[imperio59]

Let's remember it was recently proven that there is little to no evidence that serotonin levels are linked to depression: https://www.nature.com/articles/s41380-022-01661-0

It's pretty much likely to be the same deal here.

Since there is no chemical or biological test one can do to confirm a schizophrenia diagnosis, it's a subjective diagnosis by practitioners, treating such subjective diagnosis with powerful brain-chemistry altering drugs. Worse, we do not yet know whether these new drugs will be easy to get off of. Some of the other anti-psychotic type medication is VERY hard to get off of, such as abilify, where most drug treatment centers will not deal with Abilify withdrawals or take on those patients because those are so severe (extreme violence, self harm, etc during withdrawal).

Until Psychiatry can reform itself to become a real science, using the scientific method (repeatable, provable results and not just a "theory of how brain chemistry maybe works sorta but we're not sure"), it will continue to just be a big cash cow for Big Pharma while hooking many patients who do not need these drugs onto them for life, while failing to effect ANY cure on the things they are treating (Have you heard of someone getting "better" after taking anti-depressants and being able to come off them? No. They have to take them for life. That's not a cure.)

[toast0]

> Have you heard of someone getting "better" after taking anti-depressants and being able to come off them? No. They have to take them for life. That's not a cure.

Some people with acute depression can take the meds, work on the underlying issues and taper off, yes.

People with chronic depression likely need to take the meds for life.

People with type I diabetes can't get insulin one time either. People with allergies often take the allergy meds when exposed to allergens, which is always for some.

That's not big pharma being greedy, that's a chronic condition requires chronic treatment.

[smeej]

I'll raise my hand here. Took antidepressants for a year. Successfully weaned off of them. Have not had recurrence of symptoms.

I needed the boost to be able to get out of bed often enough to do the work in therapy. That led to being able to take other actions that helped my brain chemistry too, like eating better food, which reduced inflammation, and getting outside more often.

My doc said her experience was about half and half. Half of people were able to wean off successfully. Half ended up deciding it was better to stay on.

Recovery does happen. For lots of us.

[girvo]

My experience was the same; they were like a bandage we put on to allow us to heal without infection, for me SSRIs were a mental bandage so I could heal enough to get to a psychologist. I came off them, and was fine. My situation is confounded by my buprenorphine script though, as it's known to be a reasonbly effective anti-depressant in it's own right, albeit via a completely different mechanism (it's an opioid-receptor agonist, partial agonist and antagonist. Weird drug)

[Etheryte]

This is so misguided that it's hard to even know where to begin. People who develop high blood pressure without a known underlying cause take a pill for it every day for the rest of their life. You could say the same thing, they're not cured, but what actually matters is that they get to live a full life, unconstrained by the disease even if we don't know the underlying cause. Of course it would be better if we were more advanced of a civilization and figured it out, but the important thing is that these people get their lives back.

[toastau]

We don't have cures for diabetes, HIV/AIDS, allergies, plenty of ailments. Having treatments is totally valid even if they are taken forever.

People with the guidance of their doctor stop taking antidepressants all the time. External factors aren't static and often these can change. (separately or because of the treatment) You do not need to stop treatment unless you and your doctor have decided it is going to be better for you.

Another point I'd make is that we don't have exact mechanisms for action in other treatments like paracetamol. That doesn't make it invalid treatment.

[catlikesshrimp]

What is your doubt about paracetamol? This drug's pharmacology is rather well understood.

About the analgesic activity https://pubmed.ncbi.nlm.nih.gov/31734950/

About the antipyretic activity https://pubmed.ncbi.nlm.nih.gov/29738273/

[throw18376]

i'm curious what is the longest conversation you've ever had with an untreated schizophrenic person?

it's so obviously a "real disease" even if we don't fully understand the biological basis. it's subjective but honestly, there are just a ton of completely obvious cases.

abuses of the psychiatric system are very bad, but schizophrenia is so so clearly real.

[crooked-v]

> Have you heard of someone getting "better" after taking anti-depressants and being able to come off them? No. They have to take them for life. That's not a cure.

There is no medicine in the world that you can take for a limited time to fix problems forever. That's not how medicine works. That's not how the world works.

[catlikesshrimp]

Antibiotics (Most of the time) Everything surgery, I would include gene replacement therapy and auto transplants in its viccinity.

[ClassyJacket]

Yes there are? Antibiotics for one.

[copperx]

And those that change gene expression, like Accutane for acne.

[nullindividual]

An enlarged salience network may be responsible for depression in some patients[0]. Some individuals are pre-disposed to being depressed and it may be a chronic condition, like any other chronic condition. For others, it could "simply" be a chemical imbalance that taking medication for a set period of time resolves (lucky them).

[0]https://www.nih.gov/news-events/nih-research-matters/mapping...

[jmcgough]

I work as an EM scribe and routinely see patients experiencing psychotic episodes. My background is in neuroscience and I'm interviewing for med school right now.

> it was recently proven that there is little to no evidence that serotonin levels are linked to depression

This has been the consensus of the psychiatric community for the last 20+ years. The serotonin hypothesis was heavily pushed in marketing as a way to medicalize depression and convince people to seek treatment for it. Probably a net positive when it comes to reducing stigma, but few people have been seriously arguing the serotonin hypothesis. As it takes about a month for effects to kick in, most people believe that it's compensatory changes to the brain that happen in response to upregulation of serotonin, such as downregulation of 5ht2a which has an overdensity in people with depression.

> Since there is no chemical or biological test one can do to confirm a schizophrenia diagnosis, it's a subjective diagnosis by practitioners

This is true to some degree - we don't have a blood test or an fmri scan that will definitively point to schizophrenia, the diagnosis is (for now) based on DSM criteria and by thoroughly ruling out other causes of schizophrenia. We do have tests for a number of other causes of psychosis, like lumbar punctures for NMDA-receptor encephalitis.

I'd like to emphasize that there are MANY diseases and conditions that we treat empirically for based on subjective symptoms which are just as real as schizophrenia. There are no tests we can perform for concussions or migraines. The brain is very challenging to perform tests on because of the blood-brain barrier and the skull.

> Worse, we do not yet know whether these new drugs will be easy to get off of.

Cholinergic drugs are VERY well understood and used in the treatment of a number of diseases. This "new" drug is a drug that was discovered 20+ years ago and is being used in a creative way to mitigate its GI side effects. Everything so far points to this being more effective at treating the negative symptoms of schizophrenia (loss of motivation, cognitive impairment), with milder side effects (some mild GI issues which typically resolve after a few days), which is a huge deal considering how many people with schizophrenia quit dopaminergic drugs due to the side effects.

One of the biggest problems with our for-profit system is that schizophrenia is comparatively rare and largely affects those with a lower socioeconomic status, so there isn't a huge financial incentive to work on schizophrenia drugs. This one was being developed for another purpose entirely.

> Until Psychiatry can reform itself to become a real science, using the scientific method (repeatable, provable results and not just a "theory of how brain chemistry maybe works sorta but we're not sure"), it will continue to just be a big cash cow for Big Pharma while hooking many patients who do not need these drugs onto them for life, while failing to effect ANY cure on the things they are treating

It sounds like you have an ax to grind against the profession, but I can assure you that there is a huge need for it and that people largely see benefits from medication. For me, SSRIs got me stable and functional so I could better address the root causes of my depression. Psychiatric drugs aren't perfect, but for many people they're truly life-saving. There is evidence to support kindling in some diseases such as bipolar as well - that if you remain unmedicated, manic episodes become progressively worse as the brain becomes more damaged.

Additionally, psychiatrists treat more than just depression. Some specialize in sleep medicine, addiction medicine, toxicology. They are trained to tease apart primary depression from other non-psychiatric diseases masquerading as a psychiatric disease. I saw a patient once who had been treated with a number of antipsychotics by his PCP and mid-level providers for persistent visual hallucinations. He met with a psychiatrist who tried increasing his anti-seizure meds, which resolved what was likely a recurrent partial seizure.

Every drug (sans some off-label use) goes through an FDA approval process and is, over the course of several years and millions of dollars, shown to be effective and relatively safe. I can assure you that psychiatry is as scientific as any other field of medicine. It's still in its infancy compared to some other specialties - the brain is a very complex organ and difficult to study - but we have as good of an understanding of most psychiatric illnesses as we do neurodegenerative diseases such as Alzheimer's, which have been equally as difficult to study and treat.

Psychiatry is not even close to the most profitable area of American healthcare. Psychiatrists are one of the lower-earning specialties, and most people with mental illness never obtain treatment for it. Compare that to the 10% of all seniors who are on Eliquis to prevent blood clots, which costs a thousand dollars a month without insurance.

Trust me, if there was a way to permanently cure a psychiatric disease with one procedure or pill, we would all be in favor of it. Just because a diabetic needs to take insulin for life doesn't make endocrinology a scam.

[FollowingTheDao]

> by thoroughly ruling out other causes of schizophrenia.

This never happens. "thoroughly" never happens. There are many examples of this. Recently a woman who was in psychiatric care fro over 20 years was finally diagnosed with Lupus (NPSLE) and cured.

They did not thoroughly do anything for me. I had to figure it out for myself.

> people largely see benefits from medication

I have a friend with depression and they had her on two adrenal receptor inhibitors (trazadone and risperidone) and she only got worse. They they went to ECT. She had severely constipation (treated with yet another drug, Linzess) and hypotension as well. They they started her on ECT, which did not work and she lost some memory.

The doctors failed to see that adrenal blockers could be causing her depression. I showed her the science, she asked her doc to stop those meds. She she no longer depressed nor has hypotension or consipation. And now she is angry.

They diagnosed her with schizophernia after they started her on antidepressants 25 years ago.

I am not saying medication are not sometimes useful, but I cannot count the times I have seen patients get worse on psych meds.

> He met with a psychiatrist who tried increasing his anti-seizure meds, which resolved what was likely a recurrent partial seizure.

You are still in med school so I hope you learn more. Anti Seizure meds have been the go to for these disorders fro years. They put me on depakote for my modo disorder 20 years ago.

> Psychiatry is not even close to the most profitable area of American healthcare.

Psych pharm businesses are very profitable though, and that is what we are talking about here.

> Trust me, if there was a way to permanently cure a psychiatric disease with one procedure or pill, we would all be in favor of it.

There is not pill, but there is a method. It is called Personalized Medicine.

And by the way KaRXT is not going to work. You should learn about receptor density changes when people take these receptor modulating drugs. This is why they always fail. There are better ways to manage the glutamate/GABA balance if that is the persons issue which it many cases it may not be, or may not be the fundamental problem. And if the acetylcholine is the problem in schizophrenia, why does M1 and M4 receptor in the body have bad side effects but whil in the brain it is good?

I will tell you why, they are using this drug to sedate the patient, not treat the patient.

[idunnoman1222]

After one meeting with her doctor, they gave my daughter antidepressants a the class of drug that’s meant to be taken for life. She was just an angsty teenager during covid.

She didn’t take them, shes fine, but yall are the devil frfr

Admit this: if you go to a doctor and say anything about the inside of your head that makes them uncomfortable you’re getting a chemical lobotomy immediately

[consteval]

It's significantly better now, because your daughter didn't get a real lobotomy. Which was the expected treatment for a young woman who misbehaves.

It's not typical to get antidepressants after a single meeting with a general practitioner. In fact, I don't even know if that can happen.

That being said, depression is real, and it does take lives. I've known many people who have successfully survived depression via SSRI's and no longer take them. That's the flip side you're not seeing. I've also seen unmedicated people take their lives.

[idunnoman1222]

-Appeal to worse problems

-Gaslight and hand wave

-Slippery slope

I do agree that women are disproportionately affected by the over prescription

[consteval]

I would argue that you're doing the same thing. You're hand waving and gaslighting people who were/are helped by SSRIs. You're appealing to a worst-case scenario, where someone who does not have depression is immediately prescribed medication (incredibly rare, in fact not sure if this can happen). And you're claiming a slippery slope by extrapolating this to other mental health issues and psychiatry as a whole.