Hacker News Reader

Comment by knaik94 | Hacker News Reader

It's weird that we treat psychoactive drugs differently than other drugs. We don't have a fear of a diabetic becoming dependent on insulin or someone with high blood pressure becoming addicted to beta blockers. There are side effects is a bad generalization of all drugs used to treat mental health issues. When I say I am taking beta blockers, most people comment on how I am a bit young to be taking them, but when I was prescribed benzos for the same condition, everyone decided to become my doctor and tell me what I should and shouldn't take. Endless stories about how then knew someone who got addicted to pain killers and became homeless and how they heard benzos are just as bad. I chose to switch off benzos to beta blockers.

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.

View on HN

"It's weird that we treat psychoactive drugs differently than other drugs. We don't have a fear of a diabetic becoming dependent on insulin or someone with high blood pressure becoming addicted to beta blockers."

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.

I do. I equally scold anyone that says MDMA or LSD is the cure all of depression.

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.

Because the kidneys are much more simple than the brain, diabetes is diagnosed with a blood sugar test.

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.

This is where the problem is and what I argued above as well. People handwave the efficacy and use of medication by arguing "we don't understand". That is exactly what you are doing. A lot of my knowledge comes from when I was able to work with surgeons at the local university hospital in order to do signal processing on data collected from electrodes that were installed into patients who suffer from Parkinson's, for DBS.

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.

I don't think you can decouple mental health from politics and economics. Poverty is a huge stressor, especially when combined with homelessness. So to quantify suicides accurately you'd have to exclude the effects of the relatively benign 90s with the current outbreak of extreme financial stress.

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.

"Treating metabolic disorders is as complex as treating ADHD."

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,"

The validity of psychiatric diagnoses is far more debatable than the validity of a (non-psychiatric) medical diagnosis such as type 1 diabetes mellitus. The later is - at least to a certain degree - a natural category - it is very open to question whether any of the former are. I can’t agree with drawing some parallel between diabetes and ADHD while ignoring this “elephant in the room”

“Every organ is the most complicated organ”.

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.

The liver itself might be simple but the complexity is in the enzyme pathways. The marker of "elevated liver enzymes" doesn't tell us much.

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.

> 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.

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.

That is weird.

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.

... until you hit 55-60 and irreversible changes to your body's hormonal system mean diet and exercise alone cannot control your hypertension, or late onset diabetes.

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.

Reply on news.ycombinator.com