Comment by tcj_phx | Hacker News Reader

Comment by tcj_phx | Hacker News Reader

> In the course of a year, her doctors had created what’s known as “a prescription cascade”: the side effects of one medication are diagnosed as symptoms of another condition, leading to a succession of new prescriptions.

This term, "prescription cascade", should be lesson #1 at medical school. It's the natural result of an incomplete diagnosis, and is present in every medical field.

> At the hospital, where she stayed for two weeks, she was put on a new combination of pills: Lamictal, a mood stabilizer; Lexapro, an antidepressant; and Seroquel, an antipsychotic that she was told to use as a sleep aid.

(emphasis added)

These descriptions -- mood stabilizer, antidepressant, antipsychotic -- are just marketing terms that don't actually describe the actual function of the drug. These marketing terms are most useful for tricking medical professionals into prescribing these products.

'Antibiotic' is the prototypical name for a class of drug that does what it describes: acts against bacteria.

> She saw her drugs as precision instruments that could eliminate her suffering, as soon as she and Dr. Roth found the right combination. “I medicated myself as though I were a finely calibrated machine, the most delicate error potentially throwing me off,” she later wrote.

I think this attitude is probably common for all the smart people who find themselves medicated into a downward spiral.

> “It is tempting to add a second drug just for the sake of ‘doing something,’ ” a 2004 paper in Current Medicinal Chemistry warns.

This is the trap the mental health system has fallen into: the professionals want to help. The drug industry has FDA-approved drugs for the various diagnosises.

Joel on Software said a re-write is something that shouldn't be done. But what other choice does the mental health industry have? Their system doesn't work. The modern industry is based on the flawed chemical imbalance theory of mental illness.

Little bits of progress have been made, in spite of the inertia to treat misunderstood behavioral problems with patent medicines. I have to conclude this comment before I can finish the article, so I'll link to my recent comment on the submission on the Szasz's book, the myth of mental illness: https://news.ycombinator.com/item?id=19243417

edit: shortened my first quote from the linked article

"Mood stabilizer" is a quite accurate description of the usual function of the drug - in bipolar patients like me, it reduces the magnitude and stabilizes the period of mood swings. Mood stabilizers also tend to be anti-seizure meds, and have all kinds of off-label uses because of neurological phenomena we don't understand, but the label is a very useful one.

Same for antidepressants - often the same drugs (especially SSRIs) are both antidepressants and anxiolytics, but both labels are useful descriptions of the meds' common effects. Antidepressants in particular happen to be fantastically idiosyncratic drugs, but on average they do what they say on the label.

Part of the problem is that, due to the ill-understood nature of the brain, good psychiatrists need to know strange drug interactions and ill-studied minority reactions in order to serve the full range of their patients. This edges on art rather than science, which is always a recipe for cognitive biases to gain control.

I think what the parent was trying to say was that "antibiotic" describes the drugs' method of action, while "antidepressant" describes the drugs' intended affect.

> due to the ill-understood nature of the brain,

I think this is exactly the problem. We have a bunch of drugs that seem to work, and we think we know how and why they work, but we're not able to directly measure the problem in those terms. If someone has a bacterial infection, we can culture it and prescribe the correct antibiotic. If someone has a mental health condition, we almost always have to consider the way that it's presenting and make an educated guess as to which drug is going to be effective. It's not at all uncommon for that first guess to be incorrect, which leads to either iteration or a "cascade" depending on the practitioner.

I have a close friend with paranoid schizophrenia and also bipolar who, after an episode, underwent ECT.

The medication that stopped him from hearing voices pre ECT/episode started again after ECT. After a year, the Psychiatrist is still trying to find the right combination of medication to stop it - they've (I think) more than tripled his current dosage of lithium along with others that I'm not aware of but it's unpredictable how much time the medication change actually takes effect, could be anywhere from 2 weeks to 2 months.

I don't know where I was going with this, just sad to see him like this.

Sometimes less treatment is better than more treatment. If your friend will let you go to his appointments, maybe you can advocate on your friend's behalf.

If he's ordered to submit to involuntary mental health treatment, you can probably request judicial review on his behalf. This would be to let the court know that your friend was doing better before the ECT treatment, and that you are concerned that some of his problems are now caused by the treatment itself.

Edit: I commented on lithium a few weeks ago: https://news.ycombinator.com/item?id=19299137

Thanks for the reply

How can I, advocate on my friend's behalf against a Psychiatrist who has been working with him for years when I have no expertise in the field? Do I trust that his Psychiatrist has already thought the same thing?

Maybe I can leak some info to him (like those articles) so he can think for himself and talk to his Psychiatrist about it.

Technically he was doing better pre-ECT, but stress got to him and when comparing to when he had his episode (lasted a while before deciding on ECT), technically he's doing better post-ECT than during that phase.

I'll take a look at that thread, thanks

You've been a passive observer for a long time. Psychiatrists usually see their patients for a few minutes when they're at their worst, and have no perspective on how the patient actually does on a day-to-day basis. They haven't observed the patient between 'episodes'. You can help fill in the gaps in the psychiatrist's profile of your friend.

> but stress got to him and when comparing to when he had his episode

Stress is the major factor in most of these conditions. My recent comment about the Quakers and their asylums [0] is relevant: most of their patients got better with nothing more than 4 meals a day and the expectation that they could recover if given appropriate support.

Malnourishment is the other major factor. My friend's involuntary treatment provider eventually did a genetic test that found she can't turn folic acid into folate. Getting supplemental folate has made a big difference for her misdiagnosed "mental" condition. B-vitamins... eggs... more coconut oil, less vegetable oil... fewer grains, more fruit (juice, apples, etc).

[0] https://news.ycombinator.com/item?id=19243417

My dad has (probably?) paranoid schizophrenia, and life stress was definitely a trigger for that.

I am skeptical of tcj_phx's advocacy of resistance to lithium. It's a very effective drug with horrific side effects, and it seems to have worked pre-ECT. It sounds like the psych involved is aware of the safe limits for lithium, as hitting the maximum safe dosage for one drug is usually what (in my experience) causes psychiatrists to start mixing different meds. (Which comes with its own problems, since as side effects multiply they get harder to understand.)

Yeah, I'll take it with a grain of salt but I'll still do more reading on it and maybe bring it up with him to see if his Psychiatrist has ever mentioned anything similar - just to the get thoughts going.

They gave me the heavy anti-psychosis meds too (I can't remember the name) and it did nothing for him either.. But yes, he's taking so much medication I can't imagine trying to map out all the potential side-effects of any combination.

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