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Comment by PragmaticPulp | Hacker News Reader

For anyone reading this and considering seeking help: There is a strong anti-psychiatry movement online following in the footsteps of the anti-vax movement.

Please ignore it. If you have concerns about your mental health, please don’t hesitate to contact a medical professional. Note that medications are not the only approach to treatment, although we have decades of evidence showing that they do show benefit in helping many people as part of their journey toward better mental health. However, plenty of people have great success with therapy-only if that’s your preference. The most important thing is to try to make progress, try different treatment modalities, and see what works for you.

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It's not like there are two discrete camps who are either for or against everything modern psychiatry has to offer. Equating it to the anti-vax movememt is disingenuous.

Yes, if you need help, seek it. Also don't be afraid to see several psychiatrists just like you might see several doctors. Feel free to question their decisions like you might question a normal doctor. There are rarely perfect cures for mental illnesses. Be wary of anecdotal evidence online. Be wary of the side effects of both prescription medicines and herbal/nutritional supplements. Suicide is never the best option. Be honest with your medical providers about how the medications are working for you and don't be content with poor outcomes. It may take a while but you will probably find some combination that works for you. Like any medical treatment, the best cure may not be perfect and you may have to accept some undesirable side effects though. Just keep trying and have as much patience as you can muster.

But how would a depressed individual (I'm talking extreme depression) be able to consult multiple doctors and try different medications which also only become effective after several weeks?

This sounds like a task a healthy individual could carry out, but a depressed person is suffering every minute, they need immediate relief.

I saw that esketamine got approved both in the US and EU, but it's only prescribed after 2 classical medications failed.

How is a person suffering daily expected to wait so long?

Of course there will be many suicides still.

I'm bipolar with a touch of OCD so I know the struggle. I've managed to get by with illicit substances and nicotine at times but I know that's not a real option for most people. When I finally decided to seek help, the first psychiatrist I saw was nuttier than I was though.

If someone is extremely depressed, they probably aren't even going to seek out help. It's up to the people around them, if there are any, to try to get them the best care. What I was getting at with my comment isn't so much for the emergency situation as it is for the long term. You have to start somewhere, but then continue to push for better. Honestly, even healthy folks have issues with fighting for the best care though.

The real solution, if there is one, for mental health is to have healthy, intact families, communities, police, social workers, medical systems and governments all coordinating, but now that looks like a pipe dream so we do what we can.

Many people live with spouses, friends, or relatives that can help with that.

And some actually can take their medication as prescribed. I (bipolar disorder) certainly could and can. It’s a very low effort treatment. Just take the pills.

> It's not like there are two discrete camps who are either for or against everything modern psychiatry has to offer. Equating it to the anti-vax movememt is disingenuous.

I was responding to the parent comment, which claimed (falsely) that scientific consensus showed that psychiatry does not work at all. Claims like that are indeed equivalent to anti-vax movements.

I’m not suggesting that psychiatry is without nuance or debated topics, but the parent comment was spreading false and potentially damaging information.

As always, please consult with a medical professional, not random internet comments dismissing entire fields of medicine as a hoax.

> I was responding to the parent comment, which claimed (falsely) that scientific consensus showed that psychiatry does not work at all. Claims like that are indeed equivalent to anti-vax movements.

You didn't respond specifically to the claim. It was just used to dismiss all caution in dealing with psychiatric medication as though it has the degree of certainty and understanding as vaccines.

OP said "It's clear scientifically that no medication heals depression or addiction and yet these pills are happily prescribed in psychiatries."

That is a far fetched claim regarding psychiatric medications(not psychiatry in general) but it is not without merit. I chose to forgo most medications because of the side effects. I have a friend with a similar set of problems and he's on something like 7 different meds and they're still changing after years of working with his doctor. They have kept him alive and yet he is worse off every time I see him.

There are also many, many people who are helped by psychiatric medications. OP is wrong that there is no evidence for effectiveness of any medications but there is still some debate over the effectiveness of some classes of drugs(SSRIs for instance, last time I looked).

We will have to agree to disagree on the appropriateness of likening criticism of psychiatric medications to the anti-vax movement.

> OP is wrong that there is no evidence for effectiveness of any medications but there is still some debate over the effectiveness of some classes of drugs(SSRIs for instance, last time I looked).

Strongly the agree that the OP is wrong. I’m not sure why it’s so contentious.

As for SSRIs: The famous paper questioning their effectiveness has been widely panned for coming to misleading conclusions. If you read the paper, even their conclusions show SSRIs outperforming placebo. The authors used a cherry-picked analysis technique (“effect size”) to argue that the effect size was not as large as they’d like, despite showing that the effective size of SSRIs was in the direction of showing superiority to placebo.

It’s also difficult to evaluate these topics without fully understanding the science. SSRIs aren’t evaluates in isolation, they’re evaluated in relation to placebo. The problem is that placebo shows remarkable efficacy in some patients. This doesn’t mean that SSRIs are placebo (they still separate from placebo) but it does require careful analysis of the data. For example, SSRIs are significantly more effective than placebo in patients with severe depression, but they separate less in patients with mild depression. None of this means they are ineffective, but the data is often misconstrued as such by those with an anti-medicine agenda.

I’m glad you’ve found a solution that works for you, but please refrain from projecting your own medication choices on to other vulnerable people online based on a cursory understanding of the research.

> There are also many, many people who are helped by psychiatric medications.

Strongly agree.

Everyone should defer to medical professionals rather than HN comments for treatment decisions. It’s very unfortunate to see so many people choosing to avoid treatment for years out of unfounded fears of medications they’ve read online, just as it’s sad to see people avoiding vaccinations due to something they read on Facebook.

In this answer you show that you don't know what is meant by the term "anti-psychiatry".

On that "try different treatment modalities" note, for talk therapy (which is very often not handled by a psychiatrist, but by a psychologist), don't be afraid to find someone else if you feel your therapist isn't helping. Having been in and out of therapy for half my life, I've had therapists I really related to, and ones who actively made me feel worse. That being said, it can take a few sessions to figure out whether you're going to get along with your therapist. I recognize that many people might simply not have other options, and it can take months to find a replacement, but trust me when I say that sunk cost fallacy thinking of "oh, it took me 2 months to get my first appointment, and now I need to find someone else who I'll also have to wait 2 more months to see" is a trap.

Absolutely. Also note that any primary care doctor or psychiatrist will have a list of psychologists or therapists to refer.

Making medical appointments, especially therapy appointments, has never been easier now that Coronavirus has pushed everyone to adopt virtual health appointments. You can find a provider and book appointments from an app on your phone in most cases. The appointments are handled virtually as well. No need to pick up a phone to schedule something. No need to get in the car to drive somewhere.

> For anyone reading this and considering seeking help: There is a strong anti-psychiatry movement online following in the footsteps of the anti-vax movement.

There has been a strong anti-pschiatry movement in academia/science. It's not just "online", it's in the real world.

> The most important thing is to try to make progress, try different treatment modalities, and see what works for you.

We also have a over medication issue which leads to a lot of deaths just on mistakes alone.

"Well over 125,000 people die from drug reactions and mistakes each year, landmark medical studies of the 1990s suggest."

https://www.cbsnews.com/news/america-the-medicated/

More people die from drug mistakes in the US each year than has died from covid so far.

There is a lot of "anti-X" online, but there are also a lot of "pro-X" online from fanatics, pharma advertisers, etc. And for all the psychiatry and drugs, we keep getting more mental issues rather than less. Perhaps it's society.

But I've noticed a very vocal and well placed "pro-[fill in the blank]" online. Haven't a clue who is funding the "anti-X", but I have a good idea who is funding the "pro-X". But yes, people who really truly absolutely need help should seek it. There has to be a balance between no medication and overmedication because both are harmful to individuals and society at large.

> For anyone reading this and considering seeking help: There is a strong anti-psychiatry movement online following in the footsteps of the anti-vax movement.

I don't think it is fair to compare criticism of psychiatry to criticism of vaccination. The science behind vaccines is actually far more advanced than that behind psychiatry. With vaccines, we have identifiable infectious agents which we know exist and are distinct, and we are trying to develop safe and effective ways of teaching the body's immune system to fight those identifiable infectious agents. In psychiatry, the targets of treatment haven't even been clearly identified – documents like the DSM-5 contain long lists of "disorders", but few believe the DSM-5 is an accurate reflection of what's really going on in the brain [1]. People talk about entities like "ADHD","ASD","OCD" as if they are distinct entities in nature, when we have evidence that the distinction between them is mostly invented by humans [2]

The effect of psychotropic drugs on the brain, and other body systems, is very complex and not completely known. The side effects of vaccination are significantly less, and vaccines tend to act much more narrowly on just the immune system. As a generalisation, vaccines are more safe and more effective than psychotropic drugs. I don't argue that nobody should take psychotropic drugs–some people are really helped by them–but it is unfair to compare people who are concerned about their harmful side effects (e.g. antipsychotic-induced brain atrophy [3], [4]) to anti-vaxxers

[1] http://cepuk.org/unrecognised-facts/diagnostic-system-lacks-...

[2] https://www.nature.com/articles/s41398-019-0631-2

[3] https://pubmed.ncbi.nlm.nih.gov/30191724/

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476840/

Meta studies on vaccines find them to be generally effective [1] but the government has managed to screw up major drives and damage peoples view of vaccines because of those [2].

Psychiatry on the other hand has evidence that disappears every time someone tries to replicate original drug trials:

>The replication crisis addresses a fundamental problem in psychological research. Reported associations are systematically inflated and many published results do not replicate, suggesting that the scientific psychological literature is replete with false-positive findings (Pashler and Harris, 2012; Yong, 2012; Aarts et al., 2015) [...] outline some specific issues underscoring that inconsistent and systematically biased research findings persistently compromise the yield of clinical research.

>Concerning replicability in psychotherapy research, the main question to pose is: How much can we rely on the published evidence? To start with it needs to be acknowledged that the average efficacy of psychotherapy based on the scientific literature is systematically overestimated due to publication bias (Cuijpers et al., 2010a; Driessen et al., 2015; Cristea et al., 2017a).

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4599698/

[2] https://en.wikipedia.org/wiki/1976_swine_flu_outbreak

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835722/

> There is a strong anti-psychiatry movement online following in the footsteps of the anti-vax movement.

Yeah, I don't think it's fair to compare the two. I won't pretend to be an expert, but vaccines have a much better history when compared to antidepressants.

I agree that people suffering should seek help, and antidepressants may be key to that. But I also think we should be honest, for some they cause more problems than they solve.

It annoys me that any criticism of medicine puts you into the anti-vax camp. It's dismissive. Have we forgotten what happened with opioids?

Do the benefits of psychiatric medications have the same amount of evidence as vaccines?

They have the same kind of evidence. There are double-blinded studies demonstrating their efficacy or they wouldn't be on the market. When used properly most vaccines are highly effective and protect the large majority of people who get them. Maybe more importantly we understand in some detail how they work. Psychiatric conditions and their treatments are much less well understood. The medications generally don't have as powerful an effect as a vaccine. That isn't a reason not to use them.

Can you link to one?

Why would anyone want to continue to engage with your bad faith argument? Science doesn't work on the basis of "linking to one study" and to try to make a point by demanding one shows that you're not interested in an actual discussion. But, sure, here's a single, arbitrary metanalysis on several studies on the efficacy of a single antidepressant: https://journals.sagepub.com/doi/pdf/10.1177/204512531662907...

https://en.wikipedia.org/wiki/Bupropion#Depression

Thanks for proving my point.

Edit: Oh, you're the grandparent comment. I explicitly wasn't talking to you, since you're not even pretending to argue in good faith.

You've linked an article that cites one study which found weak evidence for the effectiveness in depression of one particular medication that is not widely approved for use in depression.

What is the point of this link supposed to be? That we shouldn't be prescribing bupropion to patients? Perhaps - most likely SSRIs and other drugs are more reliable, but it doesn't hurt to have a wider variety of classes of drugs to try.

"We"? are you a doctor?

"We" as a democratic society that can make new rules.

You're incredibly hostile in your remark to someone asking for a study. I haven't made any argument, and you continued with logical fallacies (strawman argument), I never said anything about one study proving anything.

I've actually researched this area for years, I was curious what your study would show and how it would evaluate the efficacy of antidepressants.

What your arrogant and antagonistic communication hasn't mentioned is that there is no link here to show anything a link to the brain, only to the symptoms (which you did mention), but failed to take the actual argument -- which is about chemical imbalances which Psychiatry as an industry (as an individuals) have been claiming they're close to since the 70s and have failed to prove that claim -- ever.

Blocking symptoms also needs to be shared with the accompanying side effects which were neglected both in your study reference and in any mention of the drug -- and you will find them _with all_ anti-depressants.

The particular one you mentioned, also in the Wellbutrin family, has had studies in eight different countries which detail their side effects, including suicide, mania, and psychosis.

Literally every psychiatric drug on the market has a clincal trial or study. In order to be FDA approved any drug has to have large scale double blind studies to prove it's safety and efficacy and those studies are public. That's the law. Here's how to find info on them. That isn't to say every drug is good, or that occasionally there are side effects which cause a drug to be withdrawn from the market, after approval, but that's very rare.

https://clinicaltrials.gov/ct2/help/how-find/find-study-resu...

Thank you. This is a much more intellectually honest response.

> That isn't a reason not to use them.

To give one example of where this is unclear, consider antipsychotics. Brain shrinkage is a known issue in schizophrenic patients that hasn't been ruled out as not coming from medication due to ethical issues in conducting the associated studies. Some schizophrenic patients also recover without them.

Comparing a valid concern like that to anti-vaxxers seems disingenuous to say the least.

Could you explain what is meant by "same amount of evidence"? Do you literally mean the number of articles published finding beneficial uses of psychiatric medications? The number of positive testimonials? Newspaper articles? YouTube videos?

Vaccinations have a scientific basis.

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