Hacker News Reader

Comment by coldcode | Hacker News Reader

I was briefly suicidal about 20 years ago, took anti-depressants for a couple of years, never needed them since. I can't say if they "worked" in a biochemical sense — perhaps the only affect was placebo — but they did keep me sane until my life circumstances improved. The brain is a very complex organ we still only vaguely understand, so "fixing" it is still very much a primitive response.

View on HN

That's very much a case of "working as intended". Most cases of depression aren't chronic, but can be self-perpetuating (low mood leads to a hard time fixing the things that make your mood low, which leads back to the low mood).

Anti-depressants can break that cycle long enough to let you get your stuff together to the point the cycle stays broken.

> Anti-depressants can break that cycle long enough to let you get your stuff together to the point the cycle stays broken.

Cycle-breaking is the selling point of using psychedelics for mental health treatment.

From what I can gather they're far more effective than "traditional" anti-depressants.

Early studies for new therapies are often much more promising than the therapy actually turns out to be once deployed on a mass scale. I absolutely agree that psychedelics should be explored as a medication of choice but some promising early studies don't mean that antidepressants like SSRIs no longer have a place or that the early promise will prove out in the long term.

Yes, the problem is in the "until my life circumstances improved". In your case they either improved on their own, or you don't talk about the possibly large amount of work you did to improve them. In my understanding (but it's not my field) the criticism is precisely of when antidepressants are used without a proper plan on that side.

I'm picking up a theme about the US health care system - that doctors respond to conditions caused by environment with a drug.

Our lifestyle (activity) is unhealthy, our food is unhealthy, our houses are nice but we don't get out of them, our relationships are unhealthy, even our culture creates anxiety. I speak for myself, but also everyone I know.

I just want to plus one this anecdote. I had a traumatic experience that led to my getting stuck in a very bad mental state. It became a cycle, where I didn't have the energy or willpower to do the things that could possibly have pulled me out of the pit.

Antidepressants gave me the mental space to break the cycle and get things back on track. Placebo or not, my mental health steadily improved once I started taking them, and soon I found myself able to get back to exercising, eating healthy, and doing the other things that led me back to a healthy life.

Edit to add: I am glad they were available when I needed the help, but I hope to God I am never in that bad of a mental state where I feel like I need them again.

This sounds like the correct way for these things to be utilized. In your case, you were approaching a bottom so in so many words, you were at the end of the line and the only way to go was up (if you wanted out of the predicament).

Where the prescriptions fail imho is with people that are nowhere close to bottoming out. They are in the murky middle and then get a bunch of scripts. They are not near destitution, so their prescriptions end up being perpetual. Taking antidepressants and other medication, and then going to therapy for years constantly talking about how much it sucks to be depressed about this and that means you are on a pathological treadmill. In sports, a “treadmill” team is good enough for the playoffs, not good enough to win a championship, not bad enough to get a top 5 draft pick that could change the whole team. They are stuck in the middle. Eventually treadmill teams realize they need to bottom out and trade most of their team so they can suck for a few years and rebuild with great draft picks (the crappier you are the, the better draft picks you get).

Bottoming out is, for better or worse, one of the most effective methods of snapping people out of an addiction.

I think it is underutilized when it comes to other issues. If you say your life sucks, then lose the job, lose the money, lose the friends, get homeless, and sleep out in the cold. Then if the natural will to live a better life doesn’t kick in, we’ll hospitalize you in a mental institution. Then we’ll try the medication. I’m pretty sure for most people, especially this demo of privileged tech workers, will at some point realize “hey my life ain’t that bad”.

In Tech we call this “fail fast”. Test your theory on how much you think your life sucks by making it suck even more, and test it quickly. Then you’ll get your perspective.

I have a coworker who got caught in that moddle ground as a teenager and is now middle-aged and still in an ssri. At some point can the brain still return to normal function if the chemicals are removed? Playing with feedback loops in my own body would terrify me. I suspect that is a major reason so few want to be in endocrinology. Its horrifically complex.

I’d look to addicts and alcoholics that turn sober. Their feedback loops are way out of whack from years of drug/alcohol abuse. Yes, you do return to normal. It’s just that addicts and alcoholics cause so much social and legal issues that they bottom out of their psychological issues in a more serious way.

If you are on a drug cocktail that mostly doesn’t let you fuck up your entire life, there will be no major turning point to snap you out of it. Clinically, this is a massive success. They are keeping people from being a complete disaster. However, the opposite of “not a complete disaster” isn’t necessarily “tremendously peaceful and happy life”. It can truly be the murky middle.

It can go on forever in those cases.

Reply on news.ycombinator.com