
Extreme side-effects of antidepressants - pmoriarty
http://www.bbc.co.uk/news/health-37682355
======
_98fj
Just a couple of unordered facts here, because discussions about this topic
tend to get very confused:

1\. Serotonin is a very basic, very old transmitter found in all bilateral
animals. Humans have _two_ sites of serotonin-production, one in the body, one
in the brain. 90% of serotonin resides in the body.

2\. Serotonin in general regulates "activity". It affects hunger, gut-
movement, sleep, cell-growth, mood, body-temperature, blood-pressure and many
other things. Any drugs changing serotonin-levels also affect these areas,
that is why there are so many adverse effects.

3\. SSRIs help exactly one group of people: those who have too low levels of
serotonin. When their serotonin is boosted, circuits in the brain like the
connection between thoughts and emotions start to work properly, hence they
get more in touch with themselves.

4\. People who have too little serotonin can show the exact same symptoms like
people whose serotonin levels way too high (!!). Prescribing SSRIs to those
people will worsen their state and may even lead to life-threatening
conditions.

5\. The level of serotonin can be tested properly by exactly one method:
laboratory blood/urine sampling, which costs a couple hundred dollars, but is
available. These doctors generally also know about amino-acid therapy, which
consists of nutritional supplements which help the body in manufacture the
missing transmitter. This can lower the need for medication, but needs proper
testing first.

6\. People can have proper serotonin levels and still be sad/angry/depressed.
The question still is which brain-circuit is malfunctioning. If the problem is
the connection between emotions and thought, serotonin helps. If the
malfunctioning circuitry concerns attention regulation [0], like with people
who have a genetic disposition towards ADHD, then dopamine helps.

7\. People can have all their neurotransmitters adjusted to proper levels and
still not be perfectly well. We are talking about signalling inside mutable
structures here. Changes in signalling affect the structure, changing the
structure affects the signalling.

Fixing neurotransmitters makes someone able to use all of his brain. He still
has to use it properly though, to get better.

[0]
[https://en.wikipedia.org/wiki/Frontostriatal_circuit](https://en.wikipedia.org/wiki/Frontostriatal_circuit)

~~~
khed
I am a practicing physician with 2 years of graduate level course work in
neuroscience.

Point 3 and 4 are wrong. There is no evidence that SSRIs work by fixing a
chemical imbalance.

There are multiple metananlyses in top tier journals that indicate that SSRIs
have an irrelevant clinical effect. SSRIs are almost all placebo with the
downside of causing serious side effects. The small effect that isn't due to
placebo is probably not clinically relevant.

The only cogent defense of SSRIs I have read is
[http://slatestarcodex.com/2014/07/07/ssris-much-more-than-
yo...](http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-
to-know/). The author is a practicing psychiatrist. The main disagreement he
has with the large metaanalyses is that even though the effect size is small
it's better than nothing.

~~~
_98fj
I know these things from a friend who is a doctor and works with these
neurotransmitter tests since about 10 years.

I asked her how accurate these tests were and she said that, while you can't
read everything off a sheet, there are patients, where she can already guess
the result of the tests from the bodily symptoms the patient is describing
(energy level at which times of the day, feeling of hunger, insomnia etc.).

Quite often serotonin is low and once it has been boosted (verified by an
additional test a couple of month later) the patient is feeling a lot better.

Which, like I said, doesn't imply that that's all there is to mental well-
being.

These tests also measure stress hormones, which usually are out of bounds as
well.

> There is no evidence that SSRIs work by fixing a chemical imbalance.

I don't even know how one would define "chemical imbalance" in such a complex
system as the human body.

All I know is that there are average ranges for transmitters and the more
somebody's results are inside these ranges, the better he typically feels.

~~~
mfukar
I think you should both stop here.

~~~
Broken_Hippo
I don't. This sort of discussion from _people in the field_ and what their
friends see is helpful because it can change how other laypeople see the
issue. Furthermore, I like seeing these sorts of discussions because I feel
they make me more intelligent through gaining a different perspective.

~~~
mfukar
I'm sorry - no text on Hacker News will convince me the person typing it is an
expert in anything. Especially when they present inaccuracies and opinions as
facts.

------
jrapdx3
This is a subject I know well, not only as a multi-decade prescriber of
antidepressants, and many other classes of medications for health/behavioral
problems. I've also been prescribed such medications for my own conditions, so
you could say I have a unique perspective, know the issues coming and going.

Of course antidepressants can cause side-effects as do _all other_ types of
drug treatments. It's inevitable, medication effects are extremely complex and
unpredictable as interaction with body systems covers a huge gamut of
possibilities. Furthermore, most effects of drugs haven't studied even when
they are known and a great deal more is not known than is known.

Also bear in mind that drugs in the form prescribed may not be the the
chemical that produces the biggest therapeutic effect. This is the phenomenon
of _active metabolites_ which are often the drivers of favorable and
unfavorable effects.

So we see how quickly these factors yield immense complexity and the reason
behind the fact that drugs often have a huge array of side-effects common and
rare.

BTW a side-effect occurring in 1% of recipients is considered a _common_
adverse event. 0.1% is _infrequent_. Maybe 0.01% is getting rare, but
definitely not implausibly drug-related.

The bottom line is that taking several drugs even one at a time for more than
a few days means there's a surprisingly high probability of have an uncommon
or rare side effect. It's happened to me a handful of times, including a
couple of pretty serious reactions.

Interesting when I tell my physicians about these reactions. There's a certain
look they get on their faces, like "what are you talking about? You're kidding
me, that really didn't happen, did it?" Well, yes doctor, it _really_ did, as
though I wouldn't know a bad reaction when it's there or I just made the whole
thing up.

This is perfectly consistent with what patients reported to me over the years.
A long time ago I'd come to believe that people weren't making stuff up,
unusual side-effects are ultimately an everyday reality among patients and all
reports of AEs must be taken seriously, exactly my policy I put into practice.

Remember this little rule, it will save everyone a lot of trouble: any drug
can cause any side-effect at any time.

~~~
vinchuco
> 1% of recipients is considered a common adverse effect

Are these rates determined in the same conditions as the medications are
prescribed?

Are there methods put in place to continue to gather side effect data after a
medication is prescribed?

~~~
jrapdx3
The FDA accepts reports of "adverse events" for as long as a medication is on
the market. That info is incorporated into the stats of drug-associated AEs.
AFAIK aftermarket AE stats aren't diagnosis correlated, so would include
approved and off-label prescribing.

------
inlined
As a quick survey, do the people who believe that SSRIs have only a placebo
effect also disbelieve any biological source of depression?

Since the plural of anecdote is data, I'll share my story. I struggle with
depression. I've kept it at bay for a long time now, but I had a big wave this
year. It turns out that was ~1wk after a Rx refill and I realized the
pharmacist refilled at half the dosage. Fixing the dosage got me on track in a
couple of days.

I know I'm not above a placebo effect. The placebo theory could explain my
recovery, but I'm not sure how it could explain regressing when my dosage was
messed up.

~~~
kqr
Not saying that is what happened, but perhaps you build a tolerance for the
drug? Withdrawal can be a batch even for drugs with no significant positive
effects.

~~~
inlined
I've had withdrawal effects. They can be severe and tend to be physiological.
They're usually fairly easy to point to and help me catch if a change in
routine made me forget to take pills (eg after travel). I found this so
interesting because a half dose didn't have typical withdrawal symptoms but
left me with a very warped view of life.

------
khaannn
Zoloft helps me live a normalish life. I'm not on a high dose and don't
experience any emotional numbing. Every year or so I try dropping the dose or
quitting and have a massive relapse. It seems to be a genetic issue in my
maternal line.

These type of articles follow a couple of archetypes:

1\. I beat depression by (insert value-signaling method here). These people
are usually in denial and/or in the initial positive rush of a life change.
The latter produces transient changes that are far outlasted by internet
posts.

2\. SSRI's don't work and have horrible side-effects. The side-effects trash-
talk causes a nocebo effect. Sexual or sleep related side effects are produced
in the general population by gusts of wind, and now you read mainstream papers
talking about them. The meds work as well as therapy for far less money and
opportunity cost. Poor and even middle income people don't have therapy as an
option for mental illness. Check out:
[http://slatestarcodex.com/2014/07/07/ssris-much-more-than-
yo...](http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-
to-know/)

------
spangry
I've been prescribed multiple SSRIs over the last decade. 5, by my count. I've
also researched them pretty extensively for about the same time. They are a
crap-shoot at best.

The best that a knowledgeable and well intentioned doctor can do is prescribe
them in a trial and error fashion, maybe with a tiny bit of guidance from
prominence of patient symptoms. But it's largely just prescribe, wait 6 weeks,
rinse and repeat. I happen to be one of the 'treatment resistant' types, in
that SSRIs don't do jack-squat for me (well, except for when there's a drug-
drug interaction, and that's definitely not the 'good kind' of effect).

The medical literature suggests SSRIs are only just barely more effective at
treating depression than placebo. There's also an interesting (and in my view,
plausible) explanation behind why SSRIs might cause an initial increased
suicide risk. A common symptom of depression is 'psychomotor retardation': "a
slowing-down of thought and a reduction of physical movements in an
individual"
([https://en.wikipedia.org/wiki/Psychomotor_retardation](https://en.wikipedia.org/wiki/Psychomotor_retardation)).
If SSRIs have any positive effect, they occur gradually.

So the hypothesis goes: a patient might be suffering from suicidal depression,
but the psychomotor symptoms prevent suicide. When they are prescribed SSRIs,
and those SSRIs start having a positive effect, they lift the psychomotor
retardation just enough that the patient is finally able to kill themself. It
probably sounds a bit strange, but I can attest to how debilitating
'psychomotor retardation' can be.

~~~
throw998away
My wife went through a rough patch a little while ago and decided she was
depressed. She had no problem getting SSRIs prescribed by the doctor.

She says as soon as she started taking them, she instantly felt better. No
more randomly bursting into tears.

But, she is no longer the wife I had. Her conversation is so slow. She
regularly forgets what she was talking about, repeats herself. Basic chores
are just forgotten about. She drinks more than ever, has started smoking. Her
diet is awful. If she can be bothered to eat it is probably a chocolate bar at
lunch time. She has gained about 4 stones in weight.

She never took up the counselling that she felt she needed before starting on
the SSRIs.

She tried cutting down on her medication a little while ago, but this made her
incredibly paranoid. So instead she has had to increase it.

All I see from it is an ever decreasing spiral into ruin.

~~~
spangry
Take her to a competent psychiatrist, maybe one that practices in a hospital.
I've never come across a symptom/side-effect profile like that before. But at
least some of them (I am not a psychiatrist etc. etc.) hint at bipolar
disorder.

One of the (unfortunately common) ways people learn that they have bipolar is
by being mis-diagnosed with unipolar depression, being prescribed SSRIs, and
suddenly finding themselves experiencing 'dysphoric mania'. Not the
"everything's great, let's have sex with random strangers" type, but rather
the "let's destroy every piece of furniture in the house" type.

But I don't know your situation other than what you've described, and I'm
definitely not qualified to tell you what to do. The best I think you can do
is to get a second opinion from a competent psychiatrist.

~~~
noir_lord
This is an _excellent_ comment.

The "let's destroy every piece of furniture in the house" is exactly what
happened with one of my parents, it's not a fun thing to witness but they
eventually got the bipolar under control with lithium but the toxicity on that
stuff is pretty horrible, regular blood tests for the rest of your life
horrible.

------
qrybam
Some thoughts from someone who's been prescribed anti depressants in
adolescence but never took them because I believed the doctor misdiagnosed:

* Do these drugs genuinely help or is it just a strong placebo response?

* If the anecdotal evidence increases the odds from 1 in 100 to 1 in 4, would this be considered normal in medicine?

Of course the symptoms could be attributed to the wrong thing here but they
sound pretty horrific. My initial reaction was that in the future we'll look
back at these drugs as barbaric, similar to how we view lobotomies today.

Edit: formatting

~~~
rtpg
I can't comment on anti-depressants, but for a similar case (ADHD meds), where
societies attitudes regarding meds are similar.

ADHD has by far the most successful medical treatment of any mental illness.
Something like 90% of cases get positive response out of medication, with
35-40% of people having all their symptoms handled.

My understanding is that for treatment of clinical depression, medication
helps around 75% of cases, but that most people continue to have symptoms even
when under medication due to the nature of the illness.

In both cases, though, treatment is understood to be a continuous process. You
cannot be cured of these illnesses, you can only cope with the side effects.

The treatments are like a prosthetic leg: No matter how much you use it,
removing it will bring you back to square one.

There's a lot of research showing the positive effects of medication (and in
ADHD's case, the futility of non-medication-based treatments), but there's
still a major fight for acknowledging the validity of this form of treatment.
Major parts of the population do not think these illnesses are even real!

But it's all pretty dangerous. We have some understanding of how brains work
around these illnesses thanks to the research gone into it, but there's a lot
of complex interactions going on. Not that physical medicine is much
different.

~~~
adamweld
>There's a lot of research showing the positive effects of medication (and in
ADHD's case, the futility of non-medication-based treatments), but there's
still a major fight for acknowledging the validity of this form of treatment.

Is this really relevant considering the extremely rapid rise in prescription
and use of ADHD medication?

In my anecdotal experience with friends who take these pills, they very
quickly create a reliance on the substance and have significant side effects
in the long term. I honestly believe they can be quite harmful to a person's
mind.

Now, for ADHD there unfortunately aren't good non-medication treatments. But
depression is a completely different matter - making lifestyle changes as
simple as going for a hike every weekend can easily be as effective or more
effective than any medication.

~~~
mickronome
They can be harmful, but diagnosed ADHD/ADD is almost guaranteed to be
harmful, maybe especially in todays society. More than doubled risk of
depression is only one of the risks of the above diagnoses, and while many of
the risks could be said to be more of a societal issue - at least in the
beginning - they tend to cause actual health problems over time.
Overprescription can always be an issue for any medication, but that's not
really an issue with the medication itself is it ?

~~~
Pigo
Maybe if the medication is 90% as fun as cocaine for large portion of the
population. I've known precious few people with legitimately diagnosed ADHD,
but I've known tons of people who use the medication as a stimulate for
studying or just for fun at parties. No one is doing this with Effexor, at
least no one bright. From what I understand it's doesn't effect the people
with true ADHD the way it does the casual user. This isn't their fault, and I
wouldn't take their crutch away. I fault big pharma and the tons of sketchy
doctors out there.

------
mcs
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2248201/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2248201/)

"Since the consumption of omega-3 fatty acids from fish and other sources has
declined in most populations, the incidence of major depression has
increased."

------
alfon
Dr. Peter C Gøtzsche: Psychiatry gone astray.

[https://www.youtube.com/watch?v=DiJcSoo3C4Q](https://www.youtube.com/watch?v=DiJcSoo3C4Q)

~~~
DanielleMolloy
Thanks. Here is his article that he is talking about:
[http://davidhealy.org/psychiatry-gone-
astray/](http://davidhealy.org/psychiatry-gone-astray/)

Along these lines (overprescription, overdiagnosis, disease mongering) "Saving
Normal" by Frances Allen may be a good read as well.

------
amelius
I'm reading this on Wikipedia:

> Several plants contain serotonin [...] These compounds do reach the brain,
> although some portion of them are metabolized by monoamine oxidase enzymes
> (mainly MAO-A) in the liver.

This makes me wonder: will people with a homozygous defect in the MAO-A gene
(quite a large percentage of the population) end up with the problem that lots
of endogenous serotonin may reach the brain?

------
ada1981
The current canon of legal psychiatric drugs won't ever cure the underlying
issue that causes the symptoms.

The only things that come close to that are the psychedelics -- psilocybin,
MDMA, LSD, etc. They have been outlawed but of course, the underground therapy
community has been keeping them alive and we should see legalization for the
treatment of things like PTSD within the next 5 years.

~~~
Pigo
They talk about these uses on almost every episode of the Joe Rogan
Experience. He has a lot of researchers on who describe their usage of
psychedelics to treat depression in particular. They describe it as "brain
reset" or more like a chance for people to stick their head out of the fog,
giving them the opportunity to see how they're stuck in a negative cycle. I
just wonder if it's like a Tony Robbins seminar, super motivating and
informative, but with little hope for long-term effects unless you keep going
to seminars or eating mushrooms. Is there no hope of genuine change in your
thought patterns outside of long-term psychoanalysis or a spiritual awakening
of some type?

~~~
soundwave106
The problem with "curing depression" as a whole is that it's a complex
syndrome with multiple causes, and our understanding of the brain is very
primitive at this point.

I kind of think that many recreational psychedelics are both over-hyped by
advocates and over-demonized by naysayers. Recreational experiences are fine
and dandy, but I haven't seen much evidence so far that serotonergics do
anything for depression. MDMA for PTSD remains experimental (worth a study I'm
sure though).

One psychedelic is an exception: the observation that ketamine actually
rapidly helped some depressed patients has sparked a whole lot of research in
the last decade, has led many to question the whole monoamine hypothesis
behind current depression treatment, and may lead to non-psychedelic
treatments that work better (or at least on a different subset) than SSRIs.
([http://www.economist.com/news/science-and-
technology/2170865...](http://www.economist.com/news/science-and-
technology/21708655-new-generation-drugs-could-change-way-depression-treated-
novel-drugs)).

So, if you are a fan of the psychedelic experience and want to try something a
bit out of the medical norms to alleviate depression, the ketamine clinic has
the most medically backed potential at the moment, in my opinion (although
I'll add that from what I understand ketamine clinic treatment is not at all
similar to recreational usage as the dosage is much less). Alternatively, you
could wait for the non-psychedelic versions or even rather unrelated
derivatives (mentioned above) to progress, that for all we know might actually
be better in the end. As the Economist article rightly alludes to, the brain
is a seriously complex organism, and science has not reached a neat simple
conclusion about depression yet.

~~~
khed
This is an excellent comment and reflects the current state of research.

There is good evidence for the efficacy of ketamine in treatment resistant
depression.

The psychedelics are not well studied.

SSRIs are not useful and may be harmful.

ECT works but causes amnesia.

Most depression gets better on its own.

~~~
Pigo
I suffered from depression pretty much my entire 20's, and looking back it
felt like the long line of anti-depressants I was prescribed exacerbated the
situation. Eventually I changed how I live my life and started making baby
steps towards improving myself. And I magically stopped being depressed. I
have no doubt there are people out there that need help with medication. But I
think the only thing that could have helped me was someone reaching out and
showing me how to get out of my rut. But even then it would have been on me to
make some changes and find out what makes me happy.

------
tcj_phx
SSRI drugs (sold as 'anti-depressants') have always been known to cause
suicide ideation... While they do seem to help some people, it is now known
that this is because of the drugs' effects on the neurosteroids [1], NOT
because of 'increased serotonin'. Anti-serotonin drugs (LSD, various MAOIs,
etc) are much more effective anti-depressants.

[1]
[https://en.wikipedia.org/wiki/Neuroactive_steroid#Role_in_an...](https://en.wikipedia.org/wiki/Neuroactive_steroid#Role_in_antidepressant_action)

There are some good articles in the Boston Globe's archives about Prozac,
circa 2000. "Prozac, Revisited", etc [2]. Robert Whitaker [3] worked for the
Boston Globe, before he wrote _Mad in America_ and _Anatomy of an Epidemic._

[2]
[http://www.narpa.org/prozac.revisited.htm](http://www.narpa.org/prozac.revisited.htm)
(the boston globe's official archives site is not so easy to use, but I've
previously verified that these stories exist)

[3] [https://www.madinamerica.com/robert-whitaker-
new/](https://www.madinamerica.com/robert-whitaker-new/)

The first patient in this BBC article could also have been diagnosed as
'exhausted':

> She had begun taking [SSRIs] _while caring for her seriously ill mother and
> studying for her final exams at Cambridge University,_ but suffered severe
> side-effects after her GP prescribed a stronger dose of tablet. (emphasis
> added)

I think 'exhaustion' is a frequent cause behind the symptoms labeled
"depression".

In May of this year, I watched Lexapro (an SSRI) destroy all the progress I'd
made with my girlfriend... She'd asked for this drug a month after she'd
escaped from her court-ordered tranquilization, because she thought it had
helped her years ago. Really it just helped her relapse on cocaine then. This
time it caused rapid heartbeat, and much anxiety. Her last benzodiazepine
turned her into an anxious wreck... The psychiatrists got hold of her again,
and they're making sure that she will never recover.

About a week ago I went through videos on my phone... and found one of my
girlfriend about a week before she was taken to the hospital. The video
proves, beyond any doubt, that she is not "persistently" disabled, that the
symptoms that originally put her in the hospital were entirely due to quitting
her addictions cold-turkey, and not due to 'defective genes' or other pseudo-
scientific rationalization for forcing her to use palliative drugs.

~~~
threeseed
Making blanket generalisations when it comes to mental health is extremely
reckless and misinformed. There are lots of SSRIs and their interactions will
manifest differently in each person.

Doctors aren't in the business to kill people. SSRI do save lives. We just
know they kill a tonne of people as well.

~~~
westvaflamer
>blanket generalizations

------
mcv
I have friends who struggle with depression and are not allowed
antidepressants, exactly because they are suicidal. My wife claims she could
easily get antidepressants if she wants them, because she's neither suicidal
nor depressed. Makes you wonder what the point of antidepressants is, if
they're dangerous only to the people who actually need them.

~~~
koliber
I'm by no means an expert in this area, but looking at your reasoning, perhaps
antidepressants are suitable for people who are depressed but not suicidal.

Every medicine has side effects. Every medicine has contraindications and is
not suitable to a subset of the population which may want to use it. It looks
like antidepressants are no different.

------
norea-armozel
SSRIs made me angry. Like really angry. I remember when I was so angry I
wanted to kill anyone making noise. I don't know why it did that for me but
when I got off of them I wasn't even nearly as angry or irritable since. So
it's why I still refuse get anti-depressants again unless the doctor agrees to
steer clear of SSRIs.

------
Confusion
Many meds have extreme side-effects in part of the population. Often we call
those 'allergies', but those are just the tip of the iceberg. There's nothing
new here, just a reminder that a specific medication may not work for you or
may work but still make things worse by causing side-effects.

~~~
MichaelMoser123
>Many meds have extreme side-effects in part of the population

My daughter was given Montelucast/singulair for treatment of asthma; now it
turns out that it can have severe side effects with kids - anxiety and
suicidal behavior [1]. The funny thing is that these side effects are not
listed on the medication guide, as these are supposed to be 'known risks'.
What exactly were they thinking when they omitted this information from the
medication guide?

[https://www.ncbi.nlm.nih.gov/pubmed/26620206](https://www.ncbi.nlm.nih.gov/pubmed/26620206)

~~~
Pigo
Is there other medications she could take instead of these? Asthma is scary
enough for children, I couldn't imagine having to worry about the effects of
the medication as well.

~~~
MichaelMoser123
there are inhalations if it comes to it, we do take care of her.

Singulair is a preventive treatment, it is supposed to prevent asthma attacks
before they happen, however the side effects of induced anxiety made it too
costly for us.

------
Unbeliever69
I can speak to this first-hand. I had written the letters and made the plans.
If not for the intervention of my ex-wife, I'd be six feet under.

------
smegel
I would say becoming "happy" when the circumstances of your life would and
should make any right-minded person unhappy is a pretty extreme side-effect.

~~~
jacalata
Then, even if we assume your base framing to be valid, you'd be blatantly
misunderstanding the purpose for which people take these drugs and/or the
definition of side-effect.

------
zby
This is perhaps getting a bit Luddite but in other news:

""" if you suffer a psychotic breakdown, your odds of complete, treatment-free
recovery are much, much better if you are treated in a third-world country
that cannot afford psychotropic medication """

[https://aeon.co/essays/treating-acute-psychosis-with-
drugs-c...](https://aeon.co/essays/treating-acute-psychosis-with-drugs-can-
prolong-the-anguish)

------
jcoffland
Skipping a night of sleep is a better way to combat depression.

[https://www.scientificamerican.com/article/why-sleep-
depriva...](https://www.scientificamerican.com/article/why-sleep-deprivation-
eases-depression/)
[https://www.ncbi.nlm.nih.gov/pubmed/7362414](https://www.ncbi.nlm.nih.gov/pubmed/7362414)

~~~
whiteandnerdy
Since there's a possibility people will try this, the linked article states
that the benefits usually only last until the patient falls asleep. This isn't
a practical treatment strategy right now, although it is interesting
scientifically. If you have depression I'd urge you to take the advice of a
medical professional rather than attempting to self-treat.

~~~
jcoffland
According to the original article taking the advice of a medical professional
could be much more dangerous. Missing a night of sleep seems to horrify some
people but it's quite safe. Just don't operate heavy machinery. But thanks for
the safety lesson.

~~~
lsc
So, uh, I'm ignoring the medication debate, but:

> Missing a night of sleep seems to horrify some people but it's quite safe.
> Just don't operate heavy machinery.

Most of us drive to work most of the time. Yes, most of us operate heavy
machinery every day, often in busy areas.

People worry all the time about guns and planes and other potentially
dangerous things; people don't worry nearly enough about transportation
accidents. If you didn't sleep, call a cab (or a rideshare, or a friend) -
don't risk the lives of everyone around you.

