
Psychiatrists Must Face Possibility That Medications Hurt More Than They Help - aburan28
https://blogs.scientificamerican.com/cross-check/psychiatrists-must-face-possibility-that-medications-hurt-more-than-they-help/
======
youdontknowtho
Their over-prescription is no doubt a problem. That being said, I have family
members that are verteran's from the Vietnam era. Anti-depressants made their
existence possible. They all had so much trouble adjusting and maintaining
relationships. The change was night and day different.

Anecdotal evidence isn't really evidence, I know that. And the pharma
companies are really just the worst. I have seen these things really work
though.

EDIT: It's funny, but people never seem to question if modern American life
actually, you know, is good for mental health. Maybe people are mentally ill
because the world is super effing weird and hard to adjust to?

~~~
komali2
I've been attacked before, even by employers, for claiming I need Adderall to
work. I'm told ADHD isn't real, I just need to suck it up and focus, that I'm
an addict, etc.

I've never really found an apt metaphor to describe what ADHD is and why I
need to medicate it. To many people, disease is on or off - you either have
the virus or pathogen or missing chromosome, or you don't. The sliding scale
of mental illnesses is hard to describe. So if I say I can't focus , they say
"lots of people can't focus ." I try to use obesity as a metaphor, like, lots
of people are fat, most people can become not fat by eating right and working
out, but a rare selection of people genuinely have a disease that make it
difficult to the point of needing medication to aid their weight loss. They
could still lose weight by doing the stuff other people do to lose weight, but
it will be way harder and they'll never be able to achieve what other people
can without medication.

That's me and Adderall. Yea, I can work without it. I can meditate and suck it
up and drink coffee or whatever. But I'm hamstringing myself, and I'm exerting
way more energy than the average person does to do the "simple" thing of
staying focused. Better if I just pop 5mg (I stay at the lowest possible
dosage) of Adderall and actually be a functional member of society.

~~~
engx
I've had ten friends take Adderall and all of them exhibited the same
characteristics as a person on meth. They are not fun to be around. Sometimes
they would be highly productive, other times they just bounce around the
house, doing nothing. My current roommate takes Vyvanse and it's incredibly
difficult to deal with.

To me, it's okay to say it's a performance enhancing drug and that some people
need more energy (e.g. coffee) to get going. But I find it incredibly
dangerous to suggest a person needs to take an amphetamine every single day to
be normal.

I am open to change my opinion, especially if things like EEGs can
conclusively establish ADHD. But all the troubles you describe, are
universally human. If Adderall helps you overcome them, I'm all for your
ability to take it. I'm just cautious about labeling everything a disorder or
disease.

~~~
komali2
I can't speak for your roomates, friends, or the psychiatrists prescribing
them drugs.

I can say that ADHD is a real disease, is documented, and Adderall is a
recommended treatment (among others). Take a look at the other comments - as I
said, mental disorders are not "on/off," and symptoms of mental disorders can
be things that everyone in the world "just exhibit" \- i.e. occasional
depression, inability to focus, even delusions, panic attacks, or
hallucinations. If you didn't get enough sleep one night and had mild
hallucinations, that doesn't mean you have Schizophrenia. Now imagine you
dealt with that, all the time, no matter _what you did._ That's why medication
exists for mental illness.

In any case, regardless of your personal opinion, it's not really up to you.
ADHD is real, according to doctors, and unless you are a doctor, you don't
have anything more than a layman's opinion. Apologies for being harsh, but
this is what I deal with. See:

[https://www.nimh.nih.gov/health/topics/attention-deficit-
hyp...](https://www.nimh.nih.gov/health/topics/attention-deficit-
hyperactivity-disorder-adhd/index.shtml)

Under DSM-5, it is listed at F90.0, .1, and .2.

If you believe your friends or roomates are addicted to adderall or
inappropriately prescribed, I recommend reaching out to their family, who can
contact their pscyhologist.

------
sharkweek
Here's my take, as someone diagnosed with OCD/Anxiety.

Life can get to a point where it's miserable with OCD. It is exactly like a
frog in water that's slowly boiling, that you don't recognize things are
getting as bad as they are until one day you just kind of feel REALLY shitty
and recognize something is wrong.

Medication can really help get over that hump in treatment, and honestly has
made it possible for me to accept the problems for what they are. This allows
me to move into a "better" place in my own head and be more open and ready for
therapy, which I believe gives the far more valuable tools to overcome
problems.

I have seen a few different doctors in my life, and NEVER has one of them only
recommended medication. In fact most have said exactly the above, that
medicine should be an enabler to make other therapy more helpful. Maybe I've
just gotten lucky with good doctors, but I kind of think this is a common
suggestion.

A lot of people on here are complaining about big pharma, but my generics cost
like 2-3 bucks a month. I don't think GSK and Pfzier are exactly making bank
off my mental conditions...

~~~
gph
>A lot of people on here are complaining about big pharma, but my generics
cost like 2-3 bucks a month. I don't think GSK and Pfzier are exactly making
bank off my mental conditions...

Not that I disagree with most of your post, but this statement is a bit
disingenuous. The fact that there are cheap generics is _because_ Big Pharma
already made their money pushing those drugs for 20 years. They might not at
this point have a huge profit motive to push these drugs, but the damage is
already done. SSRIs are now the standard treatment, and Big Pharma is one of
the main reasons that's the case. Given the questionable efficacy of SSRIs, I
think it's only right to question the role of Big Pharma in setting our
standard practices in medicine/psychiatry.

~~~
iamatworknow
And "small pharma" (or whoever is making the generics) is still making more
money than the $2-3 per month because it's subsidized by insurance.

I'm on a generic prescription now that with insurance is $5/month, and without
was $1400/month. Even if the pharma company accepts less than $1400 through
insurance negotiation, I find it difficult to believe that my insurance
company haggles well enough to knock the price down to just $5. The profit
that even a generic pharmaceutical company makes comes from somewhere.

------
0x4d464d48
I've worked in the mental health field for years and remember believing that a
sense of purpose and good social support was more important than the
medication and that the medication was not necessary and harmful. Knowing what
I know now, there are some diseases, mostly those involving psychosis e.g.
schizophrenia, where med adherence is vital to a person learning how to cope
with their disease otherwise they can't function and it is certainly not a
character failing.

I haven't read the book in this piece and not to knock on journalists but
there are things about mental illness you just won't learn without exposure to
it and actually working to help people recover. There is a massive problem
with over prescription and this idea that mental illness can be 'cured' with
medications and medications alone which is absolute flummery (but if you look
at what medications bring in the most revenue, the fact this persists
shouldn't surprise you).

Biggest take away is that you shouldn't view drugs as necessarily bad as this
piece implies. They aren't. When you have a patient who is so depressed they
can't get out of bed or another whose auditory hallucinations intensify to the
point of violence the drugs are necessary but they aren't a cure. Getting over
mental illness requires social support but it does at times also require
psychotropic meds.

And don't get me started on the bullshit pushed by pharma a few years ago that
people in pain can't get addicted to opiates. I loose it almost every time.

~~~
DanBC
> And don't get me started on the bullshit pushed by pharma a few years ago
> that people in pain can't get addicted to opiates. I loose it almost every
> time.

Watch out though. Pain comes in broadly two types - long term and short term
pain.

Opiates are great for short term pain and the risk of addiction is low.

It's when opiates are misused for long term pain that they become a problem.

------
broahmed
"You're depressed? Here: instead of fixing the problem that's causing your
sadness, take this pill and it'll all be fine!"

I find this attitude perplexing. Instead of facing the problem(s), drug your
mind so you're less aware of the sadness it's causing you. Reminds me of the
soma in Aldous Huxley's Brave New World.

And yes, I recognize that there are certain people who suffer from major
clinical depression. By all means, prescribe then anti-depressants. I just
think that our brains experience sadness for a reason: it's a signal that
something is wrong in our life and that we need to change it.

~~~
DanBC
Doctors (should) know the difference between situational depression and
regular depression.

Many people have depression and there's nothing particularly in their life
causing it.

~~~
duderific
I wonder if it has to do with the difference between expectation and reality.

If you expect your life to be like that of an attractive and successful
character on a TV show or movie, or a celebrity, then chances are you'll be
disappointed and possibly depressed. Technically, nothing in your life is
"causing it" other than unrealistic expectations.

~~~
taylorlunt
This is definitely not my experience. I would say that, other than my
depression, I am very satisfied with my life. My life isn't perfect, but I'm
happy with it. I have no self-esteem issues either. It might seem unusual to
hear someone with depression say they are, depression aside, satisfied with
their life, but sometimes depression just doesn't have a clear cause. I wonder
if depression is more biological for some people.

------
Overtonwindow
Many years ago I was given citalopram to help with severe anxiety. The big
difference between this, and the other times I'd been given paxil, stratera,
wellbutrin, Lexapro, and others, was that I had a therapist who was adamant
that drugs alone will not help. You must combine drug therapy with closely
monitored, regular one-on-one therapy. That year of therapy and the meds
changed my life. Now I'm off the meds and doing very well. Just two cents but
maybe others have similar experience?

~~~
amorphid
It sounds like therapy is learning to run, and medication is a good pair of
running shoes.

~~~
Sanddancer
I'd compare them more to orthotics than running shoes. Some people only need
them temporarily until their legs get better, some people need them for the
rest of their lives. You still need a doctor, but they help with day to day
activities.

~~~
quantumhobbit
Great metaphor.

------
pc2g4d
Blame the environment.

It's difficult for me to believe that traits prevalent in 10% or more of the
population are actually "disorders". They must have been advantageous in some
past situations in order to be passed on so much, or at least not selected
against. Right?

So what is it about our environment that makes these traits disadvantageous?
Or is that even true? Maybe "mental illness" is an appropriate response to the
injustices and impossibilities of modern life. How could we _not_ be having an
epidemic of "mental illness" right now given the profound disruptions our
society has endured in the last fifty years?

Psych drugs seem to me like a case of "you can't get enough of what you don't
really need". An alternate view is that they're like a shoehorn---they're
there to help normal people conform to the impossible expectations of society.
But maybe we don't really need shoehorns for 10% of the population---maybe
instead we need to learn to wear sandals or go barefoot.

Sorry, I know it's a stretched metaphor. And now I'm done.

~~~
concinds
Blaming culture is way too easy. Anxiety or depression have nothing to do with
how "unjust" the culture is. Many people live in the exact same society as
you, and had worse starting conditions (socioeconomics, family) but excel,
mostly because of social support and strong mindset skills (which can both be
acquired through reasonable effort), and because they likely had a healthier
childhood and more nurturing parents than others who don't end up doing as
well.

Jordan Peterson (psychiatrist) says the default state for animals is not calm,
but anxiety. An animal only becomes calm in a given environment once he sees
and smells that no predators are around to get him, and that they are not in
danger. Someone who is chronically anxious will often have grown up in a
dysfunctional family and been emotionally neglected. Society didn't do that to
them.

Traits prevalent in 10+% of the population can still be disorders. In any
given society, you'll have the rich, the middle, and the poor. You'll have the
psychologically healthy, the average, and the psychologically unhealthy (the
10+%).

These traits aren't "selected for" or "advantageous" in some situations. In
this society, most people with low self-esteem will die with low self-esteem,
since, when it comes to the psyche and emotions, most people only improve
superficially, they learn to cope rather than fixing for good. They'll
obviously pass that low self-esteem down to their children. No selection
involved. Would you say low self-esteem is "advantageous"? Is it an
"appropriate response"?

~~~
pc2g4d
I guess I consider dysfunctional families to be part of the injustice of our
society. As you say, anxiety is the default state, it's there to keep us
alive. So we should blame the family for not being nurturing or the culture
for not helping individuals learn how to deal with life, rather than blaming
the individual or saying they have some disorder.

Low self-esteem isn't advantageous. But getting anxious or depressed when life
isn't working out I would suggest actually is advantageous. Being at the lower
end of a bell curve doesn't make something a disorder.

------
khalilravanna
> ...Americans’ mental health has, according to some measures, deteriorated.

I wonder if these "measures" tried to account for the fact that the idea of
"mental health" is something that we as a society have only recently tried to
destigmatize and normalize. Seems to me that even just a decade or two ago
many mental health issues were something you brushed under the rug or
something that "other people" had to deal with but "never me". Could it just
be the case that many more people are finally coming forward with issues that
they had all along?

~~~
concinds
Do you really think we've even begun destigmatizing mental health issues? I
don't think the current situation is any better than it ever was.

Being able to find like-minded people on internet communities to discuss
mental issues they're also facing isn't the same as mental health issues being
"normalized" and "destigmatized" at the cultural level.

Wouldn't it be fairer to say that global mental health has deteriorated
because there are several factors favoring that, and fewer (I would say no)
factors acting in the opposite direction?

------
themgt
Fascinating to watch a brief video from Robert Whitaker [1]

The core of his argument appears to be that because the brain tends to
compensate for disequilibrium, psych drugs in the long-term paradoxically have
the opposite effect that they do short-term - anti-depressants are
depressogenic, anti-psychotics increase long-term psychosis, etc

[1]:
[https://www.youtube.com/watch?v=5VBXWdhabuQ](https://www.youtube.com/watch?v=5VBXWdhabuQ)

~~~
heisenbit
This argument assumes a healthy biology. The body seeks equilibrium - that
much is true and messing with it is generally not wise.

But that view is limited and assumes some linear or at least monotonic
relationship of cause and effect. The bodies myriad biochemical pathways are
anything but. As soon as one has non-linear relationships the door is open to
latching up etc..

There are ways a person can either through genetic variations or through
extreme experiences (chemical, psychological see also epi-genetics) not
exhibit a "normal" bio-chemistry. In such cases targeted intervention can help
to restore or long term maintain a state that is closer to "normal".

~~~
concinds
Would the psyche be better modeled as a complex system, then? Where mental
health isn't an equilibrium but almost an "accident", where everything has to
be in alignment?

The idea of "decompensation" seems to support psyche-as-a-complex-system
theory.

Still I don't think that that invalidates Whitaker's point, since pills or
other external treatments only add yet another subelement to the psyche
"system", rather than fixing those subelements or making the relationships
between subelements more functional. Pills only make the system more complex,
and compensate for the dysfunction in other subelements of the system, rather
than fixing anything at all.

------
cjlars
Suicide rates are up, which is perhaps the best measure of the quality of
mental health care people are receiving. However, there are at least few
plausible explanations not mentioned in the article:

1\. We have an older population -- suicide rates increase with age. [1]

2\. We have a less religious population -- Christians, Buddhists and Muslims
all have lower suicide rates than Atheists. [1]

3\. We have a lower worker participation rate -- Unemployment is associated
with higher suicide rates. Although most of the decrease in work in the US is
voluntary, there is still a plausible link. [2]

[1]
[https://www.journals.uio.no/index.php/suicidologi/article/do...](https://www.journals.uio.no/index.php/suicidologi/article/download/2330/2193)
[2] [https://www.cambridge.org/core/journals/psychological-
medici...](https://www.cambridge.org/core/journals/psychological-
medicine/article/div-classtitleunemployment-and-suicide-a-cohort-analysis-of-
social-factors-predicting-suicide-in-the-us-national-longitudinal-mortality-
studydiv/8F011545660CD98D542F48AC6B05E20F)

~~~
tptacek
4\. It became much easier and more fashionable for people in middle America to
acquire and use opiates and methamphetamine.

5\. We've had a slow collapse in the markets for routine manual labor, which
were the backbone of small/mid-market middle America, which drew people into
the cities set up a vicious cycle of depopulation and market decline in middle
America.

Maybe some of the linked research decouples the suicide rate from these
phenomenon, but I don't see enough meat in this article to make the case that
psychiatric medication is the likeliest cause.

------
evo_9
My ex has PTSD and was prescribed Adderal; it wrecked our lives for years
before I figured out what a horrible substance it is. After much trial and
error I switched her to a specific type of Fish-Oil that has the DHA and EPA
inverted (aka usually you have a very high DHA versus lower EPA). For whatever
reason this stuff was the only thing that really seemed to help.

She also in recent years added medical mj bars (thankfully we live in Denver)
and she would carefully cut up bars into smaller dosages (around 10mg each I
believe) and take one of those every 3 hours roughly.

Ultimately this was the combo, along with a good multi-vitiman that really
helped her regain a normal life.

~~~
yarou
A lot of people underestimate the anti-inflammatory and neuroprotective
effects of cannabinoids like CBD and CBN.

------
DubiousPusher
I was writing something that got way too ranty so I'll confine myself to this.

While over prescribing may be a real problem, I think they mischaracterize how
psych meds are prescribed. I've had several people in my life who suffer from
severe mental illness and finding the right meds for these people has been a
long and difficult process. I've sat in on many an appointment and never have
I seen the flippant attitudes towards prescribing these meds that this article
implies are widespread.

------
Sanddancer
Or it could be that medication keeps people from hiding from their problems. I
know people who have stopped going to therapy and thus, according to stats,
are "cured", however, they still have all the problems they had before.
Conversely, because you need to see a doctor regularly while on psychiatric
medications, it makes it a lot harder for one to hide from their situation.
Over prescribed meds are definitely an issue, but there is more at play than
just that.

Edit:

One of the data points describes the amount of people taking antipsychotics.
The article fails to tell how a lot of psych meds, like antipsychotics, have
off-label used. For example, seroquel is a sleep medication in low doses. That
would count as taking an antipsychotic even though the dosage is a tenth of
that needed for an antipsychotic effect. This article fails to describe how
psychiatric medications really are complicated.

------
aj0strow
For any parents out there: Please think long and hard before getting your kid
prescribed. Get 2nd opinions, try nature or counselling, reflect if it's
actually you who is the instigator. If you do go that route, know that your
kid might not make it to 18, and if they do, might resent you deeply.

When experts in the same field looking at the same case can't agree even a
little bit on best course of action, maybe it's not really science.

------
StanislavPetrov
Unfortunately the problem here is a serious one, and it isn't limited to
psychiatrists - hubris. Those in positions of power, whether psychiatrists or
presidents, virtually always prefer to err on the side of "doing something"
rather then "doing nothing" regardless of the risk/benefit ratio. Intrinsic in
the psyche of powerful people is the feeling of control. To these people,
inaction is a sign of powerlessness, an admission of defeat, of their lack of
control, and control is what they value above all else (whether consciously or
subconsciously).

------
gwbas1c
Ritalin and Adderal are good examples of how incorrectly prescribing
medication will have devastating effects.

Adderal is indistinguishable from methamphetamine, and Ritalin has similar
effects. Prescribing too high of a dose will result in effects that are very
similar to abusing illegal methamphetamine.

~~~
wincy
I was taking 60mg of adderall daily. It made me a monster. My doctor kept
upping my dose so I could "feel it" and I got meaner and meaner toward my
wife. Eventually she gave me an ultimatum: her and my daughter or the
adderall.

The three weeks after stopping adderall were awful. Eventually I got
productive but not nearly as productive as I had been at work. I was ashamed
at how difficult it was for me to accomplish simple tasks, not because I
couldn't do them but because I'd do literally anything but my job as often as
possible.

After a few months and having a long heart to heart with my wife, we agreed to
try adderall again but very differently. The main rule is that she's the
ultimate decider if I can take it. I take 5mg twice a day and feel so much
better. I'm productive without totally destroying my life.

~~~
lfowles
FWIW, a lot of people on /r/ADHD report having less anger issues on Vyvanse.
It is pretty expensive if your insurance won't help you out though.

~~~
wincy
Thanks, I've considered Vyvanse, but the 5mg twice a day seems to be working
great. I'm motivated at work without being a monster at home. I'm also staying
away from alcohol as the two seem to interact really negatively (probably
because they both affect dopamine). And ultimately, I trust and allow my wife
to make the call on if I'm doing OK (ADHD is weird in that it can be hard to
really know your own mental state or how well you're doing at any given time).

------
anigbrowl
Drugs can help, but really I've had greater and more lasting benefit from
proscribed ones than prescribed. Also, psychiatrists really need to grow out
of being licensed pill pushers and make more of an effort to be therapists.
Every psychiatrist I've worked with sees themselves primarily as a
diagnostician and invests only rudimentary effort in the caregiving or
investigatory aspects of treating mental illness. I think the
compartmentalization of health delivery functions is bad for patients.

~~~
rev_bird
I'm inclined to agree with you, but I think this might be an unfair demand --
you're describing two jobs that are closely related but entirely different.
I've had lots of doctors recommend therapy; I never expected any to _be_ my
therapist -- it seems a little like if you went to a restaurant and were
disappointed by the waiter because he wasn't a very good cook.

------
cannonpr
The brain isn't 'badly' designed as much as people often claim and it also
shows a remarkable amount of neuroplasticity and ability to alter it's
cognative abilities based the demands and situations that it is placed in. I
have reservations on the focus that our society places on magic pills versus
training your mind... At some point I would love to be able to modify and edit
my mind and cognition, but honestly the chemicals we peddle now are akin to
fixing a CPU with a butane torch.

~~~
Sanddancer
I feel it's more complicated than that. The problem seems to be more that
psychiatric medication is being prescribed without therapy being prescribed as
well. I don't feel I could be able to discuss the things I do in therapy
without the psychiatric medications I'm on helping with the healing process --
blocking adrenal response due to social anxiety is one example. While I try to
gain the confidence needed to socialize at all, having a medication to help me
not run and hide is definitely a good thing.

Regarding your last statement, sometimes you do fix a CPU with a butane torch.
There are techs that use butane solder irons so they don't have to worry about
cords getting in the way while repairing bad solder joints. Sometimes there
really is a mechanical problem, and not just a logic error.

~~~
cannonpr
I have some experience with therapy under medication for exactly the same
reasons you describe, and it was the right choice for me at the time, so I
agree, sometimes they buy you time and space to do the work. I also have fixed
solder joints/BGA's via last ditch attempts such as the towel technique for
xbox 360, and a few variations for certain Nvidia chipsets in certain _cough_
_cough_ apple crap. So I did choose the example for a reason, however, I
eventually bought a soldering oven and a desoldering hot air gun lol.

------
projektfu
The author of the article basically states that they are suffering from the
Baader-Meinhof phenomenon. They recently read, or read about the book, and all
of a sudden lots of studies come out of the woodwork that he thinks agree.
This is why systematic reviews are done instead of relying on opinion pieces.

------
disposablezero
Nuance/evidence-free claims. There are pluses and minuses to every situation
which must be weighed with common-sense. Also, psychiatrists spend very little
time on patient, use little or no evidence-based medicine and rarely act as
social workers.

------
warfangle
Ah, the old 'more people are being prescribed medication over time, which is
clearly causing more people to be prescribed medication.'

It's not at all tenable for other externalities to bring underlying mental
illnesses to the forefront, nope, not at all.

What lazy thinking.

------
tomquin
Prescription drugs may be necessary but only after all other therapies have
been exhausted. There are many ways to treat mental issues that do not require
nuking the brain with powerful pharmaceuticals. Yes they are needed,
sometimes.

------
anngrant
As far as I know, numerous studies have shown that some medications work only
due to their placebo effect. Though I actually doubt it refers to all groups
of drugs. I do buy some pain killers via [http://www.rx-
discountcoupons.com/pharmacies/xlpharmacy/](http://www.rx-
discountcoupons.com/pharmacies/xlpharmacy/) service. I believe that my pills
work and it has nothing to do with placebo effect. But who knows...

------
stevewillows
this is long winded.. tldr; was on a drug that didn't work, got into group
therapy that was far more effective.

\---

I've tried a several anti-depressants over the past twenty-two years with no
long-term success.

My GP's approach to severe depression was to 'change my outlook.' A few years
ago when I saw a psychiatrist, they were quick with the drugs, and, at the
time, I was thankful.

This was mirtazapine / remeron.

The first two or three months were fine -- a slight improvement that was
enough to give me hope. It wasn't until about two years of constant suicidal
thoughts (to an obsessive / fantasy level) that I realized that this wasn't
the drug for me.

With the mirtazapine and the thoughts, the suggestion was that I add another
drug to fight the suicidal / obsessive side. Seeing as these thoughts were the
reason I was taking the drug to begin with, I turned down that idea. I was
also aware of how easy it is to get into the balancing act of multiple
medications, and I didn't want to swing that again. That's when I decided
(against the wishes of everyone) to go drug-free.

It was suggested that I take close to a year to ween myself off of the little
pills -- but I figured I could do it in two months. While I was able to do it,
I had an extra two months of cold sweats, extremely believable nightmares, and
general withdrawal. It was much worse than anything I've ever experienced.

When I first expressed the feeling that the medication had stopped working,
the response was to up the dosage. This wouldn't be a bad thing if I weren't
exhibiting a good portion of the side effects.

The best solution for me was a ten-week group therapy CBT 'course' provided by
the local hospital's outpatient care. We watched clips from 'What About Bob?',
focused on 4-7-8 breathing techniques (also fantastic for those with anxiety),
and discussed the aspects of the illness that we felt were most shameful.

In externalizing the depression and suicidal thoughts, there was an amazing
transformation that came through the validation from the others that I wasn't
alone in the struggle. For me, this has been far more effective than any drug
I've tried over the past twenty-two years, and I'd suggest it to anyone --
either standalone or in combination with medication.

I'm not completely free of these thoughts or desires, but when they do come
up, I now have rational, logical tools to address them and move on. For anyone
in the struggle, look into what your local hospital has to offer.

------
lyle_nel
Could someone explain to me how this is not a correlation implies causation
fallacy?

I don't where a causal relation is demonstrated.

------
tptacek
I'm not sure I understand how substance abuse --- which appears to be
correlated with suicide --- would be caused by psychiatry, rather than on
socio-economic circumstances. How many rural Ohio opiate addicts do we think
first worked their way through antidepressants?

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matheusmoreira
The evidence in favor of psychotropic medications is vast. Any medical
treatment may very well "cause more harm than good" \-- the physician must
weigh the risks and benefits and inform the patient.

They are not the only approach to treatment. There are many others we know may
provide a benefit such as cognitive behavioral therapy and many others. It
depends on the patient.

I think it's useful to review the medical practice guidelines; they collect
the relevant evidence in one place and recommend treatments based on them.
American Psychiatric Association guidelines can be found here:

[http://psychiatryonline.org/guidelines](http://psychiatryonline.org/guidelines)

For example, lets take the Major Depressive Disorder 2010 Guidelines¹ since it
covers the most prevalent mental health issue. It is divided in three
sections:

>Treatment Recommendations

>Background Information and Review of Available Evidence

>Future Research Needs

Many treatment modalities for the acute phase are suggested: pharmacotherapy,
electroconvulsive therapy, psychotherapy and association of pharmaco- and
psychotherapies.

The discussion of the efficacy of antidepressants starts on page 33. Here's a
few important lines:

>A large body of literature supports the superiority of SSRIs compared with
placebo in the treatment of major depressive disorder

>Each of these medications [SNRIs] is efficacious (i.e., superior to placebo
in controlled studies and meta-analyses)

>Mirtazapine has comparable efficacy to SSRIs

>Although trazodone is an effective antidepressant, relative to placebo, in
contemporary practice it is much more likely to be used in lower doses as a
sedative-hypnotic than as an antidepressant

>Despite widespread use of trazodone as a hypnotic, few data support its use
for this indication

>In comparative trials versus SSRIs, nefazodone showed comparable efficacy and
overall tolerability

>Tricyclic antidepressants are effective treatments for major depressive
disorder and have comparable efficacy to other classes of antidepressants,
including SSRIs, SNRIs, and MAOIs

>MAOIs have comparable efficacy to other antidepressants for outpatients with
major depressive disorder and may be appropriate for patients with major
depressive disorder who have not responded to safer and more easily used
treatments

It's well-established that modern psychotropic medications are effective
treatments. Choosing among them and offering the patient the most appropriate
medication is a complex process. In particular, the appearance of side effects
and how well they are tolerated must be monitored.

Of course, general health advice applies. Regular exercise is likely to
improve mental condition. However, I've never had the experience where a
severely depressed person suddenly got motivated, started exercising regularly
and got better. In fact, reduced energy and decreased activity is one of many
signs² of depression.

¹
[http://psychiatryonline.org/pb/assets/raw/sitewide/practice_...](http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf)

²
[https://www.ncbi.nlm.nih.gov/books/NBK64063/](https://www.ncbi.nlm.nih.gov/books/NBK64063/)

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VLFBERHT
I came here to make a Scientology joke but I can't think of anything funny.

