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Comment by asveikau | Hacker News Reader

> It doesn't make sense to make blanket statements about "the drugs" when psychiatric drugs differ widely in this regard.

> I'd be cautious of taking advice from anyone who makes blanket statements about "the drugs". This is bordering on uninformed anti-psychiatry.

Yeah, as someone who has been close to people who need antipsychotics, I sometimes feel the anti-antidepressant crowd extrapolates to all psychiatric drugs and this is very scary. Especially since people with conditions like schizophrenia or bipolar frequently think they don't need medication.

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It's interesting that anyone other than the R&D arm of the pharma industry even cares how it works.

From the medical side what's important is what risk/benefit which is independent.

Antidepressant as a term is really only for convenience which the medications themselves being quite broad in action.

Antipsychotics too are having a bit of a revolution, the first generation seemed to all be about D2 blockade, the second generation acting on 5HT-2a much more than D2. Finally, pimavaserin acting only on seratonin (5HT-2a) and not on dopamine at all [0] now there's SEP-363856 [1] which has action not at D2 or 5HT-2A but TAAR1 and 5HT-1A.

The point is that psychiatrists are not particularly married to any mode of action or mechanism. Only the results.

[0] https://nbn2r.com/search#drug/90

[1] https://en.wikipedia.org/wiki/Ulotaront

I am not anti-antidepressant, or drugs in general. Bipolar people get huge benefit from their medications. And their families!

The ones I know also say there are times they miss the emotional highs. It's probably why they (and schizophrenics) go non-compliant.

I think it's different for a lot of people. But one common thing is to get grandiose and think that all problems are with other people. Why would such a person need meds? Clearly there is something wrong with the person who might suggest that.

Then potentially add paranoia on top of that...

Edit: and as the sibling comment said, people can feel pretty shitty on them. I know I've heard and been sympathetic to that for many years, so don't want to sound insensitive by only focusing on anosognosia.

I think you might want to do some research as to why schizophrenics might end up non-compliant. Antipsychotics are serious drugs that, historically, have had severe side effects. Additionally, they’re rarely a complete solution (people can still have delusions and hallucinations while taking medication). Additionally, like other psychiatric medication, not all antipsychotics will work for people, sometimes they’ll stop working, etc.

Antipsychotics are nasty medications. Here are the list of problems I’ve had:

- Sedation (too tired to function)

- Emotional numbness if I need to increase the dose to stop an episode.

- Headache

- Loss of balance.

- Impaired fine motor control.

- My arms and legs don’t move properly. I’ll command my arm to move, and it only moves halfway. I used to fall a lot before I learned to be very careful walking.

- Inability to orgasm.

These get pretty bad in the first four hours after taking them. During the day, if I get dehydrated or have low blood sugar, I can easily get incapacitated and be unable to drive.

And no, my dosage isn’t too high. This is the lowest effective dose I can be on. The alternative is lithium, which can be worse.

There are many, many, many pharmacy drugs that can stop suicidal thoughts fast and don't have the track record of the "modern antidepressants". Long, long, long track records. Small dose lithium and lamotrigine come to mind right away. But how they work--nope, not clear. Okay, we'll agree it's not serotonin, how does that help us? Would it help if American doctors could prescribe 3 weeks for a spa holiday like European doctors? Maybe, for low-level depression, but not for suicidal thoughts, that just won't cut it. There is bipolar I and bipolar II and so big differences. Schizophrenia, big difference. But again, knowing that it isn't serotonin, that's nice, now what?

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