrangement with (ideally) lots of roommates to socialize with and explore the city with. That way I can find my own ground in the new city and discover on my own terms whether I'd like to live there, and what I like about it. We will still see each other most of the time, and after a few months still intend to move in together. But this new plan will take the pressure off the relationship.
I am all with you that friends are often a bit of a distraction, but to me the good friends are an enhancement: they support and enable more than that they distract. I hope that some day you will find a few of those kind of supportive friends, and that they will ease your burdens. Until then I am glad to read that you have a supportive partner and family! And I wish you good luck with parenting.
(aside: after posting my message I was actually a bit worried that I would come across as one of those people who insists on constantly trying to cheer up their depressed friend, but actually only puts more pressure on them that way (I have experienced that). I'm glad it didn't come across that way - well, either that, or you're too polite to mention it)
I could not agree with you more: Both my partner and I have been on SSRIs / SNRIs before for LIMITED DURATION (3-12 mo).
We would not have a healthy, happy, functional family without these types of interventions available.
I found (I suspect like you) that having an psychiatrist - an MD, who can provide both cognitive/behavioral and pharmacological interventions - is the key.
>I could not agree with you more: Both my partner and I have been on SSRIs / SNRIs before for LIMITED DURATION. Probably over 10 times between the two of us.
You might want to consider maintenance therapy. The actual evidence for severe discontinuation effects is quite limited, but we have fairly strong evidence that maintenance therapy significantly reduces the rate of relapse. It's natural to want to avoid taking drugs indefinitely, but it's often a better option than a long-term cycle of depression, treatment, discontinuation and relapse.
I suspect that a substantial proportion of people mistakenly believe that they're "addicted" to anti-depressants, when really they're just receiving an effective treatment for a chronic condition. They feel worse when they stop taking the pills, because the pills are doing what they're supposed to do.
I’ve seriously considered it. I’ve done MDMA once in my life and it was honestly the only time I’ve ever felt anything even remotely close to peace and calm inside my mind and body. It was like this miracle evening without flash backs and anxiety.
You may be able to get into a trial. In a therapeutic setting, folks are often able to release the underlying trauma and move beyond it. A great book about this is Trust, Surrender, Receive by Anne Other (AnneOther.com).
So it turns out that your mind is implemented in your brain, which uses chemicals. There is no such thing as distinguishing "chemical" mental problems and "non-chemical" mental problems.
If you're interested in working for a startup working on improving the physical health -> behavioral health system integrations, checkout https://www.quartethealth.com/ in NYC.
The last thing we need is people who clearly lack a basic understanding of a field as complex as mental health to start working for start-ups in that field.
My heart and sympathy goes out to anybody who's on antidepressants and is trying to get off. From what I've seen and heard, it is just an incredibly painful and unpleasant experience, compounded by the fact that you need to be constantly negotiating with your insurance to cover the changing prescriptions as your dosage lowers. The withdrawal symptoms can be incredibly oppressive and disruptive. I wish there was more research into this, because I think it could help a lot of people.
It varies wildly by person, even moreso possibly than antidepressant efficacy.
I've been...fortunate, if you can call it that, that while I've taken a great many antidepressants and other psychiatric medications, the worst side effects I've ever faced from stopping have been screwed up sleep/wake cycles, irritability, and a few days of headache.
I've had friends and family members who have had much worse, and I've had to carefully consider it each and every time, because we lack any kind of monitoring or ways of informing us how bad it might be.
Much worse, something that can't be compared. Anyone would prefer a newborn which is an external person that you provide care and watch grow. Sure it will keep you up but it also provides emotions to help fuel you past those weak moments. When you are internally off where you can't sleep the affect is different.
I had a severe psychosis in my life which took approx 2 months to recover from. In the beginning, I could not sleep and felt like I was fully awake when I slept. I couldn't sleep either, though I wanted to so badly, and my emotions were virtually non-existent (the lack of self-pity was fun though). It occurred a while after I was off SSRIs (Citalopram) but not right after.
Newborn creates hormones, sure, but needs constant attention and requires high maintenance. There's no voluntary break. Ours needs to eat every 3 hrs. Can set my clock to it, and can't sleep right after feeding (she's gotta sleep first, or go through intestine pain). I know it isn't the end of the world, and given the psychosis I been through worse, but this is flat out rough [for me].
I wish I'd get positive emotions during weak moments. I mean, if I'd have that, they wouldn't be weak moments. After one hour of crying and trying to solve in every way I can think of I become desperate and feel lost. Its those moments I need to control myself and realise it isn't about me; its about her, our newborn. She's the one who's suffering, and doesn't know better. I wonder if it helps to cry with her.
Having lived in US and UK there is a big difference. I have experienced US doctors tring to upsell me on treatments for a superficial leg injury that UK doctors who have seen the same thing have not and said just leave it unless it causes pain. Similar experience with dental care in US.
Before you downvote op for an admittedly over-broad opinion you truly need to experience the USA model of overprescription, drug ads on billboards and all over TV shows targeted by demographic, all sorts of IP shenanigans to extend IP/re-patent/pointlessly reformulate/roadblock generics/cherry-pick studies for new drugs that have no real benefit but a higher price.
European medicine is indeed worlds different, and the European population is far less sick, overmedicated and suffering from iatrogenesis.
To put it in perspective, I live in the US and I have an ad for Xeljans stuck in my head. With the tagline "If methathrexate didn't work for you, maybe Xeljans is right."
The US isn't synonymous with "modern medicine". It's a weird outlier in just about every respect. Vast amounts of clinical research and practice is happening outside of that bubble.
While it's true that the US has a serious problem with overprescribing, it's also true that many other countries are seriously underprescribing psychiatric medication, due to a combination of cost and stigma. Mental illness represents an immense global disease burden, with depression being the single greatest problem. The disease burden of depression is higher in many lower- and middle-income countries than in the US, mainly due to a lack of treatment.
Although there has been a great deal of controversy over antidepressant drugs, we are now highly confident that they are significantly more effective than placebo. Generic antidepressants are dirt cheap, with most costing less than $2 per month at international wholesale prices. We shouldn't lose sight of these facts.
Quite symbolic that my original comment is flagged and now invisible. That's exactly how truth is being suppressed in the US. Original comment was: This shouldn't come as a surprise to anyone. Modern medicine is not in the business of curing diseases. It's all about disease and symptom management.
Are you saying that people are not trying to cure diseases? And instead they are only trying to manage them? If so, that is unequivocally wrong and misinformed.
That's just human nature. We can say the same about programmers. They just want to fix the apparent problems, not write a better program.
Yes, if you read Hacker News you probably object. Not everyone does that. But making the problem just go away is the prevailing, widely spread, most commonly used mode of working.
I would assume the best intentions for the vast majority of individuals working in the health system. But the economy of that system is one that favors treatment over cure/prevention. I'd like to believe that is a mistake of circumstance and not a design of human greed.
Not entirely. Whichever company comes up with a cure first will gain nearly 100% of the market, and can charge a TON to insurance companies for it. It cuts off long term profits, but investors reward quarterly growth primarily.
That's not what any doctor or scientist is trying to do, they'd all prefer a cure. They'd prefer to have treatments that work better, and are continuously working to improve them.
To say that a cure doesn't exist because they are not trying for it is 1) wrong, 2) hugely dismissive of the life's effort of tens of thousands of people, and 3) dismissive of the struggle of those using antidepressants.
If you think there are cures out there that are easily achievable, show it. Otherwise you are just perpetuating facile misunderstandings of a difficult situation.
This is psychiatry. We don't know how to cure the underlying diseases, because we don't entirely understand them. When the field can actually cure them, like for PTSD and certain anxiety disorders, it's very happy to.
Psychological treatments like exposure therapy are highly effective in treating PTSD, panic disorder and phobia. A significant proportion of people with severe anxiety-related disorders can be completely cured in a matter of weeks. It doesn't work for everyone, but thousands of lives have been transformed by psychotherapy.
The best available evidence suggests that psychological treatments are equally effective as drug treatments for most common psychiatric disorders. Psychological therapies are generally orders of magnitude more expensive than drug treatments, so unfortunately they aren't as widely available.
Psychiatry is an incredibly challenging field and there are a lot of things we just don't know. Drug companies might have a strong incentive to keep selling you pills, but insurers have an equally strong incentive to cure you outright. Single-payer healthcare systems like the British NHS have a huge incentive to use the best, most cost-effective treatments available. It's just an unfortunate fact that we can't fix everyone. There is no magic wand to cure all human misery and there's no conspiracy to keep people sick.
Take Crohn's for example. Sure you can be on Remicade for a decade with no significant flare-ups. Then the day Remicade stops being effective you're completely screwed. Plus your situation got worse over time, you just didn't get the messages your body has been trying to send you. Remicade was essentially the firewall.
What diseases are there on the field of psychiatry that can be "cured"? It seems to me that all of those diseases are only mitigated enough to help the person recover on their own.
I think we're on the verge of some really big breakthroughs when it comes to understanding the brain though. The research group I work for (for only six more days.. sigh..) just released a pre-print of a paper mapping out all of the mouse brain's cell types[0][1].
> The mammalian nervous system executes complex behaviors controlled by specialised, precisely positioned and interacting cell types. Here, we used RNA sequencing of half a million single cells to create a detailed census of cell types in the mouse nervous system. We mapped cell types spatially and derived a hierarchical, data-driven taxonomy. (...) The resource presented here lays a solid foundation for understanding the molecular architecture of the mammalian nervous system, and enables genetic manipulation of specific cell types.
(you may wonder what mice have to do with human brains: on a "cellular" and "genetic" level, mice are already close enough to humans to be decent substitutes for researching quite a lot of fundamental stuff about how the brain works)
We already had an atlas of where every gene was activated in the mouse brain since 2006, but this was at the tissue level[2][3]. Only recently it has become possible to research at the cellular level which genes are activated. That has enabled the possibility of classifying cell types by gene activation. Not only that, by tracking gene activation over various stages of development, we can see how the genes interact and activate each other, and get a better insight in how the brain develops its various different cell types.
I am "merely" a programmer/interaction designer building tools for easier data exploration, and can't pretend to understand the fine details, but that sounds like it is Kind Of A Big Deal for anyone researching brains.
For example: until now, we could only see which genes are correlated with higher chances of a certain mental illness (by looking at the genetic makeup of people with and without these illnesses). But that is not the same as knowing what those genes do. Furthermore, many of mental illnesses are partially nature, partially nurture: you have to be unlucky enough to have a mix of genes that makes it possible or more likely to manifest an illness, but for the disease to truly manifest itself you also requires an environmental trigger.
When we can follow individual cell development at the genetic expression level, we can start to figure out what changes when certain genes and/or certain stimuli are present or absent.
There is an equivalent science project underway to map out all the cell types in the human body, not just the brain[4]. On top of that, the techniques that let scientists analyse the RNA expression in individual cells are getting cheaper and faster all the time[5]. My guess is that major breakthroughs in understanding how the body works, including the brain, will start coming in very quickly.
(and I'm not even talking about the implications for machine learning)
yep, all those cancer cures somehow slipped out despite our best efforts to keep them secret.
c'mon, let's be real. The folks who try to develop new treatments are people with family members and friends who get sick too. The reason we struggle for cures is that it's hard!!!
Cancer cures are decidedly spotty. First, "cancer" isn't one single disease, it's a symptom complex with numerous etiologies. Some of those are now well-managed -- tunerculin baccilli for yreatment of bladder cancer, say.
Others have seen no progress in 50+ years and continue to have exceptionally poor prognosis.
The biggest advances in medical outcomes are virtually all based on public health, preventive measures, and improved access to fundamental care.
I've seen enough people in my life become addicted to antidepressants because of a traumatizing event in their life for me to have a dark outlook on it. Instead of therapy or taking real course of action to resolve the trauma/inner problem, a doctor will just label a person suffering depression. The greatest use of an umbrella-word "Depression" to get people on prescription medication and typically the problem never goes away as the problem is now just a word associated to illness one must have. A pseudo science practice at best and impossible for a trusting person to escape it. My personal opinion is that there are few people actually on the drug that are suffering "depression" without a rational life event cause.
Antidepressants have drawbacks, but what matters is that the benefits outweigh the cost. That is something that doctors discuss with their patients when considering such a treatment.
whether the benefits outweigh the cost, and that is something doctors should discuss objectively with their patients when considering such a treatment.
These substances are yet another instance in the history of psychopharmacology where the touted benefits have been exaggerated and the harmful side effects denied.
They have their place, but in the bodies of a sizable fraction of the current patients is not it.
There is no doubt that antidepressant therapy needs to be combined with psychotherapy, sports, meditation and just reducing the unhealthy parts of your life.
The cost of taking antidepressants is really low however. Most of the time, they have almost no side effects, and are proven to help https://www.bmj.com/content/360/bmj.k847
Where I live, they are pretty cheap.
I find that there is undue bias against antidepressants. If you need them, take them! They help.
I often see antidepressants held to more stringent standards of evidence, theoretical backing, and safety than other treatments. It's pretty common to see someone claim that the chemical imbalance theory is bunk and that antidepressants don't outperform placebo, then glowingly endorse something else with markedly less scientific support as a treatment for depressive disorders (e.g. exercise, supplements, insight-oriented psychotherapies, mindfulness meditation).
I’m not sure how this adds to answering the questions and which I’m apparently downvotes for curiosity. Apparently treatment in regard to a diagnosis of depression does not need scientific standards of evidence and we should just experiment on people willing to trust misinformative beliefs of promoting unclear benefits which may not exist.
That is absolute rubbish and you know it. There are thousands, if not millions of cases where people have had side effects.
The bias isn't undue, most of the time it's factual and comes from anecdotal experience. You sound like you haven't ever been on antidepressants, and are instead regurgitating soundbites from a medical journal.
I've seen cases where antidepressants saved people's lives.
I've also seen cases where they were pushed on people who needed psychotherapy and not medication. Access to quality psychotherapy is unfortunately very low.
Venlaflaxine not only saved my life, but gave me a new one. It shouldn't be looked to as the only solution, however, it's one of the most powerful ones in the arsenal. This bias against anti-depressants is quite miseducated and unfortunate.
I was up to 10mg/daily of Lexapro for two years. When my doctor and I agreed it was time to stop taking it, his advice was to go down to 5mg for a week, then stop.
When I tried stopping after the 5mg dose I had constant vertigo symptoms and incredible difficulty sleeping.
What I ended up doing was cutting the pills in half for a few weeks, then quarters, then removing one day a week from the schedule until I was down 2.5mg/wk. Finally I was able to stop, and only was mildly affected for 3 weeks after that.
That stuff does weird things to your brain. On the flip side, I couldn't have gotten through some really rough times without it.
I had the same issues coming off of Lexapro. Weird brain shocks. Bupropion (Wellbutrin) has been better for me all around, but I worry about what it will be like coming down off of it too. The good news is that I'm overall in a good place and feel like I probably don't need it anymore.
Glad you are in a better place than before, hope the process will go well!
I wonder if there is a form of research that could done by following patients who are receiving this treatment, and track how they wean themselves off of it.
That's exactly how I felt getting off of Effexor. I stopped taking them completely one day and after trying to push past the zaps for two weeks I got back on them. I had to get of them gradually by splitting the pills open and splitting up the little balls instead.
Okay, this is way too much information, but I googled furiously to try to discover what awful parasite had laid its eggs in my intestinal track when I started noticing those tiny white balls in the toilet.
Bupropion is marketed as Zyban as a smoking cessation aid meaning that people are coming down on it when they quit Zyban, after they quit smoking. I've done this, twice. I've also used Ritalin in the past. It works similar, and from my memory the coming down is also similar.
I tried Zyban years ago. After 7 days I stopped smoking and then had this weird time slowing down effect. I guess most people don't have that effect but I wonder how many do.
For what it's worth, from my anecdotal experience, Bupropion is much, much milder in terms of withdrawal, and the symptoms are more in the realm of energy than paresthesia - groggy and listless, but not vertiginous and electrified.
Same experience for me, and in fact I had the brain-zapping withdrawal symptoms while I was taking a steady dosage. The zapping happened with both Zoloft and Lexapro. It happened regularly many times per hour.
When asked to describe it, I tell people the zapping feels like my mind is lost for a fraction of a second. For that tiny moment I really think I'm completely non-functional, and the thought of this condition lasting for a non-trivial amount of time is frightening, although I've never heard of that happening.
Zoloft was beneficial for me, but not enough to outweigh the discomfort of the brain zapping.
The brain zapping and some other symptoms were impossible to describe accurately and I have trouble even remembering them properly. The feeling was alien.
I hope that this doesn't come over as sarcastic, but the pharmaceutical industry is a business, and they will always operate like one:
A business is about making the most money possible: Maximizing revenue is about minimizing the main costs which are generated by the activities of:
(a) acquiring the customer (through: advertising and marketing) and,
(b) retaining the customer (in this case: through dependency).
There are alternatives to anti-depressants. Some people quit depression for good with a well researched and planned LSD trip combined with long-term daily mindful meditation.
You are suggesting that depressed people may want to take LSD in lieu of SSRIs, which is horrendous advice that can, for example, trigger panic attacks in those with comorbid anxiety. Please don't.
> What study shows LSD is more dangerous than SSRI’s?
Except that's not how it works.
How it works is that SSRIs have been tested in trials, and are approved.
LSD isn't. When someone says "try LSD" (or psilocybin which seems the newest rage these days) it means they'd illegally acquire the drug (who know for sure what drug they bought? [EDIT: and who knows the dosage/strength of active substance(s)?]), and administer it recreationally without the aid of a professional.
SSRIs, in contrast, are clinically tested, legally acquired, and administered under the guidance of a professional.
> Antidepressants can also cause psychotic episodes, panic attacks, suicide, etc.
Yes, but these side effects are widely documented. There are more common side effects, btw. These are the extreme ones you mentioned, and also the most rare ones. Many side effects are temporary. And if you are suicidal, it is unlikely you get SSRIs prescribed. Unless you lie about that, of course, but if you lie to your MD you're on your own.
My recommendation is simple: seek professional help. If you don't want to take SSRIs, fair enough; your MD won't force you. Heck, they might even be reluctant to prescribe them. But professional help is much more than drugs. Think about CBT, mindfulness, under the guidance of professionals; not self-medicating new age hippies.
You keep saying "professional" as if that means anything here.
The professionals that without any evidence promoted the low-serotonin theory of depression. Who, after over a decade of prescribing SSRI's finally admitted that low serotonin doesn't cause depression. Yeah, those professionals. They don't know what causes depression yet they're happy to keep prescribing drugs. But it's the "self-medicating new age hippies" that are irresponsible?
It means a lot, it means that the person who's responsible for your therapy (which might involve drugs) has studied for years (it takes a while until one's a psychiatrist!). It means they understand the fundamentals required for their title. Such credentials are worth a lot in our societies, hence the high wage. Perhaps not in the alternative medicine field where you're flocking around but realise you are the exception here; not the norm.
Also, those professionals aren't necessarily the same people. Do you fault Linus Torvalds for a bug in the Windows NT kernel because he's a software developer? Science is constantly in motion and questioning itself. The drug usage in the past before drugs were illegal (pre-2nd part of 20th century) was more irresponsible, and its thanks to science and law this has reduced. And specifically, SSRIs are more safe than antidepressants used before SSRIs such as TCAs and MAOIs.
> Such credentials are worth a lot in our societies, hence the high wage.
Lots of professionals with great titles and affiliations steer people down a totally incorrect path.
An easy example of this is Harvard study published in the New England Journal of Medicine promoting dietary fat reduction, shaping what every credentialed person would advise for diet for the next 50 years: https://www.npr.org/sections/thetwo-way/2016/09/13/493739074...
Drug companies shoulder the rep of being cold evil capitalists. Psychiatrists also become extremely wealthy as part of this medical complex, and get to keep a positive reputation. It reminds me of ticketmaster essentially being paid to shoulder negative PR for excessive ticket fees which are often largely passed on to performers.
> Lots of professionals with great titles and affiliations steer people down a totally incorrect path.
Not knowingly, and they're expert on the field. There's a few exceptions, but those people are not 100% in the head. Diederik Stapel [1] being a recent example in social psychology.
The chance that you have a sitter without a clue is much higher. Especially because those are usually "friendz". The chance a professional knows better than a self-proclaimed expert is simply too high to discount all professionals.
> Drug companies shoulder the rep of being cold evil capitalists. Psychiatrists also become extremely wealthy as part of this medical complex, and get to keep a positive reputation. It reminds me of ticketmaster essentially being paid to shoulder negative PR for excessive ticket fees which are often largely passed on to performers.
In The Netherlands, you first try the drugs which are most likely to solve your problem but also you need to consider what gets reimbursed by insurance. Insurance also wants you to go for cheapest generic brand if possible (if patents expired, and the drug is known to work for your ailment). Example: something like Concerta doesn't get reimbursed because Ritalin exists and is considered the generic form. Even though the yo-yo effect is more severe with Ritalin.
Another example, I had the option of going for a SSRI or a SSRI plus antipsychotics. The former has a good track record for people with autism; the latter combo better but it also has more impact. Regular blood checks, and basic insurance doesn't cover the antipsychotics.
As for the positive reputation, when I went for my autism diagnosis I had an anamnesis from an asshole of a psychiatrist. He was working there temporary because they fired their regular psychiatrist very recently. I don't know exactly why, but I do know it was directly related to his functioning as a psychiatrist.
Ticketmaster problem is different (and offtopic though I don't mind analogies). It can be solved by putting a cap by law on how much percentage profit (e.g. 25%) second hand market may earn. That does require political willpower and enforcement of such regulation.
I agree with everything in your comment but take issue with your dismissive attitude toward psilocybin as "the newest rage these days."
Western medicine is famously puritanical toward hallucinogenic drugs. Human social history is long and hallucinogenics being illegal is comparatively recent. It's an insult to the study of science that such an interesting and powerful drug is taboo to even study. Thankfully this seems to be reversing in my lifetime.
That's hardly the reason for why antidepressants cause what's known as "dependency." I don't think there is malice or nefarious nature to the state of drugs in psychiatry - it's moreso that almost all the drugs that have non-subtle effects, also come with dependency. And thus, doctors' want to prescribe something that has immediacy, because most patients will have doubt and abandonment of a treatment plan if it isn't strong enough to cause immediate change.
But I would agree that the field of psychiatry (not psychology which doesn't require a medical license) has it in their interest to say that antidepressants aren't _narcotics_. And they aren't. But the cruel thing is that the difference between a narcotic and a dependency-causing-drug is blurred.
For example, Wellbutrin is a norepinephrine aka noradrenaline agonist and reuptake inhibitor. It's a stimulant - to call it an antidepressant is a bit of an ongoing joke. If someone has no energy and lacks willpower, any stimulant will get them to do things they might not otherwise have done.
The reason Wellbutrin isn't considered a narcotic is mainly because being full of adrenaline is often a shitty experience - whereas being full of a 10%/90% adrenaline/dopamine mix is quite pleasurable (ADHD stimulants - amphetamines/phenidates.) But it's entirely unscientific to say that an antidepressant cannot be addictive to a person that likes the effects more than the average neurotypical person. Just google Wellbutin abuse and you'll find a ton of personal stories.
And then lets talk about dependency. Dependency is just a rebound effect by the body to adjust its endogenous feedback in order to find homeostasis again. It's why most drugs that have large immediate "gratifying" or noticable psychological effects, also come with a downregulation in the same areas by the brain and body. So when you stop taking the drug, your body is actually BELOW baseline and it will take quite a bit of time before you are back to baseline. In some cases of extreme use, the brain can be structurally changed and permanent damage can result. See "parkinsons from stimulant abuse" for a typical example.
Dependency and addiction only have a difference in a psychological way. The physical withdrawal and rebound effects are mutual. Don't be fooled when you are told that an antidepressant drug is not a "narcotic" and isn't habit forming. It is a lie.
The only psychological drugs that are truly therapeautic are upregulators like Cordyalis, known as Yan Hu Suo in Chinese medicine. It causes neurogenesis and upregulates dopamine. It is quite a beneficial drug to consume when withdrawing from any type of stimulant or dopamine agonist.
That brings back horrible memories. I took an SSRI for several years, initially prescribed by a GP. But the problem was that I wasn't "depressed". I am bipolar, and sometimes got stuck in down mode.
The SSRI did make me more functional. But what it mostly did was make me affectless. That is, I could be sad or happy or angry or whatever, and I felt pretty much nothing. However, I still did whatever someone who was sad or happy or angry or whatever would do. You could say that it made me sociopathic. But fortunately, not homicidal or suicidal. Or at least, not in a big way. Also, I lost interest in sex, and it took forever to reach orgasm.
And yes, quitting was painful. Mostly I recall restless leg syndrome. I would kick my partner while asleep. And I got even crazier for a while, as I tapered off.
So now I'm taking modafinil and lamotrigine. Which works very well for me. I'm a little manic most of the time, but I like that. And I'm not at all sociopathic.
> Also, I lost interest in sex, and it took forever to reach orgasm.
This is a common side effect of SSRIs. I have the same, but I very much enjoy that side effect. Saves time, and already got a child anyway. I still love pleasuring my significant other just as much as before, btw.
People who have bi-polar usually get mood stabilisers such as lithium prescribed. Perhaps anti-psychotics? SSRIs are known to be problematic for bi-polar personality disorder.
Modafinil (antinarcoleptic, originally) plus lamotrigine (anticonvulsant, originally) works well for me. It's easy to tweak the ratio as circumstances warrant.
Edit: About sex. My wife at the time did like that I took longer to reach orgasm. However, after we separated, I discovered that wearing a condom made orgasm unreachable. And that did become a problem. Albeit an amusing one, in retrospect.
Nice to see modafinil getting a mention. I've found it to be near-miraculous as a fast acting antidepressant that helps combat the cognitive downsides of other meds.
Interesting - I have bipolar too (that is, bipolar II), also misdiagnosed as pure depression for a while. However, the SSRI didn't flatten my affect, but instead amplified my hypomania to where it was severe enough to be diagnosed. Now I'm on lamotrigine and sertraline, and the two together keep me stable and up.
How did you end up getting properly diagnosed for Bipolar disorder? I'm currently taking antidepressants after battling SOME kind of mental illness for most of my adult life. I'm really inside my head, and often have very existential, self-doubting moods, to the point where I have burned a lot of bridges (jobs, friends, relationships) with antisocial behaviour (that I would never logically think is the right thing to do), but in the right mood, having also tried MDMA, I act completely normal, can hold conversations, etc. (but that's once in a blue moon normally).
I was in weekly talk therapy with a psychologist and checking up with a psychiatrist every few weeks to fine-tune my meds, the two were in close contact, and one of them (don't remember which) picked up on my periodic euphoria and social extroversion.
Hmmm. I suppose that I was hypermanic. And maybe it wasn't so much that I was affectless, but that it wasn't appropriate affect.
OK, for example, I would be driving, in a hurry. And without much emotion or warning, I'd find myself running red lights and whatever. Laughing. I remember an accident, where the other driver said something like "Where the hell did you come from?" And I almost said something like "God sent me to kill you!" But I didn't, fortunately.
That SSRI truly made me a danger to society and myself.
To offer the converse, I had a very traumatic event in my life and was put on an SSRI, which helped me function. After almost 2 years of taking it, I didn't think I needed it anymore and I tapered myself off very slowly but regularly, keeping logs and setting alarms. While in the beginning I felt some vertigo and other symptoms, I tapered very gradually, and was completely free at the end of my taper. My symptoms never come back and the SSRI helped me make very real progress on my issues. I'm eternally glad for my SSRI use and a medical system that knows when to prescribe it, as I would have probably not been able to hold down a (at the time, very stressful) job during the initial phases after the event without the help of the SSRI, and it probably would have taken me many years to recover. For those that SSRIs work on, it really works.
>> I'm eternally glad for my SSRI use and a medical system that knows when to prescribe it...
Your story of recovery is a good one (and not the only good one). The problem is that a number of people in that same system don't see any need to get people off these medications. IMHO they are best used short term (whatever that means) while you work through your issues - like you did.
For those reading, there is no "correct" timeline for working through your issues. Everyone goes at their own pace. I would just encourage you to try, and not assume a lifetime of medication is a good solution.
>The problem is that a number of people in that same system don't see any need to get people off these medications
Why is this a problem? If long term studies prove detrimental effects then sure, it's a problem.
But taking a pill every day isn't inherently bad for you. If you live in a northern climate you would probably benefit from taking Vitamin D every day your entire life, so what's the fundamental difference of an SSRI?
The issue isn't taking medication daily; it's taking psychotropic, brain- and personality-altering medication for years, especially when it comes with potential for bad side effects which may last after cessation (such as with SSRIs). I take vitamin D daily and I really don't think you can equate it to SSRIs whatsoever.
Clearly SSRIs help many people in a significant way, but their mechanism of action is still poorly understood and their effects are powerful enough that they should be prescribed and taken long-term only with careful advising and caution. For some people, maybe taking them until the day they die is the best option, but it probably is also harmful for some people to take them for several years.
Hmm... I question a meta study that says it has finally solved the issue and put it to rest, when there are plenty of other studies saying the exact opposite.
"SSRIs might have statistically significant effects on depressive symptoms, but all trials were at high risk of bias and the clinical significance seems questionable. SSRIs significantly increase the risk of both serious and non-serious adverse events. The potential small beneficial effects seem to be outweighed by harmful effects."
All the major meta-analyses come to roughly the same conclusion, which is that anti-depressants have modest positive effects. The paper you linked to finds exactly this, but argues that the effect size they found is insignificant because of the high risk of bias. Other studies have gone to extraordinary lengths to control for potential biases and come up with a very similar effect size. Reasoning about the data is quite challenging, because we're talking about relatively small shifts in a relatively broad statistical distribution.
"Number needed to treat" is a useful epidemiological concept in this case. A perfect drug that cures every single patient has an NNT of one - for each patient you treat, one patient is successfully treated. When you translate the results of SSRI meta-analyses, you get an NNT of about seven - for every seven patients who take SSRIs, one more patient will recover than if those patients were given a placebo.
It's hard to know what to do with that information. Is it worth prescribing antidepressants to 1,000,000 people to treat 142,000 of them? On a pure cost-benefit analysis, the answer is a resounding yes. Antidepressants are relatively cheap and safe. Are you willing to take a pill every day to get a one-in-seven chance of an effective treatment? Maybe. If you're in the throes of a deep depression, you might be willing to give anything a try. If you're just feeling a bit blue, maybe not. By the same token, if you're taking antidepressants and you don't think that they're helping, you're probably right.
As a layman, I find it surprising that SSRIs were clinically approved for treatment based on a 1 in 7 chance of demonstrating positive effects. Are other medications anywhere near as ineffective? Whether antibiotics, Tylenol, or Viagra, I can't imagine any of those being effective in less than, say, 5 out of 7 cases.
>Are other medications anywhere near as ineffective?
Yes. Reviews suggest that statins have an NNT of between 50 and 200 depending on the patient's underlying risk for cardiovascular disease. Coronary stents are probably useless. Reviews of antibiotics, antivirals and corticosteroids show a wide range of NNTs and often show no positive effect.
The drug approval system has a relatively high bar for safety, but a relatively low bar for efficacy. A drug manufacturer only has to prove that their drug is effective for one particular cohort of patients with a particular disease, but doctors are then free to prescribe the drug to any patient with any disease. Many surgical interventions are never subject to a randomised controlled trial.
Good point. I think stents, and to some extent, statins, are starting to be exposed as often misused tools. Yet, for some reason, it feels politically incorrect to ask the same questions if SSRIs.
>> The bigger problem is “depression” is not reproducibly measurable, because it has no falsifiable or biomedical marker.
That's something I like to point out using SSRIs as an example. The claim is that they increase levels of serotonin and that the cause of the depression is reduced serotonin. The thing is, nobody actually checks your serotonin levels and says "oh that's low take this." Then there's the problem of why ones serotonin is low when it wasn't always that way. There are probably many causes of depression and quite possibly some that don't lower serotonin.
If mdma makes you friendlier, does that mean that people who are shy are suffering from friendliness deficit disorder and can I get a prescription for it.
We don't really know how antidepressants work. We don't know how a lot of drugs work. Nobody knows why acetaminophen (paracetamol) cures your headache. Knowing how a drug works is useful but not essential; modern medicine relies on hundreds of drugs with unknown mechanisms of action.
The Cipriani study is a nice meta-analysis: "The random-effects summary SMD for all antidepressants was 0·30" This site explains SMD: http://handbook-5-1.cochrane.org/chapter_9/9_2_3_2_the_stand.... This site shows what 0.3 looks like (actually shows 0.2 and 0.5): http://rpsychologist.com/short-r-script-to-plot-effect-sizes.... Typically, when people are summarizing this line of research saying that there is no effect, they are talking about these kinds of effect sizes which look like they round to pretty much no effect. I think using SMD for reporting by itself is unfortunate: my understanding is that the drugs have large effects for a minority of patients -- rather than that they shift everyone's emotional experience over a little bit.
But note that there's no attempt to control for the (extremely strong) anti-histamine effects of these drugs (particularly elavil.) You need to test them against other anti-histamines which can also improve apparent health, a lot.
Exercise is harder than taking a pill - remember these are antidepressants. Also, when you're depressed anything that gives you hope is likely to actually help and that means placebos too. Having said that, I would hope actual drugs work better than a placebo.
>> This is a dangerous opinion and can inspire guilt...
Wait what? Which part? My first sentence? There are a few opinions in what I wrote. What specifically might inspire guilt? Honest question, I try to be sensitive to such things.
We only recently have figured out how exercise protects the brain against stress-induced depression[0]. In short: red muscle (the endurance kind) produces an enzyme that breaks down kynurenine, one of the stress hormones that is associated with triggering all kinds of mental illnesses when it stays at chronically elevated levels.
But there are many more possible causes of depression than stress - one could compare it to a fever: a high fever kills, but there are many possible illnesses leading to a fever. Expecting that exercise helps with depression every time is like assuming every fever is caused by the same illness. Not to mention the fact that while having more red muscle may help with coping with chronic stress, it does not actually fix the cause of chronic stress in and of itself (although it can of course help with providing someone with the mental fortitude needed to take on that particular problem).
There are all kinds of reasons to do more exercise, but touting them as a catch-all fix for depression is dangerous and ignorant.
Since there's a lot of quoting of studies on this topic, I hope that everyone reads this very informative (and long) blog post by a psychiatrist on SSRIs and their effectiveness:
"Cannot stop" is kind of strong. More like "have nasty side effects while tapering off and puss out".
Having been on the Zoloft,I can say is got a black box warning for a reason and should only be taken if you're seriously in danger of self harm.
Shrinks like it because it keeps people coming back. People like it because they're not willing to confront their real problems and want something to numb themselves out.
> "Cannot stop" is kind of strong. More like "have nasty side effects while tapering off and puss out".
sure, but you can make the same point about any drugs that people develop physical dependencies on. aside from alcohol and benzodiazepines, you will survive. antidepressant withdrawal varies a lot from person to person though. the brain zaps can definitely be severe enough that it becomes unsafe to drive a car, for instance.
> Just say "No!".
this I can certainly agree with, for all but the most severe cases. it's almost never worth the common side effects, let alone the rare ones.
As someone currently on a somewhat high dose of sertraline (100mg b.d.), "numb themselves out" feels like an odd descriptor to use. That seems more like a benzodiazapine-class drug, and certainly doesn't match my experiences (it makes me more prone to insomnia, which I would not associate with a numbing agent) and wouldn't be otherwise be enjoyable/desirable but for the fact that it treats real problems (for me, OCD and anxiety disorder).
> Just say "No!"
They are probably over-prescribed, but a blanket "No!" ignores the cases where they do work, and provide a significant increase in quality of life.
Some people do get what they'd describe as emotional numbing. Think of it as a decreased range of emotion. Sertraline has a relatively higher incidence of this than other SxRI's
What's worse is that the longer you take certain psychiatric drugs, the greater the long-term damage it can possibly cause to almost disability. It's being between a rock and a hard place.
I've taken Abilify, Wellbutrin, Seroquel, and a number of other drugs. The biggest problem when you enter the psychiatric system is you go through pill roulette. You take a drug, try it, see what works, and keep trying till you find what works. Even worse is that I entered the system in high school which is a tumultuous developmental period.
One sad personal story is that a psychiatrist started me on a developmental drug. A drug that was approved for other problems but was "in development" for other uses. I tried it and it was worse than Seroquel. Seroquel, if I missed a dose, I couldn't sleep. For this new drug, if I missed a dose, I had a panic attack and if I took it, I would fall asleep. So if I was out too long, let's say traveling, I had to choose between a panic attack or falling asleep.
When I confronted my psychiatrist about this problem, instead of taking me off the drug, he prescribed me medication for panic attacks.
Seroquel is part of a family of drugs (antipsychotics) which have some of the worst long term adverse effects of all psychiatric drugs. Everything from tardive dyskenisia to enlargement of the ventricles of the brain are routinely observed over decades of use, and that’s not even mentioning adverse effects which appear almost immediately. In general though, these drugs have little or nothing to do with antidepressants, SSRI’s or anything most poeple will ever take.
Of course the adverse effects of psyshcosis and untreated psychotic illness are much worse, including homelessness and death. So while these drugs are undeniably difficult to live with, people who have been prescribed the family including Seroquel generally really need them to function. All of which is to say that the struggles of people on neuroleptic therapy are generally very different from what’s being discussed in the article here.
An alternate to psychosis as something to interrupt is that it's a biological process that happens when the default mode network isn't sufficient.
The ideal environment is one in which the psychosis can complete.
It's very similar to a psychedelic journey in that with the right set and setting it can lead to deeper compassion, clarity and connection.
I've been through a number of such experiences over the years; I used to be terrified of them and tried to avoid them at all costs.
Now, it's very much an initiation into whatever the next level of my life demands of me. I've learned to make symptoms bigger vs supressing them and in doing so, I recover vital parts of myself.
Without this orientation, I would never have survived so called schizophrenia, bipolar, suicidal depression, psychosis.
I’m not going to be able to debate the validity of your experiences of course, and I won’t try to. I can say with confidence however that for most people, psychosis is strongly correlated with poor outcomes including homelessness and suicide. Early intervention and prevention leads to the best outcomes, and the more psychotic events in a persons life, the worse the outcomes are on average.
Oh I don't disagree. I think the entire culture and system isn't set up for proper integration of psychosis. So given the current landscape, it makes sense that outcomes are so poor. It takes resources of time and emotional capacity to make it through.
Dr. Paris Williams has an incredible book called Rethinking Madness that was instrumental in helping me adopt a framework to complete a psychosis.
"Seroquel is only approved for schizophrenia, mania and bipolar disorders. ... Yet the ISMP found that 47 percent of all adverse events linked to Seroquel since 2004 occurred when the drug was being used for unapproved or "off-label" purposes, such as depression." May 27, 2011
Keep in mind that SSRIs appear to do little more than active placebo in the vast majority of cases with the downsides of withdrawals and all the other symptoms including deceased emotions in general.
There are many alternatives that have been shown to be as or more effective.
Writing and then reading 14 Gratitude Letters to people.
Spending an afternoon a week outside.
Practicing telling the 100% truth in your relationships.
And of course, Psychedelics.
Many of you know my story of coming from schizophrenia, bipolar, anxiety, suicidal depression, mania, etc. and going on a path of returning to my self after having a vision that what was needed to was to go into the pain more fully and then seeking out various modalities to do just that.
It's possible to do, but you'll need to seek out support outside the mainstream.
> Writing and then reading 14 Gratitude Letters to people.
> Spending an afternoon a week outside.
> Practicing telling the 100% truth in your relationships.
> And of course, Psychedelics.
Heh, a decent psychologist would suggest #3 during e.g. CBT sessions. Suggesting #4 is downright dangerous, you don't know who reads your post.
Readers, please seek professional help -based on conventional science- instead.
I tried all kind of self-help BS, including using psychedelics on my own, because I did not trust conventional science (ie. psychologists, psychiatrists). None of the pseudoscientific self-help BS helped, of course, and it gave me a severe lag in my life and professional career.
At the very least people should try out professional help first. But if I went on with it after the first failure (a diagnosis + meds for GAD which didn't quite work out) right afterwards, I might have figured out I have autism at my 27th instead of my 34th.
How is suggesting psychedelics more dangerous than suggesting the use of antidepressants? Data shows both can cause panic attacks and psychotic episodes...
Both drugs have mechanisms of action we don’t fully yet understand, and both may cause serious side effects.
> Both drugs have mechanisms of action we don’t fully yet [sic] understand, and both may cause serious side effects.
This is an extremely narrow and arbitrary ruleset you are applying...
If not merely because of the word "fully". That's a given in science.
> How is suggesting psychedelics more dangerous than suggesting the use of antidepressants?
Because psychedelics are not approved, you don't know the source/purity, and there's a lack of professional guidance.
Yes, you can get a panic attack on SSRIs. I had that when I started Fluoxetine because I almost fainted because my blood pressure was low whilst I was in a grocery store and had barely eaten. It happened a few times, though less severe (it is just low blood pressure), and went away after I got used to the drugs, which took longer than average.
SSRIs are not psychoactive, and better studied.
Finally, SSRIs are used under guidance by a professional. Recreational drugs, in contrast, are not.
> The whole point of taking SSRI's is to affect the mind, so they are literally psychoactive.
Yes, they are; I meant psychedelic/hallucinogenic.
> They are better studied, but the risks you mentioned are associated with SSRI's as well as LSD.
Yes, but the possible side effects are well documented and users are informed and screened beforehand and there is professional guidance (by licensed professionals who studied for it) in contrast to recreational drugs use.
You know better what you dabble into when you follow the regular scientific path than the alternative path which is full with shenanigans, amateurs, wannabe experts, hippies, and downright dangerous, sick human beings.
> LSD not being studied as much doesn't mean it's more dangerous than any of the SSRIs.
Ultimately, this is irrelevant. You look at the current scientific evidence when you decide which treatment you want to follow. Recreational usage of LSD to self-medicate is very low on that list: actually, it shouldn't even be on that list until its scientifically tested in clinical trials. The lack of that doesn't mean we should just suggest it to random strangers; we ought not to!
> Do you have evidence/study that shows LSD is more dangerous than SSRIs?
No, stop turning it around. The burden of proof lies at you. You claim LSD is as useful or more useful than SSRIs.
I'm not turning anything around. The claim I was responding to was that suggesting the use of LSD was more dangerous or more irresponsible than suggesting the use of SSRIs.
I'll say it again: There's no evidence the use of LSD is more dangerous than SSRI's.
Well, at least with plant medicines we have thousands of years of safe human use.
Mushrooms appear to be one of the safest mind altering substances known to man, and if used responsibly, can be healing.
Of course, they do show you what's inside, and for many people, they is going to terrify them. That is sort of the point though, to stare down the parts you've long ignored.
> Well, at least with plant medicines we have thousands of years of safe human use.
Wow, that's the most obvious argumentum ad antiquitatem I read this year.
"For thousands of years Christians have believed in Jesus Christ. Christianity must be true, to have persisted so long even in the face of persecution."
Sounds familiar? Straight out of the book. [1]
What's more, just because its natural or plants doesn't mean it is safe. Example: botulinum toxin the most toxic toxin known to mankind which you might know better under the name botox, entirely natural produced by bacteria.
What matters is that it is standardised, of known origin (traceable/provable), well studied in clinical trials, and the mechanisms well understood.
SSRIs fit all those characteristics, only the latter one not.
We certainly did not have thousands of years of standardised, safe human use. Heck, we didn't even have thousands of years of safe human use to begin with.
We didn't have known origin (a good movie about this is Into The Wild [2], btw). Especially not with amateurs. Doctors were more proficient, but not for thousands of years with every substance.
And studies, back then not. You had doctors and witches.
We've come a very long way.
> Mushrooms appear to be one of the safest mind altering substances known to man, and if used responsibly, can be healing.
> Of course, they do show you what's inside, and for many people, they is going to terrify them. That is sort of the point though, to stare down the parts you've long ignored.
I have used psilocybin, A. muscaria, Ayahuasca, MDMA (or God knows WTF it was) among a myriad of other drugs (the first 3 bought online when it was legal in my country). Terrifying it was -for the most part- not. I had fun and insightful experiences, but now that I am older I realise I was reckless [because I am sensitive to drugs and have autism]. I know you too will, at some point in your life realise how reckless you were when you used recreational drugs. And then you will perhaps realise how reckless it was to recommend that to random strangers. And perhaps you will feel utter regret. Au revoir, all the best to you.
What's reckless about it? It also seems reckless to suggest using SSRIs when we know low-serotonin does not cause depression. We know the hypothesis of low-serotonin causing depression is false, which is the entire reason for engineering then prescribing SSRIs. Yet they're still prescribed despite dubious efficacy at treating depression, and risk of dangerous side-effects and dependence.
Well, it's strange to compare mushrooms which have been used by various human cultures for 5,000 - 10,000 years with a religious figure (although I did read somewhere that Jesus Christ was actually a mushroom -- but I don't believe it [1]). A better comparison might be, people have been reading the Bible for two thousand years, so we should assume it's safe to read the bible -- not that the main character was an actual person.
I used psychedelics irresponsibly in my youth, for recreational purposes -- much like it sounds you did. I'd never take MDMA without a proper spectral analysis (which you can obtain for $100 from ecstasydata.org) and with a sitter.
Then I took a decade off until I was facing recurring suicidal depression and was not interested in deadening my emotional experience via western psychiatry.
I was fortunate enough to be given a chance to do MDMA in a therapeutic setting as well as some healing experiences with mushrooms.
No question these compounds helped me release whatever was beneath the depression and other mental issues.
“Magic mushrooms are one of the safest drugs in the world,” said Adam Winstock, a consultant addiction psychiatrist and founder of the Global Drug Survey, pointing out that the bigger risk was people picking and eating the wrong mushrooms.
Also, I never said they were safe because they were natural -- that is silly. There are plenty of things in nature that will kill you. We haven't had thousands of years of people using botulinum medicinally or ceremoniously.
As to your claim that "What matters is that it is standardised[sic], of known origin (traceable/provable), well studied in clinical trials, and the mechanisms well understood." We have had a draconian prohibition on psychedelics in general for several decades and the promising research was cut off.
So, if one is actually interested in healing, what matters is in finding what works -- and sometimes that means finding ways outside sanctioned medicine. But of course, we do have data on psychedelics and their safety and efficacy for healing -- and the results seem to be much more promising than the current approaches.
I wouldn't recommend trying psychedelics on your own, rather used in a specific therapeutic setting with a trained sitter / guide.
There are all sorts of studies on the effectiveness of psychedleic mushrooms on depression or MDMA for PTSD, etc.
Maps.org has ample info.
For me, I'm lucky that I didn't trust the mainstream Doctors who wanted to put me on antipsychotics or whatever else.
And I was blessed to find my way through medical research to find a path that worked. In no small part due to helping Peter Theil launch a startup in the private medical research space -- that experience showed my how very inefficient our medical system is at getting up to date information and practices to folks.
I'm the study you referenced, did you notice if they compared it to active placebo or just placebo? It seemed they did an 8 week eval which is still within the 3 month window in which active placebo seems to be at work.
Also, why would we want people to be less likely to stop using antidepressants (if I read your comment correctly).
Is there a reason why people are trying to stop taking it? If it helps your life, why not keep using it? For example, I have been taking antihistamine daily for the last 18 years for skin allergy. My QoL is significantly better with it, and unless there is some magical cure, I don't see why I should stop just because it's a "drug", "chemical" or "unnatural".
For example, from the article,
> "A year and a half after stopping, I’m still having problems. I’m not me right now; I don’t have the creativity, the energy. She — Robin — is gone"
Taking an SSRI more or less made me sociopathic. Sociopathic with a grin, perhaps, but still dangerous to myself and others. On the other hand, I wasn't depressed, and could work effectively.
So basically, it was side effects. Friends worried about me.
Neither mirtazapine nor trintellix affected me at all in that dept.
I can’t take paxil, zoloft or valium, so it’s probably different.
I personally wouldn’t stop antidepressants because my physiology goes straight into depression without exception, and then the relationship would likely flounder.
Because depression isn't a lifelong thing, it should be at worst episodic.
Because SSRIs have side effects, and you tolerate those if it's preventing depression, but you might not tolerate them if you're now taking a medication for life.
Except it's not for large groups of people. And for anyone with a history of multiple episodes, the long ramp up time needed for antidepressants is extremely risky to try an "as needed" approach.
>Because depression isn't a lifelong thing, it should be at worst episodic.
Says who? The DSM-5 specifically lists Persistent Depressive Disorder, formerly known as dysthymia, which is defined by chronic depressive symptoms for a period of two years or more. Many people suffer from frequent episodes of major depression; there's fairly good evidence that antidepressants can reduce the risk and severity of relapses.
Patients shouldn't be taking antidepressants in the long term by default, but it's a very good option for a lot of people. If you've had two or three previous episodes of major depression that have been successfully treated by antidepressants and you find the side-effects tolerable, taking them indefinitely might be a perfectly sensible decision.
Sure, for the people who find it useful it's fine.
But that's not most people. Most people with depression have a mild to moderate form that responds well to medication for two years and a talking therapy. These people don't need ot be on meds for life.
There are side effects to the anti-depressants that might be unpleasant. There are several types of anti-depressants that kill your libido, for example, which can have a fairly large impact on your relationship with your partner.
On top of that, some people aren't comfortable needing to take a daily dose of medication where the withdrawal symptoms are so disruptive. What happens if you forget to take your meds one morning? What if you lose your insurance coverage and can no longer afford the pills? What happens if you're traveling abroad and the bad with your medications gets stolen?
This is not 100% relevant to your point, which I do generally agree with. But does relate to your antihistamine experience.
I also took antihistamines for a long period of time (15ish years) and eventually I got to the point where I got multiple nosebleeds every day I took one. Nobody told me that could happen when I started taking them. I went off for a year (thankfully I discovered nose strips to get me through the night) and now I can take the occasional antihistamine again without my nose bleeding all over. As a result I'm a bit more conscientious of what long term effects I need to be looking out for in any other meds I take regularly. Living without is just unfortunately necessary in some cases.
I was a very different person on an SSRI. Considering the state I was in when I started taking it, that wasn't really a problem. I was generally content with everything on an emotional level, but at the same time if I sat down and payed attention to how I felt I found I was still depressed, I just wasn't experiencing most of the emotional effects of it. Worse, when I took a look at how my personality had changed, I didn't like it.
After I changed jobs, and therefore healthcare providers because yay America, I didn't bother getting a new prescription. It was a rough ride coming off the stuff. I remember distinctly crying, like really intense honest crying with sobbing and tears and everything, over some plot point in a stupid TV show I was watching and, honestly, it was delicious. I was so grateful to be able to experience again, instead of just passively existing.
After several more years, none of them involving doctors, I finally found my way to more-or-less normality. For me, and I suspect many depressed people, it was philosophical. I had this idea of how the world should work, how I felt it should work, and I knew the world didn't work that way, and the dissonance of that manifested as depression. I think this is probably the normal reaction of the mind to this state, and under normal circumstances it is supposed to serve to motivate us to reconcile our model of reality with our observations of it, but for various reasons I once elaborated on in a different post, I think our current cultural mind-set is not only ill-suited to helping us with this, but actively making it worse.
Personally I went off SSRIs because from the start I chose to look at them as a tool. I had no symptoms of depression until my mid 20s so I didn't buy the metaphor that SSRIs were filling some inborn defect in my brain. I got stuck in a rut of bad thinking patterns which I re-framed through therapy and SSRIs.
I don't think going off them had to do with worries over "unnatural" , rather it was just human curiosity to understand my own brain. I've tried other illegal drugs for similar cognitive insights. It just so happens that SSRIs are legal and have some degree of clinical efficacy.
As a side note I think therapy did more for me than SSRIs and I'm still in therapy but ymmv. Finding a good therapist is way harder than finding an anti-depressant prescription.
>Yet withdrawal has never been a focus of drug makers or government regulators, who felt antidepressants could not be addictive and did far more good than harm.
They're not addictive. They cause dependence. There is an important difference. Addictive things increase incentive salience of stimuli associated with the drug. They increase wanting. And that increased wanting leads to increased usage.
Dependence on a drug does not have this aspect. It just represents the bodies physiological adaptation to the new state.
Conflating the two is bad practice for an article ostensibly about medicine. And it leads people, and that set includes legislators, to think about using more government violence to enforce regulations of drugs which create dependence.
While your differentiation between addiction and dependency is certainly correct as the medical profession defines these thing, simple dependency would sound like addiction to a lot of average people.
Further, it should be obvious that dependency is a problem. If the medical profession thinks it's solved that problem by redefining words, I'd say state regulation is pretty appropriate step.
Having been addicted to prescription pills, and currently being prescribed (and presumably dependent on) antidepressants, I think there are a few points that make the distinction abundantly clear:
1. When I consider stopping antidepressants, I'm not filled with anything like the dread I was when I thought about giving up the addictive pills.
2. I forget to take my antidepressants sometimes. I forget to refill the prescription sometimes.
3. I have never had any desire to take more than the prescribed dose of my antidepressants.
It's an important distinction, and unfortunately one that folks in the recovery community sometimes miss. In my experience the above characterization usually brings it home much better than some heavily medicalized description of addiction vs dependency.
(I've taken so many pricey antidepressants, and feel duped. I sometimes think drug companies pulled the ultimate scam. Produce a happy pill that barely gets by the FDA? A pill that really doesn't do anything besides side effects of course?)
Ah, another Benedict Carey antidepressant hatchet job. Anecdotes about withdrawal symptoms + alarmist statistics about number of Americans on antidepressants + vague questions about lack of data suggesting that we know little about antidepressant long-term safety.
A few important points:
1. Antidepressants can truly change people's lives. Not everyone's, and they're not the only treatment that works. Somehow this reporter tends to consistently overlook the clear evidence of benefit (I think this recent meta-analysis was posted on hn: https://www.ncbi.nlm.nih.gov/pubmed/29477251)
2. Withdrawal symptoms are common if antidepressants are stopped abruptly - some of the folks who reported these symptoms originally have been favorite targets of Benedict Carey, ironically (https://www.ncbi.nlm.nih.gov/pubmed/9396960). That's why docs encourage tapering antidepressants.
3. The article doesn't distinguish between this sort of short-term withdrawal (common), and longer-term problems with discontinuation (likely quite rare) - they're very very different phenomena.
4. In some cases, difficulty with discontinuing longer-term is a result of persistent depression and anxiety (or returning depression and anxiety). It's not polite to point this out.
5. It's hard to imagine the Times writing an article about the problem with statins being that, once you stop them, cholesterol increases again.
6. If there were substantial long-term risks associated with antidepressants, we would have seen them - and believe me, people have looked and are looking.
7. BUT - we /do/ need more research to understand long-term effects of antidepressant treatment; this absence of systematic long-term study is true for most meds, frankly, but that's no excuse. My question would be: Who pays for it? There's no shortage of investigators who would be delighted to study it. But try getting a foundation, or NIH, to support such a study.
> If there were substantial long-term risks associated with antidepressants, we would have seen them
Drug makers have no incentive to see them. I can say from experience that I have seen them. I spent two months out of work when I had to discontinue Effexor. Other people complained about “brain zaps” and were largely ignored. My doctor never warned me. The evidence is there but there if you look, but there is no one with an economic incentive to pay attention. Just because there are few studies documenting these symptoms doesn’t mean they’re not. This is a wake up call that more studies need to be done.
Discontinuation effects are listed on the patient information leaflet for venlafaxine. Patients, at least in the UK, are always given this leaflet with every packet of medication.
> If you stop taking venlafaxine suddenly you may get withdrawal reactions (see section 3)
[...]
> Do not stop taking your treatment or reduce the dose without the advice of your doctor even if you feel better. If your doctor thinks that you no longer need Venlafaxine tablets, he/she may ask you to reduce your dose slowly, before stopping treatment altogether. Side effects are known to occur when people stop using Venlafaxine tablets, especially when Venlafaxine tablets is stopped suddenly or the dose is reduced too quickly. Some patients may experience symptoms such as tiredness, dizziness, light-headedness, headache, sleeplessness, nightmares, dry mouth, loss of appetite, nausea, diarrhoea, nervousness, agitation, confusion, ringing in the ears, tingling or rarely, electric shock sensations, weakness, sweating, seizures or flu-like symptoms. Your doctor will advise you on how you should gradually discontinue Venlafaxine tablets treatment. If you experience any of these or other symptoms that are troublesome, ask your doctor for further advice.
And of course, all patients read the long pamphlets extensively /s. We depend on our doctors to explain risks like this. And at the time I was discontinuing (not abruptly) the concept of “brain zaps” was met with great skepticism. I am fairly certain that some of the side effects you list (electric shock sensations) were added more recently. It took years of patients being ignored for the idea to be taken seriously.
I've also rarely received accurate advice regarding the likely effects and side-effects of anti-depressants - but I think calling brain zaps a 'risk' is a bit much. Maybe my zaps were nicer than yours, but I don't remember them being particularly painful - except one time I fell in the shower.
Anti-depressants, especially something like venlafaxine, are strong meds for a strong condition. It would be surprising if they had no side effects - and honestly, if you go to a psychiatrist instead of a normal doctor, you usually get a dose that's fine-tuned to the extent that you don't get them.
Actually, I remember now, I called mine "brain shivers". Whenever I moved my head, my visual field would stutter as if the room was only lit with a strobe light. It didn't hurt, but it was nauseating and it made standing up and walking around very difficult. It was terrifying. I did go to a psychiatrist. He didn't fine tune anything, but at the time, I trusted him. In hindsight, I can see he was a terrible doctor.
I took 2 SSRIs for about 3 years and went off them close to cold turkey. When I would move my eyes it felt like there was a delay between moving and seeing. This lasted for about a month. In general everything felt very disconnected/fuzzy/unreal. Sometimes it was close to what I imagine people describe as an out of body experience.
I think if you come off any kind of brain med cold turkey, you're gonna have a very bad time.
I still find articles like the above absolutely horrible, and wish people would stop writing them. Meds saved my life. They save the life of millions of people every year - and they make depression hands-down easier to manage and to live with.
That doctors over-proscribe is another problem. Muck-raking and fear-mongering about what are already scary drugs to very scared depressed people has real costs - people probably die because of articles like the above. Many, many people suffer for years without medication because they're afraid to start them.
If you don't read the leaflets you need to learn to say "doctor, I never read the leaflets. please can you explain what's in there?" Or ask that of the pharmacist filling the scrip.
This doesn't report the length of time one might experience these symptoms. A couple of days with the flu vs 2 months of electric shock sensations is a big difference, and could influence whether someone would want to start using these medications. (I personally experienced the latter side effect)
Drug makers aren't the people looking, the regulators are.
Here in the UK, the medicines regulator operates an open reporting system for adverse drug effects. Any patient or healthcare professional can make a report of an adverse drug event, no matter how minor. The collected data is publicly available in anonymised summary form. 110 countries share detailed reports of adverse drug events through the WHO VigiBase, which is monitored for risk signals by a dedicated team at the Uppsala Monitoring Centre. Potential safety problems are then fed back to national regulators.
All of this reporting apparatus was put in place after the thalidomide disaster. It's designed as an extremely sensitive early-warning system to detect subtle or rare adverse events. For the most part, it works. I'd suggest taking a look at the WHO Pharmaceuticals Newsletter, which shows how this information sharing works in practice.
4) Possibly true. What's unpolite about mentioning this?
5) Wrong analogy; depression only increases would be analogous to increased cholesterol. What are statin drug side effects when quitting, from the drug.
6) The mechanism of action isn't even fully understand. You're absolutely wrong to claim "we would have seen them (long-term side effects)". Isn't there an article on ceiliac disease and how long it took to pin down on HN's front page now?
7) You mentioned in #6 we should already know.
If I had a rant, about overly-confident individuals posting on forums. While I've no reason to believe you were intentionally dishonest, the over confident, "factual" sounding, behavior has the same basis as disinformation activists.
Experience? Was on antidepressants. Had a horrible side effects unrelated to depression coming off them. Safe my ass.
1. Read the reference before responding; the study looked (in part) at antidepressant-placebo differences. Also - I can't prescribe placebo.
2. Got anything to back that up?
3. OK
4. Because it implies that some of the 'withdrawal' symptoms are actually recurrent depressive/anxious symptoms (which can include somatic symptoms). Which is different than arguing that all of these symptoms are a consequence of relapse/recurrence.
5. Well, one of the critiques of antidepressants is that, after someone is on them for years, depression can recur... but fair point, not a perfect analogy.
6. Fully understood? It's not even a little understood. What does that have to do with detecting long-term consequences? We have 25 year follow-up data with antidepressants now. Despite lots of effort to find otherwise, show me some solid literature supporting risk.
7. Yup. We should. And we should keep looking.
We also agree that there's substantial harm associated with people confidently posting misinformation - so while I mostly lurk here on HN, I feel that 20+ years of treating mood disorders and 20+ years of pharmacovigilance research gives me the right to push back. Lived experience is critically important, but it does not trump data.
>> Lived experience is critically important, but it does not trump data.
I would argue that for an individual, lived experience trumps all data - for them. Data is an aggregate of individual experiences. A single persons experience is a data point, not an anecdote.
I used to get imipramine, which was replaced with venlafaxine. The latter was shit, but of course no one could prescribe imipramine just because I wanted it (also probably because it went generic and it was too cheap to prescribe). Fuck them all, bunch of crooks.
I was on 60mg/day Remeron (mirtazapine) for 9 years but discontinued due to decline in its effects. Tried a bunch of the remaining medications, found trintellix which ups anxiety 5x but addresses depression. Taking hydroxyzine as needed for anxiety now.
During taper symptoms:
- nausea
- general anxiety
After taper symptoms (continue today):
- general anxiety
- strong, brief muscle contractions anywhere in my body (myoclonus)
I am currently on mirtazapine, and this article is prompting me to look into tapering off the drug. I would much appreciate any advice you would give on the process, and any other considerations you can think of that I should be aware of.
I tried exactly 14 different antidepressants, at different dosages in the last 10 years. None of them got any positive effect and I could stop without feeling anything different too, except, on some cases, very mild "brain zaps". I do not know why not any of this drugs had any (positive) effect (only some common collateral effects in some cases) but I wonder if there is a correlation between the drug doing it's work and being hard to quit...
It's the other heroin. People can't get off the stuff, and it's everywhere.
In about 2012 I visited Copenhagen, capital of Denmark, which was until recently allegedly the self-reported "happiest nation on earth". I found it extremely weird that everyone was perfectly dressed and all the interiors were spotless, but nobody was smiling. It was like I had walked on to the set of some kind of dystopian movie. Mentioning this to an American woman who appeared and who had been resident there for some time, she simply laughed and leaned closer. "It's because they're all on antidepressants!"
Well, in the same period I have lived next to Copenhagen for three years (in Malmö) and this does not match my experience of the city nor the country in general in the slightest.
Perhaps you visited near the end of winter, or when spring just started and the sun hadn't fully returned? The long winters can suck out the energy of anyone near the end of them, but during every other part of the year the Danes I know are a very cheerful bunch.
More likely though, I think it's a different attitude towards smiling itself. In the US it seems like much more of a social thing: aside from spontaneous, genuine smiles, there is also smiling as part of how you present yourselves to others, almost like a form of politeness. That doesn't apply to European cultures.
I'm not a huge fan of anti-depressants, but this is just silly. Smiling lots is mostly a cultural difference and Americans seem to be the odd ones out there, not the other way around.
Well, it's a true story. Silly is assuming I'm American. I'm an Aussie/Kiwi/German resident in China, and at the time of the story I had just crossed over from Germany, who aren't exactly known for unbridled displays of west coast US optimism either.
Someone's personal perception of things is not a "true story". Generally, it's not anyone's place to try to assess how happy a person is from what they look like on the outside. Suicidal people may look perfectly happy on the outside, and perfectly happy people can sport very impressive RBFs.
You referenced an American in your story, and they're the only group I've ever really heard complaining about people in other countries not smiling enough, so my assumption is hardly silly. I don't know if Australia shares the same quirk, given that Australia borrows a LOT from the US culturally, are you sure you didn't pick that stuff up from the US?
And I'm not sure why the Germans didn't bother you but the Danes did, that doesn't really add up.
Anti depressants along with support from my family and therapist saved my life. Prior to taking anti depressants I would get into moods so depressed that I would have significant chest pain and headaches. The headaches were so severe that without any consideration I almost jumped from the roof of one my school buildings.
Within the first week of taking anti depressants (wellbutrin, I later switched to prozac) I would at random moments of the day begin to remember funny memories. I would be walking to my dorm from class and remember a funny gag from the simpsons and break into a stupid grin.
After two years on anti depressants I was able to stop taking them. I was able to do this by accepting and understanding that while I may have real reasons to be sad, the underlying reason that I was dwelling on these negative thoughts was my brain chemistry. Once I accepted this I was able to justify cheaper less harmful ways of medicating my depression. Whenever I began to feel depressed I would simply go to my tv and start watching episodes of `It's always sunny in philadelphia` or whatever comedy made me happy
I think the worst mistake people with depression make is reinforcing their sadness by listening to sad music, watching sad movies or reading sad books when in fact they should be doing the opposite. They also allow their depression to become part of their identity.
Whenever I began to feel depressed I would simply go to my tv and start watching episodes of `It's always sunny in philadelphia` or whatever comedy made me happy
This sounds a bit like you discovered Cognitive Behavioral Therapy. That's actually a very insightful, practical approach you developed.
>The drugs have helped millions of people ease depression and anxiety, and are widely regarded as milestones in psychiatric treatment.
History is littered with harmful, poorly-thought out "psychiatric treatments" that were widely regarded as milestones. Even if there are a tiny minority of people who's mental condition is so bad that scrambling their brain with drugs will lead to an "improvement", the widespread reliance on these drugs to treat the every-growing number of depressed and anxious people is not a good thing for individuals, or for society. This is especially true when it comes to young children, whose brains are being warped during the critical stages of development. Over a million children under 5 years old are being dosed with these mind-altering chemicals based on ridiculous ADHD or "defiance" disorders. Over ten million children under 17. Its very telling that the intelligentsia at the apex of society think that the answer to fixing our broken children is to drug them rather than to fix the broken society that they perpetuate.
I know someone who took Effexor, who went through one of the most harrowing experiences of her life trying to quit. Her doctor seemed vested in keeping her taking the drug (I personally suspect some kind of incentive to sell the drug but don’t have evidence to back that up.)
I can’t emphasize enough how serious these drugs are, and what a prison they can become.
Thanks to the comments here, I was able to figure out why my wife had been experiencing vertigo for the past couple weeks. She ran out of Zoloft and didn’t bother taking any of her refill (we were busy moving).
232 comments
[ 4.8 ms ] story [ 251 ms ] threadWhich leads to another issue that worries me: this kind of thing will end up with a backlash that likely screws over those who really do need the medication.
That being said, there are a number of GPs out there who prescribe things without fully understanding the consequences. I’ve always had a GP refer me to a psychiatrist for any mental health issues, however.
EDIT: Also, I think that even for the patients where the cause of the depression is not "chemical" in origin, that does not reduce the severity of the illness in the slightest. It just means that the causes may lie elsewhere (for example externally). I have been depressed as an indirect result of the troubles I got myself into due to undiagnosed ADD. In my case, yes, I needed medication to treat my condition, as well as therapy. But I did not need antidepressants, I needed medication for ADHD (and I just checked: lisdexamfetamine is currently not considered an effective anti-depressant[0]).
[0] https://en.wikipedia.org/wiki/Lisdexamfetamine#Depression
Completely understandable! Most people seem to have such a frustrating inability to understand that other people can have very different experiences of the world to their own, and that those experiences aren't wrong.
I am lucky enough that most of my friends do understand mental illnesses a bit better than the average person out there. Some of them who confided their mental health problems with me about the kind of reaction they tend to get, and it's just amazing how ignorant the natural state of the human mind is.
> that I’m taking the “easy” way out through medication.
Call me crazy, but I partially blame the dualist world view of the Western world for that, even if most people aren't even aware that they have been raised with a dualist mindset. This whole mind/matter division makes people think that mental problems have to be solved by thinking.
Not crazy at all. I strongly agree with this.
No-one credible talks about a chemical imbalance anymore.
Its anecdotal but I know that in my specific case it helps.. a lot! I can focus better, I am less anxious, I'm happier (though that is not my main complaint at all), and most of all I get less agitated. That doesn't just help me; it helps my significant other, our newborn, my co-employees, and my family in general (don't have friends).
Hey, you can work on that! Especially now that you have medication that seems to catch on.
First and foremost I have one very good friend (my partner!), and a rather good relation with my mother (my father passed away, alas). I consider my mother like a friend, who given her age needs me more and more and this will increase. Same with my mother-in-law. That's both OK, but also a burden of stress.
It appears difficult to become friends as you grow older compared to being young. I burned ships with my old friends because the relations were no longer mutual; no longer developmental ("stuck" or "grown different paths") or downright parasitic. Ironically, my last major friendship was my best friend wanting to use mushrooms with me at my place while I was no longer interested in recreational drugs. I was an avid gamer, but no longer have time to play games so all friends who I had who were into gaming I no longer have that in common with. That's a big blow in my social network and friendship list.
The gist is, I find individuals inherently boring and basically I don't want [new] friends; they're a hassle and nuisance. Friends are a distraction, just like this very forum. At best, they're interesting, like this forum. At worst, its annoying to waste a Sunday on a birthday (with mindless chit-chat, annoying opinionated people, eating crap I could better buy/cook myself, and travel time/cost), just like you can waste an Sunday on this forum. Heck, like Facebook, rather. OTOH, you reap what you sow. I still got like 100 movies to watch if not more, 20 books to read, etc.
My family and partner's friends and our newborn is more than enough. I need to focus on improving those connections first and foremost since my autism does put those relations under pressure both generally as well as incidentally more so. That plus integrating my autism diagnosis with my career which isn't easy in mid 30s. You could argue I'm not ready for it yet but I didn't start taking SSRIs to become more social. I do want to meet more people with autism, but that's out of self-interest, and a long-term project since right now I still feel overburdened due to the above (mostly our newborn).
I am actually going through something that is in some aspects the same, yet as a whole kind of the opposite. I have close friends, but they no longer live in the same city as I do. I emigrated for work two years ago. I didn't really like the city much, and at the time I also felt kind of heartbroken to say goodbye to my friends.
As a result I too did not feel like making new friends, but for opposite reasons: I did not want to root down in this new city, and then break my heart all over again when work finished (I knew it was a temporary thing). So in the last couple of years I have spent most of my time on work, and only "mildly" socialised. Slowly and almost unnoticeably, the relative social isolation has worn me down.
Last year while travelling I met the woman that I want to share my life with. As she lives in another country, we have been in a long-distance relationship (despite both of us having bad experiences with that before and swearing we'd never repeat that). In some sense this made the social isolation worse: we spent so much time on Skyping every day that we forget to meet our friends.
My contract is nearly ending, and our plan was that I would move in with her soon. I am really looking forward to this, and to end this period of solitude. However, she has lived in her city for nearly a decade, is "settled in" and has a network of friends. By comparison, I'm moving to for her - while the city she lives in is nice, I would not have thought of moving there if not for her. I will also have to build up yet another network of friends (like you, I am in my thirties, and I too notice how this is getting harder).
This created an unbalance in our relationship: I "need" her much more than she "needs" me, as I would have noone else in that city when I arrive. This asymmetrical dependency resulted in a a strange kind of tension, making me hyper-oriented towards her to the point where it resulted in me becoming unstable.
So now we changed the plan: I'm looking for a temporary place to live, in some kind of shared appartment arrangement with (ideally) lots of roommates to socialize with and explore the city with. That way I can find my own ground in the new city and discover on my own terms whether I'd like to live there, and what I like about it. We will still see each other most of the time, and after a few months still intend to move in together. But this new plan will take the pressure off the relationship.
I am all with you that friends are often a bit of a distraction, but to me the good friends are an enhancement: they support and enable more than that they distract. I hope that some day you will find a few of those kind of supportive friends, and that they will ease your burdens. Until then I am glad to read that you have a supportive partner and family! And I wish you good luck with parenting.
(aside: after posting my message I was actually a bit worried that I would come across as one of those people who insists on constantly trying to cheer up their depressed friend, but actually only puts more pressure on them that way (I have experienced that). I'm glad it didn't come across that way - well, either that, or you're too polite to mention it)
We would not have a healthy, happy, functional family without these types of interventions available.
I found (I suspect like you) that having an psychiatrist - an MD, who can provide both cognitive/behavioral and pharmacological interventions - is the key.
You might want to consider maintenance therapy. The actual evidence for severe discontinuation effects is quite limited, but we have fairly strong evidence that maintenance therapy significantly reduces the rate of relapse. It's natural to want to avoid taking drugs indefinitely, but it's often a better option than a long-term cycle of depression, treatment, discontinuation and relapse.
I suspect that a substantial proportion of people mistakenly believe that they're "addicted" to anti-depressants, when really they're just receiving an effective treatment for a chronic condition. They feel worse when they stop taking the pills, because the pills are doing what they're supposed to do.
I'd really hate to play Scrabble against you.
I've been...fortunate, if you can call it that, that while I've taken a great many antidepressants and other psychiatric medications, the worst side effects I've ever faced from stopping have been screwed up sleep/wake cycles, irritability, and a few days of headache.
I've had friends and family members who have had much worse, and I've had to carefully consider it each and every time, because we lack any kind of monitoring or ways of informing us how bad it might be.
I wonder if that's worse than a newborn.
Newborn creates hormones, sure, but needs constant attention and requires high maintenance. There's no voluntary break. Ours needs to eat every 3 hrs. Can set my clock to it, and can't sleep right after feeding (she's gotta sleep first, or go through intestine pain). I know it isn't the end of the world, and given the psychosis I been through worse, but this is flat out rough [for me].
I wish I'd get positive emotions during weak moments. I mean, if I'd have that, they wouldn't be weak moments. After one hour of crying and trying to solve in every way I can think of I become desperate and feel lost. Its those moments I need to control myself and realise it isn't about me; its about her, our newborn. She's the one who's suffering, and doesn't know better. I wonder if it helps to cry with her.
I know enough people in the field of modern medicine to know that that is hyperbole. At least in the European countries that I have lived in.
EDIT: I am sorry to hear from the responses to this that this may not be quite so hyperbolic in the US. I hope that trend will be reversed somehow.
European medicine is indeed worlds different, and the European population is far less sick, overmedicated and suffering from iatrogenesis.
It's that insane right now.
While it's true that the US has a serious problem with overprescribing, it's also true that many other countries are seriously underprescribing psychiatric medication, due to a combination of cost and stigma. Mental illness represents an immense global disease burden, with depression being the single greatest problem. The disease burden of depression is higher in many lower- and middle-income countries than in the US, mainly due to a lack of treatment.
Although there has been a great deal of controversy over antidepressant drugs, we are now highly confident that they are significantly more effective than placebo. Generic antidepressants are dirt cheap, with most costing less than $2 per month at international wholesale prices. We shouldn't lose sight of these facts.
http://www.thelancet.com/journals/lancet/article/PIIS0140-67... http://www.thelancet.com/journals/lancet/article/PIIS0140-67...
Yes, if you read Hacker News you probably object. Not everyone does that. But making the problem just go away is the prevailing, widely spread, most commonly used mode of working.
To say that a cure doesn't exist because they are not trying for it is 1) wrong, 2) hugely dismissive of the life's effort of tens of thousands of people, and 3) dismissive of the struggle of those using antidepressants.
If you think there are cures out there that are easily achievable, show it. Otherwise you are just perpetuating facile misunderstandings of a difficult situation.
The best available evidence suggests that psychological treatments are equally effective as drug treatments for most common psychiatric disorders. Psychological therapies are generally orders of magnitude more expensive than drug treatments, so unfortunately they aren't as widely available.
Psychiatry is an incredibly challenging field and there are a lot of things we just don't know. Drug companies might have a strong incentive to keep selling you pills, but insurers have an equally strong incentive to cure you outright. Single-payer healthcare systems like the British NHS have a huge incentive to use the best, most cost-effective treatments available. It's just an unfortunate fact that we can't fix everyone. There is no magic wand to cure all human misery and there's no conspiracy to keep people sick.
http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD0033... http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD0111...
Yet. Let us remain optimistic :)
Fortunately Psychedelic medicines are coming online that can allow for actual healing of the underlying patterns. They saved my life for certain.
Maps.org
> The mammalian nervous system executes complex behaviors controlled by specialised, precisely positioned and interacting cell types. Here, we used RNA sequencing of half a million single cells to create a detailed census of cell types in the mouse nervous system. We mapped cell types spatially and derived a hierarchical, data-driven taxonomy. (...) The resource presented here lays a solid foundation for understanding the molecular architecture of the mammalian nervous system, and enables genetic manipulation of specific cell types.
(you may wonder what mice have to do with human brains: on a "cellular" and "genetic" level, mice are already close enough to humans to be decent substitutes for researching quite a lot of fundamental stuff about how the brain works)
We already had an atlas of where every gene was activated in the mouse brain since 2006, but this was at the tissue level[2][3]. Only recently it has become possible to research at the cellular level which genes are activated. That has enabled the possibility of classifying cell types by gene activation. Not only that, by tracking gene activation over various stages of development, we can see how the genes interact and activate each other, and get a better insight in how the brain develops its various different cell types.
I am "merely" a programmer/interaction designer building tools for easier data exploration, and can't pretend to understand the fine details, but that sounds like it is Kind Of A Big Deal for anyone researching brains.
For example: until now, we could only see which genes are correlated with higher chances of a certain mental illness (by looking at the genetic makeup of people with and without these illnesses). But that is not the same as knowing what those genes do. Furthermore, many of mental illnesses are partially nature, partially nurture: you have to be unlucky enough to have a mix of genes that makes it possible or more likely to manifest an illness, but for the disease to truly manifest itself you also requires an environmental trigger.
When we can follow individual cell development at the genetic expression level, we can start to figure out what changes when certain genes and/or certain stimuli are present or absent.
There is an equivalent science project underway to map out all the cell types in the human body, not just the brain[4]. On top of that, the techniques that let scientists analyse the RNA expression in individual cells are getting cheaper and faster all the time[5]. My guess is that major breakthroughs in understanding how the body works, including the brain, will start coming in very quickly.
(and I'm not even talking about the implications for machine learning)
[0] https://twitter.com/slinnarsson/status/981919808726892545
[1] https://www.biorxiv.org/content/biorxiv/early/2018/04/05/294...
[2] http://mouse.brain-map.org/
[3] https://en.wikipedia.org/wiki/Allen_Brain_Atlas#Mouse_Brain
[4] https://www.humancellatlas.org/
[5] azernik ↗ Yup! I would just like people to stop blaming the medical profession for us not being quite there yet when it comes to clinical applications.
Others have seen no progress in 50+ years and continue to have exceptionally poor prognosis.
The biggest advances in medical outcomes are virtually all based on public health, preventive measures, and improved access to fundamental care.
These substances are yet another instance in the history of psychopharmacology where the touted benefits have been exaggerated and the harmful side effects denied. They have their place, but in the bodies of a sizable fraction of the current patients is not it.
The cost of taking antidepressants is really low however. Most of the time, they have almost no side effects, and are proven to help https://www.bmj.com/content/360/bmj.k847 Where I live, they are pretty cheap.
I find that there is undue bias against antidepressants. If you need them, take them! They help.
The study you linked doesn't scientifically prove antidepressants help.
Exactly, what undue bias against antidepressants have you found?
The bias isn't undue, most of the time it's factual and comes from anecdotal experience. You sound like you haven't ever been on antidepressants, and are instead regurgitating soundbites from a medical journal.
When I tried stopping after the 5mg dose I had constant vertigo symptoms and incredible difficulty sleeping.
What I ended up doing was cutting the pills in half for a few weeks, then quarters, then removing one day a week from the schedule until I was down 2.5mg/wk. Finally I was able to stop, and only was mildly affected for 3 weeks after that.
That stuff does weird things to your brain. On the flip side, I couldn't have gotten through some really rough times without it.
I wonder if there is a form of research that could done by following patients who are receiving this treatment, and track how they wean themselves off of it.
When asked to describe it, I tell people the zapping feels like my mind is lost for a fraction of a second. For that tiny moment I really think I'm completely non-functional, and the thought of this condition lasting for a non-trivial amount of time is frightening, although I've never heard of that happening.
Zoloft was beneficial for me, but not enough to outweigh the discomfort of the brain zapping.
A business is about making the most money possible: Maximizing revenue is about minimizing the main costs which are generated by the activities of:
(a) acquiring the customer (through: advertising and marketing) and,
(b) retaining the customer (in this case: through dependency).
There are alternatives to anti-depressants. Some people quit depression for good with a well researched and planned LSD trip combined with long-term daily mindful meditation.
No, I'm not saying everybody should take LSD.
Both drugs have mechanisms of action that we don’t fully understand and both affect the brains homeostasis.
If it’s irresponsible to prescribe LSD for depression it’s irresponsible to prescribe SSRI’s as well
Except that's not how it works.
How it works is that SSRIs have been tested in trials, and are approved.
LSD isn't. When someone says "try LSD" (or psilocybin which seems the newest rage these days) it means they'd illegally acquire the drug (who know for sure what drug they bought? [EDIT: and who knows the dosage/strength of active substance(s)?]), and administer it recreationally without the aid of a professional.
SSRIs, in contrast, are clinically tested, legally acquired, and administered under the guidance of a professional.
> Antidepressants can also cause psychotic episodes, panic attacks, suicide, etc.
Yes, but these side effects are widely documented. There are more common side effects, btw. These are the extreme ones you mentioned, and also the most rare ones. Many side effects are temporary. And if you are suicidal, it is unlikely you get SSRIs prescribed. Unless you lie about that, of course, but if you lie to your MD you're on your own.
My recommendation is simple: seek professional help. If you don't want to take SSRIs, fair enough; your MD won't force you. Heck, they might even be reluctant to prescribe them. But professional help is much more than drugs. Think about CBT, mindfulness, under the guidance of professionals; not self-medicating new age hippies.
The professionals that without any evidence promoted the low-serotonin theory of depression. Who, after over a decade of prescribing SSRI's finally admitted that low serotonin doesn't cause depression. Yeah, those professionals. They don't know what causes depression yet they're happy to keep prescribing drugs. But it's the "self-medicating new age hippies" that are irresponsible?
Also, those professionals aren't necessarily the same people. Do you fault Linus Torvalds for a bug in the Windows NT kernel because he's a software developer? Science is constantly in motion and questioning itself. The drug usage in the past before drugs were illegal (pre-2nd part of 20th century) was more irresponsible, and its thanks to science and law this has reduced. And specifically, SSRIs are more safe than antidepressants used before SSRIs such as TCAs and MAOIs.
Lots of professionals with great titles and affiliations steer people down a totally incorrect path.
An easy example of this is Harvard study published in the New England Journal of Medicine promoting dietary fat reduction, shaping what every credentialed person would advise for diet for the next 50 years: https://www.npr.org/sections/thetwo-way/2016/09/13/493739074...
Drug companies shoulder the rep of being cold evil capitalists. Psychiatrists also become extremely wealthy as part of this medical complex, and get to keep a positive reputation. It reminds me of ticketmaster essentially being paid to shoulder negative PR for excessive ticket fees which are often largely passed on to performers.
Not knowingly, and they're expert on the field. There's a few exceptions, but those people are not 100% in the head. Diederik Stapel [1] being a recent example in social psychology.
The chance that you have a sitter without a clue is much higher. Especially because those are usually "friendz". The chance a professional knows better than a self-proclaimed expert is simply too high to discount all professionals.
> Drug companies shoulder the rep of being cold evil capitalists. Psychiatrists also become extremely wealthy as part of this medical complex, and get to keep a positive reputation. It reminds me of ticketmaster essentially being paid to shoulder negative PR for excessive ticket fees which are often largely passed on to performers.
In The Netherlands, you first try the drugs which are most likely to solve your problem but also you need to consider what gets reimbursed by insurance. Insurance also wants you to go for cheapest generic brand if possible (if patents expired, and the drug is known to work for your ailment). Example: something like Concerta doesn't get reimbursed because Ritalin exists and is considered the generic form. Even though the yo-yo effect is more severe with Ritalin.
Another example, I had the option of going for a SSRI or a SSRI plus antipsychotics. The former has a good track record for people with autism; the latter combo better but it also has more impact. Regular blood checks, and basic insurance doesn't cover the antipsychotics.
As for the positive reputation, when I went for my autism diagnosis I had an anamnesis from an asshole of a psychiatrist. He was working there temporary because they fired their regular psychiatrist very recently. I don't know exactly why, but I do know it was directly related to his functioning as a psychiatrist.
Ticketmaster problem is different (and offtopic though I don't mind analogies). It can be solved by putting a cap by law on how much percentage profit (e.g. 25%) second hand market may earn. That does require political willpower and enforcement of such regulation.
[1] https://en.wikipedia.org/wiki/Diederik_Stapel
Western medicine is famously puritanical toward hallucinogenic drugs. Human social history is long and hallucinogenics being illegal is comparatively recent. It's an insult to the study of science that such an interesting and powerful drug is taboo to even study. Thankfully this seems to be reversing in my lifetime.
That's not the case (currently) for LSD, which will be of unknown quantity and unknown purity. It might not even be LSD.
LSD may be great, but telling people with a potentially fatal illness to just go try it is fantastically irresponsible.
But I would agree that the field of psychiatry (not psychology which doesn't require a medical license) has it in their interest to say that antidepressants aren't _narcotics_. And they aren't. But the cruel thing is that the difference between a narcotic and a dependency-causing-drug is blurred.
For example, Wellbutrin is a norepinephrine aka noradrenaline agonist and reuptake inhibitor. It's a stimulant - to call it an antidepressant is a bit of an ongoing joke. If someone has no energy and lacks willpower, any stimulant will get them to do things they might not otherwise have done.
The reason Wellbutrin isn't considered a narcotic is mainly because being full of adrenaline is often a shitty experience - whereas being full of a 10%/90% adrenaline/dopamine mix is quite pleasurable (ADHD stimulants - amphetamines/phenidates.) But it's entirely unscientific to say that an antidepressant cannot be addictive to a person that likes the effects more than the average neurotypical person. Just google Wellbutin abuse and you'll find a ton of personal stories.
And then lets talk about dependency. Dependency is just a rebound effect by the body to adjust its endogenous feedback in order to find homeostasis again. It's why most drugs that have large immediate "gratifying" or noticable psychological effects, also come with a downregulation in the same areas by the brain and body. So when you stop taking the drug, your body is actually BELOW baseline and it will take quite a bit of time before you are back to baseline. In some cases of extreme use, the brain can be structurally changed and permanent damage can result. See "parkinsons from stimulant abuse" for a typical example.
Dependency and addiction only have a difference in a psychological way. The physical withdrawal and rebound effects are mutual. Don't be fooled when you are told that an antidepressant drug is not a "narcotic" and isn't habit forming. It is a lie.
The only psychological drugs that are truly therapeautic are upregulators like Cordyalis, known as Yan Hu Suo in Chinese medicine. It causes neurogenesis and upregulates dopamine. It is quite a beneficial drug to consume when withdrawing from any type of stimulant or dopamine agonist.
Psychedelics used in the right setting are actually proving to be wildly successful in treating depression, PTSD and others.
Maps.org has MDMA in phase 3 clinical trials.
The SSRI did make me more functional. But what it mostly did was make me affectless. That is, I could be sad or happy or angry or whatever, and I felt pretty much nothing. However, I still did whatever someone who was sad or happy or angry or whatever would do. You could say that it made me sociopathic. But fortunately, not homicidal or suicidal. Or at least, not in a big way. Also, I lost interest in sex, and it took forever to reach orgasm.
And yes, quitting was painful. Mostly I recall restless leg syndrome. I would kick my partner while asleep. And I got even crazier for a while, as I tapered off.
So now I'm taking modafinil and lamotrigine. Which works very well for me. I'm a little manic most of the time, but I like that. And I'm not at all sociopathic.
This is a common side effect of SSRIs. I have the same, but I very much enjoy that side effect. Saves time, and already got a child anyway. I still love pleasuring my significant other just as much as before, btw.
People who have bi-polar usually get mood stabilisers such as lithium prescribed. Perhaps anti-psychotics? SSRIs are known to be problematic for bi-polar personality disorder.
Modafinil (antinarcoleptic, originally) plus lamotrigine (anticonvulsant, originally) works well for me. It's easy to tweak the ratio as circumstances warrant.
Edit: About sex. My wife at the time did like that I took longer to reach orgasm. However, after we separated, I discovered that wearing a condom made orgasm unreachable. And that did become a problem. Albeit an amusing one, in retrospect.
But why do you say "better"?
OK, for example, I would be driving, in a hurry. And without much emotion or warning, I'd find myself running red lights and whatever. Laughing. I remember an accident, where the other driver said something like "Where the hell did you come from?" And I almost said something like "God sent me to kill you!" But I didn't, fortunately.
That SSRI truly made me a danger to society and myself.
I like to say a little on the manic side. I feel more alive. But not too much, because it's bad for me. Now I can just be happy and energetic.
Your story of recovery is a good one (and not the only good one). The problem is that a number of people in that same system don't see any need to get people off these medications. IMHO they are best used short term (whatever that means) while you work through your issues - like you did.
For those reading, there is no "correct" timeline for working through your issues. Everyone goes at their own pace. I would just encourage you to try, and not assume a lifetime of medication is a good solution.
Why is this a problem? If long term studies prove detrimental effects then sure, it's a problem.
But taking a pill every day isn't inherently bad for you. If you live in a northern climate you would probably benefit from taking Vitamin D every day your entire life, so what's the fundamental difference of an SSRI?
Clearly SSRIs help many people in a significant way, but their mechanism of action is still poorly understood and their effects are powerful enough that they should be prescribed and taken long-term only with careful advising and caution. For some people, maybe taking them until the day they die is the best option, but it probably is also harmful for some people to take them for several years.
https://joannamoncrieff.com/2014/05/01/the-chemical-imbalanc...
Here's one:
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12...
"SSRIs might have statistically significant effects on depressive symptoms, but all trials were at high risk of bias and the clinical significance seems questionable. SSRIs significantly increase the risk of both serious and non-serious adverse events. The potential small beneficial effects seem to be outweighed by harmful effects."
"Number needed to treat" is a useful epidemiological concept in this case. A perfect drug that cures every single patient has an NNT of one - for each patient you treat, one patient is successfully treated. When you translate the results of SSRI meta-analyses, you get an NNT of about seven - for every seven patients who take SSRIs, one more patient will recover than if those patients were given a placebo.
It's hard to know what to do with that information. Is it worth prescribing antidepressants to 1,000,000 people to treat 142,000 of them? On a pure cost-benefit analysis, the answer is a resounding yes. Antidepressants are relatively cheap and safe. Are you willing to take a pill every day to get a one-in-seven chance of an effective treatment? Maybe. If you're in the throes of a deep depression, you might be willing to give anything a try. If you're just feeling a bit blue, maybe not. By the same token, if you're taking antidepressants and you don't think that they're helping, you're probably right.
Yes. Reviews suggest that statins have an NNT of between 50 and 200 depending on the patient's underlying risk for cardiovascular disease. Coronary stents are probably useless. Reviews of antibiotics, antivirals and corticosteroids show a wide range of NNTs and often show no positive effect.
The drug approval system has a relatively high bar for safety, but a relatively low bar for efficacy. A drug manufacturer only has to prove that their drug is effective for one particular cohort of patients with a particular disease, but doctors are then free to prescribe the drug to any patient with any disease. Many surgical interventions are never subject to a randomised controlled trial.
http://www.thennt.com/home-nnt/
The bigger problem is “depression” is not reproducibly measurable, because it has no falsifiable or biomedical marker.
That's something I like to point out using SSRIs as an example. The claim is that they increase levels of serotonin and that the cause of the depression is reduced serotonin. The thing is, nobody actually checks your serotonin levels and says "oh that's low take this." Then there's the problem of why ones serotonin is low when it wasn't always that way. There are probably many causes of depression and quite possibly some that don't lower serotonin.
You say this as if it were a bad thing but if SSRIs are as effective as exercise wouldn't that mean that they are very effective?
If you were to tell me a fat burning pill were no more effective than exercise I would start taking it.
Wait what? Which part? My first sentence? There are a few opinions in what I wrote. What specifically might inspire guilt? Honest question, I try to be sensitive to such things.
But there are many more possible causes of depression than stress - one could compare it to a fever: a high fever kills, but there are many possible illnesses leading to a fever. Expecting that exercise helps with depression every time is like assuming every fever is caused by the same illness. Not to mention the fact that while having more red muscle may help with coping with chronic stress, it does not actually fix the cause of chronic stress in and of itself (although it can of course help with providing someone with the mental fortitude needed to take on that particular problem).
There are all kinds of reasons to do more exercise, but touting them as a catch-all fix for depression is dangerous and ignorant.
[0] https://ki.se/en/news/how-physical-exercise-protects-the-bra...
http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo...
Having been on the Zoloft,I can say is got a black box warning for a reason and should only be taken if you're seriously in danger of self harm.
Shrinks like it because it keeps people coming back. People like it because they're not willing to confront their real problems and want something to numb themselves out.
Just say "No!".
sure, but you can make the same point about any drugs that people develop physical dependencies on. aside from alcohol and benzodiazepines, you will survive. antidepressant withdrawal varies a lot from person to person though. the brain zaps can definitely be severe enough that it becomes unsafe to drive a car, for instance.
> Just say "No!".
this I can certainly agree with, for all but the most severe cases. it's almost never worth the common side effects, let alone the rare ones.
> Just say "No!"
They are probably over-prescribed, but a blanket "No!" ignores the cases where they do work, and provide a significant increase in quality of life.
I've taken Abilify, Wellbutrin, Seroquel, and a number of other drugs. The biggest problem when you enter the psychiatric system is you go through pill roulette. You take a drug, try it, see what works, and keep trying till you find what works. Even worse is that I entered the system in high school which is a tumultuous developmental period.
One sad personal story is that a psychiatrist started me on a developmental drug. A drug that was approved for other problems but was "in development" for other uses. I tried it and it was worse than Seroquel. Seroquel, if I missed a dose, I couldn't sleep. For this new drug, if I missed a dose, I had a panic attack and if I took it, I would fall asleep. So if I was out too long, let's say traveling, I had to choose between a panic attack or falling asleep.
When I confronted my psychiatrist about this problem, instead of taking me off the drug, he prescribed me medication for panic attacks.
Of course the adverse effects of psyshcosis and untreated psychotic illness are much worse, including homelessness and death. So while these drugs are undeniably difficult to live with, people who have been prescribed the family including Seroquel generally really need them to function. All of which is to say that the struggles of people on neuroleptic therapy are generally very different from what’s being discussed in the article here.
The ideal environment is one in which the psychosis can complete.
It's very similar to a psychedelic journey in that with the right set and setting it can lead to deeper compassion, clarity and connection.
I've been through a number of such experiences over the years; I used to be terrified of them and tried to avoid them at all costs.
Now, it's very much an initiation into whatever the next level of my life demands of me. I've learned to make symptoms bigger vs supressing them and in doing so, I recover vital parts of myself.
Without this orientation, I would never have survived so called schizophrenia, bipolar, suicidal depression, psychosis.
Dr. Paris Williams has an incredible book called Rethinking Madness that was instrumental in helping me adopt a framework to complete a psychosis.
https://www.ted.com/speakers/eleanor_longden
https://www.cbsnews.com/news/how-seroquel-a-risky-antipsycho...
There are many alternatives that have been shown to be as or more effective.
Writing and then reading 14 Gratitude Letters to people.
Spending an afternoon a week outside.
Practicing telling the 100% truth in your relationships.
And of course, Psychedelics.
Many of you know my story of coming from schizophrenia, bipolar, anxiety, suicidal depression, mania, etc. and going on a path of returning to my self after having a vision that what was needed to was to go into the pain more fully and then seeking out various modalities to do just that.
It's possible to do, but you'll need to seek out support outside the mainstream.
> Spending an afternoon a week outside.
> Practicing telling the 100% truth in your relationships.
> And of course, Psychedelics.
Heh, a decent psychologist would suggest #3 during e.g. CBT sessions. Suggesting #4 is downright dangerous, you don't know who reads your post.
Readers, please seek professional help -based on conventional science- instead.
I tried all kind of self-help BS, including using psychedelics on my own, because I did not trust conventional science (ie. psychologists, psychiatrists). None of the pseudoscientific self-help BS helped, of course, and it gave me a severe lag in my life and professional career.
At the very least people should try out professional help first. But if I went on with it after the first failure (a diagnosis + meds for GAD which didn't quite work out) right afterwards, I might have figured out I have autism at my 27th instead of my 34th.
Both drugs have mechanisms of action we don’t fully yet understand, and both may cause serious side effects.
This is an extremely narrow and arbitrary ruleset you are applying...
If not merely because of the word "fully". That's a given in science.
> How is suggesting psychedelics more dangerous than suggesting the use of antidepressants?
Because psychedelics are not approved, you don't know the source/purity, and there's a lack of professional guidance.
Yes, you can get a panic attack on SSRIs. I had that when I started Fluoxetine because I almost fainted because my blood pressure was low whilst I was in a grocery store and had barely eaten. It happened a few times, though less severe (it is just low blood pressure), and went away after I got used to the drugs, which took longer than average.
SSRIs are not psychoactive, and better studied.
Finally, SSRIs are used under guidance by a professional. Recreational drugs, in contrast, are not.
The whole point of taking SSRI's is to affect the mind, so they are literally psychoactive.
They are better studied, but the risks you mentioned are associated with SSRI's as well as LSD.
Do you have evidence/study that shows LSD is more dangerous than SSRIs? LSD not being studied as much doesn't mean it's more dangerous...
Yes, they are; I meant psychedelic/hallucinogenic.
> They are better studied, but the risks you mentioned are associated with SSRI's as well as LSD.
Yes, but the possible side effects are well documented and users are informed and screened beforehand and there is professional guidance (by licensed professionals who studied for it) in contrast to recreational drugs use.
You know better what you dabble into when you follow the regular scientific path than the alternative path which is full with shenanigans, amateurs, wannabe experts, hippies, and downright dangerous, sick human beings.
> LSD not being studied as much doesn't mean it's more dangerous than any of the SSRIs.
Ultimately, this is irrelevant. You look at the current scientific evidence when you decide which treatment you want to follow. Recreational usage of LSD to self-medicate is very low on that list: actually, it shouldn't even be on that list until its scientifically tested in clinical trials. The lack of that doesn't mean we should just suggest it to random strangers; we ought not to!
> Do you have evidence/study that shows LSD is more dangerous than SSRIs?
No, stop turning it around. The burden of proof lies at you. You claim LSD is as useful or more useful than SSRIs.
I'll say it again: There's no evidence the use of LSD is more dangerous than SSRI's.
Mushrooms appear to be one of the safest mind altering substances known to man, and if used responsibly, can be healing.
Of course, they do show you what's inside, and for many people, they is going to terrify them. That is sort of the point though, to stare down the parts you've long ignored.
Wow, that's the most obvious argumentum ad antiquitatem I read this year.
"For thousands of years Christians have believed in Jesus Christ. Christianity must be true, to have persisted so long even in the face of persecution."
Sounds familiar? Straight out of the book. [1]
What's more, just because its natural or plants doesn't mean it is safe. Example: botulinum toxin the most toxic toxin known to mankind which you might know better under the name botox, entirely natural produced by bacteria.
What matters is that it is standardised, of known origin (traceable/provable), well studied in clinical trials, and the mechanisms well understood.
SSRIs fit all those characteristics, only the latter one not.
We certainly did not have thousands of years of standardised, safe human use. Heck, we didn't even have thousands of years of safe human use to begin with.
We didn't have known origin (a good movie about this is Into The Wild [2], btw). Especially not with amateurs. Doctors were more proficient, but not for thousands of years with every substance.
And studies, back then not. You had doctors and witches.
We've come a very long way.
> Mushrooms appear to be one of the safest mind altering substances known to man, and if used responsibly, can be healing.
> Of course, they do show you what's inside, and for many people, they is going to terrify them. That is sort of the point though, to stare down the parts you've long ignored.
I have used psilocybin, A. muscaria, Ayahuasca, MDMA (or God knows WTF it was) among a myriad of other drugs (the first 3 bought online when it was legal in my country). Terrifying it was -for the most part- not. I had fun and insightful experiences, but now that I am older I realise I was reckless [because I am sensitive to drugs and have autism]. I know you too will, at some point in your life realise how reckless you were when you used recreational drugs. And then you will perhaps realise how reckless it was to recommend that to random strangers. And perhaps you will feel utter regret. Au revoir, all the best to you.
[1] https://infidels.org/library/modern/mathew/logic.html#antiqu...
[2] https://www.imdb.com/title/tt0758758/
I used psychedelics irresponsibly in my youth, for recreational purposes -- much like it sounds you did. I'd never take MDMA without a proper spectral analysis (which you can obtain for $100 from ecstasydata.org) and with a sitter.
Then I took a decade off until I was facing recurring suicidal depression and was not interested in deadening my emotional experience via western psychiatry.
I was fortunate enough to be given a chance to do MDMA in a therapeutic setting as well as some healing experiences with mushrooms.
No question these compounds helped me release whatever was beneath the depression and other mental issues.
“Magic mushrooms are one of the safest drugs in the world,” said Adam Winstock, a consultant addiction psychiatrist and founder of the Global Drug Survey, pointing out that the bigger risk was people picking and eating the wrong mushrooms.
https://www.theguardian.com/society/2017/may/23/study-halluc...
Also, I never said they were safe because they were natural -- that is silly. There are plenty of things in nature that will kill you. We haven't had thousands of years of people using botulinum medicinally or ceremoniously.
As to your claim that "What matters is that it is standardised[sic], of known origin (traceable/provable), well studied in clinical trials, and the mechanisms well understood." We have had a draconian prohibition on psychedelics in general for several decades and the promising research was cut off.
So, if one is actually interested in healing, what matters is in finding what works -- and sometimes that means finding ways outside sanctioned medicine. But of course, we do have data on psychedelics and their safety and efficacy for healing -- and the results seem to be much more promising than the current approaches.
[1] https://en.wikipedia.org/wiki/The_Sacred_Mushroom_and_the_Cr...
Gratitude practices have been tested and shown to be significant in reducing depression, many studies on this.
https://pdfs.semanticscholar.org/a7bb/972b39435b0c5481aef88b...
Time in nature is also shown to fight depression, as found by some Stanford Researchers:
https://www.theatlantic.com/health/archive/2015/06/how-walki...
I wouldn't recommend trying psychedelics on your own, rather used in a specific therapeutic setting with a trained sitter / guide.
There are all sorts of studies on the effectiveness of psychedleic mushrooms on depression or MDMA for PTSD, etc.
Maps.org has ample info.
For me, I'm lucky that I didn't trust the mainstream Doctors who wanted to put me on antipsychotics or whatever else.
And I was blessed to find my way through medical research to find a path that worked. In no small part due to helping Peter Theil launch a startup in the private medical research space -- that experience showed my how very inefficient our medical system is at getting up to date information and practices to folks.
This isn't true. We know that antidepressants are significantly more effective than placaebo for most people. https://www.ncbi.nlm.nih.gov/pubmed/29477251
We are now gathering evidence about which antidepressants are most effective and least likely to cause people to stop using them: https://discover.dc.nihr.ac.uk/content/signal-00580/the-most...
Here is a recent meta analysis suggesting not much more than placebo.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/
I'm the study you referenced, did you notice if they compared it to active placebo or just placebo? It seemed they did an 8 week eval which is still within the 3 month window in which active placebo seems to be at work.
Also, why would we want people to be less likely to stop using antidepressants (if I read your comment correctly).
For example, from the article,
> "A year and a half after stopping, I’m still having problems. I’m not me right now; I don’t have the creativity, the energy. She — Robin — is gone"
If that's important to you, why not continue?
So basically, it was side effects. Friends worried about me.
I can’t take paxil, zoloft or valium, so it’s probably different.
I personally wouldn’t stop antidepressants because my physiology goes straight into depression without exception, and then the relationship would likely flounder.
Because SSRIs have side effects, and you tolerate those if it's preventing depression, but you might not tolerate them if you're now taking a medication for life.
Except it's not for large groups of people. And for anyone with a history of multiple episodes, the long ramp up time needed for antidepressants is extremely risky to try an "as needed" approach.
Says who? The DSM-5 specifically lists Persistent Depressive Disorder, formerly known as dysthymia, which is defined by chronic depressive symptoms for a period of two years or more. Many people suffer from frequent episodes of major depression; there's fairly good evidence that antidepressants can reduce the risk and severity of relapses.
Patients shouldn't be taking antidepressants in the long term by default, but it's a very good option for a lot of people. If you've had two or three previous episodes of major depression that have been successfully treated by antidepressants and you find the side-effects tolerable, taking them indefinitely might be a perfectly sensible decision.
But that's not most people. Most people with depression have a mild to moderate form that responds well to medication for two years and a talking therapy. These people don't need ot be on meds for life.
On top of that, some people aren't comfortable needing to take a daily dose of medication where the withdrawal symptoms are so disruptive. What happens if you forget to take your meds one morning? What if you lose your insurance coverage and can no longer afford the pills? What happens if you're traveling abroad and the bad with your medications gets stolen?
I also took antihistamines for a long period of time (15ish years) and eventually I got to the point where I got multiple nosebleeds every day I took one. Nobody told me that could happen when I started taking them. I went off for a year (thankfully I discovered nose strips to get me through the night) and now I can take the occasional antihistamine again without my nose bleeding all over. As a result I'm a bit more conscientious of what long term effects I need to be looking out for in any other meds I take regularly. Living without is just unfortunately necessary in some cases.
After I changed jobs, and therefore healthcare providers because yay America, I didn't bother getting a new prescription. It was a rough ride coming off the stuff. I remember distinctly crying, like really intense honest crying with sobbing and tears and everything, over some plot point in a stupid TV show I was watching and, honestly, it was delicious. I was so grateful to be able to experience again, instead of just passively existing.
After several more years, none of them involving doctors, I finally found my way to more-or-less normality. For me, and I suspect many depressed people, it was philosophical. I had this idea of how the world should work, how I felt it should work, and I knew the world didn't work that way, and the dissonance of that manifested as depression. I think this is probably the normal reaction of the mind to this state, and under normal circumstances it is supposed to serve to motivate us to reconcile our model of reality with our observations of it, but for various reasons I once elaborated on in a different post, I think our current cultural mind-set is not only ill-suited to helping us with this, but actively making it worse.
I don't think going off them had to do with worries over "unnatural" , rather it was just human curiosity to understand my own brain. I've tried other illegal drugs for similar cognitive insights. It just so happens that SSRIs are legal and have some degree of clinical efficacy.
As a side note I think therapy did more for me than SSRIs and I'm still in therapy but ymmv. Finding a good therapist is way harder than finding an anti-depressant prescription.
They're not addictive. They cause dependence. There is an important difference. Addictive things increase incentive salience of stimuli associated with the drug. They increase wanting. And that increased wanting leads to increased usage.
Dependence on a drug does not have this aspect. It just represents the bodies physiological adaptation to the new state.
Conflating the two is bad practice for an article ostensibly about medicine. And it leads people, and that set includes legislators, to think about using more government violence to enforce regulations of drugs which create dependence.
Further, it should be obvious that dependency is a problem. If the medical profession thinks it's solved that problem by redefining words, I'd say state regulation is pretty appropriate step.
1. When I consider stopping antidepressants, I'm not filled with anything like the dread I was when I thought about giving up the addictive pills.
2. I forget to take my antidepressants sometimes. I forget to refill the prescription sometimes.
3. I have never had any desire to take more than the prescribed dose of my antidepressants.
It's an important distinction, and unfortunately one that folks in the recovery community sometimes miss. In my experience the above characterization usually brings it home much better than some heavily medicalized description of addiction vs dependency.
(I've taken so many pricey antidepressants, and feel duped. I sometimes think drug companies pulled the ultimate scam. Produce a happy pill that barely gets by the FDA? A pill that really doesn't do anything besides side effects of course?)
A few important points:
1. Antidepressants can truly change people's lives. Not everyone's, and they're not the only treatment that works. Somehow this reporter tends to consistently overlook the clear evidence of benefit (I think this recent meta-analysis was posted on hn: https://www.ncbi.nlm.nih.gov/pubmed/29477251)
2. Withdrawal symptoms are common if antidepressants are stopped abruptly - some of the folks who reported these symptoms originally have been favorite targets of Benedict Carey, ironically (https://www.ncbi.nlm.nih.gov/pubmed/9396960). That's why docs encourage tapering antidepressants.
3. The article doesn't distinguish between this sort of short-term withdrawal (common), and longer-term problems with discontinuation (likely quite rare) - they're very very different phenomena.
4. In some cases, difficulty with discontinuing longer-term is a result of persistent depression and anxiety (or returning depression and anxiety). It's not polite to point this out.
5. It's hard to imagine the Times writing an article about the problem with statins being that, once you stop them, cholesterol increases again.
6. If there were substantial long-term risks associated with antidepressants, we would have seen them - and believe me, people have looked and are looking.
7. BUT - we /do/ need more research to understand long-term effects of antidepressant treatment; this absence of systematic long-term study is true for most meds, frankly, but that's no excuse. My question would be: Who pays for it? There's no shortage of investigators who would be delighted to study it. But try getting a foundation, or NIH, to support such a study.
/rant
Drug makers have no incentive to see them. I can say from experience that I have seen them. I spent two months out of work when I had to discontinue Effexor. Other people complained about “brain zaps” and were largely ignored. My doctor never warned me. The evidence is there but there if you look, but there is no one with an economic incentive to pay attention. Just because there are few studies documenting these symptoms doesn’t mean they’re not. This is a wake up call that more studies need to be done.
https://www.medicines.org.uk/emc/product/4487/pil
> If you stop taking venlafaxine suddenly you may get withdrawal reactions (see section 3)
[...]
> Do not stop taking your treatment or reduce the dose without the advice of your doctor even if you feel better. If your doctor thinks that you no longer need Venlafaxine tablets, he/she may ask you to reduce your dose slowly, before stopping treatment altogether. Side effects are known to occur when people stop using Venlafaxine tablets, especially when Venlafaxine tablets is stopped suddenly or the dose is reduced too quickly. Some patients may experience symptoms such as tiredness, dizziness, light-headedness, headache, sleeplessness, nightmares, dry mouth, loss of appetite, nausea, diarrhoea, nervousness, agitation, confusion, ringing in the ears, tingling or rarely, electric shock sensations, weakness, sweating, seizures or flu-like symptoms. Your doctor will advise you on how you should gradually discontinue Venlafaxine tablets treatment. If you experience any of these or other symptoms that are troublesome, ask your doctor for further advice.
Anti-depressants, especially something like venlafaxine, are strong meds for a strong condition. It would be surprising if they had no side effects - and honestly, if you go to a psychiatrist instead of a normal doctor, you usually get a dose that's fine-tuned to the extent that you don't get them.
I took 2 SSRIs for about 3 years and went off them close to cold turkey. When I would move my eyes it felt like there was a delay between moving and seeing. This lasted for about a month. In general everything felt very disconnected/fuzzy/unreal. Sometimes it was close to what I imagine people describe as an out of body experience.
I still find articles like the above absolutely horrible, and wish people would stop writing them. Meds saved my life. They save the life of millions of people every year - and they make depression hands-down easier to manage and to live with.
That doctors over-proscribe is another problem. Muck-raking and fear-mongering about what are already scary drugs to very scared depressed people has real costs - people probably die because of articles like the above. Many, many people suffer for years without medication because they're afraid to start them.
Drug makers aren't the people looking, the regulators are.
Here in the UK, the medicines regulator operates an open reporting system for adverse drug effects. Any patient or healthcare professional can make a report of an adverse drug event, no matter how minor. The collected data is publicly available in anonymised summary form. 110 countries share detailed reports of adverse drug events through the WHO VigiBase, which is monitored for risk signals by a dedicated team at the Uppsala Monitoring Centre. Potential safety problems are then fed back to national regulators.
All of this reporting apparatus was put in place after the thalidomide disaster. It's designed as an extremely sensitive early-warning system to detect subtle or rare adverse events. For the most part, it works. I'd suggest taking a look at the WHO Pharmaceuticals Newsletter, which shows how this information sharing works in practice.
https://yellowcard.mhra.gov.uk/ https://www.who-umc.org/vigibase/vigibase/ http://www.who.int/medicines/publications/WHO-Pharmaceutical...
2) They're common while tapering too.
3) Agreed
4) Possibly true. What's unpolite about mentioning this?
5) Wrong analogy; depression only increases would be analogous to increased cholesterol. What are statin drug side effects when quitting, from the drug.
6) The mechanism of action isn't even fully understand. You're absolutely wrong to claim "we would have seen them (long-term side effects)". Isn't there an article on ceiliac disease and how long it took to pin down on HN's front page now?
7) You mentioned in #6 we should already know.
If I had a rant, about overly-confident individuals posting on forums. While I've no reason to believe you were intentionally dishonest, the over confident, "factual" sounding, behavior has the same basis as disinformation activists.
Experience? Was on antidepressants. Had a horrible side effects unrelated to depression coming off them. Safe my ass.
1. Read the reference before responding; the study looked (in part) at antidepressant-placebo differences. Also - I can't prescribe placebo.
2. Got anything to back that up?
3. OK
4. Because it implies that some of the 'withdrawal' symptoms are actually recurrent depressive/anxious symptoms (which can include somatic symptoms). Which is different than arguing that all of these symptoms are a consequence of relapse/recurrence.
5. Well, one of the critiques of antidepressants is that, after someone is on them for years, depression can recur... but fair point, not a perfect analogy.
6. Fully understood? It's not even a little understood. What does that have to do with detecting long-term consequences? We have 25 year follow-up data with antidepressants now. Despite lots of effort to find otherwise, show me some solid literature supporting risk.
7. Yup. We should. And we should keep looking.
We also agree that there's substantial harm associated with people confidently posting misinformation - so while I mostly lurk here on HN, I feel that 20+ years of treating mood disorders and 20+ years of pharmacovigilance research gives me the right to push back. Lived experience is critically important, but it does not trump data.
I would argue that for an individual, lived experience trumps all data - for them. Data is an aggregate of individual experiences. A single persons experience is a data point, not an anecdote.
During taper symptoms:
- nausea
- general anxiety
After taper symptoms (continue today):
- general anxiety
- strong, brief muscle contractions anywhere in my body (myoclonus)
- weight loss (good)
In about 2012 I visited Copenhagen, capital of Denmark, which was until recently allegedly the self-reported "happiest nation on earth". I found it extremely weird that everyone was perfectly dressed and all the interiors were spotless, but nobody was smiling. It was like I had walked on to the set of some kind of dystopian movie. Mentioning this to an American woman who appeared and who had been resident there for some time, she simply laughed and leaned closer. "It's because they're all on antidepressants!"
Well, in the same period I have lived next to Copenhagen for three years (in Malmö) and this does not match my experience of the city nor the country in general in the slightest.
Perhaps you visited near the end of winter, or when spring just started and the sun hadn't fully returned? The long winters can suck out the energy of anyone near the end of them, but during every other part of the year the Danes I know are a very cheerful bunch.
More likely though, I think it's a different attitude towards smiling itself. In the US it seems like much more of a social thing: aside from spontaneous, genuine smiles, there is also smiling as part of how you present yourselves to others, almost like a form of politeness. That doesn't apply to European cultures.
You referenced an American in your story, and they're the only group I've ever really heard complaining about people in other countries not smiling enough, so my assumption is hardly silly. I don't know if Australia shares the same quirk, given that Australia borrows a LOT from the US culturally, are you sure you didn't pick that stuff up from the US?
And I'm not sure why the Germans didn't bother you but the Danes did, that doesn't really add up.
Within the first week of taking anti depressants (wellbutrin, I later switched to prozac) I would at random moments of the day begin to remember funny memories. I would be walking to my dorm from class and remember a funny gag from the simpsons and break into a stupid grin.
After two years on anti depressants I was able to stop taking them. I was able to do this by accepting and understanding that while I may have real reasons to be sad, the underlying reason that I was dwelling on these negative thoughts was my brain chemistry. Once I accepted this I was able to justify cheaper less harmful ways of medicating my depression. Whenever I began to feel depressed I would simply go to my tv and start watching episodes of `It's always sunny in philadelphia` or whatever comedy made me happy
I think the worst mistake people with depression make is reinforcing their sadness by listening to sad music, watching sad movies or reading sad books when in fact they should be doing the opposite. They also allow their depression to become part of their identity.
This sounds a bit like you discovered Cognitive Behavioral Therapy. That's actually a very insightful, practical approach you developed.
History is littered with harmful, poorly-thought out "psychiatric treatments" that were widely regarded as milestones. Even if there are a tiny minority of people who's mental condition is so bad that scrambling their brain with drugs will lead to an "improvement", the widespread reliance on these drugs to treat the every-growing number of depressed and anxious people is not a good thing for individuals, or for society. This is especially true when it comes to young children, whose brains are being warped during the critical stages of development. Over a million children under 5 years old are being dosed with these mind-altering chemicals based on ridiculous ADHD or "defiance" disorders. Over ten million children under 17. Its very telling that the intelligentsia at the apex of society think that the answer to fixing our broken children is to drug them rather than to fix the broken society that they perpetuate.
https://www.cchrint.org/psychiatric-drugs/children-on-psychi...
I can’t emphasize enough how serious these drugs are, and what a prison they can become.
Thanks for sharing your experiences everyone!