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Psychiatrists Must Face Possibility That Medications Hurt More Than They Help (scientificamerican.com)
245 points by aburan28 on Dec 15, 2016 | hide | past | web | favorite | 180 comments

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?

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.

ADHD is a horribly misnamed condition. It's caused by a delay in the development of the frontal cortex which puts people about 30% behind their peers in many higher order cognitive functions.

If depression is like the flu, ADHD is like missing a leg. You can't regrow or cure a missing leg, all you can do is use a prosthesis -- for ADHD stimulants are the prosthesis for the missing development of the higher order brain functions.

ADHD is a serious impairment to normal cognitive functioning. However everything a person with ADHD experience is a part of everyone's ordinary rational expectations: things forgotten, things missing, a lack of motivation, difficulty focusing, emotional dis-regulation, lack of social awareness. And that makes popular perception very difficult to correct -- because it isn't that these things happen, its that they happen to an extreme because of a significant neurological impairment.

I disagree with your missing leg metaphor (while agreeing with most else you wrote). I have raging ADHD, don't take medication, and do suffer from many of the cognitive impairments you describe, which are certainly disadvantageous. On the other hand I am way way better at some things than most other people - if left alone in the right conditions, I can hyperfocus and do great amounts of work or assimilate great quantities of information, I perform way better than other people in chaotic and emergent environments, and I am way better at coming up with novel solutions to problems or discovering connections between superficially disparate data points. In situations where normal people tire out easily, get overwhelmed by having too much going on, or get stuck in linear thinking patterns, I thrive because that's how my world is by default. That's one reason that a lot of people in film production have ADHD. Equally, it's why I hate post-production, because a lot of the time I'm understimulated and I get bored to distraction without constant realtime feedback from collaborators.

Incidentally I really con't like adderall much - it does work for me but I don't enjoy it and find the side effects annoying. As I said I don't take any medication, but I sure wish there was a safe legal way to dose small quantities of cocaine because that stuff works a treat and for me it's no more addictive than celery.

EDIT: I should clarify that I don't take medication at present, which goes back about 5 years. I did take a variety of prescription medications over the previous 10 years but was unhappy with the various side effects and never found a good long term fit.

> ... I perform way better than other people in chaotic and emergent environments ...

Yes! You can see more details in my other post: https://news.ycombinator.com/item?id=13188789

I dose myself based on what kinds of work I expect to be doing during the day.

I've always been an 'ops guy', though at the same time, I also write a lot of code. 'devops' before that name existed.

As a traditional 'ops guy', untreated ADHD is quite a nice characteristic to have, especially when shit's going down. It allows me to direct and redirect short bursts of hyper-focus, very rapidly.

In that state, it's hard to focus very long, but it's quite easy to context switch.

That's one of the advantages to my work schedule: I generally start working around 6am, way before most people are even awake, let alone working. So normally, during my first 4 hours at work, I write a lot of code. So I take my meds so their levels are highest then.

As people start coming in, I tend to switch modes, as I let the 'ADHD' take over.

In those rare cases where I had to manage a substantial incident while my meds were at a high level, I didn't perform as well.

During the 'heat of an incident', you don't want to go down any rabbit holes. You want to keep your eyes in a lot of places at once. But when I'm on my meds, I tend to be more 'depth first', instead of 'breath first', to use tree traversal as an analogy.

Honestly, I kind of consider my ADHD, plus meds that I can carefully control the dose of, as a kind of 'superpower'. (I mean, not really a SUPER power, but I mean as a nice advantage.)

I can relate very much to the depth vs breadth first as a metaphor to my working type when I'm on vs not on my meds.

The problem here, is in part I think, how poor people with ADHD are at assessing themselves. Autobiographical memory is very impaired, and often access to your internal emotional state and its relation to long term goals is quite weak.

So you do often find people with ADHD completely misjudging how good they are at tasks, compared to others, and so on.

I think you'll find many of the skills you rely on which give you this advantage, if you do in fact have an advantage, arent ADHD.

ADHD is a significant neurological impairment, and people with it are impaired in many higher order cognitive functions. These arent compensated for by divine intervention. ADHD isnt an alternative evolutionary pathway, nor is it part of the "healthy mixture" of society. And more than how good it is that we have some blind or otherwise disabled people around.

There really are disorders of the brain which constitute simple factual impairment, and to have this impairment improved upon enables the person to far more successfully achieve their own goals. ADHD is one such disorder: medication very often makes living the life you wish to live much easier.

It's perhaps a harsh reality, but it is reality. Significant cogantive impairment diminishes your ability to realise your own goals.

The popular mythology of the genius provided by mental ill health or disability is a pernicious one and is believed to the great detriment of many people. People with cognitive problems often cling to them in pathological ways, and this is especially common with ADHD people because they find it difficult to reflect over their life in the ways needed to realise the patterns of their difficulties.

I would strongly encourage every one with ADHD, or who think they might have it, to seek pharmacological help asap. Many of the symptoms can be greatly reduced with stimulants and they'll make realising your own goals much easier.

It looked to me like he described his hyper-focus and context switching as the advantage. ADHD causes both of those things. It looks to me like you imply that ADHD, as an impairment, can't cause an advantage in some situation. I disagree. People on the autistic spectrum, while undoubtedly also having abnormal brains, can process information in a way that others can't, sometimes giving them an advantage in 'cerebral' professions, while also possibly causing functional deficits in other contexts.

This feels to me like a one-size-fits-all reply, and dismissive of what looks like a valid and realistic self-assessment. "Significant cogantive impairment diminishes your ability to realise your own goals" doesn't hold true without context. A person may have a goal of not depending on medication, or choosing to view their state as a strength and building on their differences. Consider Stephen Hawking. I don't think he would have wished for his condition, but a friend of his once noted that when he got a book, he would remember what he saw, because he could not easily pull the book down again. If he didn't have physical impairments, he might have gone in other directions. He had to focus on a mental career. He took his position for one of strength and made the most of it.

I find your reply dismissive of this person's experience, reality, and values.

People with ADHD are incapable of making a "valid self assessment". It's a disorder of the specific faculties involved in being self-aware in the right sort of ways.

It's a very common phenomenon to encounter a person with ADHD who insists their life us going well but who are being fired every month.

We're talking about serious cognitive impairments not 'differneces' it's reckless to encourage people with this condition to avoid seeking help.

I'd argue that the ability to make a "valid self assessment" is missing from every person on the planet. We can only use the tools available to us, i.e. track our workflow against our peers, our performance in academia, etc.

I agree that we shouldn't encourage people to not seek help, that's no good. But people with the disease sharing how they can leverage it to their advantage can help.

Yes, but that's very unlikely to be the case. There are pop books out their peddling the idea that ADHD provides different advantages -- it's perverse and entirely non-clinical. No one is writing books about the wonders of blindness, or missing a limb -- because physical impairments are so obviously, on the whole, impairments even if we might imagine some circumstance they could be beneficial.

ADHD is a developmental delay in the frontal lobe which causes significant cognitive impairments, that far and away, on the whole cause havoc for people.

People with ADHD should not be encouraged to attribute their successes to their disorder, they are almost always due to unaffected cognitive skills -- NOT ones impaired by ADHD, or affected by stimulants. People with ADHD are often the worst at making this mistake which is why I wrote my initial reply -- because I am concerned for the writer of the comment that they are making this very mistake and that they should really be taking medication.

I can only speak to my own professional performance, as evidenced by people who have been paying me (quite well) to do various things for the past 25 years.

There are certain kinds of things I am better at when I'm not on my meds.

There are certain kinds of things I am better at when I am on my meds.

I'm not speaking for everyone, and I'm not encouraging people to not seek medical attention.

It's possible what I'm reporting is non-clinical, and I'll give you the benefit of the doubt and assume you're not speaking broadly when you use the word 'perverse'.

I am not down-voting your replies in this thread, but I understand why people are. You are using non-nuanced and absolutist language which won't be that effective in conveying your perspective.

I know very well (from personal experience and observing close acquaintances) that conditions like ADHD can, at times, make it very difficult to function in modern society.

But the fact that these traits are so widespread means they must have an evolutionary purpose.

And of course we can see that many highly talented and successful people are diagnosed with ADHD and related conditions, but are able to use their traits to great advantage.

Others cannot, but that's not because it's impossible, they just haven't been given the right support and opportunity to make best use of their natural cognitive preferences.

This is not at all to say that those diagnosed with ADHD shouldn't be given support, treatment or any other help they need to get by in life.

But the claim that ADHD isnt an alternative evolutionary pathway, nor is it part of the "healthy mixture" of society doesn't fit with accepted evolutionary theory, nor empirical evidence.

> But the fact that these traits are so widespread means it must have an evolutionary purpose.

No. The most you can say is that whatever causes it is not detrimental enough to reproduction (rate) to be actively selected out of the gene pool.

Objectively speaking, I agree with you.

I did read some material a few years ago outlining a way that ADHD could have been a real advantage, but I think that is still rather speculative.

True, it could be an advantage under $CIRCUMSTANCES, but there'd have to be some evidence other than "it hasn't been selected out of the gene pool" :).

It'd be worth your while to listen to the Sam Harris podcast with Eric Weinstein [1], who, on the theory that the propensity for religious belief is an evolutionary mistake that serves no useful purpose, makes the point (based in the research of his brother, Bret Weinstein, an evolutionary theorist who's spent two decades researching evolutionary tradeoffs [2]) that this trait is just so costly to human functioning that it would have been negatively selected out of the genome were it not to offer significant benefits in certain circumstances.

The same can be said for any other cognitive variances, including what we call ADHD, Autism Spectrum Disorders, Depression, Bipolar, etc.

And so we frequently see today, numerous people diagnosed with these conditions, experiencing severe challenges on the one hand but great benefits on the other - just consider the number of great artists and writers with ADHD or Bipolar, or inventors with ASDs.

So we don't need to theorise about whether or not these tendencies are sometimes beneficial, and whether they have been selected for in evolution; it's plain to see if you look around.

[1] https://www.samharris.org/podcast/item/faith-in-reason

[2] http://reinvent.net/innovator/bret-weinstein/

I'm not sure I can stand listening to another one of Harris' podcasts, but I'd be intrigued if you could explain what an economist+mathematician with some 'alternative' ToEs could teach us about ADHD. (I'm not dismissing it outright, but this definitely smells of woo, so please convince me to listen to that.)

Relax, I just thought you might find it interesting :)

But it's not necessary to prove the point, we can rely perfectly well on evidence and Occam's Razor for that:

- We can identify highly successful people who are confirmed or speculated to have (or have had) ADHD: Richard Branson, Ingvar Kamprad (Ikea founder), Nikolai Tesla, George Bernard Shaw, Jim Carrey, Walt Disney, Kurt Cobain, Robin Williams. Even if we aren't convinced that each of them exactly fit the ADHD diagnosis (which is inherently fuzzy anyway), we should be able to agree that they are/were all cognitively atypical in ways that are somewhat consistent with the conventional diagnosis of ADHD.

- In each of these people, we can see how their atypical qualities are/were integral to their talent and success, I.e. a rich imagination and enhanced creative capacity; being able to absorb and process many different ideas at once and mash them together to produce new concepts; being comfortable challenging conventional thinking and living outside mainstream norms; having the charisma to communicate new ideas to others and inspire action and change. We can also see significant downsides, most notably in Cobain and Williams who ultimately took their own lives, but anyone with these kinds of conditions will report significant difficulties, which is not surprising; in nature, every benefit comes at a cost.

- We can easily imagine how these qualities would have been beneficial throughout evolutionary history, and how it would always have been beneficial to any society or tribe for a minority of the population to have carried these traits, in order to find new solutions to problems, to invent new systems and technologies, and to break down outmoded traditions and practices to make way for the new.

By your reasoning, ADHD only confers a cost on its carriers, but not one that is severe enough to be selected out of the gene pool. I.e., ADHD is a genetic accident that has continued to be maintained in the gene pool despite having a great cost to the fitness of those who have carried it.

But the "genetic accident" theory doesn't survive Occam's Razor. In addition to it being unlikely to have survived and remained so widespread if it only imposed a cost against fitness, we just don't need to add it into the explanation when the explanation works perfectly well without it: that ADHD-like behaviour is beneficial in the right circumstances, and is necessary to exist in a minority of members of any tribe or society in order for it to survive and progress.

> In situations where normal people tire out easily, get overwhelmed by having too much going on, or get stuck in linear thinking patterns, I thrive because that's how my world is by default.

Huh, yeah that's exactly how I see it, as well. Too bad it's impossible to always be in those situations...

> I can hyperfocus and do great amounts of work or assimilate great quantities of information

As someone who has been medicated on and off, I can tell you that hyperfocus is not something that medication will switch off entirely.

It is merely that if you want to stop, you can, and you can train yourself not to hyperfocus on irrelevant things like video games, clicking through Reddit, writing blog articles that don't get posted, etc.

ADHD is all about being unable to properly tune your attention without taking what to other people would be considered heroic levels of effort.

I agree with pretty much all of this. It can be a benefit in certain situations. I kick ass at hackathons. I can dive into the middle of an unfamiliar code base and quickly get oriented and solve bugs that the other developers haven't been able to. I can solve interesting and complicated problems across many domains like few others can. The problem is, life isn't just a series of interesting and complicated problems. In fact, the vast majority of it is trivial and boring and dealing with trivial and boring things is exhausting.

I started taking medication in my mid-20s, despite having been diagnosed with ADHD around the age of 12. I also have been diagnosed with dysgraphia.

I think the effects of dysgraphia are much more akin to losing a limb than ADHD, but taking medication is honestly one of the most life-changing experiences of my life. I tried medication way back when, and the side effects were horrible. I didn't try them again until I was having trouble at work, and I visited a psych for a doctors note requesting some mild accommodations related to my dysgraphia. I had avoided medication because until that point I was sure I could do anything else anyone else could, and I was afraid it would fundamentally change who I was.

That fear was largely unfounded. Some medications give me side effects, and some make me feel like I'm not myself. Eventually I found the right medication and dosage. After about a month on that medication, I looked at what I had accomplished and I was so overwhelmed with emotion I honestly cried. I had been making life so unnecessarily hard for myself, and I had been so hard on myself. Like, I cannot believe how much easier everything is. I feel like I used to get everywhere by running in molasses, and then someone told me about highways and cars.

The thing about medications is that they don't turn your life around for you. They basically give you the power to control your life.

Maybe there isn't a medication out there for you. Honestly, a huge part for me was finding the right doctor. He is one the few docs I've ever met who specializes in adult ADHD, and he's really fucking sharp. I don't actually like our meetings very much, cause he's not much of a conversationalist and is pretty gruff, but he knows his shit. He's willing to write prescriptions that most doctors won't write because the dosages are too abuseable or whatever. (And his other specialty is addiction, so he definitely has a view on that).

For instance, I tried Ritalin, and I hated it. I just felt angry the entire day I was on it. I was suddenly aware that I should be concentrate, but I couldn't concentrate at all. Instead of spending several months titrating me up on Adderall, he just gave me a pretty high dose, since my reaction basically indicated my ADHD wasn't going to respond to lower levels. Adderall helped, but the side effects were miserable. I felt like I wasn't myself using it, almost like a zombie. I felt like I couldn't change gears at all.

Anyways, long story short, I found Evekeo actually worked best for me. Adderall is 25% levoamphetamines, and 75% dextroamphetamines. Evekeo is 50/50 levo/dextro. My basic understanding is that Levoamphetamines affect the rest of the body, whereas dextroamphetamines mostly affect the head. For this reason, the DEA has typically felt that l-amp has less clinical value and is more abusable, but the difference between Evekeo and Adderall is night and day for me. I actually feel like myself. Now, I have never taken cocaine, so I can't tell you how it compares, but if you feel like adderall takes away your ability to do all of those things you listed as benefits, I'd say that Evekeo is worth a shot.

I can relate to wanting to truck it out though. After my second consultation, my doctor said he was amazed by all the achievements I have in my life, given the degree to which I am ADHD. His assessment was that I must be one of the most overwhelmingly stubborn people on the face of the planet. I never have thought as myself as a stubborn person, but my family and closest friends would definitely agree with that statement. I think that stubbornness is what prevented me from seeking help earlier, but also what motivated me to keep going.

From what I've gathered over the years, dextro-amp is primarily responsible for focus, attention, and (potentially) euphoria while levo-amp is primarily responsible for peripheral effects like anxiety, jitters, and other "body-centric" things.

As a result, I've always understood d-amp to be considered more abusable and part of the reason for the mix in Adderall and generic equivalents (although it's also allegedly a better mix for treating most ADD/ADHD).

It's why you can get Adderall if you're diagnosed with these disorders but it's rare to see anyone prescribe Dexedrine (which is just d-amp). Abuse potential is higher and also l-amp lasts longer so the mix may be seen as more effective overall as a pill you take once or maybe twice a day.

Never heard of Evekeo though.

As a side note, it seems a lot of ADD/ADHD sufferers should be diagnosed with (instead of or also including) ODD or an executive functioning disorder.

Our brains, largely, are badly designed. And it sucks, especially with the HN crowd, we'd all be ten times more productive if we didn't all suffer from the same shit.

For readers, ODD == Oppositional Defiant Disorder.

Basically ADHD is just a symptom checklist, what causes it also causes a whole variety of other stuff not included in the same checklist for somewhat @political" reasons.

In particular ODD means being reflexively and exaggeratedly defiant and hostile to authority. Possibly because its associated with external demands that are inherently difficult to meet (because of the ADHD part) and so quite tortuous and frustrating.

What's remarkable is that the oppositional characteriststs associated wiith ADHD are significantly helped by stimulants. Which doesnt make any sense, if the oppositionality were some personality characteristic. It arises due to the very same cognative impairments.

> causes a whole variety of other stuff not included in the same checklist for somewhat @political" reasons

Like what?

I have ADHD. I tend to notice that other people I know, who also have ADHD, tend to have a lot of other "not normally associated with ADHD" things in common with me. But I don't know which are true correlations, and which are just pareidolia on my part.

Stimulants work because ADHD brains have whacked out dopamine regulation. Stimulants help smooth out the peaks and valleys associated with ADHD. Hyperfocus = overstimulated by dopamine, inattentiveness = understimulated. Taking a stimulate provides a consistent baseline level to help reduce the extremes.

Stimulants work because they activate the underperforming portions of the prefrontal cortex related to attention management.

Chalking it up to dopamine is a gross simplification.

Adderal, for example, stimulates the release / reduces the re-uptake of dopamine, norepinephrine, epinephrine, serotonin, histamine, and CART peptides.

This is the first time I've heard of ODD. To be honest it seems almost comical that defiance of authority has its own medical diagnosis as a disorder.

According to ODD, every pioneer in human rights (I.e. Susan Anthony, Thomas Jefferson, MLK, Jesus) should be regarded as mentally ill and drugged into submission.

The symptoms of the disease don't necessarily translate to having the disease. Not everyone that is sad has clinical depression, not everyone that is obese suffers from glandular disorders. Etc.

Not every problem a guy has with his girlfriend is necessarily caused by the capitalist mode of production.

It's not a generic "defiance to authority", as I understand it's more like anyone trying to exert any kind of authority over you is bound to generate a kneejerk negative reaction, big issue or small, reasonable or not. Could be a parent, supervisor, partner, teacher, cop, etc. ODD is not related to an actual battle against your oppressors.

ADHD /is/ classified as an executive dysfunction (specifically, in regulating attention).

Autism spectrum, schizophrenia, depression, and parkinson's disease are other well known disorders classified as an executive dysfunction.

ODD ("a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least six months") is not at all the same thing.

Badly designed for what? Coding CRUD apps?

This is a real question, not rhetorical: Does ADHD exist in similar numbers in societies that are less sedentary?

Is this "30% deficit" (citation needed) conquerable by training and meditation?

It wasn't for me. It may be for some.

As I got older, I've had more and more trouble focusing. I also started to suffer from confusion. The scariest part was when I was talking to someone about a technical subject, and suddenly what they were saying literally stopped having any meaning. I just couldn't understand a single word they were saying. I saw and heard them speaking, but didn't understand any of it. This lasted only a short time, but it happened a couple of times.

I then started taking DHA and CDP Choline, and all of the above symptoms went away. I was back to "normal". Through experimentation with stopping and restarting both DHA and CDP Choline, I figured out that it was the latter which was responsible for the change. There were days when I'd forget to take the CDP Choline and then later in the day notice that I felt I had trouble focusing and then realised, "oh yeah, I forgot to take the CDP". Starting to take it again would relieve the symptoms. This happened more than once. I also went for months without taking either supplement, where I'd run out and procrastinate on getting a refill, and sure enough, I'd go back to having trouble concentrating. Then I'd finally get a refill of CDP and I'd be able to focus well again. All of this has convinced me that CDP really is working for me.

Later, due to some other health issues (not related to cognition) that I've had, I took a good hard look at my diet, and found out that many health issues that I have and have had in the past could very likely be due to various vitamin and mineral deficiencies. Though I've always known that my diet wasn't really healthy, I never realized how much of a profound effect the lack of proper vitamins and minerals could have on my mental and physical health.

I started eating a lot more healthily (in particular, eating lots of fruits and vegetables, which were almost completely missing from my diet in the past), and taking supplements for some of the nutrients which I was still not getting adequate amounts of from my diet.

As a result, I feel much better, have a ton more energy, feel in a better mood, and have no problems concentrating.

I strongly encourage you to take a hard look at your diet to see if you're missing or low on any essential nutrients, and consider supplementing those (or, better yet, getting them through eating more nutritious food). It can really make a world of difference.

Have you tried Alpha-GPC? Some people say it works better than CDP Choline, but it seems to be very situational.

Lately I've had more issues with staying focused and refocusing after distractions and I've started looking into nootropics. Unfortunately they seem to affect everyone differently.

I have not tried Alpha-GPC, but I am aware that it is similar to CDP Choline. From my own reading of the many comparisons of the two, CDP Choline is supposed to be the more effective, safer, and cheaper one. I might try Alpha-GPC at some point, but right now I'm pretty happy with CDP Choline.

I'm not super gung ho on experimenting with nootropics in general, and try to be very conservative and err on the side of caution. There are all sorts of different nootropics out there that sound really cool, but I'm just not very much in to using myself as a guinea pig for them. So I don't try a lot, and when I do I go for ones that are known to be super safe and widely used.

My experience with diet exactly matches yours, due to health problems I had to start eating the fodmap diet, improvement in mental state and focus was incredible, I felt like I was back in my twenties again.

I genuinely appreciate your advice, and I always like to investigate alternatives to Adderall. That being said, I've been tackling ADHD and depression from multiple angles for a couple decades now, and luckily that resulted in me finding I'm happier when I eat well and exercise (so I keep doing it), but in the end the medication is what it takes to allow me to perform alongside my colleagues.

I have ADHD as well, and I started treating it with meds quite a few years ago.

Before I took meds, I was generally very productive, but it was a huge strain.

I've always been pretty religious about getting enough sleep, and so back then I was consistently getting more than 8 hours of sleep every night. And I would wake up refreshed, and I'd feel great.

Then after a work day containing a fair share of intense concentration, I would be absolutely exhausted. Most days, I'd take a 90 minute nap as soon as I got home, so I could have some kind of useful evening.

I've always been, for myself, extremely reluctant to take any kinds of medication. I don't put that on anyone else, but it's just my own personal perspective. So I resisted getting the ADHD treated for a long time.

I finally went in and got a scrip for Adderall.

My blood pressure and pulse rate were, at the time, in the normal range, but slightly high. So I did some experiments, tracking my BP and pulse rates at various intervals after taking the meds.

Even though Adderall is speed, for me, it clearly lowered my pulse rate and blood pressure after I took it. My mind wasn't racing around in many directions at once, which I assume allowed my BP and pulse rate to go down further into the normal range.

Further, I no longer needed to take a nap in the afternoon after work.

Note: this wasn't because the meds were keeping me awake. I never take them after noon, so their levels are very, very low when I go to bed. Sleep is still important to me.

I manage my consumption of the ADHD meds pretty rigorously. My doctors have always given me that flexibility by giving me many tablets of small dose, so that I can slice and dice the dose as I see fit. This has been quite useful, since I'll actually dose myself based on what's expected during the day. And on days off, I'll almost never take the meds.

One last point: I don't think ADHD is a mental illness per se. I know that people who have it might not fit as well into some parts of our modern society, but more than anything, I think it's just a personality trait, one that provided evolutionary advantages at some point in our past.

I think finding a doctor that will let you manage your own doses is _really_ important.

Other side of the coin: I have a friend who went to a psychiatrist and was given an Adderall prescription. A couple years later he was hopelessly addicted, taking over 90 mg at a time. He may well have had ADHD but the drug ended up being worse than the condition. Amphetamine is not something to take lightly.

90mg is an obscene amount of adderall. I'm wondering how no doctor or pharmacist over the years caught this addiction and reduced his prescription. In Texas I had to go in every 3 months for a reevaluation. I worked closely with my psychiatrist to help me keep my adderall dosage at the lowest possible. You're right, it's a powerful drug.

Have you looked into Provigil (modafinil) before? I originally started taking it for fatigue attributed to mis-diagnosed sleep apnea but have since continued to have a subscription through a psychiatrist, as I've found it to do wonders for concentration without some of the negative side effects of amphetamines (and the psychiatrist was thrilled that I already had a positive experience with an attention drug that wasn't an amphetamine).

Modafinil is on my list, I'm considering switching to it early next year to possibly replace adderall. If anybody is in a similar boat to me and is curious what my experience will be on it compared to adderall, I'll be publishing an extensive analysis on my blog, which is accessible through my user profile on this site.

I don't have ADHD but I've used both drugs for work, and Adderall works better, but Modafanil is not addictive. Modafanil gives you a similar hyperfocus without the euphoria of amphetamine. It has a high tolerance curve. It also has a flatter dose response curve (i.e. taking two modafanils won't give you twice the effect).

When my health insurance lapsed I was put on Adderall because despite modafinil being a generic, it was still too outrageously expensive to pay for out of pocket. I got no euphoria from Adderall. I was able to stay alert but I was jittery and wildly irritable. As soon as I was able to get good insurance again I dropped it for modafinil. I guess I should be thankful that Adderall didn't appeal to me due to its addictive potential.

The only way I can describe it to people is by identifying how disruptive distractions are, and how powerless I am to stop being distracted.

My go to example, being in an open office, is to point out how every time somebody walks by my desk in eye shot it is very difficult for me to not immediately look over at them. I would really not like to, I trust our building's security to keep me safe, people who walk by are quiet and polite, and I know the things I'm trying to focus on are more important.

My brain does not let me do it. I have to look over every time.

I tend to leave out the hyperfocus thing b/c it's hard to describe what it's like to somebody who's never had it, because to some people it directly contradicts the other point: "See? You can focus!"

Genuinely curious, and hopefully this doesn't come across as inflammatory. When you say you can't focus, and they say "lots of other people can't focus" - you mean that they don't know what it's like for you - but how do you know what it's like for them?

I can't add much more value than CocaKoala's response already has, but in the end while I don't know what it's like for them, I don't really have to. I trust the medical science and various doctors that indicate to me I have a disease that I need to treat. I believe them when they demonstrate that my behavior/inability to focus is abnormal.

Experience with depression has taught me this is the right stance to take - while I have had friends who were sad, and were able to "get over it," when I was very sad (clinical depression though I would refuse to call it that at the time) I wasn't able to just "get over it." I fought and fought and never "got over it." I finally caved and trusted the school psych grad student that was urging me to see a professional, saw a psychiatrist, got medicated, and solved the problem. Now I understand that when it comes to illness, sometimes I just have to trust my doctor and follow their advice.

One way is to look at work output; if you see somebody putting out significantly more work with no apparent trouble focusing, then perhaps the challenges they're facing aren't the same as the challenges you're facing.

A friend I used to live with was in grad school to become a teacher, and she was Miserable. The program she was in was somewhat accelerated, and she just didn't have enough enough time in the day to get all of her work done between schoolwork, homework, student teaching, and basic housework (in this context, "housework" is things like "unpacking her stuff from the boxes they were put in when we moved into this house together" and "finding time to cook dinner for herself a few nights a week"). I was working as a baker, starting work at 630am four days a week. She was up before I was, and usually going to bed later than I was, just trying to get enough time to finish everything.

On a rare occasion that she took a break and went out to get dinner with some friends, she got in a car accident and totaled her car. She was too stressed out to focus, she was so worried about the work she had left to do, she didn't notice an oncoming truck and the front half of the Maxima she was driving got ripped off. She was essentially barely functional from lack of sleep, and she just didn't have the time to catch up. It was a pretty vicious cycle; she had trouble focusing on her work to complete it, so she had to stay up later, the sleep deprivation made it harder to focus, so she had to stay up even later, and so on. She went to some herculean efforts to try and get everything done, and ended up failing out of the program.

When she talked to her mother about how and why she had failed out, her mother explained that when she was a child, she had been diagnosed with ADHD, but her mother resisted getting her put on medication; she didn't want her child to be "labeled", and she worried that teachers would treat her child differently. My friend was naturally intelligent enough that she was able to cruise through high school without issue, and she made it through most of undergrad without too much trouble, but in grad school she hit a wall. Just couldn't do it. Not for lack of trying, not for lack of desire, not for lack of motivation, but she just couldn't muster up the focus to get everything done in a timely manner.

She took some time off, got on a medication schedule that works for her, got into a different program at a different school, and is now a happy and successful teacher. When I asked her how the new program was treating her, before she graduated, she said that it was great but the real success was the medication; all it did was help her stay on track, and that was what she needed.

The fact that it is enhancing your performance and you are able to tolerate it is reason enough to not judge you for using it. If I could take a drug that made me significantly smarter, I would be willing to pay vast percentages of my income for it, like up to 50%. We must pathologize to justify enhancement. But there really should be no need. We all wish to improve ourselves. If responsible use of amphetamines betters you, that's enough to justify its use.

You know there are plenty of drug and money free ways to make yourself "vastly smarter". Unfortunately it takes about a year to go through the natural route.

Read Mindset by Carol Dweck. Worked wonders on me.

There is no known intervention that can raise IQ.

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.

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:


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.

That's because adderall is basically meth. I know it's very hard to grasp the idea of ADHD as a condition but there are lots and lots of mental conditions whose existence cannot be conclusively demonstrated or dismissed by EEGs and the like; we just don't understand the brain as well as we'd like right now.

speaking as someone who has struggled with ADHD since being a small child, having to assert the existence of a sometimes-crippling condition to people who demonstrably don't understand it very well is really, really insulting and I am sick of it. You don't have to believe in my mental illness but unless you have a superior psychiatric model to offer, then please stop stigmatizing it by questioning the reality of something you don't understand.

Do you tell people who are color-blind that they can totally see red (or whatever) color, insisting they're just not looking hard enough? Probably not, because you likely know we can explain color blindness by unusual differences in the retina. But we only gained that knowledge relatively recently in history. You would not have been helping anyone who was colorblind by telling them to 'look harder' before that discovery was made, would you? Then please accept that you're not helping anyone with ADHD by telling them they just need to focus harder/ learn better habits/ etc..

...if for no other reason than that when I'm trying to explain ADHD, having to listen to someone's poorly-informed opinion on a complex medical topic is really distracting. It's very tiring for me in a face-to-face setting to have to stand there waiting for someone to catch up with my substantive arguments. I don't say that to be rude, I just don't know how else to explain what it feels like; to me most people are slow and talking them is about as much fun as driving in a traffic jam.

One of the problems is that our models for "physical" nonbehavioral illness don't translate well into neurobehavioral problems.

Something like ADHD is heterogeneous (the AD problems are different from the H problems), but not totally so. Also, attention and behavioral control problems are normally distributed, like the good ol' bell shaped curve. They're fuzzy.

So those who claim it is not a real disease are correct in a sense: it's not like color blindness, or having a missing limb, or Huntington's disease or something like that. They're also right that it's normal to have attention problems at various points in life for various reasons. However, those who claim it is a real illness are also correct: there are people who have very unusual levels or patterns of attention problems, and even though they're not qualitatively different, they're quantitatively different, and they have serious problems as a result, and are not just screwing around or lazy.

Behavior problems are often much more akin to something like blood pressure or weight. So, it's true that you wouldn't say "high blood pressure is a disease." However, it is a state of illness, might reflect a disease, and can lead to death and other problems. Same with excessive weight. Some pudginess is normal, but at some level it becomes medically threatening. The boundary is vague, and arguments about whether or not weight problems are biological or environmental or social or behavioral are misleading: they're all of the above.

The problem is that when people say "I see my neighbor with ADHD, and think they just need to realize that's a normal part of life," part of what happens is that they're assuming that their own experiences with attention problems are the same as theirs, or that their neighbor who might be exaggerating is the same as everyone else with an ADHD diagnosis, or that their neighbor who has mild but clinically problematic attention problems is the same as the person with severe problems.

My favourite analogy, that I can't believe doesn't come up more often in these discussions:

Having a degree of ADHD is like having a degree of nearsightedness. Yes, almost everybody has some. And you know what that translates to? Almost everybody wearing glasses. It's "normal" to be nearsighted... and it's just as "normal" to wear glasses to correct it.

Imagine if people with a small amount of nearsightedness were expected to just struggle through their life without glasses. Wouldn't that be weird?

Thanks for taking the time to write that - I'm going to recycle several of your points in future conversations. This is a frustrating topic for me as I've been through not acknowledging to myself that I had a problem, getting therapy, trying many different medications, investing time and effort to change diet and exercise habits and so on. Many things have led to incremental improvements but it's still An Issue, and explaining things to people from scratch really gets old.

If a person in a house with a working thermostat is comfortable in a room that is at 21 degrees, then they should, obviously, keep their thermostat at 21 degrees. They don't need to touch the dial; the default is sensible for them, and most humans.

If a person in a house with a broken thermostat is comfortable in a room that is at 21 degrees, however, they might have to set their thermostat to 25 degrees to make the room 21 degrees—because when their thermostat is set to 21, the room ends up 17 degrees.

That is the point of stimulants, and most other such neuro-active drugs: they move the dial on your (complex, multi-dimensional) neurochemical thermostat.

If you don't have a chemical imbalance—if you're neurotypical—you shouldn't "move the dial"; you'd just be moving it out of the comfortable human reference range.

If you have a chemical imbalance, then your "thermostat" is mis-calibrated, and so its default dial position is out of the comfortable human reference range. You definitely do want to "move the dial"—to move it into that range.

The point of stimulants is like the point of glasses: to shift everything by precisely the right amount so that they cancel out the problem, leaving you "normal." A person who has ADHD and is on the right dose of the right drug, shouldn't be able to be differentiated from a neurotypical person. If they can be, then, by definition, they're not on the right dose of the right drug—just like someone who still can't read the letters in the optometrist's office obviously has not yet found the correct diopter rating for their eyes.

(As others pointed out, Adderall is basically meth) First, there are non-stimulants. For example, Straterra is one, and it works great for me. So if your complaint is amphetamine, problem solved! The truth is we are pretty much still in the "using leechs to let blood" phase of being able to target drugs to brain chemistry. We know there is stuff firing wrong/activating wrong. We have theories why that is the case. But thoes theories are pretty basic, and we lack the capability to build drugs that affect the changes we want.

So, instead, we find existing drugs that help cope with symptoms.

As for the EEG part: you,in fact, can start to do that (using EEGs and qEEGs). See NEBA, etc.

"Conclusively" is hard, of course. You often can't conclusively establish someone has a brain tumor from an EEG, and those often have huge impact on the brain.

> 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?


Agreed for sure. As someone who's lived or spent time in a number of other cultures I do think there's something excessively (if not uniquely) toxic about American life, which if I had to summarize (and agree with Sebastian Junger), would be: lack of community.

It's more than just the absence of community. The real sorrow comes from a culture that actively encourages us to abandon community in favor of striving for personal gain.

Community is there and possible. We just don't know how to reach it.

I can't help thinking organised religion was /the/ way to create a local community. Unless the state steps in and "forces" locals to gather regularly (in the way fear of god "forces" worshippers together) there's little reason for family X on road A and family Y on road B to meet, let alone shared experience for them to bond over.

Well, part of the issue is being able to find time+energy to be part of a community. With a "work/life" balance actually being a "work/children" balance in many cases, thanks to the nuclear family, it's very difficult to find time to do anything since the expectation is that you're keeping a hawk eye on your kids at all times.

Young people (or, at least, young people who don't feel the need to work 80-hour work weeks) do actually have a significant sense of community since they still have time to be active in communities. Personally, knowing that I have people I could arrange to be around on short notice who actually care about me is an incredible boost to my mental health.

I think one of the biggest missteps of modern industrial society was to disregard religion as outmoded without making any attempt to fill the psychological void it leaves. Seen in this light, atheism is clearly not interchangeable with religion. There are no weekly gatherings of atheists who praise the beauty and glory of creation. Religion is a reminder to take a step back and think about the big picture. Atheists can do that as well, of course; they just don't have much reason to do it, because atheism is not something you practice. It's not a way of life. It's just a void. And like you said, that void threatens the integrity of a community.

We need a new religion. Nothing out there right now is cutting it.

Another problem lies in the extreme pursuit of youthfulness, and the lack of respect for the elderly, the latter of which is opposite to what you find in "happy" cultures.

It creates a rather sad outlook on life.

I agree, having also lived in a multitude of cultures for some decades (~5), mostly Western(-ized) and so on, and in the case of America, had the opportunity to observe the culture, at scale. i.e. from top to bottom and back again, and so forth.

For me, the summary would be: America loves itself too much. Most "mental ill" Americans I met were, simply put, just too full of themselves. Its a tragic thing to have to explain, but the mirror seems to be one of the most dangerous weapons of all, and .. Americans sure do love that mirror.

So perhaps the (super-)self awareness of your average USA-branded citizen is one factor. I note that in other nationalistic/adornment identity- cultures, there are also 'mental illness' lunatic fringes (literally, pun!) which - in my opinion, are meta-physically transferrable - infections at a mental level - and therefore the best remedy is indeed an active and positive attitude about mental conditions.

For the most part, in lieu of pscyho-pharma-industrial dependence, I just travel. It totally works.

Agreed 100%. "Pill culture" is real in America, and in the West. But taking a pill just alleviates symptoms, it never cures anything.

I would say that for minor mental conditions (anxiety, depression, grief), psychiatric drugs exist solely because talk therapy is still primitive and ineffective.

It's much easier, logistically, to give a statin to a group of obese people, than it is to help each individual increase their self-esteem, start taking care of themselves, and teaching them the mindset skills they need to to make sustained changes.

Pills never fix the root problem. Some (more indigenous) cultures are very pro-grief, so when somebody loses a loved one, other villagers and even strangers try to support them, emotionally, so they can get through it. This is simply not the case in America, where people never receive the support they need and take pills to stop feeling so bad. The problem is an emotionally repressed culture, which can't be fixed with pills. Yet nobody actually tells it like it is.

> It's much easier, logistically, to give a statin to a group of obese people, than it is to help each individual increase their self-esteem, start taking care of themselves, and teaching them the mindset skills they need to to make sustained changes.

Your advice to people sounds like "just stop being fat", but what specifically should they do to take care of themselves and what are those changes? The people prescribing the drugs might not know or might've told them something that doesn't work and lost credibility.

I agree about the lack of community. There is also something about "artificiality" - it troubles me when walking around a city to know that all this was constructed by other people; and getting to grips with the 'documentation' for all this can be daunting.

Do you know of any other authors/philosophers who explore this idea more fully?

Ernest Becker's "The Denial of Death" is the most recent book I've read that touches on the overwhelming nature of modern life. In a nutshell, his idea of a solution to this problem is to not think about it. People who don't dig into the symbolic/artificial nature of society tend to function better.

Jean Baudrillard and Michel Foucault among others. [0][1]



Having lived in placed in America where people "have community", I'm generally happier without it. I despise being socially forced to be like the people who happen to be in my immediate geographic proximity.

Maybe those communities were just dysfunctional, not nurturing, or the people making them up weren't good to be around anyway (in the sense of "you are the average of the 5 people you hang out with most").

That doesn't indict communities and their social and emotional importance.

If anything, it proves GP's point. The coexistence of dysfunctional communities and no-community within a culture actually seems pretty congruent. It just points to both of these being caused by dysfunction in the culture.

Communities are of course important. A great many people find their communities critical to their social, emotional, and sometimes economic well-being.

Nearly every community is healthy and wonderful if they're like you in the ways you care about and you have membership. Nearly every community is dysfunctional if it's different in the ways you care about and you lack membership.

Most people I know seem to define "community" based purely on geography and some localist shared identity. I, personally, am not a fan of this. I find it too arbitrary and and far too likely to attempt to co-opt me into supporting things directly against understanding of my interests. I fully understand why some other people value such things.

And yes, it's possible that I'm just an asshole that nobody ever wants in their community.

It's also entirely possible that parent is just an asshole and those communities are better off without him.

What places are you referring to?

Large swaths of the American Midwest "have community", in the common sense of people in an area sharing and identity and caring about one another. People know each other. Look out for one another. Spend time together socially and culturally.

Of course, all of this only applies if you're sufficiently like them to be judged worthy of membership.

>Of course, all of this only applies if you're sufficiently like them to be judged worthy of membership.

Well, of course. A group who accepts anyone and everyone loses its identity. The real problem is that people don't have freedom of movement: that is, the ability to seek out and join a group that they truly fit in with.

Arguably, part of the problem is that people do. The ones who do come into conflict with the people who have no desire to use their freedom of movement.

> 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?

To me this is self-evident.

Our lives have become more and more comfortable physically, less challenging, less stressful.

But from a mental perspective, we are doing FAR more deliberate, conscious effort than any of our ancestors. Emphasis on conscious. Being a hunter-gatherer surely required a lot of processing power, but over time we've adapted so that a lot of that effort is not conscious. And we don't seem to have a problem processing a heck of a lot of data unconsciously.

It's this newfangled, forced-conscious processing that we are not adapted for, and is very stressful.

> 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?

Anecdote: my mother told me that when she was young and they could - living in Poland - finally get to watch some American movies, they were perplexed by one thing: it seemed that every other American goes to a shrink. They used to laugh at the western lifestyle because of that. Fast-forward ~30 years, and every other person in Poland also visits a psychiatrist...

As much as I want to believe things are over prescribed, and that medications don't actually help, my anecdotal experience is very similar to yours. I've heard nothing but extremely positive things. Comments like "I have my life back". And "I finally feel okay in my own skin".

I've been long skeptical of the pharma industry, and those drugs... But the more I hear personal accounts like that, it's hard to remain skeptical.

Well, in my case, the result of me taking antidepressants was gaining 120lb, stopping leaving the house, and spending hours a day posting on 4chan and jacking off to porn since I no longer cared about the negative emotions such actions would have previously inspired in me. I also felt like I was going crazy when I stopped taking the medecine. The result now is that I'm very high performing in all areas of my life, and I have lost over 120lb and achieved a nornal weight, but I believe that my stint with antidepressants have permanently taken several years off my life span. They also contributed to significant delays in my economic, intellectual, and social development, as they seemed to bring me from relatively poorly functioning (but functioning) human being to out of control explosion of self-destruction and shit. But maybe it's different for older people who take them.

My anecdotal evidence was closer to yours than everyone else's on here apparently. I'm a 35 year old who acts closer to 22 or 23. I wasted a least a decade going deeper and deeper down a psych-med hole. I was on a large amount of Effexor when I decided I'd had enough and went cold turkey. It probably wasn't smart, but I didn't care about anything when I was on that stuff. Once the world stopped shifting every time I turned my head, my life steadily got better and I started to care others and stopped focusing solely on myself. Maybe it stopped me from suffering some really bad lows, but it also kept me from enjoying any good things in my life (including sex). I was living in a perpetual "Fuck it".

I'm still learning how to cope with missing a very important part of my life, but I couldn't imagine where I'd be if I kept listening to any of the numerous doctors who had nothing for me but more prescriptions. I think all I ever really wanted was someone to care enough to listen and coach me towards making positive steps. I think a lot of people don't know what to do with their lives.

I'm surprised that your primary care, or psychologist didn't take you off the meds after the first 20 lbs of weight gain? That sounds like a horrible experience...

My limited understanding of psych meds is that they're hit or miss, and that you may end up trying a few until you find one that "works". Side effects like weight gain, and not giving a shit about the ramifications of negative behavior, would certainly strike me as the kind of things that would warrant a reconsideration of a prescribed medication?

So I guess it begs the question, what was the role of your doctor in all of this?

Were you talking to your psychiatrist about this at the time? If you were prescribed medication there should have been a doctor involved in the process at some point that could consult you about possible side effects of the given drug and addressing them, probably by changing medication.

Did different doses and added more drugs.

Placebos have been shown to be nearly as effective as anti depressants.

Who would say getting high on drugs could fix lifes instead of destroying them...

A lot of medications have different effects based on dosage. For example, DXM, the active ingredient in most cough medicines is a deleriant at very high doses, and people take it recreationally (robotripping). Does this mean we should ban Robitussin? Another example is that cocaine in small doses is used as a numbing agent. Medications can and do have different effects given the dosage.

The sarcasm flew right over your head...

"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?"

American Life is very harsh and unforgiving without doubt. There are upsides to everything being competitive and everybody supposed to make his own luck. But when you have a problem you are in a very unfriendly environment.

Prescription drugs save lives (or one's quality of life) all the time, and it sounds obvious but people forget or don't recognize that.

It doesn't always work because it's not an exact thing, two bodies can have different reactions to the same prescription. The same body can different reactions to the same prescription at different times. And some doctors make mistakes and some exercise poor judgment. But too many people latch onto the negative anecdotes and the narrative of us vs. the evil drug companies.

It's like with police. You can see them as fundamentally your enemy, or else fundamentally on your side but since they're just people like all of us, many are below average at their job and some outliers are incompetent or truly evil. The way you choose to see it says more about you than about law enforcement.

One part of ‘American life’ is the intense Puritan/Calvinist streak that holds that suffering is necessary for redemption: using mere science to make people feel better is evil. Among those that would claim to reject Puritanism the appeal to nature is a search-and-replace copy. Then you have Chernyshevsky's “the worse the better”: the proles need to be kept miserable so they'll revolt.

>One part of ‘American life’ is the intense Puritan/Calvinist streak that holds that suffering is necessary for redemption: using mere science to make people feel better is evil.

I've been living in the US for five decades, and I've never, ever run into someone who articulated that belief.

The Bible tells that after the Fall, when Adam and Eve ate the apple in the garden of Eden, man is now destined to forever work for survival (such as tilling the earth for food) as part of our punishment.

This has large implications for social policy, universal basic income, etc. It isn't usually directly stated, but I have heard it a few times.

To be fair, I'm not cetain how influential this idea is in overall Christian thought.

> I have seen these things really work though.

The argument (based on some large scale trials and other data) is that after 2+ years, those on SSRIs are worse off than they would have been without them.

The issue is that by taking SSRIs, you may be getting a few weeks of negligible benefits in exchange for a lifetime of being disabled, when otherwise you'd have been better after a few months using other interventions.

> are worse off than they would have been without them

With, or without continuing monitored dosage to account for the body's corrections towards what it perceives as equilibrium? If without a continued dosage, is this before or after a "withdrawl" phase?

> With, or without continuing monitored dosage to account for the body's corrections towards what it perceives as equilibrium?

The efficacy of SSRIs isn't dose dependent. And the the monoamine hypothesis is a long disproven myth.

> The efficacy of SSRIs isn't dose dependent

This is rather surprising, given that most pharmaceuticals are, and contradicted by the experience of people I've known who've been prescribed them and advised to taper withdrawal - which is then experienced as reducing effectiveness.

That means there is more to figure out, not that people shouldn't be taking them. It could be that a combination of therapy and SSRI's are the answer, or they only work with certain blood chemistry and we develop a test for such a thing so we'll know.

Someone with a major mental illness might just do worse after a couple of years, despite medication. Some folks with bi-polar disorder truly can't work, despite the medications, for example. They'd definitely be doing "worse" after starting their medications, some of which might easily include SSRIs, but it isn't really because they started medications.

None of this means we shouldn't use them, just use them responsibly with a bit more medical oversight. After all, for some people these really do help.

Can you cite this?

The book the article is about...

> 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?

Clearly these people have not been to India, China or some place like that. At least in India mental issues are not even diagnosed and people suffer from mental issues rest of their lives unable to cope and sometimes disowned by family. Modern american life might have its issues but I think it is probably the best kind of life humans are living compared to past or elsewhere on earth.

I agree with the first part that India does not handle mental issues well, but I disagree with the latter part. The US as some have pointed out here is quite exceptionalist in that it's unforgiving to those who are not the highest achievers. This is certainly not the case to the same extent in India, where in my (limited) experience an average honest middle-class lifestyle is more admirable in and of itself. This leads the US to have an entrepreneurial spirit at the cost of some other aspects of life.

Good doctors are fully aware of the bio-psycho-social factors to "illness", and they recognise the strength of multidisciplinary teams that work across all these things.

But mental health tends to be underfunded, and employment support or drug and alcohol rehab or whatnot even more so.

> It's funny, but people never seem to question if modern American life actually, you know, is good for mental health

Speaking as an outsider, it seems to me that the US lionises some mental illnesses. For example, someone gets up on stage and gets passionately frothy about 1776, and they get accolades. In other countries that person would be treated as a nutter.


What you are ultimately saying that drug X made the person's existence possible under the current circumstances and given the current options.

My anecdotal evidence is a friend who went for years working a night shift and playing RPGs during the day, wracking a massive sleep deficit and engaging in other irresponsible behavior. Antidepressants made his existence possible. Until they finally stopped working and he reached full psychological disability.

It is extremely difficult to say this means. My reflex is to give the "folk psychology" explanation that he'd pushed away the "real problem" for so long that when it "caught up to him", he couldn't deal with it. But it could just as well be the chemicals gave him a few more years.

Now if I suspect, chemicals or not, if he'd had job/leisure activity combo that satisfied him more and didn't produce sleep deficits, he would have at least lasted longer.

You are right about the modern life being the problem for most of us.

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...

>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.

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.

Antidepressants are a 15B market globally.

That definitely seems like "making bank" to me, specifically considering it is a pretty consolidated space where that value is being shared by a relatively small number of players.

They certainly are not selling them for charitable reasons.

When I went through a bout of depression, I didn't want to medicate because I was convinced I could just "tough it out." Maybe I could have, but over the course of months I never managed it, because the nature of depression is that it depresses your ability to think, act, motivate yourself, etc. A couple months on SSRIs and I was in a place where I could motivate myself to dig out of that hole. That was years ago and the things I learned while I was on SSRIs are enough to help me fight off the random upticks of depression I occasionally get, but now without medication.

There was honestly no better day in this process for me than having the self-realization that I COULDN'T tough it out on my own; what a liberating feeling, knowing that you're now open to getting help.

Are you comfortable sharing what drugs you have tried? What is your experience with them?

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.

> 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.

"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.

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.

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.

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.

This isn't an area I'm an expert in, so take this with a grain of salt, but my understanding is that one of the symptoms of depression is the inability to feel certain emotions, and that antidepressants will in some cases restore your ability to feel those things.

(The reverse may be true for some people as well, but it's not generally true that the purpose of antidepressants is to make you numb to your problems.)

You can't always change the things in your life, or change yourself. It's easy to say "I should be more motivated, change job, get that degree". Anti depressants help people to feel less bad, but it won't change them. It's not a magic pill but it's welcome.

Psychiatry is about medicine, it's not about changing the world or changing people.

>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.

Forgive me, but I don't understand how someone can just decide to come up with alternate explanations of attentively studied medical conditions. While there's still a long way to go in understanding clinical depression, we know for sure that particular chemical imbalances in the brain, or the inability to process those chemicals, cause the most commonly recognized symptoms and behavior. This is like telling someone with diabetes, "I just think your pancreas is trying to tell you that your life is missing something."

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?

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

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.

Great metaphor.

Wellbutrin for anxiety? That drug made me more anxious and wired.

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.

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"?

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.

> They must have been advantageous in some past situations in order to be passed on so much, or at least not selected against. Right?

No. Evolution only requires that you get to breeding age and have viable offspring. It doesn't care about how you feel, or what happens to you after you've bred. As long as the general population of an organism can get their offspring to a viable independent status, it doesn't matter what happens to you. As a results, traits don't have to be beneficial to be passed on; they just need to allow successful breeding.

Look at the male insects that are devoured by their females on mating. Once they've mated, they're not necessary to getting the offspring viable, so it doesn't matter to the continuance of the species that they immediately die.

Well, perhaps we don't meed prosthetics either - these people should just find jobs that don't need fully functioning arms.

> ...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?

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?

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

This makes a certain amount of sense; its something we see in drug addicts. But this doesn't account for cases where there already exists a disequilibrium. Also, the body's ability to correct a disequilibrium is not infinite; it can be overwhelmed and the effects retained (see alcohol, for example).

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".

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.

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... [2] https://www.cambridge.org/core/journals/psychological-medici...

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.

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.

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

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.

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.


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.

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.

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).

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.

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.

The stuff is not a joke, especially for people who are prone to addiction. A friend of mine was in a similar situation to you and I started buying it off him for work. After a while I found myself calling psychiatrists telling them about my adult ADHD symptoms. Luckily they all saw through my bs. It totally fucks with your brain chemistry so that once you remove it, you cannot function. It's a real drug for sure.

When I read people online talking about how amazing it is and talking as if there's no downside, red flags go up in my head. It sounds like what every early stage addict says.

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.

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).

On the other hand, when they are used properly, they have an absolutely aazing impact.

Show me any other medicine that removes almost all the symptoms, has so few side-effects, works within 30 min of taking it, and is effective in 90% of cases.

To be precise, adderall is amphetamine salt, which is different and slightly less potent than methamphetamine.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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/ service. I believe that my pills work and it has nothing to do with placebo effect. But who knows...

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.

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

I don't where a causal relation is demonstrated.

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?

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:


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_...

² https://www.ncbi.nlm.nih.gov/books/NBK64063/

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

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