There have been several posts on Hacker News about this the past few days.
I know myself. I'm a hacker, right? I can reprogram my body to accomplish anything.
But sometimes people do need help, and that's not bad.
I love this site, and the people on it. I hope these recent posts don't create a culture that rejects all depression management methods.
It's a very fine line. The previous post mentioned that the "placebo effect is growing stronger".
That may be true, but recent stressful events in the world have taken a toll on people. Seeking help should be a zero cost option, or maybe even slightly less.
Not everyone needs help, but those who do may find an explosion of links to this by friends off putting.
Just something I'm keeping in mind for myself when talking to my circle.
To me, people who are not doctors or neuro scientists who criticize ssri are like antivax people.
I'm tired of people linking to exploratory studies on psychedelics and then saying they're better than SSRI. Same anecdotal people who claims psychedelics cured them of depression while they were not diagnosed, and there is no proof it cured them.
Psychedelics are not FDA approved treatments you can use without supervision.
I'm suspecting there is a lobby of people targeting gullible patients who have mental health problem and sell them whatever. It's an insult to me.
People hack their body every day in the gym and at school. As long as biology/physics would allow it, there's a good possibility you can learn. By persistent training over years it's for example possible to program your body and mind to overreact on small stress triggers and acquire an 'anxiety' ability. Another body hack could result in running a marathon, or being able to empty your mind through meditation, or walking barefoot in the winter.
Consciously reprogramming your body is hard because often there's not a quick or obvious training/reward cycle and it takes time. You might not even know what to train or how, and even if you get detailed instructions you might have difficulty translating it to your body and how you would feel/experience it. I could explain how to twitch your ears, but chances are you're not even aware of the muscles that would allow that. A first task would be to become aware of a bunch of face and ear muscles and go from there.
Another example is when someone mentions your neck is all tensed up and you think you're all relaxed and chill. Over time you've hacked your body to recalibrate your feeling of being relaxed, to the point where you don't know to really relax your neck muscles. Hacking your body/changing behaviour takes time and conscious effort, and it really helps to be convinced that it is possible, or at least doubt that it is impossible to hack.
There's a related issue with trusting the system you're in that hackers might often feel too. "I'm a programmer, I've seen how many bugs are in my own code... I've seen the spam I get..."
Again, these articles might be technically correct. But some people might need some help in addition to those who are doing ok.
The slang sense of "cope with" (as in can't hack it) is recorded in American English by 1955, with a notion of "get through by some effort," as a jungle (phrase hack after "keep working away at" is attested from late 14c.). To hack around "waste time" is U.S. slang, by 1955.
The US 1955 slang 'hack around', is to waste time. A description that applies way too often, for users on the peripherary of technology and tech education, I'm afraid.
Article claims that SSRI are overpresribed, and that only 15% derive any benefit. To me it seems that people who don't need it and were over-prescribed the drug do not derive any benefit. But it does not mean that drug efficiency is 15%.
It's like giving aspirin to people without headache, and claim that aspirin does not work.
No statistics are actually cited for the "mounting evidence" but the 15% is cited to a "single study" -- so is 85% overprescribed by definition, if they're not helping?
FYI, psychiatrists don't (can't) really check to see whether the drugs are "helping". As long as you're staying out of the hospital, not going fucking nuts in their face, and you're not screaming about ten side effects, they'll keep you on all the ineffective drugs you can afford. (n.b. be careful about mentioning side effects; that's a good way to get bonus drugs.)
Your aspirin analogy is perspicacious. I often struggle with use of pain relievers, because how can I know that they've relieved any pain, or my pain just subsided somewhat coincidentally? I was in ER for kidney stones, for example, and the pain was excruciating and I vomited and writhed around, so they gave me an IV dose of "NSAIDs on CRACK!" as the nurse so aptly and professionally described it. Within 10 minutes my pain was receding rapidly. I had no lingering complaints, long after it would've worn off. So, correlation or causation?
Conversely, I've never perceived even the slightest relief from OTC pain meds, and I've run the gamut. Experimenting with Bali Red Kratom this year.
> No statistics are actually cited for the "mounting evidence" but the 15% is cited to a "single study" -- so is 85% overprescribed by definition, if they're not helping?
I don't know, but could be. Anecdotally all my friends were taking anti-depressants at some points for their life, including me. But not because they struggled with sever depression, but because of "stress" in life. I used to fallback to antidepressants when I had struggles at work, relationships, etc. Just go to a doctor and say you feel sad and not motivated, and you have a prescription.
I don't do it anymore. I think depression exists, but what I have had wasn't depression, and I could have resolved it without drugs with tons of side effects.
Right, fully understandable. My own situation? I recently decided to compare it to a stubbed toe that's been bothering me these 30 years.
30 years ago I discovered that I had stubbed my toe long ago. It really smarted and bugged me! I could barely walk so I started seeking care for it! Of course I was an extremely sick boy, with lots of latent ailments undiagnosed, but all anyone ever wanted to look at was that darned toe. How many times am I taking off my sock for some woman stranger?
I've incurred charges amounting to ~1/3 of a million dollars (that's a conservative and honest estimate, including 4 hospitalizations) on that "stubbed toe" issue. Not to minimize bipolar disorder, but it's defined as a "mood problem" so if you have mood swings or are moody then you have a mood problem. Mood is a mere symptom; an affect. On the scale and scope of issues bothering me, it is truly trivial and minor. Since 2008, I literally don't have mood swings. I sometimes get agitated and testy; I take strange irrational actions, but it is a normal sort of mood that would be considered natural in any undiagnosed person. Furthermore, I was formally diagnosed "IN REMISSION", via second opinion, about 3 years ago.
So the doctor denies my remission now, and insists that I still have a stubbed toe and insists that I must take drugs to avoid the hospital and dire consequences. Why, how, is stubbed-toe medication going to do that? Don't I need something stronger? You consistently detect serum levels as sub-therapeutic but you don't even bother to ramp up my dosages. Like, surgery or intensive PT or something??! Scheduled drugs, at least? It was literally only 5 years ago when I discovered how profoundly ill and messed-up I was. The doc says I literally have brain damage, and it's true. That stubbed toe really snowballed over 45+ years.
Of course I've sought manifold treatments and I've had mixed success, and I really believe that there is healing and recovery for these people who "stubbed their toe" and ran into so, so many problems afterwards. But today, 30 years on, I have bigger fish to fry; sorry doc but I'm off all of my meds.
Years ago I had a boss who had a nervous breakdown. I went to visit him in the mental hospital where he was being treated. In his case he was on a very structured day routine and meds. I asked him what he felt did him the most good. He told me that he had a hour each day in the gym where he was to do some type of exercise. He said that he felt best during and after that time. Since then a great deal of research has validated his observation.
It’s just so reliable too. If I’m feeling off.. I just do 15 minutes of cardio (or enough to get me in that zen-like sweaty breathing state) and then I take a hot shower and switch to cold water before getting out.
Those 30 minutes are enough to keep me feeling really good for hours - or the whole day.
It’s become my secret weapon. I do it after work on especially hard days, I do it before dates or other social gatherings. Works like a charm.
My friend eventually figured out for herself that she has the genetic condition of not being able to methylate the provitamin folic acid into Vitamin B9 (important for dna synthesis). She told me how adding L-methylfolate to her routine was like flipping a switch from ‘depressed’ to ‘not-depressed’. #MTHFR: https://twitter.com/jamesknochel/status/1595562181692907520?...
MAOIs are reasonably effective at lifting people’s moods, and start to work right away - helpful for breaking 'depressions' negative feedback loop.
SSRIs were promoted because they were profitable, not because they’re especially effective. Now that the patents have expired the harms of these drugs are getting more attention.
I keep seeing all these placebo studies regarding anti-depressants, and yet I know for a fact that SSRIs were able to get me out of 2 episodes of months long depression in life within a few days of taking them. Everybody reacts different is my only explanation
My wife is a psychiatrist. She told me I the past that anti-depressants are a bit like roulette - you have to keep trying until the right one lands. Unfortunately, that can take years as most antidepressants take 4 to 8 weeks to take full effect. Everybody’s body is just slightly differently so it can take a while to find a drug that pairs well with your body.
Further, there’s a lot of indication that antidepressants depressants are far, far more effective when paired with cognitive behavioral therapy (CBT). I think of this like liposuction, you can remove the weight quickly - but without sustained lifestyle and diet changes, you’ll end up being back in the same place.
It's very possible that the combination of antidepressants and CBT is superior. Antidepressants enable you to relearn faster und CBT teaches you what to learn.
This finding seems to account for SSRIs rather than other classes of antidepressant. It’s difficult to believe that classes like NDRIs (which behave similarly to an amphetamine) would show such low superiority to a placebo.
NDRIs were great at causing me brain zaps. So much so, that I could not meditate for more than a year after stopping the medication without reaching a brain state that caused similar brain zaps. Fortunately, that has long passed.
I'd been referred to a psychologist and so I started attending appointments in his office, at the Children's Hospital with the playsets in the waiting room. He was a kind man, and our sessions were trustful and frank. He spoke to me with candor and not unlike Mr. Rogers on my TV, only he was there for me alone.
Shortly he handed me off to his accomplice who pushed drugs. I got fluoxetine HCl. That's mostly fluoride in case you're not a chemist.
Back home I was playing with the cat and smiling. I'd perked up, because I'd formed a new relationship with someone who cared, and I felt like life was better because there was intervention and perhaps these awful feelings would be addressed properly. My primary abuser exclaimed how happy I was, "it's like we've got $SON back!"
I'd been on the pills about two days. I'm still puzzled after decades how a chemical is supposed to be responsible for the profound personality change that happened at that time. Unfortunately I wasn't able to keep up sessions with the shrink, so it was all a flash in the pan.
Indeed. The placebo effect is a real and known effect, a kind of psychological artifact. If it didn't exist, testing medication effectiveness would be much easier, as there would be no need for tests to be double blind.
I compare placebo to noise, as in, signal to noise.
I think we shouldn't fall into the trap of thinking that taking/doing a placebo would most often be an effective enough treatment, because tests show that the placebo effect happened. That would be like saying, just use full noise instead of the signal, since tests show they are close, rms wise.
Some forms of antidepressants can be related to lower libido. If your prescribing doctor doesn't talk about this, get a new one.
My psychiatrist was very open about this and we tried different medications to see which impacted this the least. But, you know what else is related to lower libido? Depression. So let's not act as if the antidepressants are only to blame.
I'm not sure who the 'people' you reference are, but if your prescribing doctor doesn't talk to you about side effects, get a different one.
Doctors I speak to go like this. You want antidepressants? They'll solve XYZ problem. They're good, but they don't always work. Do they clash with any medication or health problems.. no. Anything else? Take these ones with food, here's your script/referral/whatever.
Then I take it and it sucks. Literally the government puts up ads saying smoking is going to kill me, but chemical castration (tiny bit exaggeration!!) from SSRIs is A-Okay!
Better article:
In a 2003 survey, approximately 41.7% of men and 15.4% of women discontinued psychiatric medications due to perceived sexual side effects.4 Given that SSRIs may cause sexual dysfunction in 40% to 65% of individuals, these side effects may exacerbate depression and create a barrier to medication adherence.5,6
Note that the evidence for psychotherapy or physical exercise substantially outperforming placebo (or SSRIs, for that matter) for major depression is even sketchier. Your best bet is to try all three, but there are no guarantees in any case.
I know myself. I'm a hacker, right? I can reprogram my body to accomplish anything.
But sometimes people do need help, and that's not bad.
I love this site, and the people on it. I hope these recent posts don't create a culture that rejects all depression management methods.
It's a very fine line. The previous post mentioned that the "placebo effect is growing stronger".
That may be true, but recent stressful events in the world have taken a toll on people. Seeking help should be a zero cost option, or maybe even slightly less.
Not everyone needs help, but those who do may find an explosion of links to this by friends off putting.
Just something I'm keeping in mind for myself when talking to my circle.
To me, people who are not doctors or neuro scientists who criticize ssri are like antivax people.
I'm tired of people linking to exploratory studies on psychedelics and then saying they're better than SSRI. Same anecdotal people who claims psychedelics cured them of depression while they were not diagnosed, and there is no proof it cured them.
Psychedelics are not FDA approved treatments you can use without supervision.
I'm suspecting there is a lobby of people targeting gullible patients who have mental health problem and sell them whatever. It's an insult to me.
Is there a name to that way of thinking? That's how I've been thinking lately but I can't help but think it's wrong.
Consciously reprogramming your body is hard because often there's not a quick or obvious training/reward cycle and it takes time. You might not even know what to train or how, and even if you get detailed instructions you might have difficulty translating it to your body and how you would feel/experience it. I could explain how to twitch your ears, but chances are you're not even aware of the muscles that would allow that. A first task would be to become aware of a bunch of face and ear muscles and go from there.
Another example is when someone mentions your neck is all tensed up and you think you're all relaxed and chill. Over time you've hacked your body to recalibrate your feeling of being relaxed, to the point where you don't know to really relax your neck muscles. Hacking your body/changing behaviour takes time and conscious effort, and it really helps to be convinced that it is possible, or at least doubt that it is impossible to hack.
There's a related issue with trusting the system you're in that hackers might often feel too. "I'm a programmer, I've seen how many bugs are in my own code... I've seen the spam I get..."
Again, these articles might be technically correct. But some people might need some help in addition to those who are doing ok.
The slang sense of "cope with" (as in can't hack it) is recorded in American English by 1955, with a notion of "get through by some effort," as a jungle (phrase hack after "keep working away at" is attested from late 14c.). To hack around "waste time" is U.S. slang, by 1955.
The US 1955 slang 'hack around', is to waste time. A description that applies way too often, for users on the peripherary of technology and tech education, I'm afraid.
Older: self-mastery
It's like giving aspirin to people without headache, and claim that aspirin does not work.
FYI, psychiatrists don't (can't) really check to see whether the drugs are "helping". As long as you're staying out of the hospital, not going fucking nuts in their face, and you're not screaming about ten side effects, they'll keep you on all the ineffective drugs you can afford. (n.b. be careful about mentioning side effects; that's a good way to get bonus drugs.)
Your aspirin analogy is perspicacious. I often struggle with use of pain relievers, because how can I know that they've relieved any pain, or my pain just subsided somewhat coincidentally? I was in ER for kidney stones, for example, and the pain was excruciating and I vomited and writhed around, so they gave me an IV dose of "NSAIDs on CRACK!" as the nurse so aptly and professionally described it. Within 10 minutes my pain was receding rapidly. I had no lingering complaints, long after it would've worn off. So, correlation or causation?
Conversely, I've never perceived even the slightest relief from OTC pain meds, and I've run the gamut. Experimenting with Bali Red Kratom this year.
I don't know, but could be. Anecdotally all my friends were taking anti-depressants at some points for their life, including me. But not because they struggled with sever depression, but because of "stress" in life. I used to fallback to antidepressants when I had struggles at work, relationships, etc. Just go to a doctor and say you feel sad and not motivated, and you have a prescription.
I don't do it anymore. I think depression exists, but what I have had wasn't depression, and I could have resolved it without drugs with tons of side effects.
30 years ago I discovered that I had stubbed my toe long ago. It really smarted and bugged me! I could barely walk so I started seeking care for it! Of course I was an extremely sick boy, with lots of latent ailments undiagnosed, but all anyone ever wanted to look at was that darned toe. How many times am I taking off my sock for some woman stranger?
I've incurred charges amounting to ~1/3 of a million dollars (that's a conservative and honest estimate, including 4 hospitalizations) on that "stubbed toe" issue. Not to minimize bipolar disorder, but it's defined as a "mood problem" so if you have mood swings or are moody then you have a mood problem. Mood is a mere symptom; an affect. On the scale and scope of issues bothering me, it is truly trivial and minor. Since 2008, I literally don't have mood swings. I sometimes get agitated and testy; I take strange irrational actions, but it is a normal sort of mood that would be considered natural in any undiagnosed person. Furthermore, I was formally diagnosed "IN REMISSION", via second opinion, about 3 years ago.
So the doctor denies my remission now, and insists that I still have a stubbed toe and insists that I must take drugs to avoid the hospital and dire consequences. Why, how, is stubbed-toe medication going to do that? Don't I need something stronger? You consistently detect serum levels as sub-therapeutic but you don't even bother to ramp up my dosages. Like, surgery or intensive PT or something??! Scheduled drugs, at least? It was literally only 5 years ago when I discovered how profoundly ill and messed-up I was. The doc says I literally have brain damage, and it's true. That stubbed toe really snowballed over 45+ years.
Of course I've sought manifold treatments and I've had mixed success, and I really believe that there is healing and recovery for these people who "stubbed their toe" and ran into so, so many problems afterwards. But today, 30 years on, I have bigger fish to fry; sorry doc but I'm off all of my meds.
It’s just so reliable too. If I’m feeling off.. I just do 15 minutes of cardio (or enough to get me in that zen-like sweaty breathing state) and then I take a hot shower and switch to cold water before getting out.
Those 30 minutes are enough to keep me feeling really good for hours - or the whole day.
It’s become my secret weapon. I do it after work on especially hard days, I do it before dates or other social gatherings. Works like a charm.
MAOIs are reasonably effective at lifting people’s moods, and start to work right away - helpful for breaking 'depressions' negative feedback loop.
SSRIs were promoted because they were profitable, not because they’re especially effective. Now that the patents have expired the harms of these drugs are getting more attention.
Further, there’s a lot of indication that antidepressants depressants are far, far more effective when paired with cognitive behavioral therapy (CBT). I think of this like liposuction, you can remove the weight quickly - but without sustained lifestyle and diet changes, you’ll end up being back in the same place.
I'd been referred to a psychologist and so I started attending appointments in his office, at the Children's Hospital with the playsets in the waiting room. He was a kind man, and our sessions were trustful and frank. He spoke to me with candor and not unlike Mr. Rogers on my TV, only he was there for me alone.
Shortly he handed me off to his accomplice who pushed drugs. I got fluoxetine HCl. That's mostly fluoride in case you're not a chemist.
Back home I was playing with the cat and smiling. I'd perked up, because I'd formed a new relationship with someone who cared, and I felt like life was better because there was intervention and perhaps these awful feelings would be addressed properly. My primary abuser exclaimed how happy I was, "it's like we've got $SON back!"
I'd been on the pills about two days. I'm still puzzled after decades how a chemical is supposed to be responsible for the profound personality change that happened at that time. Unfortunately I wasn't able to keep up sessions with the shrink, so it was all a flash in the pan.
That's a staggering lack of understanding of how basic chemistry works.
Hydrogen is 66% of water and yet water is not flammable.
*Well maybe just the once, but the jury determined that it was definitely not Prozac-Related Human Combustion (PRHC)
I'm not quite sure how this could be utilised in psychiatry though.
I compare placebo to noise, as in, signal to noise.
I think we shouldn't fall into the trap of thinking that taking/doing a placebo would most often be an effective enough treatment, because tests show that the placebo effect happened. That would be like saying, just use full noise instead of the signal, since tests show they are close, rms wise.
They have way more side effects than is publicly talked about.
People know more about the side effects of smoking, than they do, doctor prescribed medication. Something is wrong with that picture.
My psychiatrist was very open about this and we tried different medications to see which impacted this the least. But, you know what else is related to lower libido? Depression. So let's not act as if the antidepressants are only to blame.
I'm not sure who the 'people' you reference are, but if your prescribing doctor doesn't talk to you about side effects, get a different one.
Here's a HARVARD website [0] that lists sexual side effects to common antidepressants, including anorgasmia (inability to experience orgasms).
I have experienced both (colloquially known as blue balls) anorgasmia and lower libido from depression..
How cruel is that irony! Can't get it up from depression, can't seal the deal from SSRI induced anorgasmia!
There is no act or blame here, only science, observation and lived experience.
[0] https://www.health.harvard.edu/womens-health/when-an-ssri-me....
Doctors I speak to go like this. You want antidepressants? They'll solve XYZ problem. They're good, but they don't always work. Do they clash with any medication or health problems.. no. Anything else? Take these ones with food, here's your script/referral/whatever.
Then I take it and it sucks. Literally the government puts up ads saying smoking is going to kill me, but chemical castration (tiny bit exaggeration!!) from SSRIs is A-Okay!
Better article:
In a 2003 survey, approximately 41.7% of men and 15.4% of women discontinued psychiatric medications due to perceived sexual side effects.4 Given that SSRIs may cause sexual dysfunction in 40% to 65% of individuals, these side effects may exacerbate depression and create a barrier to medication adherence.5,6
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007725/#:~:tex....