Medication for neurological issues isn't and shouldn't be the end-all-be-all but can indeed be a way to manage the issues at hand while teaching the tools needed to deal with the symptoms via therapy if possible.
I've seen a child's broken arm go from a scheduled intervention to an emergency surgery because the xray techs manipulated it poorly. The kid felt nothing thanks to the opioids she was given, and so didn't protest when they made a further mess of it.
The depressing days are the ones where my brain decides to sample from its wine cellar of my past mistakes without my permission.
I'm basing my understanding of what depression is on accounts of people who were depressed and got their meds. They always mention starting to actually feel some emotion. Like in case of this patient it was sadness about his children that made him cry for the first time after many years of just thinking how sad it was. Another case that ifluenced my tinking was illustrated accout by Hyperbole and half. After she got her meds she initially started to feel anger then joy then sadness in sort of explosive manner. As opposed to before the meds when she was feeling just empty and wanting to not exist.
The belief that underlying cause is not events or thoughts but physical damage to nervous system comes for me from experiments with ketamine I read about, where in vivo it shows to grant very rapid improvement in depression symptoms and in vitro it literally makes neurons grow new dendrites (or similar structures).
As for me personally I recently experienced a loss of a loved one and my life is very empty right now. So I'm thinking about it a lot and I have some of the coping mechanism the patient from this article invented. Like for example I started walking a lot this year and thinking about a lot not so great things when doing that. I walked to the point I injured my feet from the sheer amount of walking. Ball of my right foot still hurts after two months since I quit. But I still can cry or laugh or be excited about stuff and while some aspects that were never my strong suit like keeping my living environment orderly are now very inadequate I managed to function for 3 years with my sadness gradually lessening.
This belief that depressive thought have physical reason I think is helping me a lot. It makes easier to disassociate from their content.
I can just gloss over their content with statement that of course I'm making up bad stories and interpretations because I'm in a bad mood caused by bad physical condition. Once I improve it by eating, sleeping and all that I'll think more reasonable thoughts.
> misguided as not taking pain medicine when you have a broken leg until it has properly set first.
I'm arguing that pain killers are a calculated risk, and can lead to further trauma, even in situations of broken limbs. It's not misguided to forgo them entirely, if you can.
More broadly to the greater discussion: treating mental illness as a chemical imbalance risks further trauma because it risks masking the symptoms without treating the cause. It can be appropriate, but should not be taken in isolation as a potential cure or sole treatment.
This is a bad analogy in so many ways. Most pain medications are short-acting, so one knows pretty quickly whether they work. People prescribed antidepressants are told to wait weeks to see positive results, and a large percentage of them won’t actually see any-and even those who do see positive results, it is often unclear if the improvement is actually due to the medication, or due to something else instead (therapy, lifestyle changes, self-limiting disease course, etc).
If someone out there is taking antidepressants, and they feel it works for them-great. But having tried a range of antidepressants over the years (SSRIs, MAOIs, SNRIs), I’ve reached the conclusion that for me, they are pointless-I’ve never got any benefit from any of them. Some people will swear that they’ve saved their life - I see no reason to argue with that, it could well be true - but I’m sure there are many other people out there just like me. It’s a game of chance, and deciding not to play (or to stop playing) can be a rational and informed decision (at least for some people in some circumstances.)
But not even trying? I don't think that's a rational and informed decision. Sure, it might take two weeks, and sure, there are side effects, but if it works, it'll greatly improve your condition. If your condition is serious, taking a pill every day and waiting for two weeks isn't a huge investment.
It's like betting at roulette, you don't have to pay to bet $10000, but you'll get the full win if you're lucky. And you have to wait two weeks after each bet to know whether you won.
My GP told me that for mild to cases of mild to moderate depression, he’s hesitant about introducing antidepressants-be said they can worsen concentration at work, impairing performance, thereby introducing additional life stressors, leading to more depression not less. A person seeking antidepressants who was dissuaded from doing so by that advice is arguably making a much more informed choice than if he’d just given them what they wanted from the start.
Of course, there comes a degree of severity (drawing that line is sometimes a subjective judgement call) when he doesn’t have these qualms any more.
Although (this is my view, don’t know whether he agrees), if one’s situation is severe enough to warrant trying antidepressants, they might not be enough. While I’m no great fan of antipsychotics, if I was in a real crisis situation, I’d much rather something that delivers noticeable results right away, than something which might take 2-4 weeks to do nothing.
Doctors and the patient are the best judge for the benefits and risks of living with certain conditions vs being medicated for them. In most cases there aren't side effects.
It not that weird. The brain is the most complicated organ in the human body. Science understands how the kidneys work but largely doesn't understand how the brain works.
If you think these drugs are worth trying, I think you should make the argument without these sorts of analogies.
"Doctors and the patient are the best judge for the benefits and risks of living with certain conditions vs being medicated for them."
Okay, but if you were to follow this advise you should scold anyone who says "People with mental health problems should take drugs..." That's for the doctor and patient to decide, right? But you only scolded the person pushing back at this statement.
It's not an analogy. There is no mechanical difference between someone using Amphetamines to treat their ADHD and someone using insulin to treat their diabetes. There are just as many external as internal factors that go into how someone can get diabetes and what dosage of insulin they need at a specific moment in time. Science has advanced to a point where diabetes specifically can be monitored easily by a patient. The same is true of hypertension.
The difference for mental health issues is that there is no easy quantifiable way to diagnose someone.
Every organ is the most complicated organ in the human body, at a certain level every organ has a mechanism science doesn't understand yet. That's not a valid argument.
The same is true for pain management. And Multiple Sclerosis.
I would suggest you look into the modern state of neurophysiology and neuropsychopharmacology. The "we don't understand" is not true anymore. The reality is that there are so many factors affecting a certain visible outcome that it's hard to specify a root cause.
I am not a medical professional, I have only taken some 300 and 400/grad level courses in psychology.
That sounds like "we don't understand" except now we slightly better understand how little we understand. We don't even know how Tylenol works.
No, that’s blatantly untrue. The liver is one of the simpler ones as it’s all single cells, and the brain is definitely the most complex. I’ve never heard anyone say they are equally complex.
That doesn’t mean we understand everything about the liver, but we are hell of a lot closer than the brain.
Taking a step back, there is only one organ I will admit we understand better than the brain, the heart. It's the only organ where we know enough to replace it with a mechanical counterpart. We don't know enough to make it last a long time, but it's enough to prolong someone's life in a meaningful way.
In contrast, mental health diseases are generally diagnosed by talking to the patient, because there is little understanding of the underlying biology.
"I am not a medical professional, I have only taken some 300 and 400/grad level courses in psychology."
Do you believe your professors would agree that the mechanism of treating ADHD is the same as treating diabetes, or that the kidney is as complicated as the brain?
"I would suggest you look into the modern state of neurophysiology and neuropsychopharmacology. The "we don't understand" is not true anymore. "
Last time I "looked into it" did not result in a belief that we understand the brain.
I just "looked into it" for a minute or two, and here's an interesting APA article from 2012 where a professor of brain science and Nobel prize laureate is stated to believe the field is where cardiology was 100 years ago. I recommend reading it:
https://www.apa.org/monitor/2012/06/roots
I half expect you are going to tell me, with great enthusiasm, that everything important was learned over the last 10 years.
I would urge you to look into the recent advances in neuroimaging.
https://www.biomedcentral.com/collections/advances-in-neuroi...
https://www.additudemag.com/neuroimaging-adhd-findings-limit...
The reality is the news tools for research are still in their infancy. It's not close to the maturity that the diagnosis of diabetes and other diseases are at. But there is a very clear path forward, it's no longer theoretical.
There is still no clinical definition of insulin resistance.
And as far as ADHD and Diabetes go, yes I can confidently say the current medications and therapies that are available for Adhd can address most cases similar to how insulin does for diabetes. Treating metabolic disorders is as complex as treating ADHD. Stimulants don't "fix" ADHD any more than insulin does for diabetes.
The complication doesn't come from the lack of science, it comes from the fact that behavior and cognition is affected directly by the stimulus people are exposed to. I can't play music that will distract a kidney but I can distract a child very easily the same way.
I did read the article you listed,
"In McNally's view, there's little danger that mental health professionals will forget the importance of environmental factors to the development of mental illness. "I think what's happening is not a battle between biological and non-biological approaches, but an increasingly nuanced and sophisticated appreciation for the multiple perspectives that can illuminate the etiology of these conditions," he says.
Still, translating that nuanced view to improvements in diagnosis and treatment will take time. Despite decades of research on the causes and treatments of mental illness, patients are still suffering. "Suicide rates haven't come down. The rate of prevalence for many of these disorders, if anything, has gone up, not down. That tells you that whatever we've been doing is probably not adequate," Insel says."
He argued exactly what I am still arguing. Specific to how far out he thought these tools of diagnosis were, I would absolutely disagree. Having a Nobel prize doesn't mean his predictions are prophetic.
It's not just the field of neuroscience, the last 10 years of technology have reshaped the entire landscape of medical diagnosis and treatment. If I said that AI will be able to help diagnose cancer in the next 10 years in 2012, most people would think I was being optimistic to a fault, but that's where we are now. The fMRI was invented in 1991.
From APA, if you clicked on neuropsychology and scrolled down, you would have seen Michael Treadway’s fantastic work at Emory on the relationship between inflammation and stress and how it links to depression.
https://www.apa.org/monitor/2021/09/career-lab-depression
"“What I’m seeing with my research, and that of others, is that there are many types of depression, schizophrenia, or any number of mental illnesses, each with its own source,” Treadway said. “I would really like to get to the point where we have discrete definable pathologies that are measurable, using objective tests, for different types of depression, for example, or even different symptoms of depression. That could really open up a world of new treatment possibilities.” "
I can only hope you gain some of my enthusiasm after reading some of these.
This sentence presumes ADHD is a medical discovery, not a social construct, and several other things other things which are debatable.
(This is not to discount the suffering of anyone being treated by a psychiatrist, suffering is real, diagnostic criteria, the objective reality of mental health categories, and what percentage of people benefit from drugs is debatable).
"the last 10 years of technology have reshaped the entire landscape of medical diagnosis and treatment."
I care about whether people are healthier than they are 10 years ago, not how exciting it is to read an article with the words "cancer" juxtaposed with "A.I."
This quote suggests people aren't getting any healthier, which suggests your claims about the wonderous advances over the last 10 year may be overblown:
"Suicide rates haven't come down. The rate of prevalence for many of these disorders, if anything, has gone up, not down. That tells you that whatever we've been doing is probably not adequate,"
I agree with your last point though. Mental illness is the result of a complex mix of social/personal, political, and financial stressors, biochemical weaknesses, and unhelpful cognitive habits. But current diagnoses are behavioural, not contextual. And treatments tend to concentrate on one factor to the exclusion of others.
Having said that, I think "you'll feel better with insights" line of psychoanalysis continues to be bullshit. Analysis has a terrible record of delivering useful results, and "insight" usually means "learning the mental model the therapist uses without questioning it."
There are better and more effective cognitive and psychotherapeutic techniques which work more quickly and are cheaper. Combining them with chemical and welfare help shouldn't be an issue.
Diabetes can sometimes be treated with methods other than insulin [0]. I think that these dietary treatments are always a better option than insulin.
The same way with high blood pressure. High blood pressure should always be managed by "diet and exercise" before meds are brought in.
All of these drugs (diabetes drugs, high blood pressure drugs, heart medication) that are regularly being used to treat lifestyle diseases should be seen as a last resort with the main goal being to help people get to a point where they don't need them.
I mean sure. Try. I had 10 years on Hypertension meds, 15 off, and I am back on despite significant weightless and increased physical activity. Idiopathic can happen.
Antidepressants fall in the same category for me, even though I always avoided them. But if things are really dark, I would use any tool.
Anti-depressants don't take pain away. In some cases, they make it possible to even feel pain.
I'm ~6 years into my therapy journey at this point and I'm not on antidepressants at the moment, but I have been in the past when I needed them.
I'm fortunate that I was able to stop, and that was partly because I put my work life on hold to go on sabbatical and use all of my capacity on myself for awhile. But that doesn't mean everyone can or should.
I think it's also worth noting that especially now, mental health issues are increasingly caused by advancements in technology we don't yet know how to cope with, and from which there's very little escape.
Meds allow one to do the hard internal work that would be significantly harder to achieve if they don't have the capacity to keep a well functioning life up and running.
I think only embracing one or the other exclusively is where things start to go wrong, and what I took from the article.
Isn't this common knowledge and accepted? I feel like debate makes no sense unless your motive is create more mistrust in science
“Recently the thought occurred to me that we have antidepressants back-to-front, as it were. The listed side-effects of these drugs (mostly SSRI’s) is really the main action, and the advertised effect is the real side effect.
In other words antidepressants reduce anxiety and depression as a side effect of reducing libido – in the more inclusive sense of ‘life force’. Perhaps the relief of depression occurs because anxiety and depression are symptoms of libido or life energy hitting up against an obstacle or difficulty either in the internal or external world. This obstruction interferes with the ability of libido to express itself. Reduce libido and the unpleasant effects (depression and anxiety) of libido encountering an “obstruction” are correspondingly also reduced.”
It's hard to see where the libido is in someone who doesn't want to get out of bed, even to eat. Or in the case from the article, someone who feels like a piece of wood, and who paces the hospital like a Roomba.
All effects of drugs are effects and they become side effects when they are undesirable. You used to be able to buy the same medication as either a decongestant and an appetite suppressant. In either case, the other effect is a side effect.
On the other hand, if you took an antacid every day for your depression, and had no effect on it, for years, you might consider that it didn't work. However, the analysts didn't think that was possible to say about analysis.
Here is a link for Study protocol for a randomised, placebo-controlled, single-blind phase II study of the efficacy of morphine for dyspnoea in patients with interstitial lung disease (JORTC-PAL 15) https://bmjopen.bmj.com/content/11/5/e043156 .
I would suggest you look into the drug approval process in the US, I think you will learn a lot.