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Comment by nicolashahn | Hacker News Reader

They're both effectively performance-enhancing drugs, and I'm not sure I'm totally against this. Anti-depressants boost your stress tolerance and stimulants enhance your focus and productivity. Unless it's been shown that usage of these damages people permanently in the long term, the net outcome is a more effective medical industry.

(strong opinion weakly held, tear it apart)

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I think the problem doesn't lie as much in the use of the drug, but in the environment that leads to consumption. If we assume strong social stigma against it, and yet a majority of students end up doing it, it means there is a very strong pressure to increase performance by whatever means necessary - that is to say, that students are not in a state where they consider their workload bearable. That's in a pool of people that have been somewhat preselected for being high achievers and willing to work a lot.

While medicine is a field where there should be high expectations for students (given what's at stake), I don't think keeping students and workers around the very edge of what they can mentally handle is at all healthy or worth it in the long term. We don't want burnout, we don't want to have them suffer from stress-related issues, we don't want to increase their chances of making mistakes at work, and from an ethical viewpoint we don't want them going through a miserable life even if it's a net win for society (at least I don't).

100% agree with this. We see the same mental health epidemic in PhD students. Clearly, there needs to be a paradigm shift where we can enable people to achieve high levels of education (and hold them to high standards) without making it a nonstop do-or-die mission. Mental wellness training should definitely be part of the curriculum for medical students (and everyone).

Stimulants all downregulate. They will end up having to use more unless they take breaks to resensitize ( couple weeks off take a tiny dose then another week off).

The antidepressants are worse. In people with violent thoughts (are there people without?) they can make people more likely to act out those thoughts. In everyone else it destroys libido and has has physical withdrawal. Anecdotally I have also noticed people on them don't draw boundaries where they should. They are OK with treatment from employers and friends that they shouldn't be.

Yet for others, stimulants and/or antidepressants are a potentially life-stabilizing treatment that cannot be achieved any other way. The only thing your dismissive comment could achieve is to make people who need them feel discouraged (which is potentially dangerous).

The context is 75% of a profession in training taking these drugs to handle the pressure they are under. Not people with ADHD or chronic depression/anxiety that doesn't respond to therapy.

I also meant to say that stimulants and antidepressants shouldn’t be expected to solve the entire problem. Stimulants, in particular, are a double-edged sword that can amplify sleep deprivation, anxiety, poor-diet, etc. and make problems worse in the long term. But I wouldn’t hesitate to encourage someone to seek medication that they need. I can see how the line gets a bit blurry with medical and PhD students—at what point does chronic academic stress crossover into anxiety/depression/ADD? We don’t want people popping Adderall as an academic requirement.

In any case, I think preventative mental health education and destigmatization would be a more effective solution overall.

Until there is a multi-decade study on the long term effects of this in combination with a stressful job with long hours I would advice to be cautionary. I would really like to know the heart attack rate in those people over 40 compared to non-users.

There's high-quality evidence that SSRIs can be cardioprotective, at least in high-risk individuals: https://www.ncbi.nlm.nih.gov/pubmed/30043065

Interesting opinions, you might enjoy testing the strong-hold in winds of an anti-depressant related discussion - https://player.fm/series/philosophy-for-our-times/e123-minds...

There's a strong social stigma against. Look at how law enforcement handles it.

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