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Moss_Piglet comments on Open Thread, October 20 - 26, 2013 - Less Wrong Discussion
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Trying to reason your way out of mental illness is like trying to pull yourself out of quicksand by yanking on your hair.
Depression screws with your thoughts and perceptions in incredibly profound ways, including your ability to make predictions about the future, and is absolutely a tamp on rational thought. That's true whether it is caused by another mental illness or a traumatic event in your life; it's just as "chemical" and just as difficult to escape either way. Throwing off depression with strength of reason or willpower is a misunderstanding of how untreated depressed people adapt and occasionally heal, not a prescription.
The human body is built to survive, and the brain is no exception, but a rational person should always try to supplement their natural strength with medicine when their life is on the line. Advising anything else seems irresponsible.
Gwern is the go-to person here, but it is my impression that "standard" anti-depression drugs are neither particularly effective nor free of serious side-effects. And things which are more effective -- like ketamine -- are very rarely prescribed.
More or less, but it's a question of levels. SSRIs didn't do much for me and a lot of other people, plus weight gain sucks (luckily no sexual dysfunction), but they're not particularly dangerous from what I understand. Stuff like Bupropion is awesome, as long as you don't mind sobriety and have a low risk for seizures. There's other drugs which modify SSRIs too, but I've never had any and they're supposedly more on the 'side-effect-y' side. New stuff like Ketamine is waaay out there, like almost on par with electroconvulsive therapy, in terms of how likely you are to see it but IDK what it's like in terms of safety.
But once the 'trial-and-error' portion of dosing is over with though and you're on something that works for you, it's absolutely night and day. I can only speak for myself obviously but it was a complete perspective switch, like someone flipped a switch in my head to 'not miserable.'
(Obviously I'm not an expert, just a guy who's spent some time on the patient end of things. I am really interested to hear Yvain's answer if he has one.)
Many drugs are probably not what you would call effective, but they're still worth trying. You'd be surprised how many drugs are not free of serious side effects. Luckily these effects are usually too rare to care about. It's just that taboo drugs get most of the attention and armchair medicine.
I really wish these kinds of discussions would begin and end with "I think you're depressed, it's a medical condition, go see a doctor. insert social support" Don't screw with a life threatening condition. Not pointing at you specifically.
Well, it's a bit more complicated than that.
First, diagnosing strangers with psychiatric disorders over the Internet has a long history and, um, let's say it didn't always work out well :-D
Second, depression is a spectrum issue -- there are clear extremes but also there is a big muddle in the middle. You have to be careful of medicalizing psychological states which is a bad direction to go into.
Agreed. That's what the "I think" and "doctor" parts are for. Better safe than sorry.
That's why there are experts whose job is to assess what's medical and what's not.
What is bad about medicalization? This could be an interesting topic to explore.
It narrows the range of what's considered "normal". It proposes medical solutions to what are not necessarily medical problems. It is, to a large degree, a way of expanding the market for the big pharma.
Lots of problems, google it up if you're interested...
I think your perception of this problem has more to do with stigma associated with medical conditions. If you taboo the associated words, what you're left with is improving people and what's wrong with that? Do you oppose transhumanism on the same grounds?
And big pharma, we meet again. What is this singular, evil, money grabbing entity? I'd try to google it but I know I'd meet a violent mess of blogosphere mythology.
In the most narrow definition big pharma means AstraZeneca, Bristol-Myers Squibb Eli Lilly, GlaxoSmithKline, Merck, Novartis, Pfizer and Sanofi-Aventis.
If you define it a bit more widely it also includes the other members of PhRMA.
Those companies make money through being gatekeeprs. In the words of Sanofi-Aventis CEO Viehbacher that idea gets expressed:
In addition to validation big pharma also invests a lot of money in capturing the political process and pushing their drugs through various forms of marketing on as many people as possible.
As they make money by being a gatekeeper they make it harder for other people to enter the health care market.
The goal of transhumaism isn't to make people more normal. Various forms of transhumanism increase human diversity.
Upvoted for defining big pharma. Ok, let's say big pharma makes money as a gate keeper and controls policy. Does this argument lead us to some definitive point where's it's clear which drugs and treatments are good and which aren't, which drugs and treatments should be opposed and which shouldn't?
Making people normal isn't my goal either.
What makes you think it's improving people?
Look at my post again -- which words would you like to taboo? I am pretty sure I can rewrite it without them.
It's neither singular nor evil. However it is a collection of entities which have certain goals (which mostly involve profits) and incentives to pursue these goals.
I'm not saying medicalization = improving people. What I'm saying is most solutions that are pejoratively called medicalization probably improve people in their opinion. From your post I would taboo "medical", "medicalization", "normal" and "big pharma". Keep in mind that medicine is optional and patients have different perceptions of what they would call improvement. I think they should have as many options as possible and safe.
I was unfair and I agree with this. They also compete with each other and with regulating mechanisms. Therefore I think "big pharma" is a lazy and misleading expression.
Sure.
The trend to consider certain conditions and psychological states "diseases" or "illnesses" (which implies biological causality) is bad because:
It narrows the range of what's considered acceptable human variation. Consider e.g. a grumpy guy. Would it be good if he were to be diagnosed with the illness of grumpiness (with associated social costs) and prescribed a pill for that?
It assumes biological causality for what are not necessarily problems of human biology (or biochemistry).
There are considerable forces in the business world which would stand to gain huge amounts of money were this to happen. This is not an outright argument against per se, but it does make one suspicious.
If you're interested in anti-depressants, you should talk to Yvain, what with him being a head-doctor and all.
I would recommend investigating the safety and efficacy of selegiline. Seems somewhat effective, safe, and available (albeit from overseas for US users). Do your own homework though.