I cannot stress this enough: I live for the day these cruel bastards get gulaged. This shit is why I’m a leftist.
You must log in or # to comment.
RFK wants more people to be treated like his aunt.
so do half the people in this thread apparently
I’m actually surprised to be seeing people here apparently being cool with restricting life saving meds from people. Are we for real?
It isn’t exactly news that hexbear is ableist as fuck.
the meds i was prescribed did immense harm to me and my quality of life. nobody is supporting RFK’s version of this, we’re asking for hemophilia not to be treated with leeches and bloodletting.
Are you capable of understanding that not all psychiatric medications are the same, not all psychiatric conditions are the same, and that not everyone has the same reaction you did to them?
If I didn’t have my meds - which it was INCREDIBLY difficult to get because of medical gatekeeping in part paused by ‘deprescription’ sentiment - more likely than not I would kill myself, and even if I didn’t I wouldn’t be capable of living even a half life because I’m so mentally ill I need stimulants to fucking shower on a semi regular basis.
The only thing propagating this rhetoric right now does is hurt the people who need psychiatric medications the most. It’s great for you that you can function without them.
Not everyone is you.
i said
nobody is supporting RFK’s version of this
and don’t be so fast,
It’s great for you that you can function without them.
i wouldn’t call it functioning, it was just much much worse on them and the process cost me everything that made life worth living
I think it’s possible that SSRIs are over prescribed and kind of not great medications because they kind of take a hammer to a whole number of systems when you’re generally trying to bang one or two back into shape while it also being true that not a single person in this government is actually pushing for their replacement out of compassion or respect for psychiatric science or because they want to find a better treatment
Like, my opinion is this is awful and these people should be thrown into a pit, but also I do truly believe that 100 years from now, if we’re lucky enough for scientific civilization to survive that long, people will look back on SSRIs the same way we do electroshock therapy (assuming better solutions are developed and they’re not, like, the most advanced psychiatric medications we end up able to develop)
Like for example sertraline can literally permanently destroy a person’s sex drive, among other long term severe side effects, and I also think a lot of people who are presently suffering from depression are ultimately feeling the way they do not because of a permanent physical condition requiring medication but because they live in literal fucking hell with constant reminders around all of us and I have a really negative opinion on SSRIs being used for such a condition and i really dislike thinking there are millions with legitimate grievances with society who are told to take a pill to change how they feel about it (don’t take this to mean I don’t think depression is real. I just know for a fact that for me, personally? Most of the shit that would lead me to be considered as having depression all leads back to issues resulting from life under capitalism i.e. financial insecurity, work relationships and power dynamics, etc.). Like I’m not going to support taking the medication away from someone who presently needs it but I also watch stuff like my partner feeling sick with anxiety due to their job callously and arbitrarily forcing them from their position while saying it’s not a layoff due to untenable return to office bullshit and they literally can’t eat and their doctor just gives them more fucking sertraline and I think “this is medical malpractice to some degree and it’s happening on a gross scale”
(she meant to prescribe them a proton pump inhibitor but either “forgot” or over relied on the medical LLM bullshit she was using, but don’t worry, I’m smart and doctor shithead (me) got them some omeprazole while wondering why the fuck the doctor didn’t give it to them. Imagine how angry I’d be posting about this if she didn’t tell us she intended to describe a PPI and ALL MY PARTNER GOT for their situation was “just take some more zolofy, dawg”)
Anyway that’s my opinion on SSRIs but also I think people should be able to choose whatever drugs and therapies they want without them being gatekept from them
I agree with you on that. That hits hard because I’ve been there. Unfortunately when that cripples you sometimes the only way to keep going is to take the stupid SSRI. I hate it too. We need to change the whole damn system so none of it is needed, but I just don’t see that happening under capitalism.
I’ve had electroshock therapy and it was better then ssris TBH
i’ve had a really bad time on all the brain pills i’ve been proscribed and we might literally be completely backwards wrong about how SSRIs work. RFK isn’t doing anything right but the status quo of prescribing stuff that we don’t know how it works to treat conditions we don’t understand very well is also bad and correcting the latter might look like not prescribing stuff as much.
I agree that certain antidepressants are downright dangerous (I tried Effexor once, never again)
But in saying that, making medication harder to access in general, even ones that could really help people is just going to lead to people being denied the ones that don’t suck too. You know what these institutions are like, they’ll tar every medication with the same brush and make important treatments too hard for most people to access
yeah you can’t have a blanket policy like he wants to do. stimulants are currently egregiously limited in the US and people can’t even get what they’ve been prescribed
Can’t wait for one of these chuds to go after Trump or Kennedy or any of these ghouls after they get cut off their psych meds.
It’s worth noting that the US consumes 25% of the world’s prescriptions with 4% of the population. Hard to say how much of this is overdiagnosis, and how much is a necessity that the rest of the world can’t afford.
But what’s more certain is just like he got played by the Fanjul sugar cartel, RFK will get rolled on this as well. There’s certainly something to be said for preventing mental debilitations at the source, but it’s not profitable to do this, he doesn’t have that structural understanding, and trying to brute-force it is going to backfire.
The problem is that if you gatekeeping medication too hard, it becomes harder for people who really need it to access it.
There’s also a ton of mental conditions that people are born with that no amount of prevention will fix. There are a ton of conditions that people need to be medicated for before they can function enough to properly utilize other avenues of treatment.
Someone with severe BPD should not be denied their meds
There’s certainly something to be said for preventing mental debilitations at the source
CWs: Ableism, sui, drugs
Well, what is that source? The source of my ADHD is that something about my dopaminergic neurochemistry is totally fucked. What prevents that at the source is administering amphetamines. Behavorial measures are a massive help, and i employ a ton of these, i know how to organize tasks in a way that saves my limited ressources, i know how to stim to deal with inner unrest, i know how to talk to my inner child to calm me down when i am emotionally dysregulating, i have a robust support network of neurodivergent friends that get me and have similar needs and that i can hang out with if i need to socialize without masking. In short, i am fairly close to the optimum of behavorial and environmental means of coping with ADHD. And i should be, givent that i’ve had psychotherapy and ergotherapy and have read up on the stuff and whatnot.
But i am still not capable to live an independent life without strong psychostimulants. I am organically not able to be a functioning adult that routinely gets done more on a given day than take the trash out and go grocery shopping, and even that takes effort. Which is fine ig, there’s pills against that and they work. Oh, they are also gatekpet af because people are scared of overprescribing psych meds.
Anyways, why i am hitting you over the head with a diatribe about ADHD, in a thread about SSRI’s, is the simple fact that depression is very similar in many ways, just with a different neurochemistry behind it and different meds that can treat that. Yes, there are depressive symptoms that have exogenic causes, but actual depression is an organic issue and needs pharmacological treatment, to say otherwise is ableist “just do more sports and clean your room” crap that is actively harming people every day. I have friends that may not be with me anymore if they would not have been put on SSRIs in time. I know people who’ve lost loved ones because these loved ones decided, without telling anybody, that it was time to get off their meds and then the rebound hit them so hard they killed themselves. Antidepressants save lifes. Even when brain chemistry is not the root cause, they can be an indispensable temporary help that puts people in a position to got for the actual cause. Yes, there are people that would benefit more from talking cures and other stuff that’s psychotherapeutic instead of psychiatric. But the solution for that is to make psychotherapy widely avaible for free, not to take away medication that can have drastic effects when it is discontinued too quickly.
really enjoying your posts as usual. i was wondering, is biology as the root cause the current consensus in depression research? (if that is what you mean, i may be misunderstanding you. i suppose “organic issue” doesn’t necessarily discount depression being downstream of material factors) absolutely not trying to dispute the claim at all, i just haven’t done the investigation myself and i suppose my vague impression was that there isn’t exactly a great consensus on root causes in depression research. it was my strong impression especially that the jury is very much out on “chemical imbalance theory”. i just want to know if i am way off base with this.
i know you did state that biology is not always the root cause. i have treatment resistant chronic depression myself and i struggle a lot internally wondering whether i would be a radically happier person in a better world or whether this is just something i would always have to struggle against to some degree. i have had great results from DBT around my other emotional problems but a lot of the time it does feel like my depression arises from my material conditions moreso. the way i generally lean is that my condition is more like “shit life syndrome” than something genetic or biologically rooted. just something I’ve been vaguely meaning to do more investigation on and wondering if you have any good places to look. i know this thread has turned a bit sour so sorry if i am adding to any stress by replying. sorry it’s a jumbled string of thoughts also i am on the bus
My point was mostly that sometimes, it makes sense to treat the human mind as a blackbox. Our approach to psychiatric medication is frankly built around “let’s try stuff that has a track history of working”, and many behavorial forms of psychotherapy openly state that they use a blackbox approach that evaluates treatment methods by the evidence for their outcomes.
But yeah, i feel what you say about depression and material conditions. I’m absolutely not saying that does not have an impact. And i generally prefer to work with medical stuff that is aware of the intersection between mental health and such sociopolitical factors. One reason i stuck with my ergotherapist is that in our first session, she said that her aim is not to enable me to mask or assimilate better, but to give me tools for managing my ressources better and to enable me to choose when i apply them and when i focus more on things like self acceptance. Which is a big thing for ADHD treatment, especially in our society - a lot of patients first have to learn to be kind to themselves and not to constantly judge themselves as failures.
Eh, idk where i’m going with this. I think i’m digressing, But yeah, it absolutely eats at people’s mental health to see where the world is headed. It’s a dilemma that a lot of therapists are aware of. How do you treat somebody who suffers to a degree that is actually appropriate to an unbiased, sober and honest look at the conditions we live in? How much cope can you teach them before a survival tool becomes an enabler of accepting conditions that should be unacceptable? I don’t have an easy answer for that. I absolutely would have broken by now if i would not have ways to manage the emotional toll that living in our world takes. I honestl wonder if it’s enough or if i need ways to distance myself further to survive. I’ve seen with some dear friends where activist burnout leads, i don’t want that kind of damage on top of everything else. But then there’s this voice in my head that asks if this isn’t a sacrifice we have to make for a better world when so many comrades have literally given their lifes already. It’s a mess, frankly.
thank you for the thoughtful response. totally, therapeutic intervention that doesn’t shy away from acknowledging material realities is always going to feel more honest and likely do more to help people like us. i found DBT to be great for this personally, polar opposite to the stuff you find in e.g. CBT. and that shit works. i didn’t really have a point either, mostly just a lot of what you said struck a chord with me and i wanted to share my experience and struggle with this dialectic. philosophically the brain as a black box is frustrating to me but it is accurate. i am glad to hear you have been able to make progress and find help with your own struggles, despite the awful world outside. on my bad days those feel incompatible. but we have to struggle on as you say. solidarity comrade:)
I too have severely debilitating ADHD. Through grappling with it and also depressive episodes in my own life, I often wonder what it’s like for people in poorer countries, or whether these are diseases of modern society. For psychological issues it’s extremely hard to discern what is purely genetic and what is largely environmental/social.
I work in healthcare and it’s already been a policy. The standards of care basically require that we use the lowest dose for the shortest time possible. We have meetings on a regular basis where we’ll review the psychotropic medications the residents are on and see if we can start removing them. Sometimes we find that they can come off and we taper them off without too much issue. Other times it’s a nightmare.
I’m often in two minds regarding this. These medications can have significant side effects so getting people off them isn’t a bad thing. The other side is that a lot of the time they the behaviors and feelings these medications were meant to address end up coming back, but there’s a lot of pressure to just keep them off usually requiring nursing to fight to get them back.
Over the past few years the restrictions on certain psychotropic meds have become a lot stricter in nursing homes. Apparently down in Florida there was some large issue where people were diagnosing people with schizophrenia in order to give out more antipsychotic medications so now there are more restrictions as a result. When I worked on a dementia unit, the restrictions became really frustrating since you’re dealing with psychotropics on a very regular basis. On their face I don’t think they’re bad, but in practice it’s just even more work I’m expected to do when I’m already overworked and understaffed.
Not to mention the idea of forcing an elderly person to go through withdrawals with their condition reemerging is horrifying
Given that it is the US, and RFK specifically who is responsible, it’ll probably cause a lot of unnecessary suffering for the people who need it the most. But I believe the idea itself is actually neither wrong nor bad.
Long argument incoming:
There is no conclusive evidence supporting the idea, that any mental health issue is caused by a chemical imbalance in the brain. At the same time, there is plenty of research pointing to the contrary. The reasoning has basically been, that since introducing X chemical to the brain helps it must mean that lack of X is the problem - with no further evidence to support it. Two major arguments against this reasoning are as follows:
- There is evidence that medication increasing the uptake of serotonin lessen the symptoms of depression, but there is also evidence that medication decreasing the uptake of serotonin lessen the symptoms of depression. We can only conclude that some drugs work sometimes for some people, but not why they work.
- When going off antidepressant, antipsychotic or anti anxiety medication people experience withdrawal symptoms. These can range from mild to severe. This is why you need to slowly taper off. The reason we experience withdrawal symptoms is because the brain needs time to regulate itself back to normal - what we call homeostasis. When the withdrawal symptoms disappear it means that the brain has regulated its own uptake of X to fit with the previous levels. The fact that people who are depressed and use antidepressants are capable of homeostasis in regard to the specific chemical targeted by the drugs means that we are unable to account for what we really mean by a chemical imbalance, since imbalance implies a brain incapable of this.
By accepting the chemical imbalance hypothesis and using that reasoning when prescribing medication, we end up overprescribing medication while neglecting to investigate treatment that could actually be more helpful. This is a problem, since medication is both expensive and has many severe side-effects that people just have to live with if the only perceived alternative is to keep being depressed, psychotic, etc.
In the end it boils down to something akin to the cars vs. public transport debate. Public transport is undeniably better, but it requires the political commitment to invest in the necessary infrastructure. As long as this infrastructure is non-existent, and we live in a world of paved roads, owning a car can be a life saver.
The same can be said about psychiatric medication. It only becomes the necessary, or go-to, treatment because we are unwilling to address the bigger causes of our suffering - and by bigger I mean something much more drastic than just public transport infrastructure.
All of this to say, that the idea of deprescription can be helpful if we in turn focus on changing society and the way we live, both together and as individuals. However, merely limiting the access to psychiatric medication without changing anything else will only lead to suffering.
The reasoning has basically been, that since introducing X chemical to the brain helps it must mean that lack of X is the problem
Many of my trans siblings all over the world are denied HRT with the exact same idiotic argument that openly, shamelessly dismisses empirically observable beneficial outcomes: Apparently, it is not ok to shoot up estrogen simply “bEcAuSe wE dO nOt kNoW tHe uNdErLyInG cAuSeS” of gender dysphoria, disregarding that these causes can only be observed through looking at symptoms in the first place.
That “fuck empirical evidence for patient health, my ivory tower garbage about how we do not yet properly understand this phenomenon trumps your human rights” bullshit is the entire justification for why healthcare is taken away from us, and you use the exact same reasoning to justify Robert Fucking Kenney Jr. taking healthcare away from people. Oh yes, it will be a bad thing when he does it, you at least admit that much, but i guess his heart is in the right place, because while you midly object to the implementation, you fully agree with the core of this policy.
I do not need anybody to understand why trans people exist to shoot up estradiol and i do not need anybody to understand what causes ADHD to take methylphenidate. In both cases, the proven and demonstrable benefits these medications have for an overwhelming number of patients are reason enough to justify treatment.
IT IS NOT REQUIRED FOR THE TREATMENT OF ANY CONDITION THAT WE FULLY UNDERSTAND WHAT CAUSES THIS CONDITION. EVIDENCE FOR THE EFFICACY OF A TREATMENT IS ENTIRELY SUFFICIENT. IT IS A BETTER EMPIRICAL FOUNDATION THAN LITERALLY ANYTHING YOU ARE ADVOCATING FOR.
All of this to say, that the idea of deprescription can be helpful if we in turn focus on changing society and the way we live, both together and as individuals.
Let’s disregard for a moment that ADHD is not fucking me over because of capitalism, but makes it impossible for me to life a normal life even when i am unemployed and can, for the time being, focus on just existing and then getting my life in order. I’m a privileged European living in the last days of our welfare state existing, so this is actually my material reality. I get money for nothing while i try to sort my shit out. I have a really cool ergotherapist who is competent and supportive and woke and who teaches me little life hacks, i have a trans inclusive psychotherapist, i have not quite the kind of healthcare you dream of but thanks to careful research, living in the right place and just being extremely lucky i come pretty close. I am as close to the living example of your idea how to treat mental health problems as you’ll ever get. And i can’t get anything but the miost basic chores done without medication, no matter how well i manage my time and how much i body double and how many other skills and copes i employ. In spite of having zero responsibility, i struggle to take care of myself, to socialize as much as i want or to pursue hobbies and activist work adequately. It just does not work, because my brain says no. That’s how mental disabilities are sometimes. But you don’t know anything about that, all you know is that i should clean my room and stand up straight with my shoulders back. That is literally what you are arguing, Jordan Peterson self help bullshit, but from a leftistperspective where the antidote to chaos is not fascism, but socialism. Do you think i could function like this under AES? LMAO, fuck off. You do not know jack shit about these things, sorry to be so blunt but stop making judgements about the lifes of disabled people. It is insulting. It is openly insulting what you do.
I’m gonna axe the part where i get into the politically illiterate part of your post. I do not have the spoons for that. I have procrastinated grocery shopping for more than an hour to type out this reply already because guess what, i lack the medication to do this any faster because my gatekeepy psychiatrist will not prescribe me methylphenidate until next week, if she will do so at all, so i have to save my remaining stock for absolute emergencies. Isn’t it great how the gatekeeping you advocate for saves me from being given side-effect heavy medication for a condition we do not properly understand yet? I will not waste another hour where i tear you apart further. But believe me, you would deserve it. You would also deserve a much more hostile reply than this, but then the mods will tone police me and you will refuse to listen, so have this instead and please take it to heart. This goes for all the ableist pro-RFK cryptochuds in this thread. Fix your hearts or die, i am serious.
Another good post :cat-trans: thank you serial experiments
EVIDENCE FOR THE EFFICACY OF A TREATMENT IS ENTIRELY SUFFICIENT.
SSRIs work less than half the time? would be cool if we could determine someone was in the lucky third before delaying other treatment or subjecting people to horrible side-effects. HRT and stimulants have much better records.
I’m unsure how to reply to your comment. I don’t think I’ve experienced someone being so hateful towards me before. I’m sorry that I hurt you.
See my comment above for some elaboration, but I am not arguing that people should have their access to medication removed. And I don’t believe that the cure to mental health issues is self-help. We can discuss it further, but only if you would find it meaningful.
I’m just really really allergic to people arguing in favor of medical gatekeeping, which is almost hardwired into the goals you’re arguing for. I’ve had to navigate systems like that during my transition, i am back to having to do this now due to my ADHD, in fact exactly because my country’s healthcare system is biased in a direction you are advocating for when it comes to adult ADHD. What you’re writing just hits very close to home and i’m tired. I don’t know how much longer i can go on unmedicated. I just want to do more than existing, why is that so much to ask when there is an obvious, workable solution?
Also, like i said, that kind of outburst is an actual symptom of my disability. I don’t feel that way now, and that kind of swiveling back as if nothing happened is also fairly typical (and comes with its own problems), but i seriously couldn’t stop that shit anymore after a certain point. It’s something i’m working on, and yes, somewhere down the line i may end up taking an atypical antidepressant to rein it in because frankly, this stuff is overwhelming and i don’t like the pace at which i’m making enemies. Just to reiterate, there are a fuckton of ADHD symptoms that have literally no relation to functioning under late stage capitalism and that can still ruin my life if they go unchecked. This issue is more complex than some people here assume.
In the end it boils down to something akin to the cars vs. public transport debate. Public transport is undeniably better, but it requires the political commitment to invest in the necessary infrastructure. As long as this infrastructure is non-existent, and we live in a world of paved roads, owning a car can be a life saver.
I think a big difference between these two is that public transit infrastructure and car infrastructure are both competing for the same limited physical space. The more paved roads and highways, the fewer railways. Psychiatric medication and general improvements to society do not have that kind of dynamic. Lowering the amount of prescribed antidepressants won’t have any effect on outside circumstances that make people depressed.
I generally agree, and the comparison was mostly to get the point across that medicatiin is not ‘bad’. But one could argue that there is a similar competition regarding the ideas of what constitutes a cure/treatment/wellbeing etc. The psychiatric and medical industry is very intent on furthering the use of psychiatric medication as the safe, correct and responsible way to deal with mental health issues, while downplaying the feasibility of other options.
The psychiatric and medical industry is very intent on furthering the use of psychiatric medication as the safe, correct and responsible way to deal with mental health issues, while downplaying the feasibility of other options.
“The trans industrial complex is very intent on furthering the use of hormones and irreversible surgeries instead of resolving your struggle with gender roles through open-ended therapeutic measures” oh wait that was not what you were saying, it was only the literal same argument applied to another diagnosis, based on the fact that the same guy who is attacking SSRIs right now has argued against gender affirming care in this way before. Funny how much you keep sounding like a literal transphobe.
Oh sorry, i did not want to write another reply to you. That was mean. It was also a collossal waste of my time. I guess that’s what happens when you have unmedicated ADHD, you just get sidetracked. I should probably read another self help book or talk to my therapist for another year to fix this, after all not understanding the underlying causes of my condition is only a concern with a pharmacological treatment of my symptoms and when i do behavorial therapy it is suddenly ok not to know understand what is going on in my synaptic clefts.
I wrote in another comment to another post how imagining we know anything about why psychoactive substances do what they do is mere hubris, and it is. This argument is misguided, comrade. At best, it’s utopian thinking. What is happening in practice is maximal suffering, with no benefit to public health (or positive outcomes on the individual level!) - how do we change society? Inventing a world where deprescription as it has been and is actually implemented ceases to exist somehow is utopian.
There’s no contradiction between rejecting the chemical imbalance theory (which was originally a marketing scheme for Zoloft) and supporting the use of psych meds for those who benefit from using them.
I’m going to try and go a different direction here since other commenters have already said everything I’d like to say: psychiatry is extremely faddish, and deprescribing has been gaining some powerful friends the same way other interventions have in the past. As such it deserves to be treated with the same critical eye as any other trend in the field. Deprescribing is hot now because there is a way to profit from it. Any benefit or risk that accrues is incidental to the further commidification of disability and disabled people. Other people have written at length about this, if you’re disabled you’ve probably seen it yourself: what drives trends in treatment is what treatment is available and who can monetize it. If it weren’t profitable we wouldn’t be seeing such a push for deprescription now, the same way we wouldn’t have seen anxiety become depression become bipolar disorder (merely changing the name for the same underlying phenomena as different medications come on or off patent).
Benzodiazepines were considered largely benign until the manufacturer of Buspar decided to salt the literature to make space in the market for their “non-addictive anti-anxiety medication”. MDD and GAD got redefined in the DSM as SSRIs emerged as alternate “serenics” or “anti-depressants”. Social anxiety as a diagnosable nosological entity distinct from other anxiety disorders only exists because Paxil needed a new indication to extend its patent life. PMDD as a distinct nosological entity distinct from what had existed before but been coded as PMS or PMT (non-billable) is a thing because Prozac was going off patent and the manufacturer reformulated fluoxetine as a pink tablet to keep their rate of profit up. BPAD got fuzzed to include “has moods” as the market for “mood stabilizers” appeared around the turn of the century.
There have been no real advances in psychopharmacology since the introduction of the SSRIs and SGAs in the 1980s. We’ve been running on fumes and recombining old treatments for decades, creating prodrugs (Vyvanse/Elvanse) of 100 year old drugs, or turning ketamine into a single-enantiomer nasal spray. There’s no money to be made in psychopharmacology now. Everything is generic, there’s no marketing teams creating the pressure that there was 20, 30, 40 years ago.
The failure of nosology to account for human experience has nothing to do with whether somebody benefits from a medication or not. Force-tapering people is violence, but there’s money in violence. There’s metrics to create and hold prescribers to! We can further enclose and extract rent from the human experience and from human suffering in ways that don’t differ from forced prescribing (or overprescribing, whatever) at all. Medication has no moral valence by itself but the choice to prescribe or deprescribe (and the necessity of a prescription to access certain medications in the first place) does.
And lastly, there is the whiff of disability-as-moral-failing and disability-as-contagion to this reasoning. Whether the cluster of experiences we call ADHD is nosologically coherent or not doesn’t change the fact that there exist drugs that improve executive function and quality of life for certain people, and those people (myself among them) should have access to the medication they need without judgement or gatekeeping. “If we could treat the underlying causes then disability would cease to exist” is ahistorical. It’s the same argument RFK is making, ultimately.
While I am (maybe a bit too) hyperbolic in my comment, I would never argue that we can eliminate mental illness, not even in a utopic world.
I also want to point out that I in no way whatsoever support deprescription in the sense of either force-tapering, removing access to medication or obstructing the path to recieve medical help.
When I have encountered ideas of deprescription previously, it has been connected to initiatives such as:
- Informed consent about what the side effects may be, and the difficulties that some people experience when stopping SSRIs.
- Better guidelines about how to stop or taper off SSRIs, along with regulation for companies to produce dosages small enough to taper off in a safe way.
- A call for professionals to stop viewing medication as the “final stop” of treatment, but as another tool in the toolbox, where different options should be explored as well.
All of which are aimed at helping people who don’t find their medication helpful and are either unable to stop without the proper help or have been told that they shouldn’t stop by their doctors.
Public transport is undeniably better
Nah that’s super easy to deny. Sucks to pay 80€ for a 3 hour round trip. Sucks to be squeezed in between strangers if you are lucky enough to get a seat. Sucks to be stuck to an inflexible schedule that the transport company fails to keep. Sucks to be stuck in a box with 100 people during flu/covid season.
There are certainly plenty of things better about public transport but it’s not better in every conceivable way. There are reasons I prefer riding my bike when feasible.
To take this back to mental health … not really sure what you meant by the analogy in the first place.
Just that one being ‘better’ in a best-of-all-worlds scenario doesn’t mean that we should disregard the other on an individual level, since circumstances might differ.
Of course its not as definitve as i made it out to be, that was just for the sake of making a point, as this is about mental health and not transportation (I also prefer my bike).
yeah pretty much my opinion
Thank you for laying it out far more eloquently than I could. Psychoactive medication, or at the very least antidepressants, are not treating the underlying condition we call depression (or ADHD, BPD, whatever) and they never can. Fighting against their overuse should be celebrated. Of course, taking into account the party behind this changes things somewhat, but on a fundamental level, I think we should strive to lessen our dependence on psychoactive drugs.
Yeah okay, except there is no way to treat ADHD without stimulants. You’re taking away some peoples only ability to function
I’m sorry, I wasn’t notified of your reply. But I’m not clear on where I said I don’t want to treat people? Why are you talking about me “taking away” anything? My position is that psychoactive drugs are being recommended too much, especially in indications like anxiety and depression. And that’s not even touching the subject of hospital care, where you will still see cases of sedative/anxiolytic abuse (from the doctors’ side!) to better manage an unpleasant patient.
Other people in this thread have made claims that evidence of treatment efficacy is sufficient grounds to treat. If that were the case, we wouldn’t need to have phases 1 and 2 of clinical trials. The critical axiom of medicine and healthcare is “do no harm”, and that applies on a population level as well. Psychoactive drugs can have serious side effects and they shouldn’t be viewed as pills you pop just to get some spring in your step.
To reiterate, I’m not against pharmacological treatment of conditions like ADHD, GAD, depression etc. As you say, sometimes it is the only viable option. But that was not my point; my point was that these are powerful substances that we don’t fully understand and we should treat them with respect, not throw them at people from all angles.
E: I just realized, I disagree with the statement that there is no way to fight ADHD without stimulants. And I’m not talking about “just focus harder” or similar nonsense, rather prevention. Any medical professional worth their salt knows prevention is better than treatment, and there is good evidence (as far as I remember) that some chemicals, lifestyle factors etc. play a role in ADHD as risk factors.
I see, sorry for jumping to conclusions. It’s a touchy subject for me.
No worries, glad to have cleared that up. I’m a bit miffed that I only noticed the debate three days later, because I would have something to add, but oh well. I’ll limit myself to saying that I have a medical degree, and
- the amount of overmedication I have seen during my studies and in hospitals
- the lack of understanding of both the nervous system and the way our drugs interact with it (to be clear, this applies more broadly to pharmacology, you can see unexpected side effects pop up in many other fields)
has made me view pharmacological substances (in general, not just psychoactive) as a sometimes necessary evil. They can help people function, save lives even; but you should always think before you prescribe them. I think that’s where a lot of the disagreement in this thread stems from. Me and some other people saw the text linked and thought “great, reducing unnecessary prescription is exactly what we want (in principle, RFK is not a great source)” while you and some other people thought “oh no, RFK’s gonna try to take away access to needed medication”.
ITT: People who don’t understand how much ADHD meds help people in personal life (hobbies, hygiene, etc.), not just for work and school.
Seriously, some of you still have a D.A.R.E. mindset when it comes to stimulants
fr, this thread makes me wanna scream
There are non stimulant treatments like strattera and i think wellbutrin affects adhd? but I haven’t personally tried them. I agree with you that stimulants are very helpful and shouldn’t be gatekept from people who need them though. And they’re coming after drugs like those too since they’re an SNRI and NDRI respectively
I will indulge my inner pendant and point out that there are a couple of non-stimulant treatments for ADHD that have their place, but they all have in common that none of them are as effective as stimulants are.
There’s a reason stimulants have been first line treatment for what we call ADHD now since some dude first gave some hyperactive kids Benzedrine in the 1930s. I’ll dig out the study if I can find it. They work, they’re well tolerated, and they’re safe. Even if they weren’t, I’d rather be able to function and take them than have fucking RFK or whoever tell me I can’t for my own good.
And there’s another point to make here: we only know stimulants work for ADHD because some dudes decided to give them to kids and see what happened. There’s a lot of throwing shit at the wall and seeing what sticks in psychopharmacology, or used to be. Moving away from that model hasn’t made treatments any better, either. I have a psychopharmacology textbook from the 1950s in my collection that treats serotonin’s presence in brain tissue as a mere curiosity. Everything was adrenergic then, and only a fool would think serotonin does anything but affect bowel function and platelet aggregation, according to this textbook. No one even knew dopamine was found in human brain tissue at that point, either, and it would be decades before its function as anything but a metabolite of noradrenaline would be recognized. I see today the same imperious tone being taken towards serotonin in the literature now that it’s had its moment in the sun, just as other neurotransmitters got sidelined when there was big money in serotonin. BDNF and tPA are sexy in the literature right now. In 10 years it will be something else entirely.
None of this has anything to do with what works, or what doesn’t. Potentially safe and effective treatments for various conditions have been mothballed because there’s not enough market share for their development to be profitable. Shit, “cries a lot” is on the depression screening because SSRIs are great at suppressing the ability to cry, irrespective of whatever else they do. It’s true that drugs are big business, but the supplement industry and the crunchy granola “holistic” fascist wellness shit are also absolutely raking in the cash. We don’t hear about that enough in these discussions. Supplement dudes see the opportunity to get their bag, and they’re taking it.
Regarding ADHD specifically I think we (in most of the western world at least) live in societies that demand a lot from the individual regarding planning, structure, bureaucratic work and timeliness - all things that are difficult for most people with ADHD. So yes, that would be taking away their ability to function as members of society.
In this sense, ADHD medication is still not a cure, but a tradeoff that allow us to keep having the same expectation of peoples ability to comply with the above values, regardless of who they are. As the expectations become more demanding, so does the need for ADHD medication.
My original point was not that it is good to take away medication and leave people to themselves, but that (in the case of ADHD) embracing neurodiversity and the demands we put on each other as a society could lessen the need for medication, thereby making less medication = good. Of course this is very much an oversimplification of what would be needed.
For me, the biggest problem is that there appears to be very little awareness in politics about this tradeoff. Keeping the same kind of societal demands and also wanting less medication is impossible and harmful.
This is too insulting and dismissive to reply right away, i would only get mad at the sheer ableism and cruelty on display, but i’ll come back to this later. I’ve made another post itt that lays out why this is so infuriating to me, maybe read that if you want a perspective that is not ableist garbage.
Regarding ADHD specifically I think we (in most of the western world at least) live in societies
yes, we live in a society, i am very much reminded of this whenever i read the crap you post in this thread.Oh right, i’m back. Thank god i am not an AmeriKKKan living in a food desert, but live in a mostly walkable environment where i can do this stuff quickly. I seriously do not know how i would get anything done if i would need to drive for half an hour first. But guess what, it is still not enough. You cannot change society to the point where it allows me to live the way i want to because the problem is not structural, it is neurochemical. Material conditions under capitalism make it worse, more stressful, often more costly because i have to pay late fees all the fucking time, living with ADHD under these conditions often fucks me over in ways that relegate me to the bottom rungs of capitalist society, like that one time where i had to drop out of college because of ADHD or that one time where i lost my job because of it or that other time where i lost my job because of it. All of these are actual issues were capitalism intersects with my disability.
But people like you, YES YOU, who pretend that my problems are not actual problems are another factor that makes my life harder. You do not do the thing that most other ableists do, where you argue that i am lazy and should just pull myself up by the bootstraps. Instead you are a socialist ableist who dismisses my problems as mere symptoms of capitalism. But that does not change that you dismiss my symptoms to the same extend that any chud who thinks i’m just a stupid loser who refuses to pull her own weight dismisses them.
that demand a lot from the individual regarding planning, structure, bureaucratic work and timeliness - all things that are difficult for most people with ADHD. So yes, that would be taking away their ability to function as members of society.
And this is how i know that you do not spend enough time with people who have ADHD. We are also impacted in all other parts of our lifes. I struggle to keep contact with anybody but my very closest friends that require the least amount of effort to socialize. I struggle to maintain relationships because i am forgetful and can’t listen and lack the spoons to be mindful and bring little gifts and i get distracted during sex. Having a functioning relationship with somebody who has another form of neurodivergence is a struggle, having one with a neurotypical person is outright impossible for me. THESE ARE COMMON DIAGNOSTIC CRITERIA FOR ADHD BTW. This condition is not defined solely by how we fit into a work or school context. It constantly interferes with out social lifes. Do i have to get into how impossible it is for me to be patient with ignorant know it alls like you who seriously carry water for RFK jr. because they love to talk down to me so much? Do i have to explain to you how hard this shit makes it for me not to crash out all the time, how severe my abandomnent issues are, how i spiral because i can’t move from one emotional state to the other or how sometimes the exact opposite happens and i do not clear arguments up properly because i cannot remember how mad i was 5 minutes ago? Don’t worry, that is not happening right now, i’m in hyperfocus now, so it’s all good. Maybe i should make a list of the hobbies i have abandoned over my life next. I would do the same with activist work, but i can’t do that without doxxing myself.
But yes, clearly the problem is only how a poor bean like me does not fit into late stage capitalism. Socialism would of course fix me. Don’t get me wrong, it would be necessary to actually live with dignity, but it would still require meds. If we would get socialism and you’d be the general secretary, i would be fucked.
In this sense, ADHD medication is still not a cure, but a tradeoff that allow us to keep having the same expectation of peoples ability to comply with the above values, regardless of who they are. As the expectations become more demanding, so does the need for ADHD medication.
SHUTTHEFUCKUPSHUTHTEFUCKUOPSHUTTHEFUCKUOP OH MY GOD PLEASE JUST SHUT YOUR STUPID MOUTH
My original point was not that it is good to take away medication and leave people to themselves
But that is literally what you are defending here. This is a thread complaining about how that exact thing is about to happen in the US and your reaction to that is “well i think he has a point actually.”
but that (in the case of ADHD) embracing neurodiversity and the demands we put on each other as a society could lessen the need for medication, thereby making less medication = good. Of course this is very much an oversimplification of what would be needed.
“Embracing neurodiversity” is not what you are doing, you are shitting all over it.
I see a lot of my adhd friends struggle to get stuff done they want to do, hobbies, hangouts, finishing projects etc. It effecting their social lives. I think they’d still want to finish hobby projects regardless of capitalism or not.
Yes that would be nice. It’s really hell trying to fit into a structure that your body refuses to conform to
It sure is. I just wish we could lessen the burden on people, so they wouldn’t have to go through all that in the first place.
some or most ADHD should just be accommodated but that’s not the society most of us live in
I like to accommodate my ADHD by taking stimulants so I have enough executive function to wash my clothes and read interesting books
i have fully given up on reading but technology like those single unit washer/dryers and having one in my apartment instead of having to walk up and down several flights of stairs three times to get to the laundry room would go a long way toward doing the laundry more consistently
To quote myself because i do not have the time to reply originally to this ableist horseshit:
IT IS NOT REQUIRED FOR THE TREATMENT OF ANY CONDITION THAT WE FULLY UNDERSTAND WHAT CAUSES THIS CONDITION. EVIDENCE FOR THE EFFICACY OF A TREATMENT IS ENTIRELY SUFFICIENT. IT IS A BETTER EMPIRICAL FOUNDATION THAN LITERALLY ANYTHING YOU ARE ADVOCATING FOR.
I’m gonna indulge in a bit of snarkiness, because this comment frustrates me and I feel the need to refute it even after three days.
Did you know that thalidomide was very efficient in preventing early pregnancy vomiting? Or that benzodiazepines were much more efficient as anxiolytics than the preceding class of barbiturates. Antibiotics in general, we don’t even need to mention them and their efficacy. Oh and if you want to help someone in shock with oliguria, load them up with diuretics, that’s the most efficient method of inducing urine production after all!
My point is, understanding the causes of a condition is critical in finding an actual cure. You can have treatments, symptomatic or otherwise, even without it (see lithium for BPD, valproic acid for epilepsy, many others) and that’s fine. But claiming that you don’t need to understand the safety profile, potential side effects, risk groups, or anything other than efficacy is, as you say, horseshit.
The examples we were talking about were mostly amphetamine, methylphenidate and estradiole, all of which have been in use for many decades and are extremely well-studied in their side effects. I actually didn’t say ONCE you do not need to be aware of a drug’s side effects, it’s frankly dishonest to claim i would have said “we do not need to understand anything other than efficacy” when i said “understanding efficacy is more important than understanding the exact neuroscience behind things like ADHD or transness”. These are VASTLY different statements.
I still think your objection is making fair valid points that i will not debate because i obviously agree with them, but do not put words into my mouth 3 days after i’ve crashed out on a completely new account that did nothing but well actually RFK jr.'s policies. That’s uncalled for.
Deprescribing, when I first encountered the concept years and years ago, was a very different beast than this shit. There is a kernel of a good idea in here - med lists for people in long term care facilities or being treated by a rotating cast of people with prescriptive authority adding medications to their regimens more or less at random. People who want to stop taking medications but whose concerns are dismissed. Bad medicine, bad pharmacy, whatever. It’s beside the point because that is not what deprescribing in practice looks like.
What it has looked like in practice is this shit. It’s unconsciable, it’s cruel, the people I’ve seen who do it are, for lack of a better term, gleeful sadists who share with the ghouls who would medicate anyone who deviates slightly from the norm into oblivion against their will a total contempt for bodily autonomy or material consequences or anything besides making an arbitrary metric (# meds prescrived/patient, # controlled scripts/patient-year) go down.
I’m not getting into specifics right now. The people who support this are absolute ghouls. RFK is the perfect representative of the crunchy granola school of fascist who wants anyone who deviates from whatever he decides normal is dead, or institutionalized, or whatever, so long as we’re out of sight and they can pat them selves on the back for being so enlightened.
From what I’ve seen, the most vigorous advocates of deprescribing-in-practice are the exact kind of provincial petty bourgeois boat-dealership class dullards who should not be trusted to run anything but do through the power of nepotism alone. The dudes love steroids, for whatever reason - somehow, this doesn’t count. They have med lists just as long as the people they’re enthusiastically deprescribing. Some of us were raising concerns about the increased monitoring and surveillance of controlled substance prescriptions (including the rollout of PMPs) a long time ago and, look at that! Exactly what we said would come to pass is coming to pass, exactly the way the people who have been pushing this shit have been saying it would for at least 25 years now.
Every single one of them the most obnoxious meathead I’ve ever met, pill cops who would turn to dust if they were capable of self-reflection. ACAB includes this shit. Watch an 80 year old go through benzodiazepine withdrawal before winding up in hospice and going right back on them if you think this shit is okay and get back to me. Leftists shouldn’t be supporting the groundwork being laid for woke 21st century Burgerreicher Aktion T4, imo.
While the way they’re implementing this will obviously be terrible, I actually think in its fundamental form it’s a positive goal. Medications are massively overprescribed where, in the worst case, they’re actually worse than nothing, but in most cases other, simpler and cheaper, non-drug interventions would be significantly better.
I wish I had been given better informed consent when doctors shoved me onto antidepressants and steroids to make me go away without telling me the full implications, short and long term. If I knew then what I knew about them now, I would’ve told them to shove it.
Instead my naive ass gets traumatized because of doctors trying to downplay the manyfold risks of antidepressants (to literally quote the response to my formal complaint “otherwise nobody would take them!”) days before I end up on the floor, in public, curled in the fetal position crying my fuckin’ eyes out. (Only a couple years later do I work out the actual major contributor to my depression was domestic abuse. None of the five doctors I saw even considered it, and the abuse itself was basically disregarded by everyone because I’m male-presenting.)
I know many people who have had similar experiences. I think doctors should help people understand what it means to go on these types of medications in the first place - that it is not a cure but more of a trial-and-error experiment, which might help but can also result in severe side effects, and that other options are available.
it is not a cure but more of a trial-and-error experiment, which might help but can also result in severe side effects, and that other options are available
Exactly. If antidepressants help you then fuckin’ more power to you, I love that for you, have all the helpful drugs you want.
But patients need a lot more information to actually give informed consent, and need more choice and help and time, where genuinely useful alternatives are also available. Instead western society hugely pushes drugs as “the” solution for a one-size-fits-all answer.
I’m disappointed to see apologia here for this particular, concrete implementation of deprescribing. Nothing good will come from this.
To me it seems intuitive that pathologies are generally not universal conditions of a universal human mind but are historically situated like the rest of subjective experience, and that the DSM is a deeply political text - and that changes not one goddamn thing about the fact that this deprescribing is yet another weaponization of the US medical system as-fucking-always.
Of all the times and places to philososophize about how some imaginary, better version of US healthcare with no connection to reality would involve fewer medications, this is among of the most foolish, or else the most violently bigoted. As we dismantle the remnants of our welfare state, am I going to see some
on here equivocating about how, since it was a liberal welfare state, its dissolution might actually be a good thing for the people losing food and housing?Anyone here have experience of SSRIs helping?
I do. They helped me not to rot in bed for most of the day. My suicidal thoughts are also mostly gone, among other benefits.
Yes. I take sertraline daily and it helps my anxiety.
Edit some additional info: I tried lexapro and risperidone for about a year each before being put on sertraline. Lexapro made me manic and risperidone made me fat. I’m on 100mg of sertraline daily and that seems ok, I could probably do with tapering down to 50/75 to boost my energy a bit. I was on 150 and was pretty much a zombie.
I have social anxiety. I was in therapy while taking these meds. I find they help my brain slow down so I can analyse my thoughts and not immediately jump into a panic attack when my phone rings.
not ssris, but mirtazapine which is an atypical antidepressant. i’ve probably been on it a decade and i spent many years on various ssris before that.
i’m a very anxious person. before mirtazapine, i had regular panic attacks and i had a lot of trouble sleeping because i was in a constant state of alert. the lack of sleep compounded my mental state and i was unable to function. i’d stay in bed for days or even weeks because it was the only place i felt safe.
with mirtazapine, i can generally sleep fairly well and i’m much more able to function. i still sometimes get panic attacks, i’m still a bit unstable, and i’m still judged to have “limited capability for work”. but i eat regularly, i exercise, i clean, and i go out and do things now that i never could before.
Yes.
It really is the vilest thing I can think of, pushing this sort of eugenicist stuff, which is only ever intended to harm and eliminate the disabled, but wrapping in a “we just care about their welfare.” facade.
They do this every time they cut any social welfare programs for disabled people too, it’s never open vileness, it’s always them planning on extermination while pretending that eliminating their already very meager support will somehow help people.
![[CW: Medical abuse] This is eugenics. This is evil. This will mess with peoples ability to manage medical conditions and will take away the lifeline to be able to function safely from them.](https://hexbear.net/pictrs/image/7818ac05-52a2-47d6-9f85-d26b2987db7c.jpeg){kind=link}