It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?
Luckily, sertraline was an almost instant cure.
I can come off it for periods, but it tends to reoccur after a while. So, it does mean I have to take a drug indefinitely, but is that really a problem? It turns my life into one worth living.
The reason we can't take sleeping pills daily is because they stop working in fairly short order. But if, like antidepressants (typically), they didn't lose their effectiveness over time, would there even be a problem with using sleeping pills if you had trouble sleeping?
Why buy 1mg pill when you can buy 100mg pill?
There actually is a condition that calls for extremely high (100mg+ doses), but it is a very rare thing, no one should ever consider that much without instruction from a doctor. But you'll find it right next to the normal <=5mg doses without any explanation.
They also give you low quality sleep, because they just knock you out. It's not a natural kind of sleep.
At least that's how it was a while ago. Maybe the situation has improved.
Fortunately it has. Orexin antagonists don't cause dependency and provide high-quality ("natural") sleep.
Chemistry trumps psychology. Good enough chemistry enables cognitive treatments. But to fix the wrong chemistry you need chemistry.
When looking at the same reality one persons sees the situation as OK and another as a an endless and hopeless disaster it is hard to tell who is right. A depressed person would tell that most people around him are wrong and are optimistic only because they don't understand how bad all is.
No, anxiety and depression aren't simply a matter of perspective.
Or because of a legitimate chemical imbalance or some other cognitive issue they can’t control alone. Right?
- https://www.psychologytoday.com/us/blog/insight-therapy/2022...
and
> "the etiology of depression is incredibly complex, the narrative that it is caused by a simple “chemical imbalance” persists in lay settings. We sought to understand where people are exposed to this explanation"
- https://pmc.ncbi.nlm.nih.gov/articles/PMC11752450/
and
> "Onset of depression more complex than a brain chemical imbalance. It's often said that depression results from a chemical imbalance, but that figure of speech doesn't capture how complex the disease is. Research suggests that depression doesn't spring from simply having too much or too little of certain brain chemicals."
- https://www.health.harvard.edu/mind-and-mood/what-causes-dep...
and
> "Analysis: Depression is probably not caused by a chemical imbalance in the brain – new study"
- https://www.ucl.ac.uk/news/2022/jul/analysis-depression-prob...
(These are not thoroughly checked articles, they're the first few search results; however claims that depression is caused by a chemical imbalance ought to be able to show where that idea originated, how the imbalance is measured in patients, where that hypothesis is supported by evidence, why antidepressents don't fix depression in half of patients, and several more suspicious things).
(I've written paragraphs and paragraphs thinking through some of my views in this thread. You wrote three words naming a thing which doesn't seem to exist. If you want more engagement, engage more. What words am I twisting? Where did you say it was anything more detailed than that? What behaviour that people "can't control alone" are you talking about?)
For emphasis: I do not think it is simply/exclusively “chemical imbalance.”
I'm incredibly optimistic and am content with my position in life. My default state is being mindful of the present and I don't think about things too far into the future. I very rarely ever feel stressed out over things in life.
However, none of that changes the fact that I feel completely empty and find no joy in things. Interests are nearly non-existent, emotions dialed to 1, and the only thing I'm motivated to do is lay in bed staring at the ceiling... unless I'm on sertraline.
Admittedly that's just anecdotal, but I worked in a clinical neuroscience lab researching treatments for severe treatment-resistant depression (read: people who tried so many options including CBT that they even tried electroshock therapy). The only thing that helped those subjects was a regimen of personalized neuroimaging-guided transcranial magnetic stimulation for 10 minutes every hour for 10 hours every day for a week. Even then, it wasn't permanent. Some saw improvement for months, others only weeks.
For some people, it's not just a matter of "perspective".
Maybe the idea that we should find joy and feel full is wrong?
We are on a random planet circling a random star in an unfathomable Universe.
STOP looking for meaning and you are liberated. The quest for meaning by itself might be exhausting and makes you feel depressed.
It's not as liberating as you might think. A joyless existence is either suffering or nothingness. A life without meaning, either internal or external, is one where nothing is meaningful with no motivation thus one of crippling catatonia til death.
All I can say is just that it doesn't feel good and if you can't feel good about anything, your calculus of your life inevitably leads to the conclusion that existence isn't worth it.
Go somewhere where you need to work physically you az off to afford daily food. You will be so exhausted eventually that: 1 you will not have any energy left for thoughts. 2 If you have any energy left, you will give it to angriness which will lead to other circumstances which are none related to find the meaning of life.
Ignorance may lead to happiness and friends :)
I didn't have anxiety, just depression. I rarely thought. I existed on autopilot. I was physically exhausted on a daily basis as a division 1 athlete in college. Often went days without eating either because I simply forgot to eat or forgot to make time for it between classes and training. Didn't change anything.
I think something people are forgetting is that motivation is either driving you toward something you want or driving you away from things you specifically don't want. A complete lack of motivation means I wasn't motivated to do anything to get something, but also I wasn't motivated to anything to avoid something either. I wasn't motivated to eat to avoid hunger pangs. I wasn't motivated to quit my sport to avoid routine physical exhaustion. Instead, my empty autopilot existence just freely acted on the expectations of those around me as a proxy for motivation.
If One can´t be happy with what One have now, One will never-ever be in any circumstances.
This is not your case certainly but is connected with the autopilot (meaning we don´t get to choose.
This one came out good :)
In my own opinion, we need to stop viewing "mental health" as a separate class of conditions from general/physical health. A mental illness is a health/medical condition just like any other and shifting our views and diagnostic criteria in that direction would do a lot to remove the stigma associated with mental illness.
Someone with depression has a chronic illness, not a temporary "it's just in your head" condition.
In case of depression in particular, it appears to be a label given to a big bag of various issues you may have causing similar symptoms.
To nitpick: The mind is applied biochemistry. Psychology intervenes in the chemistry, like many other activities do. The goal of that is to solve the root cause so that your future levels will be maintained at the right level, instead of just forcing the level by sourcing the respective chemicals externally.
A good rule of thumb in biology and particular any kind of hormone production and balance is "use it or lose it" - if you start regularly receiving something externally, internal production will scale back and atrophy in response, in many cases permanently.
There are ways to "hack it".
For example, ~6 months ago I started trt (testosterone replacement). It was the best decision health wise ever. I feel way better psychologically, first time in my life I managed to stick with cardio training for so long (before 3 months was the most). There are other benefits too.
So what about the "loose it" part? Well there is a hormone called HCG one can take a twice a week to trick one's balls into producing some natural testosterone. Its use prevents atrophy and infertility.
Interesting.
Well, I don't think you'll be able to avoid testicle atrophy even if it minimizes it, but the important part is understanding the tradeoff. Particularly, that adding testosterone will cause changes throughout your entire body (including, for example, shortening life expectancy a bit), and that adding other hormones to the mix will likewise cause changes around the entire body and not just one single process or organ.
But it's your body, your life, your priorities and decision. I also wouldn't consider it a good decision health-wise to take steroids to get huge, but I have no problem with someone deciding that absurd bulk is their main goal in life and worth the tradeoff.
I only take 250iu twice a week. 6 months in I can't see any atrophy. Some people take it every other day.
This hormone HCG is very interesting. In fact it is what many urine pregnancy tests test for. I wonder if I did a pregnancy test it would cone out positive :-)
But, the reason why I'm talking about it is to explain that it works the same as another hormone called LH produced by the pituary gland that regulates natural testosterone production by testes
So when one takes external testosterone the mechanism through which body shuts its production down is by shutting down this LH hormone.
By taking HCG ones testes are told to make testosterone. Not a lot of it, but it seems to be enough to prevent atrophy so far.
> Particularly, that adding testosterone will cause changes throughout your entire body (including, for example, shortening life expectancy a bit), and that adding other hormones to the mix will likewise cause changes around the entire body and not just one single process or organ.
For sure. Many of these effects are very positive. For example I was a little pre-diabetic, this has improved a lot (but one may argue via exercise - then again I manage to be consistent with the exercise thanks to psych. changes caused by the testosterone).
Another is these psychological changes. I feel more "stable". I never was really unstable, at least I never noticed, but it feels better. Like, whatever happens I can most likely solve it kind of feeling, even when things go wrong.
Finally about the shortening of lifespan. I think I offset this by exercising, but another factor is getting regular blood tests. The doc monitors things like hematocrit etc. I'm told to drink a lot more water, to measure blood pressure even though I never had high pressure etc to keep it in check.
I think most problems happen with people that do not realise their blood gets "too thick", they get high blood pressure, miss it for years and end up with circulatory system issues.
It is a tradeoff. Not everything is ideal. One negative side effect I did get is worse skin until I found a procedure to exfoliate/moisturise and so on. It's a bit of a pain in the arse as before I'd just have quick showers. Now it takes longer. But so far it is worth it.
We don't really know how SSRIs work, but there's some evidence that it's through desensitizing serotonin receptors, not directly addressing the lack of serotonin. If so, "use it or lose it" doesn't apply; long-term adaptation is the point, and SOMETIMES does persist after quitting.
Very basic and very often wrong rule, so take it with a grain of salt.
Insulin for example is the opposite. "lose it then use it" would be a general rule for type 2 diabetics where insulin resistance commonly due to weight gain is the primary problem. Losing the weight leads to better uptake and usage. For a type 1 "lose it then use it" you typically lose the ability to produce insulin to an an autoimmune disorder, then are stuck using insulin for the rest of your life.
The body itself typically attempts to main homeostasis, but at population scales this is something that is going to have a massive range of ways it shows up. Evolution, at grand scales, doesn't care if you survive as long as enough of your population survives and breeds. At the end of the day you might just be one of those people that was born broken and to work properly you need replacement parts/chemicals. A working medical system should be there to figure out which case is which.
You're describing entirely orthogonal issues. In case of insulin resistance, your natural production is running full blast with demand exceeding supply because the consumer stopped caring about the hormone. In case of autoimmune disease, the natural production was killed - you can neither use nor lose what is already dead, and even if some capacity was left it will either soon be killed or atrophy under external insulin, but it will not be mourned.
So no I would say it is exactly the same - "use it or lose it" - but that does not mean that there is never a reason to manually overrule your body's attempt at homeostasis through direct manipulation. It just means that there is a very significant consequence to the process.
> The body itself typically attempts to main homeostasis, but at population scales this is something that is going to have a massive range of ways it shows up.
As a somewhat sidenote, this is also why I dislike the idea of trying to classify people into "normal" and "divergent/atypical". In my eyes we're all normal people and an entirely normal aspect of being a human is that we all differ and have individually specific needs by virtue of being built by a trillion micro-meter sized workers, each with their own hand-copied version of the blueprint, only caring about the millimeter of you in their immediate vincinity and not really talking to any of the others.
A few HN submissions recently are in the style "thinking about doing the thing is not doing the thing. Planning the thing is not doing the thing. <etc etc>. Only doing the thing is doing the thing". Comparing a brain to a large software project with bugs hiding in it, in that vein giving the computer 11 hours of 'sleep' each night is not debugging the code; overclocking or undervolting the CPU is not debugging the code; installing the latest updates and patches is not debugging the code. 'knowing there is nothing to worry about' is not debugging the code. Only debugging the code is debugging the code. Reading a badly explained idea on an internet comment and dismissing it with a mocking "thanks I'm cured" isn't debugging the code. Saying "I've tried everything" isn't debugging the code.
A more specific example, if you are going on a rollercoaster and you are experiencing physical and mental symptoms of worry - nervous, anxious, angry at the person pushing you to ride, twitching and trying to back away, eyes looking around searching for an exit, coming up with excuses to do something else instead, nervous shaking, dread tightness in the chest, affected breathing, perspiring, gritted teeth, etc. etc. then washing over all that with "I know there is nothing to worry about so this must be a problem of brain chemistry" seems a clearly incorrect conclusion.
Such a person clearly has a worry. Quite likely one that's out of proportion (e.g. "rollercoasters kill thousands of people every day!"). Possibly one that's completely incorrect (e.g. "going more than 10mph makes people's insides fall out!"). Quite likely a less clear and less obvious one - which could be anything, e.g. they saw a documentary about a rollercoaster which behaded a child and that's their only thought about rollercoasters; they saw a show about fighter pilots pulling high-G maneouvres and passing out and think that will happen to them on a big rollercoaster; they see the rollercoaster track and support flexing and don't understand that a some flexibility doesn't mean weakness; they went to a theme park as a child and older children bullied them into riding a scary ride and they wet themselves and figuratively died of shame and buried the memory; they were pushed into learning to drive at 15 by their wicked stepfather and this is pattern matching to the same kind of experience; etc. etc.
Saying "there is nothing to worry about, rollercoasters are safe enough and you know it, so your brain chemistry must be broken" isn't debugging the problem. It isn't even explaining the problem. Why would broken brain chemistry particularly affect them at a theme park, or in Winter, and not the rest of the time? How was this broken chemistry identified and measured and quantified and that hypothesis proven?
Likewise, just because the parent poster has tried sleeping and exercising and taking Vitamin D, doesn't address that humans evolved in Africa, connected to oceans and trees and tribal living, and not commuting to a fluourescent lit beige box filled with strangers writing JavaScript while being bombarded with news items about wars and genocides and stories of how everyone else is having a wonderful Christmas, earning more money than you, with a cost of living crises always on their mind, etc.
> "Good enough chemistry enables cognitive treatments."
Drugs can force people to carry on with a life that's making them miserable when they have no other available options to find out why and fix it. That isn't evidence that "there is no root cause"(!). Any more than turning it off and on again can let you get on with your job, but that doesn't show there's no root cause for a program locking up.
> "then you deduce that the black cloud is produced within."
And you have a lifetime of your prior experiences affecting your mood. When you remember that your aunt hit you when you swore at the dinner table, or you saw someone slip on ice and fall over and break their wrist, or watever, every life learning experience is "the mood is produced within".
Ha, of course it can be! Our brain chemistry is not stable through our life! Many children are born with epilepsy, but some people develop it later in life. epilepsy, like all neurological disorders are nature AND nurture, genes AND the environment.
Using your roller coaster analogy, there very well may be genes that control; how much fear someone experiences when riding a roller coaster. The problem society has is telling people that they all should be able to not have feear riding a roller coaster and if youa re too afraid to ride a roller coaster you should take xanax.
Citation requested. Because, y'know, it's not like your leg muscles suddenly don't work from age 40-50 and then start working again and we say it's because of unstable "leg chemistry". It's not like your stomach, liver, kidneys, <organs> suddenly stop working after you lose your job or your life partner and we say it's both inexplicable and because of a deficit of "body chemicals" and nod agreement with each other that "body chemistry isn't stable" through a lifetime.
These are just unsatisfyingly crappy non-explanations.
And quick attempts to assume that Doctors, Neuroscientists, Psychiatrists, Psychologists must have a better detailed knowledge of brain chemistry and I'm just falling for nonsense seems to find that they actually don't, and they don't agree that "brain chemistry" is a good explanation, and it can't be measured in a patient, and the idea isn't strongly supported by evidence, and even the mechanism of action of "drugs which correct brain chemistry" isn't agreed on, and when given to people to "correct brain chemistry" it often doesn't make the problem that was blamed on brain chemistry go away.
> "there very well may be genes that control; how much fear someone experiences when riding a roller coaster."
I will lump "genetics" in as another pet-hate unsatisfyingly crappy non-explanation that people tag onto whatever they want so they can stop thinking about it further. There probably are many genes which affect how much fat bodies store, or burn, or food cravings, or what constitutes hunger, or production of various leptins and grehlins and insulins and stomach acids, but that doesn't mean "I'm obese because of my genetics" is any kind of explanation at all. Or "I have this personality because my parents and grandparents had it, it's genetic" is an explanation. Downe's Syndrome is a good use for genetics as an explanation. "I have a macro-scale set of vaguely related behaviours, symptoms and body effects and no clear cause, it's my genetics" isn't.
Even if you have sequenced your genome, and have some specific gene that is associated with extra fat storage, genes can be turned on and off through a lifetime by behaviours and environment. Having a gene from birth doesn't mean it's being expressed and is therefore causing a specific problem, or that the problem can't go away and can't be fixed. ( https://www.cdc.gov/genomics-and-health/epigenetics/index.ht... )
> "The problem society has is telling people that they all should be able to not have feear riding a roller coaster and if you are too afraid to ride a roller coaster you should take xanax."
I agree with this. Society likes assuming everyone is the same. Imagine if we collectively noticed that Adrenaline gives people "a burst of strength" and decided that daily exercise, individual strength training plans, gym visits, were all too much bother and that ageing adults were suffering from "an imbalance of Adrenaline" and when they struggle to carry their massive haul of groceries in from their car they should carry an auto-injector of Adrenaline to help their chemical deficiency.
Ohhh, leg chemistry, good choice! You know that leg "chemistry" is control by neurotransmitter release, yes? So you must have never heard of Familial Periodic Paralysis then. Let me tell you what happens with that, because it happened to me while taking Seroquel. Familial Periodic Paralysis is also called Hyperkalemic periodic paralysis and is due to mutations in the gene that encodes the alpha-subunit of the skeletal muscle sodium channel (SCN4A).
https://www.ncbi.nlm.nih.gov/books/NBK1338/
"The paralytic attacks are characterized by decreased muscle tone (flaccidity) more marked proximally than distally with normal to decreased deep tendon reflexes. The episodes develop over minutes to hours and last several minutes to several days with spontaneous recovery.
Some individuals have only one episode in a lifetime; more commonly, crises occur repeatedly: daily, weekly, monthly, or less often. The major triggering factors are cessation of effort following strenuous exercise and carbohydrate-rich evening meals. "
Look at that! Their muscles stopped and stared working again!
And yes, this happened to me while taking seroquel because it lowered my potassium so much it affected my nervous system.
Any good psychiatrist will tell you that they have no idea what is going on. But that does not mean neurotransmitters cannot be changed and that they do not effect behavior.
> I will lump "genetics" in as another pet-hate unsatisfyingly crappy non-explanation that people tag onto whatever they want so they can stop thinking about it further.
As someone who, as an armature geneticist, helped design a genetic study for Stanford, can I say that I put more energy into thinking about these things over the last 45 years than you can even imagine?
>Or "I have this personality because my parents and grandparents had it, it's genetic" is an explanation.
I have my hair color, height, skin color, all the physical traits from my parents, so why do you think the brain is not physical as well? Or or adrenal system? The brain is effected by genetics, this is true as has been shown clearly as a risk for schizophrenia. I have no idea why people think our mood, which is dictated by our thoughts which are created and sensed by our brain, which is a physical organ, does not have anything to do with genetics and neurotransmitters.
and then you go on to talk about epigenetics, like that matters by genes don't? Do you know that genes control the epigentic response? Genes like DNMT1? So people with differences in DNMT1 will have different epigenetic responses?
> I agree with this. Society likes assuming everyone is the same.
So how are we different? nature AND nurture. Genes AND environment. I agree the solution to these problems are wrong, but your solution are just as bad as the ones your are prescribing.
Listen, there are times when our neurtranmitters are supposed to be different, like when we are in pain or when some one dies. But some people, like me, have these changes regardless of the situation and we can like them to other environmental factors like diet, sunlight, weather, etc.
I could tell you whey and why I think am so sensitive to the world but I doubt you would listen, because no one listens, because everyone knows.
If your old fashioned TV glitches and you hit it and it works, that doesn't mean it had a percussive imbalance. If you sledgehammer your brain chemistry that can change your mood and behaviour, and that doesn't mean you had a chemical imbalance and need a sledgehammer every week forever. It's the lack of supported good explanation that I'm against, especially after becoming convinced that a lot (not all) depressions and anxieties are addressable with therapy - but not just any therapy with any technique, just like a TV problem can be traced to a bad solder joint or a loose wire or a warped chassis shorting out a wire, but not by just randomly poking wires and replacing components without any training or experience and saying "I tried everything so it must need hitting". Similarly, "genetics" can be a fine explanation which is why I edited Downes Syndrome into my comment, also blue eyes, Trisomy 21, Huntington's Disease, and many others.
> "As someone who, as an armature geneticist, helped design a genetic study for Stanford, can I say that I put more energy into thinking about these things over the last 45 years than you can even imagine?"
And how do you feel about these quotes I just found on Reddit: "I think my genetics are stopping me from losing weight. I am 25F 5'2 and 145lbs and I have been having the hardest time trying to lose 20 lbs; or "I hate my genetics. I'm lifting 5~6 days a week since october last year, what means almost 10 months of consistent training, but my measureaments and bodyshape still like shit" or "Are my genetics/health screwing me over or am I just shit? r/GuitarQuestions"
Do you think those uses of 'genetics' are good explanations, that the poster should be satisfied with? Explanations that have good predictive power and a clear model of finding other people with the same problem, and suggest what to do next to compensate? Or are they (as I grumble) bad explanations which don't have any predictive power because they don't specify any particular gene or its effects, in much the same way that saying "it's fate"?
> "your solution are just as bad as the ones your are prescribing."
My solution of fix the TV electronics is just as bad as "hit the TV and accept a bad explanation for how that helped"?
Human evolved to have no modern medicine, indoor heating or refrigerators.
My personal preference is to always suggest getting actual daylight on your retina for 20 min three times a week. Not through glasses, including eyeglasses, but can be through eyelids. That loads transferatin, as in transfer, this loads the enzyme that make serotonin. This then allows the body a better chance to make the intermediate between Serotionin and Melatonin, and is the one believed to help. But the patents have expired so it is like an orphan drug now.
It's not at all clear that chemistry is the root issue. The brain is a synaptic graph that does something. Some graphs can have weird paths that lead to pathologies (maybe bad feedback loops). Chemistry seems like fairly a blunt instrument for bludgeoning a "bad" graph into one that's "better".
Forced habits, like cognitive exercises from psychology, can sometimes rewire the graph by themselves because that's how the brain learns/adapts, but we still don't have a good grasp on how to do this truly effectively in many cases.
That said, the blunt instrument of chemistry can sometimes be useful, particularly if it enhances neuroplasticity, as I think psychedelic research is beginning to show.
Source: multiple friends, family and forums (while researching how to help friends & family get off of various SSRIs).
Your second paragraph reveals a biased motive behind your opinion.
I'm really tired of reading anti-medicine testimonials from people who had anecdotal bad results. Yes, penicillin won't stop antibiotic-resistant strains of some germs, and in fact may kill people like me if we take heavy doses. That's worse than what you're describing for SSRIs; does that mean doctors shouldn't prescribe it?
Not that my personal experience is actually a statistically significant sample, but I don't know anybody who takes sleeping pills. Or maybe I do, but they haven't told me. I've also never heard heavy sleeping pill use is one of the stereotypes about Americans. There are an estimated 342 million people in the United States, so impressions aren't always meaningful.
Doctors of all countries have been under a lot of pressure by patients and health administrators to "fix the issue and quick". The last thing that your doctor wants is giving you pills so you go away, but that's what the context very strongly incentivize. You want doctors to stop abusing pills, stop asking them for immediate fix. Give them less patients, more time and more resources to deal with the health of the population. Also, prevention.
Prevention is one of those things that when we actually attempt to fix it would have to completely change the world you live in.
Humans are social creatures and a huge part of our mental health is dependant on the society around us. If the actual problem is "wow capitalism is really broken and showing us ads 24/7 that say were not good enough is killing us", then taking a pill is a valid solution because changing the system will take generations or very violent wars.
Except for all the doctors who do want just that.
> Doctors of all countries have been under a lot of pressure by patients and health administrators to "fix the issue and quick"
While such patients exist, I don't believe they're a global majority, and the group of patients who want the exact opposite, more time rather than "quick", is the bigger out of the two.
Literally a few comments down from this one:
> N=1, but last yearly physical my primary care doctor asked me if I ever had anxiety. I said yes, but that I wasn't really interested in treating it outside of lifestyle change. They asked if I wanted a prescription for prozac, without explaining anything about how to does it or titrate up or down or a time frame. I said I wasn't interested again, and that I particularly didn't want to take any medications that you can't just stop taking one day on a whim (a statement she didn't respond to). She then proceeded to say "well I'll just write you the prescription anyway and you can do your research later and decide to fill it or not".
> I was actually shocked by this interaction, and think about it often. She's a regular family doctor with the local hospital system, and this was just a regular checkup. I answered one question with a "yes, but it's manageable and I think I can handle it with lifestyle change" and then said no twice to medication and ended up with a prescription, which I ignored but don't appreciate having on my record, since it's a false indicator for future prescribing physicians.
I don’t know how rampant that problem actually is, but I don’t think you should discount the impact of social stigma when it comes to mental health. It is only in the past 10 to 15 years, at least in the US, that mental health has entered the public dialogue in any meaningful sense. Historically it has been a source of massive shame with people expressing embarrassment at their loved ones suffering from mental health crises. And now we have a whole generation of influencers and politicians who are trying to tell people to pour out all their medications, reject doctors wholesale, take their specific brand of colloidal silver, and be free.
I just think this is a lot more complicated than “psychiatrists abuse the diagnosis.”
It's not a great idea to make general assumptions about such a large and diverse country. Some drugs may be over prescribed, I have no idea if Ambien is one of them, but trying to fit 340 million people across 50 states into the same box isn't going to be very accurate.
I can't speak for USA but in parts of Europe a lot of people have PTSD that prevents normal sleep, so they end up on these pills, and then they end up with PTSD and worse insomnia caused by long term use of sleep meds.
I think it's just incentives. Easier to take a pill than to deal with horrible trauma. And that probably stays true forever.
What is either revealing or terrifying is seeing how many people attempt to prevent that. Sexual abuse for example is pretty rampant in the US. Sexual education at a young age so people know they are being abused under no uncertain terms is a good solution for this.
And yet you will run into far too many people that under no uncertain terms want their children to be excused from sex abuse education. What deeply concerns me is when you see people with this position that you know where sexually abused themselves.
I don't know, people really suck.
Yes, that's normal in the US. I have multiple family members who take Ambien (zolpidem) before bed every night.
https://www.cdc.gov/nchs/products/databriefs/db462.htm
Seems like daily users would be less than 10%.
something weird is going on there, for sure.
Because it's easy to say change your habits when the problems are systematic as you say. Cutting yourself off social media, or stopping watching the news isn't easy. Being bullied/stressed about work and not having other work options isn't easily dealt with. Being bombarded with advertising telling you that you suck is not something you can personally deal with.
The US especially has this idea that we're all rugged individualists and any problem we have is our own and not one created by the larger society around us and therefor communal solutions are bad, and you should toughen up.
But that’s exactly what many claim. Even this article is trying to claim that Vitamin D has 4.5X higher effect size than antidepressants (e.g. that they don’t work)
> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?
USA is actually not the world leader in over medication in this domain, even though it’s popular and safe to hate on Americans. The rates of benzodiazepine and Z-drug prescription in some countries like France are substantially higher than the USA.
Similarly, SSRIs have much better evidence in treatments for many other situations, like anxiety, and yet the medicine itself is attacked, not using it to poorly treat a disorder we barely even begin to understand.
The "hate" is not based in science, despite the fact that SSRIs are objectively a mediocre treatment for depression.
We just don't really have much in terms of better treatments because we know so damn little about depression.
The medical community knows SSRIs are mediocre and have a low success rate at treating depression. They don't have better tools. Everything is a bad treatment for depression because "depression" is a loose collection of symptoms and statistics that we have really poor understanding of, and will certainly be broken up into the actual diseases that make it up when we figure them out, and we will be able to medicate those diseases more effectively.
Every single doctor that would prescribe you an SSRI for your depression will also prescribe vitamin D supplementation if your blood shows low levels.
Someday we will also have a situation where we are going to have to admit that for some subset of the population, their depression has no cause other than "Your life is utterly terrible, for reasons entirely outside of your control, and nothing I can do as a medical professional can fix that".
The lingering roots of Calvinism in the US cause us all kinds of problems.
"You were born broken because god made you that way, don't make yourself better, and hurry up and die" permeates huge parts of our culture. It's why lots of other cultures look at us and what we do with relative confusion.
I wish people would stop saying this.
Our understanding of the brain is not sufficiently sophisticated to allow us to identify the "root cause" (whatever that means) of depression in most people. Indeed we have no reason to believe that there even is a root cause to most people's depression.
If you take antidepressants, go to therapy (or meditate or exercise or whatever), then go off them and still feel good, that's great.
And if you take antidepressants indefinitely because doing so improves your life, that's also great! Your life is improved! This isn't an "abuse" of the drugs.
No psychiatrist is making you do anything. They're advising you based on their clinical judgement and experience, but ultimately it's your decision to take the pills or not. If your goal is to go on antidepressants temporarily, any decent psychiatrist will support you in that (because, again, they understand that they can't make you take the pills one day longer than you want to).
I've been on Lexapro and done evidence-based therapy for years. They both have been helpful, but if I had to pick one, I'd immediately pick Lexapro. For me it is a miracle drug. And the miracle is, I can choose how I feel.
(I also added a small dose of Buspar to help with the sexual side-effects.)
If you're on the fence about trying an antidepressant, I really encourage you to talk to a psychiatrist. If you try it and hate it, then you can stop. But a lot of people try it and love it. And I think a lot more people would be willing to try it if the notion that this is somehow "wrong" were gone.
For further reading I recommend https://lorienpsych.com/2021/06/05/depression/. I don't agree with everything Scott Alexander says, but his writing about mental health specifically has been useful to me.
For a long time I wrote off my symptoms as being all in my head. And after a formal diagnosis, I am 100% certain they are all in my head because that's where my brain is. Symptoms are also unequivocally psychosomatic. What I'm feeling can influence my physical symptoms and rather abruptly at that. It's right in the definition of the illness. None of this means that disease is imaginary or not real or I can talk myself out of it. It's as physically irreversible as losing an arm. There are some very good treatments, but I will never ever be cured (barring a miraculous breakthrough).
While the causes of mood or personality disorders are less well understood, it seems entirely plausible that they can be just a physically inevitable. Every thought, feeling, sensory input and motor output is a physical process originating in your brain and your brain can malfunction if it's ill. And we can treat illness with medicine.
Frankly, I see this as similar to telling diabetics that they should use just enough insulin to get them to learn to stop being diabetic. That’s possible for a few type 2 diabetics who could make lifestyle changes that got them back into good ranges. It’s completely useless for type 1 diabetics, or type 2 who can no longer go back.
I’m neither diabetic nor depressed. I don’t have a dog in this hunt. I’m just always astonished at “have you tried not being depressed?” Some people can “snap out of it”. Many times that number of people cannot.
There's a lot of this attitude, at least in the USA, when it comes to mental illness in general. I have ADHD, it's a common trope/meme at this point of "Have you just tried focusing?" "Gee thanks, I'm cured!"
It's a form of institutional ableism, particularly prevalent in the US I think because of our hyper individualist culture. A lot of people tend to assume that you are just lazy, or not trying hard enough, as if it was just a matter of willpower.
Kind of frustrating, because those same people would never walk up to someone in a wheelchair and say "have you just tried walking?" but for some reason mental illnesses get a free pass to be ableist.
In before "of course things are easier when you're taking stimulants!", which is another dumb thing I hear too often. I feel basically nothing from taking Adderall, and not in the least stimulated or more alert or more awake or anything. I can just concentrate on boring things afterward.
Calvinism.
There's been a number of papers written about how pervasive Calvinistic ideas are in the medical community. This tracks with the New England area of the US pumped out the most doctors while medicine was 'growing up', and protestant christianity was the most common form there. When you view the creation of the US medical system with that view many of our screwed up systems make sense. A lack of willpower is a failure of man to be in touch with god, and not a problem a doctor should solve.
It's actually like statins. Ideally, a doctor will recommend diet changes in addition to the pills. However, relying on lifestyle interventions almost never is effective, And the more we learn about it, the more we realize that cholesterol is mostly genetic based rather than diet based anyway. So the most effective thing they can do is say "here, take these indefinitely". And thank God they do because it saves thousands of lives annually.
For many people with depression, a neurochemical imbalance is the root cause. Just like with statins, addressing it means taking some pills.
This has been true across two countries (Scotland, Hong Kong) and multiple doctors, with a third country's (China) doctor suggesting I try out sleeping tablets for a few weeks - and only giving me a very limited supply of them - to try out instead.
I wonder if the "here take these" is a predominantly American phenomenon due to the weird incentives around health care costs (I'm being genuine here - maybe it's predominant in other countries too, I honestly don't know!)
^ citation needed
What does "would have responded" mean? Are you saying that >50% of people with depression that are "helped" by antidepressant, would have been helped _to a similar extend_ with a placebo?
That placebos can work should not be seen as undermining the severity or pain of the depression, but rather underline the power of tricking the mind into improvement.
And yes, agreed with argwhat.
Only true for some. Inarguably, well-proven false for others.
Likewise, placebos and aspirin are comparable at relieving those headaches where aspirin doesn't really solve the source, but that doesn't mean aspirin's well-documented effects are meaningless in general.
How would you have formed that impression? Whatever media and culture you’re consuming, or how you are interpreting it, is leading you to incorrect conclusions. You should examine that.
We all live in a cultural bubble but any time you find yourself thinking that millions of people somewhere else do something crazy, you should probably talk to someone from there.
Sleeping meds might be prescribed at a higher rate in the US, that wouldn’t surprise me due to the specific incentives in our health care system. But that’s a far cry from your impression.
I know this road leads to SSRIs at the very least, so I always reply in the negative.
The parent comment hints to me that this might be a mistake. I do not want to become accustomed to an antidepressant, so perhaps my course of action was correct.
I was measured low on Vitamin D, which I've hopefully corrected, and I haven't always eaten fish regularly. Perhaps I should pay more attention to that.
Seems odd. Your doctor can't force you to take anything. If they say "do you want to try X?" just say "No". Not giving your doctor full medical context seems like a mistake - for example, maybe depression would be indicative of another issue, or maybe people who are depressed really shouldn't take a specific medication.
To each their own, and perhaps you have other reasons, but this seems like a less than ideal solution to a very trivial problem if the goal is just to not take an SSRI.
Getting treatment for "depression" doesn't always mean SSRIs etc. Sometimes it means treating the underlying condition(s) that are having downstream affects. I would suggest everyone gets their Testosterone levels checked among other common things.
I am doing several blood analysis with a functional doctor and lyme may be around or was in the body, and so many other things. I was thinking I had lucky gut, but seems negative..
I did get my Vit D up to 65 and I seems to be issues with ADH hormone since kid and probably that makes dehydration. It's a fucking nightmare..
I may only see a testosterone replacement as a solution maybe..
This is actually a somewhat difficult diagnosis to make, especially when diagnosing adult ADHD without the user documenting and bringing in a well defined log of their behavior (and possibly another person to point out things they don't know about themselves).
>ADHD is a highly heterogeneous disorder with a significant comorbidity rate.
Is thing that you read about in literature around it. And even more common than that is the comorbidity of all the above symptoms, that is ADHD and depression + more in autism.
She then proceeded to say "well I'll just write you the prescription anyway and you can do your research later and decide to fill it or not".
I was actually shocked by this interaction, and think about it often. She's a regular family doctor with the local hospital system, and this was just a regular checkup. I answered one question with a "yes, but it's manageable and I think I can handle it with lifestyle change" and then said no twice to medication and ended up with a prescription, which I ignored but don't appreciate having on my record, since it's a false indicator for future prescribing physicians.
The brain zaps were also hell if I was even like an hour later than usual to take it
1.) It's killing my libido 2.) It's too strong
For 1.) - yes, this is a very very common side effect. And it's logical - you simply get "triggered" less. Applies for me, too.
And 2.) is the same that a lot of people fail to understand: Then try a lower dosage!
Unlike most anti-depressants, where you have to constantly increase the dose because your brain just generates more receptors to fight back, SSRIs hardly wear off.
Also, relax about the "become accustomed" part. Should your Serotonin levels be too low, then they are too low. Just think about it like you think about table salt. It would be just as unhealthy to try to "get off" salt.
All of this being said: There are tons of different kinds of root causes for depression. A good rule of thumb is: Are you depressed because bad things happened to you? Then seek psychological therapy, and potentially combine this with medication in case it would be too painful to uncover the dark things. Are you depressed on a regular basis, but can not name any valid logical reason? Then your brain has a chemical problem, so stop treating it like this is an illness, but do what you would do if your car would turn on the "oil warning" lamp. You can not replace oil with therapy or willpower.
I'm not sure if it is common but I've definitely taken my fair share of my dog's trazodone.
meanwhile people are like "just take magnesium or melatonin lol"
Everyone should check with their doctor, but it's an inexpensive supplement and the effects (if any) show up pretty quickly, so IMO it's worth a shot.
Well that but also they have poorly understood long term effects even after being discontinued (in some people, not others) and they don't work for everyone. The latter is probably most of the reason they get hated on. I don't recall the source but a given antidepressant only works for something like 1/3 or less of the population. So take a person not in a great place emotionally, who is also statistically not in a great place in life overall, subject them to an insufferable bureaucratic process, give them a drug that doesn't end up working for them, add in some pretty wild side effects, sprinkle on a few long term effects that persist after they discontinue the thing that didn't work to begin with, and of course you end up with a bad reputation.
The tl;dr is that our understanding of the brain and mood disorders kind of sucks.
And when you question this approach, the famous lecture comes: "but diabetes patients take insulin for life. You realize depression is a real condition and need to be treated right?"