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Prozac Nation Is Now the United States of Xanax (nytimes.com)
144 points by daegloe on June 11, 2017 | hide | past | web | favorite | 161 comments

I think this is a symptom of a relatively peaceful and comfortable life with no bigger meaning. My parents lost their homes in WW2, my dad got shot twice, almost died, spent months eating moldy bread and list a lot of friends in war.

They have a totally different outlook on life and it's smaller crises.

I don't want to diminish the suffering of current generations but I think everyone looks for something that gives their life focus and if there is no big challenge then people will look for something that makes their life important. To me the last 30 years were sort of stale. The west has no big project to work on and for the not 0.1% life seems to stagnate. So people look for something else to give life meaning. This can be religion or watching scary news and having anxiety over non issues.

Not sure what the solution is but I think somehow people must have a mission in life and the feeling they are going somewhere. Without that anxiety and other psychological problems develop.

I just finished listening Joe Rogan's podcast with Sebastian Jurgen [1] where they talked about humanity's need to be involved in society in order to feel happy. While they talked Jurgen mentioned something interesting that I've never heard before and don't know if true or not. He said that the survivors of The Blitz in some weird way missed the time that they spent hiding in the subway tunnels of London. Similarly, many veterans missed the combat after arriving back home and settling back into normal life. The obviously didn't miss the horrors. They missed the comradery. They missed the purpose they had. Their lives were all of a sudden critical to their own survival and the survival of others. And I too believe that our often sedentary way of life is the reason why we fall into depression and anxiety. We are starved for deeper meaning.

[1] https://www.youtube.com/watch?v=W4KiOECVGLg

You'll see the same trends in software. The healthy greenfield projects and disruptive startups share cultures of competitive individuals united by a greater fight, but the real challenge is adapting the culture to slower growth or steady-state maintenance... the faster the change the harder it gets.

America's is a young nation that has been constantly growing and fighting for much of hour history, we have never sat still for long enough to develop a more mature unifying ethos. Our culture is crumbling because it's at odds with the world we now live in.

Just wanted to say thank you for sharing this episode, what Sebastian discussed had really resonated with me. I am fortunate enough to live a pretty comfortable life, but can't help but notice the psychological effects that it has on me. Some of his points gave me a deeper insight into what I may be feeling, and it was quite intoxicating to discover that :)

You're welcome! It was a quite fascinating discovery for me as well. It's amazing where we are as humanity. Yet sad that we're so comfortable that it's literally making us insane.

This resonates with me. I would like to add age element. When I was younger learning to a ride a bike was an all consuming objective and a big achievement. I didn't need an alarm to wake up to go try riding again. This was followed by the different big schools, football matches against what always seemed were bigger boys ... Each one all consuming.

Being a middle class grown up is not inspiring. Work, code, moderate exercise (no more football), meetings, dinner, pay bond, repeat. Its been pretty much the same for the last 15 years in my case.

> Being a middle class grown up is not inspiring. Work, code, moderate exercise (no more football), meetings, dinner, pay bond, repeat. Its been pretty much the same for the last 15 years in my case.

I'm only in my late 20s, and I have a friend group that I gather is unusually social, but I sense this type of malaise in my friends too.

I don't understand it at all! I have personal projects in fields I'm no good at, I play and write music, I play intramural sports, I'm learning another language, I read voraciously, I periodically take sabbaticals to do extended travel... My problem is that there aren't enough hours in a year. I can't personally relate to the notion that life is unchallenging, and I would like to understand it. Sure, unlike in school, stimulation won't force itself on you ad mandatory, but that seems like a weak complaint.

One of the only explanations I have for it is that working too much leaves people too mentally exhausted to do much else with their time. If I was stuck with 40 hrs/wk + 2 wks vacation a year I would be pretty miserable, and it occurs to me that this is something I had to recognize and take action on personally. And note that I'm not talking about lower-income folk, for whom "work less, make less" may be unrealistic. As you mentioned, we're talking about middle class or higher.

I've heard that other industries can be far less flexible in terms of how accepting they are of unconventional schedules like time off on between work. Does that fully explain the mismatch you're describing between "I feel unstimulated and yet don't have stimulating hobbies while also having the extra resources to buy the extra time in which to do these hobbies"?

Sorry if this is sort of rambling, but it's something I've been wondering about for at least a few years. I used to think I was odd for not being cut out for the de jure work schedule of the US (not even talking about extra work), but it seems far more universal, even if people won't admit it to themselves and thus do something about it.

Your rant is justified and I will take it as wake up call. I am 41, played rugby until I was 30. Now I have a bond, child and in Africa you can't exactly pick and chose your job. There is a post below that captures my sentiments, the cost of living is high. All manner of taxes, interest on bond repayments, utilities like cable, school fees. I cannot take any more time off work or take sabbaticals. Yes I diligently read every post on passive income. Wealth as in number of days you can survive without a salary the deciding factor in staying put. I have a good job and mostly like it but honestly I will not be waking up with same vigor I did in my youth.

Final thought, the source of my anxiety right now is that it is 10pm and I need to go sleep to be fresh for my Monday morning project update meeting. A meeting where I will have to answer pointy haired boss (Dilbert) style questions.

Edit: grammar

If I was stuck with 40 hrs/wk + 2 wks vacation a year I would be pretty miserable, and it occurs to me that this is something I had to recognize and take action on personally.

Well don't keep us in suspense, what'd you do about this?

The initial way that I solved it was periodic, extended sabbaticals (the first one was 15 mos, but that's obviously a little extreme: I like taking 4-6 mos off between jobs). Since then, I've moved to smaller companies that are more conducive to healthier work schedules. I gather that the marginal sale of an hour of labor isn't perfectly efficient, but fundamentally you are still selling hours of labor and there should be some point between 0 and 40 that an employer would want to buy for some value between 0 and $[full salary]. If you can imagine making 20% less without being horribly financially insecure, then trading that top 20% for something that you consider worth it should be doable. This is obviously more feasible with smaller companies, where the cost of managing custom employee contracts isn't infeasible and they're able to be more pragmatic about win-win situations. My current employer is getting someone of my skills for a steal, even if I'm not working a full 40, and I'm getting a work environment that's more than worth the lost salary.

In my current job, I make about 35% less than I did in my last job (incl. expected value of equity). This is probably an outlier due to various details of my career. But it's illustrative of how much I'm willing to walk the talk, since I was very clear on the reasons for the switch and decided that they were worth the cost to me.

I'm not suggesting that everyone has a magical dream job waiting for them at the perfect point on the salary/quality-of-life spectrum. I'm just saying that, at least among all the people I know, it's a lot more in your hands than a lot of people realize (with the caveat reiterated that some industries are just too slow and dumb collectively to treat workers as anything but inflexible cogs.

Can't speak for the OP, but what I did is I found me a job where I only work part-time. At the moment I'm working 30 hours / week, although I had it at 26 / week last year and found this to be optimal to be honest. I still get to do software engineering, which I love, but I also have enough time on my hands to... basically not feel stressed all the time. (I'm certainly not as active as my parent poster, but I try to be engaged in different activities as well).

I figured this out very early on in my work-life after falling into depression after my first work year, which prompted me to re-adjust some things in my life. After I got myself back together I looked for a job to get into it again and have been with my current company almost 3 years now.

EDIT: Oh, also where I'm from there's 5 mandatory vacation weeks per year, so that helps too. I still try to take all my overtime (which I do still accumulate! :)) in time- rather than money-compensation though.

It seems like many people have a natural drive that frequently goes wasted in modern society. I wonder how we could use this drive allowing people to be happier and also benefit society in the process.

Agreed, it seems harder to mobilize people in times of peace than in times of war. As an African, things were much clearer when it was a case of fighting colonialism. Now that we are "free" there isn't much to inspire us and keep us on the same page. We caught up in mindless politicking. Not having a cause or something to look forward to is a source of anxiety for me. The moment I am caught up in something new. Building a hydroponic garden, planning journey home then all else falls aside. I don't even read HN during those times when I am occupied.

Don't just look at the big stuff. Look at the everyday environment.

I've had -- partially bad luck; partially trying to accomodate bad advice from authority figures -- a horrible time trying to achieve simply a quiet living space. And a peaceful work environment.

It's not "big, dramatic stuff", but it has dragged on me, day in, day out.

Jobs used to be more secure. Neighbors, even if they were jerks, didn't have so many instruments with which to be so loud. And neighborhoods tended to have more cohesion, including allies when you needed to deal with the jerks.

A lot of people are not being shot at. They are just being chronically, highly stressed. In everyday ways that add up.

P.S. Yes, definitely a U.S. perspective. I'd say "first world", but an increasing portion of the U.S. is actually in the process of leaving the first world, if it ever was in it.

But, there is a level of social isolation here, and a lack of a sense of allies and someone who "has your back", even if at the same time someone else is trying to "take you out".

I guess I can't really compare. I don't have the experience. But, for a lot of people in the U.S., the everyday stuff is plenty stressful. And, it never goes away.

> But, there is a level of social isolation here, and a lack of a sense of allies and someone who "has your back", even if at the same time someone else is trying to "take you out".

This nails it I think - which then creates a myriad of social issues that end up being a feedback loop. I do also strongly feel the US "suburban" style of living is a large driver of this. The more I travel and the more places I experience I've come to the conclusion that density matters. A lot.

Even small towns were dense walkable communities in many ways until recently. The forced day to day social interactions naturally built up social cohesion and trust - and those cannot be replaced by scheduled human engagement.

The lack of "community" in the US is quite concerning. There are many reasons, but being locked into various boxes (house, car, cube/office) through pretty much 100% of your day has to add up. The natural ebb and flow of a socially vibrant neighborhood just is nonexistent in I'd posit the extreme majority of the US.

> The more I travel and the more places I experience I've come to the conclusion that density matters. A lot

I live in an 8-storey high building in an Eastern European capital, and about a couple of hours ago my gf called me telling me she had gotten stuck in the elevator. I was still at work, my work is 20 minutes by foot from home, but not 5 minutes pass and my gf calls me again telling me that a neighbor had helped her get out of the elevator. So, now I know that at least one of my neighbors (whom I don't even know) would be kind enough to get me out of a stuck elevator if I'd ever need it. Also, the small talk you usually do from time to time with your neighbors helps a lot when you're living life as a single person, had I lived in a suburb instead of a very dense neighborhood after my divorce I would have had an even worse depression.

> Neighbors, even if they were jerks, didn't have so many instruments with which to be so loud.

This, I think, is under-recognized. People with phones, cheap stereos, and small portable speakers, have made many places that used to be quiet into noisy areas. Worst is when they are all competing with each other to hear their own music.

I'm sympathetic to your pov, but those big traumatic events likely left huge scars on the psyche of the previous generations. The PTSD was not being diagnosed at the time.

Big struggle may not be the recipe for mental health.

Totally agree. Many WW2 probably had serious PTSD. My point is that people who haven't gone though serious struggle tend to "sweat the small stuff". When I hear people being crazy angry and depressed about the Trump election it seems it me that they are looking for a mission in life. Modern corporate life doesn't​ offer a meaningful mission so they go overboard with politics or something else really not that important.

Exactly, except it's just as important.

You know, there were probably a lot of Germans in 1930 going overboard with politics, yet Hitler got elected.

Bad politics was bad politics back then, and it's bad now, and it's good that there are people trying to lift the quality and substance of political discourse. Even if it means spending weeks debunking clueless, loud and aggressive ignoramuses; going to rallies, writing to reps and senators and so on.

Maybe, as the folks back then weren't too effective, the folks nowadays might be not very effective either, but that doesn't mean the problems are less important.

For example, there are more people now that in the 1940s, and a lot more pollution, and so more people die thanks to pollution than back then, so if you can persuade others to help curb pollution, you help saving millions of people. The same thing goes for other aspects of life.

And yes, people are bad at appreciating the paperpusher numbercruncher aspect of change, and naturally feel the awe and the epicness of a world war.

And the same way a war affects millions a financial crisis, a flood or drought, or an epidemic does too, yet one is a lot more palpable, with good and bad actors, with bad guys to shoot at.

Another interesting aspect is how people treat refugees and civilians (interment of Japanese, sending back Cubans, now the handling of Syrians) which again is a lot less glorious than a world war, but potentially (and likely) affects a lot more people.

To me the current political debate in the US is just manufactured theater to keep the people busy arguing about unimportant things. No real issues are being discussed, no path forward for the country. It's just "You are bad. No, YOU are bad". I have no idea what the Democrats stand for otherwise than maintaining the status quo and the Republicans just want to make sure that the upper class gets richer. And the electoral system doesn't allow anyone with new ideas to come up.

Well, yes, if you watch "news".

https://www.youtube.com/watch?v=6fKsBj2M-T8 https://www.youtube.com/watch?v=4pS4x8hXQ5c

But there are real issues voted on. And even if there's no clear path forward, it's important to not go backward!

> It's just "You are bad. No, YOU are bad"

And? It's how ideas are criticized - ideally, by pointing out the errors in them.

If someone uses ad hominem arguments, maybe try to find better people to listen to? (Economists, sociologists, policy scholars?)

> And the electoral system doesn't allow anyone with new ideas to come up.

Then don't spend time on those things, spend time on election reform, look at where those are, look at interesting things that matter and that help predict the world.



So, the debate is what you make it to be.

Unimportant things like climate change and affordable health care? You can't say that now that Trump is President and is making important changes that Clinton wouldn't have made.

Humanity has had big big challenges up until maybe about the industrial revolution. Then we had us a couple of wars to deal with. The post-war period has been a new era of human evolution, one in which survival is a given for most people, expansion through conquer and war is mostly out of the question, and even scientific discovery - yes - has seemed to plateau in recent decades. Not to say all of these things affect some people, but each of these is diminished on a population scale. With industrial agriculture there is a lot of food to go around, nuclear weapons make total war a thing of the past, and the low-hanging fruit of scientific endeavor has been picked. Major advances come from large teams with big funding, much more than, say, the enlightenment or the industrial revolution. Most people alive today in first world nations face no existential threat or deep motivation for betterment, not like in the past history of humanity. In the history of humans, this is not normal, we're built for striving and surviving, and fighting each other for territory and resources. We have been honed through thousands of generations to be ambitious and cut-throat and daring. But the future calls for a different ethos, one of efficiency and moderation. One where economies cannot grow indefinitely, and wars cannot be waged. Where people can find meaning outside of labor, as pretty soon we won't need human labor - physical or mental. The more likely scenario is that we will see a regression before that future hits us, the expansionary drive is too ingrained in the human psyche and societal norms. War will come, sooner or later, and give a 'purpose' to the world. And I fear this is unavoidable.

They lived through fear during the war, lessening the anxiety they likely felt pre-war. Things look an awful lot like the relatively peaceful and comfortable times before the last wars, and the military advances are terrifying since then. This is where anxiety thrives.

I've always viewed at least one source of modern anxiety as the gap between perception and reality re: your own potential as a human being. This gap seems to be increasing. Perception - you are just one mobile app away from becoming the next Mark Zuckerberg. Reality - a generation burdened with student loan debt and extremely high costs of living in urban areas. Objectively, life is better (more comfortable) now than ever before. But to a lot of people it doesn't feel that way. We should train for mental health the way we train for marathons and sporting events. In the absence of that, perhaps ignorance is bliss.

Xanax withdrawal is a seriously horrible experience. Sadly it seems to be given out like candy when it shouldn't be used for more than a few days to help you get through the absolute worst moments.

I made this account specifically to reply to this comment.

I take Klonopin. It is the ONLY thing that works for me. I have tried nearly everything. Every form of therapy you can think of, basically every class of drug to treat anxiety...

But Klonopin (benzos) are the only things that allow me to function enough to work and provide for myself. If I didn't have Klonopin, I would be without a job and would be homeless. I would literally be unable to function outside of the house (by function, I mean interact with people, work, go to the grocery store...), until I were forcibly removed because I haven't paid rent in months.

So if this attitude you and others share continues to embed itself into the minds of doctors, then people like me will be left without proper care. And what that means is that people like me will be unable to work, and unable to slog through the process of acquiring disability (and trust me, it's hard as hell), so we will be homeless or forced to burden our families with our care. It's not some abstract issue, one that can be handwaved away, one that you can distance yourself from by saying "the drug is bad so it should not be used with regularity; those who need it with regularity can instead be treated in other ways". There are zero other ways, in my case, and I am sure in many others' cases too.

Sorry if I seem accusatory, but people's insistence that these drugs be given only for short periods of time is in effect an insistence that I be left without any options after that short period of time expires.

We have to look at both benefits and harms. Benxodiazepines have caused absolutely immense harm, because they have a cluster of very nasty properties.

Tolerance and physical dependence develop rapidly. For most patients, the actual effect of the drug disappears within a few weeks unless the dose is increased. The most common withdrawal symptom is rebound anxiety, so you'll feel worse after stopping the drug than before you started. Benzodiazepines are respiratory depressants and tolerance of this effect develops more slowly; higher doses present a substantial risk of overdose, particularly when combined with alcohol. Paradoxical effects are remarkably common, with a significant proportion of patients developing impulsivity, aggression and mania.

I accept that long-term prescription of benzodiazepines may be a reasonable option for some treatment-resistant patients as a last resort, but America is grossly over-prescribing benzodiazepines with disastrous consequences. Here in the UK, benxodiazepines are some of the most strictly controlled prescription drugs and new prescriptions for more than 14 days are rare.

Thanks for your comment. I was appalled that the article didn't mention the implications of being prescribed benzodiazepines (both culturally, behaviorally, and physically). I wish in America these consequences were taken more seriously AND that people were more educated about it, but it almost seems like a long-running joke from the 50s -- "Oh, just take a valium! You'll be fine!" and etc. I really wonder how long until that is not socially acceptable...

I actually have the exact opposite experience. I was on klonopin a long time, and it does get addictive. My doctor thought it was the best way for me to function with anxiety. After a couple years, I got a new doctor, who was far more cautious with medication. I got off it, which was incredibly hard. In fact I don't think I could have done it if the resulting agoraphobia hadn't prevented me from leaving the apartment to try to get more.

It took a very long time in what was the psychological equivalent of someone going through physical therapy to learn how to walk again, but I was able to identify and work through the underlying causes of my anxiety. I'm doing better now without the medication.

To be clear, I am NOT saying medication is bad or unnecessary. Some people do need these medications long term. But benzos really need to be prescribed with the same responsibility as opioids, because the risk of addiction and withdrawl is very real.

As with everything there are exceptions to the general rule and it appears that you are one of those exceptions.

My point was more that prescribing a strong benzo like Xanax is done too easily. There are people, like yourself, who need such medicine long term but with doctors handing them out to almost anyone who has a little bit of anxiety opens them up to abuse which then makes it harder for people like you to get medicine they really need.

They're both benzos, but xanax ain't klonopin. It has a half-life around 12 hours while klonopin is about 30 hours. You can get interdose withdrawal with xanax, while it's less likely with klonopin.

You should try meditating a few hours a day.

Do you meditate a few hours a day?

I have started to take a more active role in my wife's ongoing treatment for this very reason. While I generally like her doctor, his willingness to bounce from drug-to-drug in an effort to treat her depression and anxiety is incredibly troubling for me as someone who grew up in a society where medication was seen as a last resort in the treatment cycle.

She has now been on Xanax, Cymbalta, Lyrica, Klonopin, Ativan .... I could go on. Every time she begins a new medicine or comes off an existing one is a trying time for both of us as the side effects (both mental and physical) can be incredibly brutal.

> I have started to take a more active role in my wife's ongoing treatment

You might be interested in the English NICE website, which sets out some evidence based standards for treatment of various disorders.

Here's what they say for general anxiety:

Recommendations for treatment: https://www.nice.org.uk/guidance/cg113

Quality recommendations: https://www.nice.org.uk/guidance/qs53

Pathways: https://pathways.nice.org.uk/pathways/generalised-anxiety-di...

Over what kind of time period is that? You're definitely not supposed to change drugs every few months.

For me the scattershot approach is most alarming; it would be far better if there were some kind of in-vitro test to see what would be best rather than "suck it and see". I've seen a few other people have problems with that.

From what I heard, it is this way because there is currently no better way of determining which psychiatric drug will work best besides going for trial and error.

It's been over 2-3 years, but I would say on average her regime changes every 3-4 months. We saw another specialist recently who introduced us to a test that does a genetic screen to help identify what medicine should theoretically be the most effective. Here's hoping it works!

EDIT: the service is called GeneSight: https://genesight.com/

What non-medication treatments have you been trying, if any? And which had the most positive effect, in your estimation? To be clear, I'm asking this purely out of curiosity, not because I think medication is a bad solution or anything like that!

Not contradicting your statements, but I thought I would offer a single anecdata point for a different perspective.

I take Alprazolam (generic for Xanax) in a low dose (0.25mg) 2 or 3/day. This makes the difference between my being able to work and not, so in my case it is certainly effective and beneficial. I haven't noticed adverse side effects at this low dose level.

After over two years of use, I haven't felt any need to escalate the dose. I have only one experience stopping (as an experiment). Disabling anxiety returned in less than five days and persisted without change for 3 weeks. Stopping was otherwise not difficult, certainly not "seriously horrible". Resumption of the med after four weeks off returned me to manageable anxiety levels in two days.

I've considered the tradeoffs inherent in long-term use and have decided for now to continue. Things that could change my mind about this: absence of relapse into disabling anxiety after an experimental stop; unambiguous demonstration of damage caused by long-term use; appearance of a better alternative.

Check with your doctor before using this med. There are contraindications and adverse interactions with other meds.

Further, anxiety is highly idiosyncratic, therefore YMMV. My mother was essentially disabled by chronic anxiety for her last 3 decades, and I suspect I'm predisposed to chronic anxiety. Others will of course present differently and need a different treatment plan.

> After over two years of use

That's not how short acting benzodiazepines like Xanax are intended to be used (Klonopin is more likely for longer term use). Most psychiatrists would be getting you onto a regular antidepressant regimen within a few weeks of the onset of generalized anxiety.

Agreed. I seem to be an edge case. Klonopin adversely interacts with an antidepressant I take, otherwise it would be the choice for management of long term anxiety.

Just smoke some weed on the weekend, works better than antidepressants.

Sadly, you need the right strain - if you live in a state where cannabis is legal, you're lucky.

I have 3 different types right now, only one is actually good for anxiety and stress, the other 2 make my thoughts race. And I can't choose what I buy, the dealers tend to go for high THC content because it gets you high. I suggested the lower THC plants and they said I'm crazy.

While I am generally pro-legalization and believe cannabis has medicinal benefits, I would caution anyone with anxiety to do their own research before trying this and be careful with dosage. THC can be harmful to people with severe anxiety or who are predisposed to things like schizophrenia. It's pretty irresponsible, IMO, to casually prescribe drugs when you don't even know the difference between a benzo and an SSRI.


I used to smoke weed every day for years but had to stop around the age of 24 due to ever-increasing paranoia and anxiety. It was really messing with my head and negatively affecting my life.

I can smoke fine these days but there is always that slight sense of anxiety and negative introspection when I do. It's not a pleasant feeling at all, so I I generally avoid weed these days.

Strange really as I do LSD and MDMA maybe once or twice a year for special occasions and have no problems.

That said I am definitely pro-legalisation. I just think people need to be educated about it. Legalisation proponents with genuinely good arguments can often find themselves drowned out by by those that refuse to acknowledge any potential downsides to their favourite recreactional drug, which is a shame.

Came here to say basically this. It can take months or years to taper down. I've seen a lot of people prescribed a lot of benzos (Klonopin specifically but also others. I think there are rules about how Xanax can be prescribed in my home state) , even when my peers and I were younger. It seems to me that these drugs are surprisingly accessible to people with the right resources. Unless there is no other way you can function taking Klonopin for long term

To my untrained eye being prescribed any benzo for extended daily use seems like it should be an exceptional treatment, but maybe I'm wrong.

Aside from being a terrible experience, death is also a possible side effect of benzodiazepene withdrawal.

I wonder why drugs like propranalol and gabapentin aren't used more as first line treatments for anxiety. Propranalol is particularly effective in treating anxiety without the potential for abuse.

Propranolol is one of the most common pharmaceutical treatments in the UK, alongside SSRIs and SNRIs. It's more common for social anxiety or phobia than generalised anxiety. It's a particularly popular choice for the treatment of young people, because of the suicide risk associated with SSRIs.

Pregabalin is growing in popularity as a second-line treatment if SSRIs or SNRIs are ineffective or poorly tolerated. Some caution is necessary here, due to the uncertainty over dependency, the potential for abuse and possible risks of suicidality. It doesn't appear to be more effective than the common SSRI treatments, although it may be better for treating psychosomatic symptoms.

I was given Gabapentin when I started having seizures. My seizures became worse. We didn't know why, so months go by. Until one day I had enough and stopped it - no more seizures since then (and they were calling this treatment resistant epilepsy.) It took me about a MONTH of insane withdrawal effects and maybe 3 months to come back to baseline again.

I've had benzos, painkillers to help with the after seizure care, and their withdrawals were absolutely nothing compared to the gaba/prega. Most medications give you maybe a week at max of physical withdrawals, not a month...

However, it's absolutely great for anxiety! I would really exercise caution to everybody. If you don't believe me, Google first hand accounts on Reddit, Bluelight etc.

I would never touch it again.

Medication isn't indicated as a first line treatment for anxiety. An evidence-based talking therapy is. That would be something like 12 to 14 weeks of cognitive behaviour therapy; one hour per week; face to face with a therapist; not in group sessions.

If that doesn't work or if the anxiety is particularly severe (anxiety disorders can be debilitating and cause years lost to disability) medication might be indicated.

> propranalol

I've noticed an atypical anti-anxiety benefit from metropolol (which I take for the usual bp/heart effects). It's not an anxiolytic; it won't do much to stop stop a panic attack that has already started. What it does is reduce the slope of increasing anxiety, which means more time before a minor/moderate anxiety can grow into a full panic. Very occasionally this has let me avoid a panic attack.

Is there a tipping point as to how much you can take and quit without experiencing withdrawal effects? I'd think it would affect everyone individually, but it would be interesting if there was a safe amount of time.

It depends on the benzo I think. Klonopin and Xanax have shorter half lifes so you would need to take them more consistently for a longer period of time to get addicted, but they may be more psychologically addictive since they drop off faster. I took an insane amount of Valium (longer half life) and blacked out for two weeks but didn't have any physical withdrawals at the end of it that I noticed. I took 6mg of Xanax once and had an acute anxiety/panic attack coming down from them. Also, people I knew taking Xanax for anxiety took a dose of 0.25 mg which was laughable to me as someone who abused it. I don't really understand how you could get addicted to that dosage or have serious withdrawals from it.

Oh my god this is such a true statement!!!

Unless you want to be curled up on a couch for 5 days and sleepless with your muscles and forehead visibly spasming every 15 seconds, DON'T take any benzos, and DON'T quit them cold turkey.

I had the misfortune of experiencing this first hand, but others have had it much worse, going into seizures and dying after trying to quit benzos for years.

There are definitely other treatment options. Don't mess with benzos unless you absolutely cannot bear an acute situation!!!

Good luck to everyone who is truly suffering out there! You can make it through !! :)

Decades-long anxiety sufferer here, basically cured with thyroid hormone replacement...

Thyroid underactivity is a very common condition (thyroid hormone is the third-most prescribed medication in the UK), and some of you anxiety sufferers out there may have a thyroid problem (either under- or over-activity).

The most common problem is an underactive thyroid, which 90% of the time is caused by auto-immunity.

Detection is complicated by an ongoing controversy over reference ranges [1][2]. I recommend you seek the advice of the most careful practitioners. If you suspect a problem but your doctor won't treat, keep testing. The results will fluctuate, and even more so if you have a problem.

Beware TSH measurements consistently above 2.0. That may put you at risk of chronically elevated cortisol [3], which has been shown to cause anxiety in mice [4].

[1] https://www.ncbi.nlm.nih.gov/pubmed/16148345

[2] https://www.ncbi.nlm.nih.gov/pubmed/16148346

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520819/

[4] http://www.apa.org/news/press/releases/2006/04/stress-mood.a...

I got tested for hypothyroidism after my hair started falling out one day. I had a TSH level of 64.0.

My body was effectively screaming for more thyroid hormone.

I've also had high levels of anxiety and cortisol, I wasn't aware of the relation though. Unfortunately hypothyroidism is so common place that my doctor's don't really give me the info. I'll read through your links to find out more about this.

EDIT: After reading the chronic exposure article I think I'm going to avoid adrenalin releasing activities for a while. Coffee and intense video games :)

While we're at it, we should also add sleep apnea to the list of disorders to screen for. Sleep apnea causes anxiety. Estimates of prevalence range from about 1-2% at the low end to 30% for certain demographics. And increasing with time due to changes in the facial skeleton. Diagnosis rates remain low because the symptoms can be difficult to trace back to it and there's low awareness among doctors still.

Thyroid test is the first thing psychiatrist look at when dealing with mood disorder. Wouldn't this kind of problem be diagnose and treated immediately? Or are the "standard" tests not accurate enough? What kind of "non-standard" tests should one be asking for?

I'd hope that was the case everywhere, but there's still a big grey area. The British Thyroid Association says:

"There is no evidence to support the benefit of routine early treatment with thyroxine in non-pregnant patients with a serum TSH above the reference range but <10mU/L. Physicians may wish to consider the suitability of a therapeutic trial of thyroxine on an individual patient basis" [1]

So what might happen to you if your TSH is, say 3.5, for at least a decade (hey hey, I know the answer to this one...)? Well, you're at risk of elevated cortisol with resulting mental illness, to which my previously posted links will attest. Doctors, if they're not especially attentive, will just prescribe the usual anti-depressants (perhaps a low dosage as an anxiolytic) which are band-aids and don't get to the root of the problem.

Note that I never mentioned non-standard tests - "keep testing" means "keep getting the standard tests". The problem is that interpretation of the standard tests varies - some test results may or may not indicate disease, and this is not always carefully followed up on. There are of course many more people in this grey area than there are people with overt disease. I'd say if you're in the grey area and you have chronic mental health symptoms the risk/reward ratio is overwhelmingly in favour of treatment with thyroid hormone (carefully monitored of course).

[1] http://www.british-thyroid-association.org/info-for-patients...

The link seems to be 404, was this the document you intended to link?


Yes indeed, thank you.

But then why not just look at the t4 and t3 levels?

"Currently, measurement of the serum TSH concentration is the most reliable indicator of thyroid status at the tissue level. Studies of mild (subclinical) thyroid hormone excess or deficiency (abnormal TSH/normal range FT4 and FT3) find abnormalities in markers of thyroid hormone action in a variety of tissues (heart, brain, bone, liver and kidney). These abnormalities typically reverse when treatment to normalize serum TSH is initiated" [1]

The reference has loads more detail...

[1] https://www.aacc.org/-/media/Practice-Guidelines/Thyroid-Dis...

I wasn't arguing that, I was suggesting that if it wasn't clear why the tsh level is high or low, to add on a t4 level check. Which is what is currently done, at least in the US.

Well, there's a common condition called subclinical hypothyroidism which may be asymptomatic and harmless, or it may indicate thyroid disease and be accompanied by various non-specific symptoms. It's defined by slightly elevated TSH but normal T4 test results. Anybody with that condition would not be helped by what you are proposing.

In general, it seems to me that you will get some false negatives when using a less sensitive test result to qualify a more sensitive test result.

I have many friends being treated by psychiatrists, and none have checked thyroids. Psychiatrists behave like pill dispensers, not like actual physicians.

The primary healthcare providers that referred your friends to psychiatrists may well have checked thyroid levels but, as I've pointed out elsewhere in this thread, tests do not always lead to appropriate detection and diagnosis.

Not preaching just curious did you try any diet changes?

I made major dietary changes before I went on meds. My overall health improved a lot, but mental health improvements were insufficient.

Self-awareness about anxiety certainly seems to have an impact. After it was suggested to me that I might have some 'anxiety issues', my anxiety issues got way worse, probably because of a positive feedback loop the self-awareness created: if I noticed I was exhibiting symptoms of anxiety, the symptoms would start increasing since anxiety symptoms were something I was anxious about.

Edit: I mean to also point out that as our society becomes more conscious of the effects/risks associated with anxiety, it increases the likelihood of creating issues like what I described above.

Counter-anecdotally, this worked the opposite way for me. I had a pretty shitty childhood and had panic attacks until I was about 24 and realized it by googling air hunger. Prior to that, I was so clueless that I thought that my regular inability to fill my lungs was due to my minor allergy issues or something, and had no idea why I would seemingly unpredictably start sweating and (separately) why my heart would beat rapidly sometimes.

Being able to identify the problem made it way easier to handle, even before I started actively trying to fix it with things like mindfulness. These days whenever I notice air hunger, I stop and think what I might be anxious about and am usually able to reason my way out of subconsciously freaking out (even if it's as simple as "this isn't going to make it _more_ likely that the situation resolves well").

It seems just as likely to me that more awareness of anxiety will work in the opposite direction from what you're describing, mitigating anxiety off for people earlier since they're able to start recognizing and managing it earlier through greater awareness.

> our everyday argot, our thrumming lifeblood: not just on Twitter (the ur-anxious medium, with its constant updates), but also in blogger diaries, celebrity confessionals (Et tu, Beyoncé?), a hit Broadway show (“Dear Evan Hansen”), a magazine start-up (Anxy, a mental-health publication based in Berkeley, Calif.), buzzed-about television series (like “Maniac,” a coming Netflix series by Cary Fukunaga, the lauded “True Detective” director) and, defying our abbreviated attention spans, on bookshelves.

Is there a good more-factish article about this? I'm the type of person who wants to read words like "thrumming". For an article about anxiety, the prose seems to be designed to produce further anxiety. Anxiety about anxiety is probably the most dangerous kind.

> Anxiety about anxiety is probably the most dangerous kind.

So the prose was effective! Sometimes being dry and objective is not the best way to get across a point.

I often find that being dry and objective is the best way to get my subjective point across.

Readers find it distressing when we as reporters don't speak in an authoritative voice; it makes readers question if we really have a definitive answer to the problems we present to them.

The answers are all right there in the article. Want to reduce the influence of sociogenic anxiety? Lay off the Twitter & TV, and specifically ignore Trump. It's what I do and it works like a charm. It won't cure a chronic case, but it'll stop making it worse.

I knew as I clicked the link that Twitter would be mentioned, and it occurred just 40 words into the first paragraph.

I also knew "Russia" would appear, which is especially ironic when you consider that most of what you hear about Russia nowadays is utter bullshit - listen to Putin talk about the US sometime if you want to feel calm. I'm dead serious about that.

You should do your damnedest to limit the scope of your anxiety to things you can actually do something about.

Delicious irony that this is in one of the main pushers of crisis news.

After my mom retired she started watching a lot more cable news. She became noticably more anxious after a while.

If you're feeling anxious, I'd suggest stop watching/reading popular news media. Turn off push notifications. Reduce or eliminate social media apps.

Our psychology did not evolve with constant input about every crisis happening in the world.

Live your life slowly and locally. You'll be happier.

The New York times? I don't think so. They're not pushing any crises, they're just reporting what's going on in the world. Maybe you're a bit biased.

They are supported by ad revenue. They can't not be like this, they need the clicks. This is not about political left or political right, it's the new commercial reality. It will be like this until they go back to being like print - i.e. you pay for your daily copy and all the ads are fixed price up front.

They are reporting mostly negative news because "positive" news is not newsworthy, and it has always been like that since newspapers have been invented. Nothing has changed in that respect, and, frankly speaking, I'd be wary about people who want to hear more positive news just to feel a bit better about the world.

As for TV channels, yes, they are all crap.

Your point seems unrelated to that of the OP. NYTimes might be reporting negative news for good reason (I agree), but it might still be a cause for increased anxiety and perhaps consumed more sparingly.

Personally I strongly agree. A lot of news consumption serves little purpose, and might very well have all sorts of negative effects. My solution is to avoid most news sources most of the time, read some updates occasionally or, ideally, use sources that write longer articles (that have the added benefit of context and filtering).

Here in Holland we have one paper that has this as their mission statement (De Correspondent). For other perspectives or updates on other areas I mostly rely on a few newsletters and 'bigger picture' articles from various sources. Also my feed reeder for skimming.

My first point was that newspapers have not changed their reporting in any substantive ways over the past decades, so any perceived or measured increase of anxiety cannot have been directly caused by their reporting. Selectively picking news or overexposure to news sources could be part of the problem, though. Nytimes is not a major pusher of crisis.

My second point was that the OP did not differentiate between newspapers and TV channels, but that their reporting is substantially different. I have no doubt that exposure to an abundance of 'news' TV channels such as Fox News or CNN, and their online services, can increase anxiety and maybe even distort people's views of the world. For example, the overall conditions for mankind is continuously improving in terms of standards of living, hygienic and medical standards, equality, absence of wars and major conflicts, etc., conditions have generally even improved in the worst regions of the world, but this is not commonly perceived that way.

But the claim is that this effect is mostly due to TV, not due to newspapers and other news sources. Of course, I could be wrong about that, just wanted to clarify what I've meant.

Finally, neither this nor any other statement I have made has anything to do with politics.

If you think the NYT is unbiased, you might do well to read a few alternative sources for a while to compare and contrast. Once you've been to other lands, it's easier to spot the oddities of one's usual locale.

But more importantly, even if the NYT were entirely unbiased, that does not mean that it's good for your mental state to be reading it. Being exposed to a lot of problems that you cannot do anything about might not be a good thing.

Could you provide examples of NYT crisis-driven reporting? And alternatives please! People always recommend "alternatives", but don't really provide any :(

Try breitbart and thenation as alternatives, for example. Sure, some of it's drivel, but after a while you'll realize that some of the NYT is drivel as well.

And actually, if you just carefully compare NYT _headlines_ to their corresponding _articles_, you'll realize that the headlines really are pretty crappy. Certainly nowhere near the standards for headline writing we used to have in ninth grade journalism class.

I really hope to see a resurgence of classical quality journalism. But I'm not optimistic.

Breitbart doesn't seem like a source I'd use as they seem to lack journalistic integrity, they seems like raw data, a collection of things to look into - the usual selection to anger GOP voters, about how those damn Dem/libs are at it again.

Headlines are crappy everywhere, agreed.

But there is difference between bias and fake news.


That said, I think there's always place for a (or many) counter-culture sites, but I expect a more rigorous intellectual foundation from them not a lesser one to be taken as proper alternative sources. Kuhn's paradigm view is helpful here, MSM is not perfect, but a lot better than fringe/crackpot explanations of the world, and sure, there is probably a better one, but that's not the dominant one yet, but it'll be found by better and more data, better analysis, better methodologies, not by less, and not by more anger. (Sure, reading alt-news might feel right, you might get the feeling of OMG WHY I HAVEN'T BEEN TOLD OF THIS! DAMN I'LL HAVE TO USE THIS to keep myself free from MSM bias!! But to get less biased the solution is to explore the topics at hand from more primary sources (like watch a few youtube videos about the topic, watch a lecture by an accepted scientist/scholar), not by perusing even more biased sources).

Breitbart and The Nation both have a rather dramatic skew. But, since it's obvious and generally consistent, it's relatively easy to "null out". This leaves you with additional signals that are still relatively uncorrelated with (say) the NYT signal. This can provide additional information, and sometimes it leads by several days or even weeks, which is interesting.

(If I had a source of future stock price deltas that was almost always "wrong", I could be a very rich man.)

That said, I've personally come to the realization that my marginal hour spent reading daily news is generally better spent reading ancient philosophy. News is certainly addictive, but I'd be hard pressed to come up with examples where it's improved my life.

> If I had a source of future stock price deltas that was almost always "wrong", I could be a very rich man.


> better spent ...

Again, agreed.

Every news source is biased, and that's no problem if you can distinguish news from opinion.

Overt opinion is pretty easy to spot. Subtle "editorials" in the form of omissions, slanted word choice, etc., are harder, esp until you start looking carefully for them.

> They're not pushing any crises

Did you read the title?

People are stressed because they are never free. In a capitalist society we can do whatever we want (TM) except if you have no money. Then you can't do anything.

High land prices mean we can afford to rent (the cost of carry on the debt on the land) but never own. Therefore we can never be financially independent. With technology and globalisation eroding job security for everyone we are never able to relax. Always looking over our shoulder, unable to refuse overtime, hunted.

Yes this might not apply to the upper class tech of hacker news but they are not representative of the vast majority of people.

>People are stressed because they are never free.

I disagree that this is the root cause. News media and social media have both become extremely efficient and high speed conduits for "stress loading" upon our population.

A local news story used to only isolate the stress to a small locality; now, however, mass media is amplifying and propagating this local stress all around the country. It's only going to get worse.

> Yes this might not apply to the upper class tech of hacker news but they are not representative of the vast majority of people.

It should be clear that this doesn't encapsulate the problem if there's a reasonable segment of the population feeling the same effect without being subject to the same causes. And the stuff you're describing is on the order of 20% here, not 1%.

I find a great diminishing of my anxiety the more I read history books and biographies of figures who were involved in the tumult of their times. It's great for contextualizing the world today and accepting its ebb and flow beyond my capacity to affect it.

Care to recommend any good books?

Maybe people have anxiety because they are worried about having anxiety? I find it funny that drugs like LSD are illegal because it might change how your brain works, yet people take Xanax to change how their brain works. Maybe people are diagnosed with anxiety because they are given prescriptions to drugs that drug companies make more money off of? Drugs for depression may not make enough money these days since there is insufficient evidence that they really do much. Opioids are getting a bad name since they don't actually work for long term pain and are horribly addictive, and there aren't all that many new ones. So drug companies are anxious to find a new source of sales [pun intended].

There's a huge difference between hallucinogens and tranquilizers. People are probably seeking help for anxiety or depression, not just going to a doctor for a physical and ending up with a prescription. Anxiety medication has been around for a long time, thus isn't patented, so it is unlikely that your drug company conspiracy theory holds water.

Xanax in particular has been off patent for over 20 years.

> drugs like LSD are illegal because it might change how your brain works

Drugs like LSD are illegal because people enjoy them in a non-medical context, enough to become a visible cultural phenomenon. This is the entirety of what motivates (or at least used to motivate) US drug policy.

> Drugs for depression may not make enough money these days since there is insufficient evidence that they really do much.

Ignoring the fact that I'd like to see your evidence for the latter claim, there certainly hasn't been a drop in prescriptions of antidepressants or a lack of new patented (and popular) ones.

Here is a decent summation of the effecticeness of anti-depressants as modalities for different conditions:


My .02c: Modern anti-depressants are less effective than the MAOi's they replaced and haven't advanced much in the last 50 years. It's not surprising since our knowledge of the brain's function and structure (at the cellular level and below) is roughly where our understanding of genetics was in the 1950's (note, it wont take 60+ years to catch up). The Human Connectome(mapping of the 100 trillion connections our neurons make) and Obama's BRAIN initiative (taking ultra detailed scans of super thin slices of the brain) as well as a mature brain informatics field will push knowledge quantum leaps forward.

Lets hope scientists have learned their lesson from rhe genome and don't label parts of the brain they dont understand as junk neurons or simply take a reductionist approach. The brain is fractal... we have more or. less the same neurons as a fly. Using these same parts and simple instructions, when you scale a brain, you get us. When you Garry Kasparov was defeated by Deep Blue who tried to control them by saying you were defeated by quantity not quality period he retorted with enough quantity comes quality

You're right, MAOIs and tricyclics are usually more effective than any of the newer classes. They also have drastically worse side effects, especially when you look at discontinuation rates. We're talking about the difference between making eating cheese extremely dangerous and possibly fatal (some MAOIs) and sexual dysfunction (most SSRIs).

That also wasn't what they said: the claim was that antidepressants weren't really effective, not that they haven't really gotten better in the 21st century.

> You're right, MAOIs and tricyclics are usually more effective than any of the newer classes. They also have drastically worse side effects, especially when you look at discontinuation rates. We're talking about the difference between making eating cheese extremely dangerous and possibly fatal (some MAOIs) and sexual dysfunction (most SSRIs).

You're looking at the older class of MAOIs. Although it is probably a bit overhyped, Selegelline has all the advantages of MAOIs with hardly any of the dietary restrictions. Only those who subsisted on a diet of aged, stinky cheese like Roquefort or otherwise consumed excessive amounts of Tyramine are at risk. You still have to be careful not to take certain medicines, mostly those containing pseudoephedrine. As selegiline is also used as a treatment for parkinson's, it has shown to be neuroprotective, and enhances/induces the differentiation of neural stem cells into neurons (neurogenesis) and is used off label as a nootropic. (Disclaimer: I was taking this prescription until I no longer needed it and saw tremendous results)

Modern anti-depressants certainly are more effective than a placebo and have saved many lives. However, I think that a significant % of people would also receive the same or greater results from exercise or mindful meditation. I don't have any numbers in front of me, but anti-depressants are over-prescribed to people who are not clinically depressed but who aren't as happy as they feel they should be.

As we glean more results from the various public/private brain research partnerships our undeerstanding should lead to more effective modalities of treatment. How long it takes to get through clinical trials.

SSRIs are a much better choice for doctors, but they're not necessarily a better choice for patients. For a doctor, it's a no-brainer to sacrifice a bit of efficacy to avoid the rare catastrophic risks of TCAs or MAOIs. For a patient, the choice may be more nuanced. The side effects of SSRIs aren't particularly dangerous, but they're often very unpleasant.

The common side effects for most TCAs and MAOIs are also much worse than SSRIs, as demonstrated by both incidence rates and (more importantly) discontinuation rates. The second in particular removes doctor choice from the equation.

This blog post seems pretty well-cited: http://slatestarcodex.com/2017/06/05/is-pharma-research-wors...

Note for the uninitiated: I'm being sarcastically understated here. The author in question is an authority in drugs for depression and writes extremely lengthy and well-cited essays. He's also a very engaging author.

I've read his blog for a number of years. He is saying new drugs haven't improved much on those available at the beginning of the 21st century. Scott is not very pessimistic at all about SSRIs being useful. Here's an essay from him (that is much longer and better cited) debunking the "antidepressants are basically placebo" narrative: http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo...

And another where he explicitly recommends SSRIs: http://slatestarcodex.com/2014/06/16/things-that-sometimes-h...

I was really shocked that you posted something from his blog, but I guess if you've already decided the answer you can find evidence anywhere you look.

How is this any different from the so-called "opioid epidemic" or any other prescription or substance abuse? Will the politicians and news media give this as much hysteria? Will they take punitive actions against patients?

People are medicated, self-medicated, addicts, etc for various reasons. Why are we so obsessed with what other people do or don't do?

I might be misunderstanding where you're coming from, but presumably the concern isn't for medicating the anxiety, it's for the prevalence of anxiety itself. If there's a novel high incidence of anxiety across the population, how is that _not_ interesting? Is the concept of concern for other people really that alien to you?

Hell, even if we stick with your model of "why would I ever care about another person's well-being", understanding that anxiety is apparently so common can help an individual better understand where his anxiety is coming from (eg perhaps weighting universal factors more heavily than personal ones).

People are apes. The anxiety level in apes is directly linked to the dominance hierarchy and where they are in the dominance hierarchy, and how secure they feel in that position. The dominance hierarchy in modern society is directly liked to your place in the corporate hierarchy. So the economy is directly linked to how much anxiety workers feel being a part of a dominance hierarchy that is incredibly unstable and sociopathic. If we want to reduce anxiety in the population we have to do something about the way business is conducted most likely globally. And universal income totally does not address this problem because if you are on it, i.e. that's your only source of income, you are automatically at the bottom of the social dominance hierarchy and therefore automatically feel high levels of stress, and you will self-medicate with drugs to reduce that stress.

But I'm a nobody and I feel great when I meditate.

Is it because I don't occupy my mind with any memory or thoughts of that problematic?

The world feels splendid when you don't keep in mind your past or future experience of it.

If you are oblivious to the dominance hierarchy then it does not affect you until you try to interact with it... like getting a mate or getting a certain level of recognition from your peers who are actively aware of it and their place in it.. etc. The hierarchy is part of a game, that you don't have to play unless you are forced to by other people. Due to economic need, sexual need, etc. There are alternative dominance hierarchies too, we call them sub-cultures that you might try to join instead for much the same purpose.

Is the trick in not interacting with it?

Meditation showed you can step back from the anxiety generated by the social hierarchy. It should also help you interact with it without letting it push your buttons.

That seems to be the trick the Buddhists and yourself have figured out. The language, however, is dated. Maybe you could update Buddhist mantra for 2017 using all the parlance of our times?

Well Buddhists may claim to, but how often does that not beak down into some other similar game where you have some sort of hierarchy form like for instance in Tibetan Buddhism, you have a guru and his disciples and they are better for their religiosity and what not. Maybe an ascetic monk aspires towards that, again at the cost of loneliness and then maybe through that he can assert his moral superiority over some group. It's all the same game bro.

I am better than you ... because... if anything in your existence has anything to do with that then you are in the game.

Is dropping this profound knowledge on us another way to play the game? Is the trick to happiness just carving out a facet in your life where you're secure in the hierarchy? (I'd borrow from Keith Johnstone and say High Status).

Don't people do that anyway. I am not dropping any wisdom, I am telling you how it is. What you do about it is up to you. From a societal perspective we are already doing things to make the dominance hierarchy of the corporation more amenable to humans. Stopping bullying by higher ups, harassment, etc. are all about that.

What prevents more of that is the nature of the game of business and the competition that goes with it, which is dog eat dog. Businesses would go out of business very quickly if they catered to the social needs of their employees rather than the business itself. The point then is to design a business process which isn't that ruthless with different objectives.

Maybe it's not zero, but some environments have much weaker hierarchies than others, and the various meditative practices seem like they could help with that.

Depends on what you want. If you are okay being socially isolated, then sure. But that causes its own psychological problems... loneliness.

If the nytimes, bbc and the media would disappear, it would solve a lot of the anxiety problem.

The media is poison for the population. Not only do they deceive the population, they intentionally try to cause fear and anxiety in the population to sell ads.

Probably the opposite, as people then now would be scared of all the crisis happening without them knowing it ...

If reading a piece of text makes you have an anxiety attack, the problem lies in you and not in the fact that that piece of text was published.

This is getting ridiculous.

This article is a great example of "unless it's reported by the media, it doesn't exist."

Is this article really drawing a conclusion that nobody was anxious during the 1990's? That's how it seems to me.

It's a great example of the nytimes and the media having to create stories in order to sell ads.

The easiest way to get clicks is to sell fear. "Opioid" crisis. Trumpaggaedon. Ebola/SARS/etc. "Your child might die from this!!! Click to find what it is before your child might die! Click NOW!"

Think about it. If absolutely nothing happens in the world, the "journalists" have to write something to sell themselves and make the newspaper money.

These people are no better than clickbaiting youtubers.

Also, fear and anxiety are great ways to control and manipulate the people. It's what north korea does to its people. It was the nazis did in the 1930s.

Just like reading the bible critically is the cure for christianity. As a former 7-day subscriber to the NYTimes, reading the NYTimes critically is the cure for propaganda.

No, they're making the point that anxiety is both sociological as well as biological, and that the sociological dimensions of anxiety have worsened. I'm not sure I agree either, but is that so hard to gleam from TFA?

Here's a book that adds to this point that mental illness "spreads" in a social contagion sense: https://www.amazon.com/Crazy-Like-Us-Globalization-American/...

>Is this article really drawing a conclusion that nobody was anxious during the 1990's?


>This article is a great example of "unless it's reported by the media, it doesn't exist."


Because they call out the "slacker" generation of the 1990's like it's a good proxy for everyone in the US. The people anxious today were probably anxious back then too!

Your feelings are valid, because it's true that reading the article made you feel that way. The writer should have been more considerate of how his choice of words would resonate.

And, as humans, we are not prepared yet for all those notifications we have right on our pockets. Psychologically, we feel pleased when we check it and the notification disappear, so we do that unceasingly.

and the way they are presented as "alerts" creates more suffering than it's worth.

Alerts should be for things like tornadoes, floods and hurricanes, not upcoming birthdays.

And even more fundamental than that, most of us are unprepared to deal with such intimate knowledge of one another. The goody-goodies are losing it when they realize how much suffering there is in the world. It makes us all feel so powerless (if we let it).

Humans apparently evolved to have enough memory to deal with about 150 personal relationships... We're now pervaded with human contact and persona from thousands of people at varying distances...

And our mistakes, instead of being dealt with on a personal, intimate level of people nearby to us are projecting outwards to the entire globe! And stored there indefinitely!

I liked playing low-res video games and calling BBSes, but this world-wide persistent network is too intense!

Would grateful to hear anyone's experience taking SSRI's (Zoloft, etc.). Was it effective, how long were you taking it, what were the side effects it any, how was the experience of stopping (withdrawal, etc.)?

I'm on Lexapro (very low, 2.5 at the moment but normally 5mg. 7-10 mg causes tension headaches for me) and have also taken zofoft, celexa, lithium, and also the usual Ativan/Xanax thing as well as a bunch of other meds years ago. The SSRIs have side effects for me so I battle with them constantly, going off for many years, getting back on, etc. However, they are side effects I know very well and are all fairly benign compared to the kinds of side effects associated with other antidepressant classes. And they work, they make it more likely that any given thought or sensation is just going to be... What was I thinking about? Like that. My depression / anxiety are very ruminative. When outward stressors are lower, I like to lower my dose which leads me to be a bit more creative and also reduces other side effects, but I become more emotionally reactive - a thing i practice a lot in trying to recognize in a flash and control. It's a lifelong struggle.

Been taking Lexapro for over two years now. Started at five, moved up to 7.5 and ultimately been settled at ten for the last year and a half. Have not seen side effects (I was deathly afraid of something like ED but if anything my sex drive is enhanced thanks to no longer being depressed).

It has been one hundred percent effective. If I miss a day, I know (and so does everyone else). We (psychiatrist and I) tried to see if I had gotten past the point of needing it by tapering off. Didn't work, so I'm back at ten, probably for life. That's fine, there's way worse medications to be dependent on!

> tried to see if I had gotten past the point of needing it by tapering off

A small point, but the "discontinuation effects" for these meds can be severe, and they can make people think they still need to take the meds. This keeps people taking meds for very long amounts of time.

Some people are okay with the side effects, and they've made an informed choice about the risks of taking these meds long term.

The Guardian newspaper has been running a couple of stories about long term use. I think they're a little bit alarmist, but the personal experiences are useful.




Are you sure the symptoms you got by tapering off were because you not longer have the drug you need in your system, or because of discontinuation syndrome?

My psychiatrist determined it was the former.

> Would grateful to hear anyone's experience taking SSRI's (Zoloft, etc.)

The experience of others doesn't mean a darned thing. Each person's biochemistry is highly individual which is why the success rate of treating various mental disorders using medication is so low.

I, for example, get rapid tolerance to just about everything, so even the few SSRIs that worked didn't help for long.

Of course people are more axious now. It's by-design and shows the media and advertising efforts of the last decades are working. Anxious people are more likely to over-consume (a clear example, stress-eating) and are more likely to 'stay tuned in'. If you want to reduce your anxiety, withdrawal from media (in both senses) for a month and see how you feel.

If for the sake of argument we presume the postulate true and we envision a better informed future could a company such as Google (or others) be obliged to a point where past a certain threshold social media and media in general adjust one's exposure to counteract people's unhealthy impulses?

For example, if (Google) knows you are living beyond your means then ads targeted change in aspect from aspirational to more basic needs and the news and social media surfaced to you modify so that you feel less stressed and less out of a loop till the time you have more disposable income?

(just a thought experiment)

Perhaps I am cynical, but what's the profit motive for Google? They're much more financially motivated to be complicit and find vulnerable people to advertise to, if not create vulnerability, assuming that there won't be backlash against them in particular.

If Google is about cataloging the world's information and making a profit via advertising, then it might be in their interest to have healthier consumers over anxious and perhaps sick (mentally vulnerable) consumers. For example, they might prefer making a dollar in revenue selling a pair of eyeglasses over selling a bottle of night train.

In a symbiotic relationship it's in your interest for both entities to remain healthy.

In the alternative scenario, ultimately it ends in selling a casket, however presumably there is more money to be made in a healthy and happy customer.

I think the general trend in business is to squeeze out as much from a customer now and worry about consequences later. I doubt this will work and it's probably not desirable to have some giant company determine what's good for people. Especially one that lives off advertising.

I think the general trend in business is to squeeze out as much from a customer now and worry about consequences later

No large company can see further ahead than the next quarterly earnings report.

True for companies in commodities but not all companies (ex. AMZ, GOOG, MSFT --they take longer views) and then you have state underwritten companies, or reporting regimes are different (CN, JP, etc.)

Ultimately, it comes down to the attitudes of shareholders. There are two major competing trends in this respect.

On the one hand, the shareholder value movement has done immense harm to the long-term planning of businesses by focusing fanatically on quarterly profits. At its worst, this turns into corporate raiding and asset stripping.

On the other, an increasing proportion of equities are held by tracker funds; Vanguard are largely indifferent to the performance of any one company, as long as the market as a whole keeps growing. The entire business of index tracker funds is predisposed upon stable long-term growth.

It's an interesting concept but I think the application would be troubling. Corporate responsibility is a system that's not particularity well suited a tool for spiritual or emotional guidance at an automated level. You can argue it is the very culprit for increased anxiety in the face of an automated workforce, and an escalating competitive workforce intellect amongst the population at large.

tl'dr You recharge you batteries in life a number of healthy and natural ways.

There are also privately-owned companies, for example with IKEA supposedly them moving heavily into Russia was just because Kamprad thought it was a good idea. It went horribly at first but they stuck to it and eventually it paid off.

The longer they remain paying customers for cell phone plans and cable bills, the longer they'll likely remain google customers.

Or, perhaps this falls under their "do no evil" mission statement!

>Could a company such as Google (or others) be obliged to a point where past a certain threshold social media and media in general adjust one's exposure to counteract people's unhealthy impulses?

Only if people strongly demand it. It wont come from politicians who those companies have in their pockets...

Well, ads for casinos and alcohol (in New York USA at least) come with fine print at the bottom encouraging responsible use and/or how to get help for problem gambling.

Yes, a perfect, benevolent, god-like corporation would do something like this. What is the point in pretending something like that could ever exist?

Self-regulation does exist, and not because of perfect benevolence. It's usually for fear of actual legal regulation (which is scarier because it's less under their control).

Once we all agree on the acceptable level of unhealthy impulses, we can do that

Media and advertising may result in increased anxiety, but it's a bit conspiratorial to imply that its a concerted effort with anxiety as the goal. I feel like it's more of a perverse incentive.[1] In media (in the news in particular), stressful stories get more attention, so they are reported more aggressively. In advertising, companies can sell more of their product if they can make you feel insecure, and then sell you the purported remedy. When it's difficult to feel calm and self-assured, it's easy to feel anxious.

[1] https://en.wikipedia.org/wiki/Perverse_incentive

> Anxious people are more likely to over-consume

Do you have a source for that ? (Eg empirical study)?

> are more likely to 'stay tuned in'.


FOMO is real. Look at how much Bitcoin and the stock market have gone up over the past few years. "Everyone is getting rich but me"

When did it become the case that having "anxiety" isn't a stupidly clear indication of mental disability?

I think the the way this article is written, is both the symptom, and a factor helping the proliferation, of the issue it discusses.

It is more or less a trivia style collection of references and anecdotes, from different sources related to the topic. It feels a bit like a tweeter feed itself, if you search #anxiety - a really wide collection of tangentially related observations (haven't actually tried that, no twitter account, but you get the point). No attempt of synthesis, no deeper analysis of the connections between topics, no statistics.

The way I understand it, when there is no core but a shattered collection of associations, that by itself can cause anxiety. Because the reader now has him/herself to build connections, or leave that as uncertainty, and uncertainty will cause anxiety. And to expect the reader will do that is unrealistic - even the skilled reader will need time for that.

Also, consider how the article came to existence: The author seems to be a professional writer, 2-3 articles a month, half of them about hand watches. You have just read a socio-cultural analysis by the author of hand watch surveys. On nytimes.com.

Granted, life of writers is tough and jumping to conclusions here would be premature. But even if the author is capable of writing a thoughtful piece, writing that kind of article on a serious subject should be a violation of some kind of writer's version of Hippocratic Oath.

Couldn't nytimes.com find a reasonable expert to write that? It could, but it wouldn't for some reason.

Finally, the first paragraph mentions Sarah Fader, "the Brooklyn social media consultant", "who has generalized anxiety disorder" with her tweet - apparently a gesture by one of the common people. One of the last paragraphs mentions her again, but now "the Brooklyn social media consultant who also runs a mental-health advocacy organization called Stigma Fighters". So perhaps more a calculated step rather than a gesture, but why spoil the hero story right in the first paragraph?

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