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Comment by DubiousPusher | Hacker News Reader

> We offer, and are offered, drugs as the first, and often last, recourse.

This is one of the many mental health memes I wish would die. I've lived my entire life with several close family members and friends who have severe mental illnesses. I have been to hundreds of appointments across dozens of providers. I have never NEVER seen a doctor give a patient a once over and then prescribe meds.

I understand there are bad psychiatrists out there. Just like there are bad mechanics, bad accountants and bad everythings. But I believe the vast majority of psychiatrists understand the limits psychoactive medications. I think it would be farely rare that a psychiatrist doesn't also discuss lifestyle changes and recommend some kind of talk therapy along with medication.

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I think many psychiatrists prescribe first because people who are clinically depressed have such a high rate of suicide that it's better to first reduce the risk pf death before further treatment.

I'm not saying that applying that principle so broadly is a good thing, but I can see where they're coming from.

Sometimes antidepressants can increase the risk of suicide, however. This is a commonly enumerated side effect in their advice leaflets. One theory of depression is that it's evolved to take away our motivation to kill ourselves in the face of extreme adversity.

True, the link between antidepressants and suicide is a current area of study.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034101/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353604/

In no way do I want to diminish how serious these drugs are. They can have a profound effect on a person's behavior that occurs in a very short period.

Finding a medication regimen that works for a person is a serious undertaking. It often takes years. A person may have to taper on and off dozens of different regimens to find a good effect while minimizing side effects. The constant personal changes a person experiences through this process can strain relationships, ruin careers and much worse.

Also, at least here in Australia, it's way more expensive to see a psychiatrist than a psychologist. I imagine if you've made your way to a psychiatrist (someone that can prescribe meds) for depression then you've already had plenty of therapy, and things are still bad enough to warrant escalation. Which then ties in to your point. If someone is making it in front of a psychiatrist for depression, suicide is probably on the table.

Its very different in different countries, even different states. Are you in the US, UK, Australia, or Canada? Very, very different circumstances than France, Germany, Austria, etc.

It is true that there are generalizations; but the statistics of abuse of pharmaceuticals cannot be denied, nor is it safe - at all - to ignore the commercialization of mental illness by multi-national pharmaceutical corporations. In Germany, pharmaceutical corporations use sales agents to directly promote and sell their wares to doctors: and this is perfectly legal. In the US, they use conferences and junkets. You cannot ignore these things, given that pharmaceuticals are demonstrably over-prescribed in the West. It is very naive to ignore the drugging of society by corporate interests.

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