Has the Drug-Based Approach to Mental Illness Failed? | Hacker News Reader

Has the Drug-Based Approach to Mental Illness Failed?

scientificamerican.com

25 pointskeiferski20 comments

The problem is that drugs are seen as a political issue. For some reason, other people think that it is their business what you put into your body, even when it's medicine. A side effect of this is that you get doctors that "don't believe in X illness" or "don't believe in treating X with medication Y". As a result lots of people are going to get inadequate treatment for their problems.

When you read forums discussing ADHD you'll find plenty of stories where people were unable to get medication, because they had to change doctors and the new doctor was unwilling to prescribe it.[0][1] Many of those people will likely have their lives fall apart following that.

Discouraging drug based treatments further is likely going to cause more situations like this. I think what would really help is if mental illness treatment became more specialized. You'd go to a doctor that really knows the illness you're dealing with.

[0] https://www.reddit.com/r/ADHD/comments/antrln/doctor_refuses...

[1] https://www.reddit.com/r/ADHD/comments/lb5gq3/psychiatrist_w...

"For some reason, other people think that it is their business what you put into your body, even when it's medicine."

Let's say we had a legal regime in which you could go to a pharmacy with a prescription your wrote yourself and get it filled. Opioids, stimulants, cannabis, ketamine, whatever.

Wouldn't you still advise a friend that they should find a credentialed doctor and ask them to write a prescription before taking some of the more powerful substances? It's important to be able to get the advice of an expert, particularly when that advice goes against your intuitions.

Issue is that your pharmacy is pretty much standardized. Walk into 100 pharmacies and ask for the same thing and you’ll walk out with the same thing from each one. Same inputs = same outputs.

Credentialed doctors are all over the place. Go see 100 psychiatrists with the same issue and you’ll get as many treatments.

This is because there is a disconnect between medication and our understanding of the underlying mechanisms driving mental health issues

I think that this a bit of a separate topic. I wasn't advocating for making all drugs freely available, but rather wanted to caution that there are already plenty of doctors who try to not prescribe drugs based on some moral feelings (or fear).

However, on this topic I do think that there should be fewer restrictions on what you can buy. I have asthma. I would like to have an emergency inhaler for those rare situations where I have trouble breathing properly. But I can't have one, because asthma medications are prescription only here and I do not have health insurance. I am uncertain whether it's worth spending the likely €100-200 it would cost out of pocket to see the doctors and do the tests to get the prescription. So I make do with caffeine, wet blankets and sleeping upright on the rare occasion that I have a problem.

I can afford the medicine, but the mandatory doctors visits are too much. As I said though, this is a bit of a different issue.

That's definitely a problem, but it's not the only problem. Medications often have side effects, and sometimes for some people they are worse than the symptoms they are supposed to manage.

Since I was 13, I was told it was a chemical imbalance, and that chemistry was to blame.

I was lucky enough to live in the brief epoch where any substance can be delivered to any door, for a reasonable price.

Having worked my way through the Erowid vault, through all the domains of types of drugs, it wasn't until external life changes outside of neurochemistry that the chemistry was "balanced"

It wasn't internal chemistry that was at fault, but external social interactions, richer than what 3-MEO-PCP, 4-ACO-DMT, 25i/b/c, ketamine, or MDMA/MDA/MXE could achieve in isolation.

We aren't just biological computers in a vat, we are social animals. Drugs have different interactions with people based on expectations, which is cultural.

Sometimes it's not the drugs, it's the circumstances. We didn't evolve to stare, eat, and be entertained from a series of ever-rounding rectangles.

Correction: we are social biological computers

This is a really old debate in psychiatry. My father studied it in the 70s and said that the establishment of his day were suspicious of all medications and all the academic literature suggested drugs should only be used as a last resort. There was apparently a lot of animosity between the pro and anti-medication faction.

Since then the pendulum has swung the other way and the pro-medication camp are now the establishment. The truth is probably somewhere in the middle but for better or worse academic literature always takes a thesis/antithesis approac.

A major reason for the rise of the medication side is because for many acute mental health episodes medicines, like lithium for example, are extremely effective at treating the episode. Even the most anti medication psychiatrist must acknowledge that for a lot of acute mental conditions, the evidence is overwhelmingly in support of medication even if we don't understand very well their mechanisms of action.

The interesting push back that is happening against medication I think is because for more chronic and long term mental health conditions, the medications we have aren't as clearly effective for everyone and as a result of their chronic nature, the types of evidence we can collect and analyze will be further limited.

My bipolar disorder is managed quite nicely with a low dose of Quetiapine. It's been a life saver.

Some people really have a problem with psychiatry and psychiatric meds. The following claim is suspect.

> the pharmaceutical industry, has inflicted iatrogenic harm on millions of people

What is verifiably true is psychiatric medications have helped millions of people. But you can't tell that to people who have an agenda against psychiatry and psychiatric meds.

I have permanent tinnitus as a side effect of taking a psych drug for 6 months a few years ago. On the other hand I might not have survived at all without the drug.

how bad is your tinnitus?

I’m really happy you found something that worked. I’m sorry it still had a cost.

My tinnitus started from having had to be on a high dose of a medication for a short term. This side effect I deal with now is far better than the alternative, and I don’t imagine I would be here to complain otherwise. The other side effects sucked as well, but same.

I get pretty steamed when people try to blanket-statement their personal experience or lack thereof onto these deeply personal trade offs and issues and try to invalidate what does or does not work for the sake of sounding smart. Fuck those people.

Lost my hearing totally within 2 hours of taking Zyban.

Tinnitus is all that I hear nowadays.

Chiming in late here, also had tinnitus with Bupropion, which remained for months even after I stopped taking it. Lowered my job performance because of it, never had any prior or posterior issues with other amphetamine-like medication (ritalin & vyvanse). I found relief in corticosteroids (combined pill of betametasone + chlorphenamine), which made the tinnitus disappear in a week. Now if it comes back it's very minor and I can ignore it, or go through a short course of medication again to make it go away for a couple of weeks. Oh, and keep out of some noise cancelling headphones, they make it worse for some reason.

There is room for both perspectives: you can take your meds and benefit from them while people discuss the negatives about neuroleptics and aim to minimize treatment for mild cases.

I lost the ability to control my hands, legs, tongue, face and more thanks to antipsychotic induced dyskinesia; plus it left me with severe attention deficit. It has been over 5 years and it has not gotten any better.

I haven’t taken those pills in over 5 years as well either.

Psych drugs work for some people. They don't work very well for others. They tend to have nasty side effect profiles, also--they should be used with a lot more care and only when it's clear they are needed.

I used to take olanzapine religiously at 25 mg for Schizophrenia. I did exactly what the doctors asked because I wanted to be a good person and not the stereotypical person who doesn’t take their drugs.

In my opinion drugs and therapy are useless. If they were actually rational pills everyone would be taking them recreationally. Antipsychotics are simply sedatives in my opinion.

The idea of talking to a patient about their delusions is stupid to a degree I cannot comprehend. Therapists should instead say “You are full of nonsense, listen to Classical and read 2 Chapters of War and Peace for next time”. The goal of this beneficial technique is the same as brainwashing - to replace part of the brain, except in this case with a concrete and rational reality.

If I could have a do-over, I would have gotten a dog instead of taking those pills.

There is only one reality, as Murakami once wrote.

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