Comment by asdfman123 | Hacker News Reader

Comment by asdfman123 | Hacker News Reader

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There is a fine and very important distinction to be made here.

If you have a health problem, you should do your best to get exercise, eat healthy, etc. However, that doesn't mean medicines are wasteful or pointless. People often greatly benefit from them.

I've struggled with ADHD, depression, and anxiety my whole life. And indeed, yes, the best treatment I've found is diet, weight training, and long-duration cardio. Which I do.

But people who are "in the hole" need medicines to dig them out. And also, people with kids/multiple jobs don't have as much time as I do. And these habits take years to finally stick. And I still need ADHD medication.

And the best treatment for things like this is to try every treatment you can together, but don't overwhelm yourself in the process (and it takes wisdom to not overwhelm yourself).

People on Twitter opine about this kind of stuff piss me off. They think their vague notions about what is right for society--that they have no experience with--should take precedence over my decades of (informal) research and lived experience. It's okay to have opinions and discuss things, but don't try to bully the people who actually know what they're talking about.

Diet/sleep/exercise/sunlight are always the first step, and if you don’t at least get those, you’ll be hard-pressed to feel decent no matter what else you do, regardless of whether you have other medication-dependent conditions.

That said, there are way too many people out there who have no experience with conditions which require medication, who seem to think that those things are a substitute for medication rather than a baseline that must be kept up alongside medication.

I’m no psychologist, but I tend to assume that a driver to thinking this way might be the sense of safety that comes with self-righteousness. Similar to victim-blaming in crimes, where people pick at the personal faults of crime victims (however slight) in order to reassure themselves that a similar thing couldn’t happen to them. Imo it’s a coping mechanism for a world where long-term suffering can be brought on totally at random.

> That said, there are way too many people out there who have no experience with conditions which require medication, who seem to think that those things are a substitute for medication rather than a baseline that must be kept up alongside medication.

It is complicated. Some people have mental health conditions which are always going to require medication. Some people have mental health conditions which are never going to require medication. And some people have mental health conditions where it depends on environmental circumstances. For that last group, lack of sleep/diet/exercise/etc can be part of the environmental circumstances which makes medication required, so fixing that can make medication less required, and may even go some way towards making it no longer required. Even if certain other things can make medication no longer required, sometimes it is still helpful in the short-to-medium term to give you the space to implement those things

> but I tend to assume that a driver to thinking this way might be the sense of safety that comes with self-righteousness

There are serious concerns about iatrogenic harm in mental health due to overdiagnosis, misdiagnosis and overprescribing. Some people who are critical of medication are approaching the issue, not from some sense of superiority, but rather from negative personal experiences with the topic, for themselves and/or family members.

Taking psychiatric medication and being critical of it are not mutually exclusive-I myself do both. Medication is the least worst thing for me right now, but I hope one day I can solve some other problems in my life and remove some stressors and I may eventually wean myself off it. And simultaneously I believe a lot of people out there are being harmed by being prescribed the wrong medications. For example, the widespread prescribing of antipsychotics to adults and children without psychosis, by prescribers who are ignorant of the risks of brain atrophy [0] and who don’t communicate those risks to patients/parents. If you have schizophrenia, those risks may be the lesser evil; if you have a kindergartener with Aspergian traits and mildly violent behaviour, I’m not convinced it is. Maybe as a last resort once you’ve exhausted every alternative, but I know clinicians for whom risperidone is their first resort for such a patient not their last

[0] https://journals.sagepub.com/doi/10.1177/0004867418797419

I was hospitalized for two severe manic episodes in my late teens and was told I would have to take lithium for the rest of my life or I would inevitably end up back in the hospital. I did take it (and Zyprexa) for about nine months during my freshman year of college, got the fattest I've ever been, and spent almost the entirety of my free downtime zoned out in my dorm room.

That summer after my first year of college, I spent my days moving stuff around in a furniture store and golfing 9 holes after work was done, and weaned myself off of it. I haven't relapsed into the hospital in two decades since, despite more than a few high risk periods I've gone through over that time, and a lapse during fatherhood in my ability to keep up with exercise as much as would be ideal. I don't know whether my brain was sufficiently re-wired by those 9 months of pills or what, but it's a bit strange to me that essentially every psychiatrist would have insisted something like this was impossible.

> I don't know whether my brain was sufficiently re-wired by those 9 months of pills or what, but it's a bit strange to me that essentially every psychiatrist would have insisted something like this was impossible.

Bipolar disorder disappears in some people spontaneously. Around 10% of people who have a first bipolar episode will not go on to have a second one, even if they permanently discontinue medication. And some people who have a second episode will never have a third, even if they stop taking medication, although I don't have an actual statistic on that. Let's suppose it is 1% of all bipolar cases – which is a figure I just made up, but probably in the right ballpark. Since bipolar is around 1% of the population, people like you would be around 0.01% of the population. That sounds insignificant, but in a country like the US there would be over 30,000 people like you, and worldwide could be over 700,000.

I think the psychiatrists who told you this is "impossible" probably knew that it actually wasn't. It is just that it is rare, and they don't want to give patients and their families false hope or encourage non-compliance with treatment, so instead of telling you the truth that it is 10% or 1% or whatever of all cases, they tell you a "white lie"/"simplification" that it is 0%. 90-99% of the time, their lie turns out to be true for the person they told it to.

In terms of whether 9 months of medication "rewired your brain" – it is impossible to say. It is possible that without medication you would not have gone into remission, and would have had further episodes. It is also possible that you were always going to remit anyway, and still would have even without medication. Nobody really knows. The fact is, for just about all psychiatric disorders, our knowledge of what causes them, and how the medications work, is extremely incomplete, and we don't know enough to answer those questions in individual cases.

Yeah, as someone with ADHD, good diet, exercise, sleep, etc. are critical for managing symptoms. They're also effectively impossible to maintain consistently without medication.

> They're also effectively impossible to maintain consistently without medication.

This is key. As someone with bipolar disorder, I'm forever stuck in a cycle of stable with good habits -> episode happens -> can't keep the habits -> get worse -> medication changes/episode passes on its own -> I go back to good habits -> stable...

With mental illness you never know when it's going to act up and ruin your life, so the least you can do is use your energy - when you have it - to keep your body in a decent baseline.

Thankfully, this cycle takes many months to start again, so I live a decent life most of the time.

This sort of stuff always reminds me of this passage:

> To this day

> He is a stick of TNT lit from both ends

> Could describe to you in detail the way the sky bends

> In the moments before it’s about to fall

> And despite an army of friends

> Who all call him an inspiration

> He remains a conversation piece between people

> Who can’t understand

> Sometimes becoming drug free

> Has less to do with addiction

> And more to do with sanity

  - To this day, Shane Koyczan

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