Reality lies somewhere in the middle, that is ADs are neither garbage nor life saving for all. It is absolutely personalized
Turns out I just needed to succeed in life and suddenly I’m not depressed anymore. I was keenly aware of what a loser I was and through marriage and a small amount of amphetamines am doing pretty well now.
It's better for me, my wife, and the world around me for me to manage my sphere of influence and use it to make a space that is comfortable and fun for my family. Learning that I have the power to change some things I don't like is gratifying.
I do worry that practicioners jump too quickly to antidepressents versus attempting other interventions, but I've also seen practitioners fail to have even basic alternatives. To quote one MD, "Oh that sounds bad... uhm, maybe therapy?" No referral, nothing.
We are starting to see Cognitive Behavioral Therapy take flight not just as a guided therapy but also something where the patient can just work through a workbook solo and try exercises on their own.
When your life actually sucks, no amount of positive thinking is really productive. At some point trying to turn everything into some kind of positive is basically self-abuse.
Using medication to force your brain to stop being unhappy in truly crappy circumstances is more or less the same.
To non-psychiatrists depression is a synonym for sadness.
To a psychiatrist depression is more about the functional impairment (social occupational effects).
How sad you are is only a tiny part of how clinically "depressed" you are!
Check out how depression is graded in research and clinical practice.
* https://www.mdcalc.com/calc/10043/hamilton-depression-rating...
* https://www.mdcalc.com/calc/4058/montgomery-asberg-depressio...
* https://www.mdcalc.com/calc/1725/phq9-patient-health-questio... (sadness isn't even the first question for the PHQ9!)
You could have a wildly effective antidepressants that doesn't make you happy, or you could be crushingly sad and not depressed (subclinical depression).[0]
Here's a real mind bender. In social anxiety (at least), people on the same antidepressants will have detectable differences in neurochemicals based on if they were told the pills would work, or won't work.
Mind bender.
As an N=1 report, I've been taking the Zembrin supplement (per the Astral Codex guy) for about a year, and it does _seem_ to knock out the sadness component. But this leaves the "unproductive" component, which is sometimes just a small drag, and at other times leaves me almost catatonic. Alcohol mostly fixes that, but has other problems, and I've lately quit.
No specific advice other than to just keep reading and experimenting. And if you're in a bad life situation, try to get out of it.
I tried to remember what I was like ten years ago and was definitely “severely depressed”, the first link said that. I was constantly agitated and anxious, had insomnia, would call people crying at 3am, and was obsessed with thinking I had some terrible illness all the time.
Despite some mild anxiety the same rubric says I’m normal now, so that’s nice.
The Adderall doesn’t really improve my mood so much as it lets me accomplish the things I need to do in a day, so instead of having a bad feeling in the pit of my stomach like the sword of Damocles over my head, I can relax.
Most interesting to me is how I was completely self absorbed and only had myself to worry about, and now that I have a wife and kids, I was less depressed in the years we didn’t know if our young daughter would make it to adulthood due to illness. My remembered experience is that my mid-20s when I was flunking out of college and playing WoW 60+ hours a week was a way more painful time in my life.
HN struggles with this concept in general.
But we can and should default to trusting advice from reputable people over hearsay; credentials inform our assessment of how reputable they are.
The last three years would like a word.
> But we can and should default to trusting advice from reputable people over hearsay; credentials inform our assessment of how reputable they are.
Tell that to the doctor 50 years ago that recommended his favorite brand of cigarettes. Or the experts that made the food pyramid.
There is nothing unusual about the last three years. Public health measures have frequently come with stiff penalties, since the beginning. “Sin taxes”, drug prohibition, water quality and vaccine mandates, etc.
The new problem is how internet people encourage others to self medicate with psychedelics. Everytime there is a trial study, you can read a lot of them.
This is a seriously annoying and recurring issue on HN. It's the "just hit the gym, bro" equivalent of silicon valley.
Doing it alone, or with some burnt out druggie friend is not likely to work except by pure accident, and making it worse is just as likely.
That psychedelics can worsen mental disorder?
Psychedelics can help you process bad experiences, and it can generate new ones. You can unlearn unhealthy biases or gain new ones. The papers tend to discuss this.
This claim, that doing it alone is unlikely to work, or likely to worsen your situation.
> That psychedelics can worsen mental disorder?
That sentence is not the same as the previous claim.
And I didn't suggest worsening was likely, but I think it's about just as likely as stumbling into a real treatment effect by accident, which is what I said. I'm not sure what data exists on the relative probabilities here, probably fairly little.
Most of the time, you'll just achieve nothing at all other than maybe an afterglow that makes you think you're better for a couple of weeks.
I've used a lot of different psychedelics in different settings over the years(pribably somewhere around 100 experiences with something like 10 different psychedelic drugs), Exactly once I've had a concrete, non-temporary improvement in mental health. Another time I had such a bad experience I took me months to properly recover.
Most of the times I felt like progress was being made, but it turned out just to be an afterglow effect that quickly went away.
Sometimes we don't have good data for good reasons.
But no, they're not.
I once had a life-saving surgery, which was a relatively new procedure and that I felt could sort of reasonably be called a "miracle surgery" (to make an analogy to your comment).
The surgery required all sorts of right settings- a sanitary operating room with lots of light and climate control and space for multiple medical staff to be in the right positions and complex after-care that involved medications, IVs, monitoring of vitals in a specific setting.
I would never say "since my surgery required the right setting, it's probably because it wasn't a miracle surgery". Nor even, "since my surgery required additional medications..." or "since my surgery required required subsequent physical therapy" or anything else.
Lots of treatments for lots of conditions are going to involve a mixture of many modes of treatment, or only be successful if multiple independent things are done in unison.
(Does HN support ~strikethrough~? On mobile or I'd try to find the official documentation.)
According to the article: "In around 15% of cases, they offer large benefits". If this figure is accurate, then I would somewhat speculate that this figure would drop to less than 5% just by fixing diet alone.
I'm not sure how many doctors would actually suggest a _correct_ dietary change. (the general advises avoid junk food , eat your greens and lots of fiber: while the former is correct the latter two is not, and can even be a disaster)
You are replying to someone explaining that their professional experience shows that the answer can be neither generalising anecdote because what works for one will not necessarily work for another nor simply broadly applying statitics because, to oversimplify, something which works perfectly for 20% and not at all for 80% as a terrible average rate of success but is indeed what you want if you are amongst the lucky 20%.
What are you complaining about in this take exactly?
I think this is a good example of misunderstanding the purpose of both science and medicine.
So doctors are looking for rare conditions in 1 of 10 people, where we all have rare conditions and a lot of them. We are walking bags of rare conditions. Thankfully there are direct to consumer While Genome Sequencing which is pretty easy to find your SNPs and look up which ones are attached to studies about being pathogenic.
I figured out that I have pathogenic TNXB mutation myself despite the gaslighting of many doctors for many years and WGS confirmed it.
It’s a totally different way of doing medicine that bypasses doctors.
Interestingly enough one of the treatments for my specific mutation is one sub class of anti depressant.