Mental Health

[BerenTebogo]

Sath I completely agree with where you are coming from and I agree self medicating isn't a smart path to go down. But I don't think this is a fair analogy because you are comparing a terminal illness with a disorder (or however you want to categorize it) that is not life threatening in the immediate sense and any sort of treatment is there to make life easier and more comfortable.

And often times there isn't one set drug for treating a mental disorder and the doctors will ask you try one and see how it makes you feel and if you don't like it they will keep prescribing different ones until you find one that you like and works for you.

You're right about the analogy. Although I chose Cancer/Chemo because one of the biggest reasons people choose to seek "alternative treatments" when diagnosed with cancer, like homeopathy, acupuncture, etc, is because Chemo makes them feel like shit. So, effectively, they take away any possibility of their condition improving because they don't want to feel shitty, they want to feel good!

Anti-anxiety meds (prescribed for OCD usually) make you feel like shit (compared to marijuana).

It's hyperbole and it's a stretch, but any way you look at it you end up with a fucking idiot who doesn't know what the fuck.

[Tellahh]

And often times there isn't one set drug for treating a mental disorder and the doctors will ask you try one and see how it makes you feel and if you don't like it they will keep prescribing different ones until you find one that you like and works for you.

I was actually on a drug regimen combined with therapy for about a year~ and saw little to no improvement, even swapped prescriptions about 3-4 times throughout the year. I didn't see the point of it when I already had something that actually does improve my condition the moment I take it. Sure, I probably could have found a med that worked if I kept trying them, maybe even improved my condition with more intensive therapy, but I got sick of it. Also, if I was cured of my OCD I wouldn't stop smoking weed the next day, it's just a nice bonus that it helps my OCD.


@Sath
[Youtube]gl2NKZtl07c[/Youtube]

[CDF]

I'm saying that if the criteria that the study is based off of is incorrect the findings aren't valid. If the people who fit into your study are comprised of people who have disease 1a, people who think they have disease 1a but don't, people who have disease 1b which shares major symptoms with 1a but responds completely differently to treatment, people who have disease 2a which shares a differ...

Of course, proper definition of the study population and inclusion/exclusion criteria for a clinical study is important, but what you have described can still be modeled as "random" variability where randomization of subjects to treatment has been applied.

Setting the aside the "philosophical" question of what really is "random," the "randomized" part of a randomized, controlled clinical trial is supposed to eliminate selection bias (as both investigators and subjects should be blind to the randomization scheme as they should be blind to treatment allocation) and help to minimize confounding due to uncontrolled, unknown factors (things that can affect the outcome of interest other than the treatment(s) of interest). (If you knew them you could control for them statistically.) And there is a reason baseline characteristics between/among treatment groups are reported in papers.

[Gadritan]

You have some good points Sath, but lumping marijuana in with cocaine and heroin is rather ignorant.

It's like lumping O'Douls together with Everclear and Bacardi 151.

[BerenTebogo]

Of course, proper definition of the study population and inclusion/exclusion criteria for a clinical study is important, but what you have described can still be modeled as "random" variability where randomization of subjects to treatment has been applied.

Setting the aside the "philosophical" question of what really is "random," the "randomized" part of a randomized, controlled clinical trial is supposed to eliminate selection bias (as both investigators and subjects should be blind to the randomization scheme as they should be blind to treatment allocation) and help to minimize confounding due to uncontrolled, unknown factors (things that can affect the outcome of interest other than the treatment(s) of interest). (If you knew them you could control for them statistically.) And there is a reason baseline characteristics between/among treatment groups are reported in papers.

Everything you're saying is right, but the degree on minimization is variable and to say variable within only a small amount would be disingenuous.

Few days ago a paper got published in a legit journal documenting prayer as an effective means of healing or something. It got retracted like a day later with an apology, but the damage to the credibility of the journal was already done. Point I'm making is that just because a study is being publicly promoted does not mean it was rigorous in any way.

The acceptance of less rigorous studies into a study of a group of studies (augh) taints the data as a whole also.

Randomization takes care of most everything when you make the best effort you can to control all variables that you don't want to interfere with the results. Randomization is less effective when you just kinda say "fuck it, let's do it!" which sounds like a rare situation, and I'd like to think it's a very rare situation, but from my experience (anecdotal, I know a few psych grad students) it isn't. Especially not if there is a bias in regards to funding or a lack of documentation on similar studies that produced results that weren't what we wanted to see and go thrown out.

This isn't limited to the psych field but it is a lot more prominent just because of how hard it is to exactly recreate previous research. People are different and sources are tainted, etc.

Edit: To be more specific, it's hard to recreate the same study with the same people under the same conditions and using different people will always yield different results. If you want to test the diameter of the crater made when you drop a sphere with r=10m^3 weighing 100lbs from a height of 100ft you're gonna have an easy time recreating the experiment no matter what the color of the sphere is or what type of plane you're flying, etc.

People are the problem.

You have some good points Sath, but lumping marijuana in with cocaine and heroin is rather ignorant.

It's like lumping O'Douls together with Everclear and Bacardi 151.

Not really, only if your opinion is skewed in favor of marijuana. They're all illegal narcotics that will land you in jail if you are found in possession of them. Idgaf what you think about the law or their effects, on the basis of legality they're equivalent.

Re-quoting the original post before some other pothead comes in here with the "you can't compare weed to coke, man!"

I hate that I have to spell out why self-medicating with illegal, unregulated, and potentially horribly unsafe narcotics is fucking stupid.

[Byrthnoth]

imma use bold here so people read it, because this thread has gotten bogged down by crap that I could care less about.

In a world with a questionable working definition of depression and equally questionably efficacious drugs to treat it, is it worth the risk of prescribing drugs that we know cross the blood-brain barrier and have widespread neural effects?

Think about it. There are basically five classes of disorders I can think of at the moment:
1) ADHD
2) Bipolar disorder
3) Schizophrenia
4) Autism (now autism spectrum disorder, which overlaps with number 5 iirc)
5) Things you prescribe Prozac for. (Everything else)

In my opinion, it's not. We might well be chemically lobotomizing these people without knowing it.

Spoiler: show

Interesting tidbit:
The "inventor" of the frontal lobotomy won the Nobel prize in medicine. People liked it too, regardless of the side-effects. As far as I can tell, there's no reason to believe that the medications we're taking now have more reversible effects than taking an ice pick, shoving it through your eye socket into your brain, and wiggling it around to try and damage the frontal lobe white matter.

[BerenTebogo]

imma use bold here so people read it, because this thread has gotten bogged down by crap that I could care less about.

In a world with a questionable working definition of depression and equally questionably efficacious drugs to treat it, is it worth the risk of prescribing drugs that we know cross the blood-brain barrier and have widespread neural effects?

Think about it. There are basically five classes of disorders I can think of at the moment:
1) ADHD
2) Bipolar disorder
3) Schizophrenia
4) Autism (now autism spectrum disorder, which overlaps with number 5 iirc)
5) Things you prescribe Prozac for. (Everything else)

In my opinion, it's not. We might well be chemically lobotomizing these people without knowing it.

Spoiler: show

Interesting tidbit:
The "inventor" of the frontal lobotomy won the Nobel prize in medicine. People liked it too, regardless of the side-effects. As far as I can tell, there's no reason to believe that the medications we're taking now have more reversible effects than taking an ice pick, shoving it through your eye socket into your brain, and wiggling it around to try and damage the frontal lobe white matter.

Leaving behind the fucktwits, I'll give my opinion.

I think it is 100% worth it. All progress comes at a price. We wouldn't have the understanding we have today (as little as you may perceive it to be) if we didn't stick ice-picks into eye-sockets.

It is 100% worth every risk we take in good faith towards the prevention, treatment, or curing of any mental ailment.

I don't think we should substitute eradication for reform. Hold psychiatry up to the highest scientific standards possible, remove the overly obvious bias in terms of funding, and push forward as best we can. Just saying, "it's too dangerous" because it's perceived to be too hard to make any real changes in the system is flying in the face of hundreds of years of scientific and medical progress.

It's always worth the risk, and that's from someone who has been subjected to it firsthand.

[Weiing]

Actually, your classification of disorders is kind of... off. How well versed are you in mental health/DSM-IV-TR?

I feel like I'm talking to a wall. There are strict guidelines for meeting criteria for a diagnosis. Thus, questionable working definition? I'm not so sure about that. DSM obviously isn't end-all-be-all, it's a guideline to help somewhat understand.

I think properly prescribing medication is beneficial for some disorders, especially with the SPMI population. Most medications prescribed are not properly monitored or used conjointly with proper therapy techniques.

It's difficult to say whether or not the pros of a certain medication outweigh the cons. This is mainly due to the fact that our brains, the function of them, are still a mystery. If someone with bipolar disorder, let's say it's Bipolar I or II, would benefit from medication to help them with their mania in order for them to function in society and not cause harm to themselves or others, even if some of the medications may lead to tardive dyskenisia, perhaps they'll want to take it.

I'm not sure it's chemical lobotomization... Some medication for mood regulation may dull a person's mood but, lobotomy? Also, what about people with schizophrenia that have negative (meaning reduction of) symptoms, such as muteness and catatonic?

[Gadritan]

Not really, only if your opinion is skewed in favor of marijuana. They're all illegal narcotics that will land you in jail if you are found in possession of them. Idgaf what you think about the law or their effects, on the basis of legality they're equivalent.

Depending on where you live, yes, you are correct about the legality of it for the most part. I was more so referring to this:

...Basically, cocaine is the world's best ADHD drug. If you legitimately had ADHD, cocaine will help you more than Adderall or Ritalin will. Does that mean that everyone should spurn sound medical advice in favor of doing a few lines? No, it's fucking stupid and illegal.

Heroin is a fantastic painkiller. Alcohol is a fantastic treatment for the manic side of manic-depressive disorder. On and on and on...

...potentially horribly unsafe narcotics is fucking stupid.

Heroin is still used to treat patients for pain in many parts of the world, including the UK. Cocaine is still used as a local anesthetic. Obviously the medical uses have been reduced throughout the years due to the serious side effects these drugs can cause, including permanent psychological damage, physical dependence, and death.

Can you die from self-medicating with marijuana? Nope. Can you cause permanent psychological damage? Nope. Can you become physically dependent on marijuana? Nope.

Apples & oranges.

[Effluo]

Not really, only if your opinion is skewed in favor of marijuana. They're all illegal narcotics that will land you in jail if you are found in possession of them. Idgaf what you think about the law or their effects, on the basis of legality they're equivalent.

Um, I would just like to point out that in many states, Marijuana posession may be illegal, but only in cases or large amount will it land you in jail. Posession of a couple of joints or the equivalent is a misdemeanor and a fine and many don't go on your record if it's a first time offense. How did they say it, decriminalization?

[BerenTebogo]

Depending on where you live, yes, you are correct about the legality of it for the most part. I was more so referring to this:



Heroin is still used to treat patients for pain in many parts of the world, including the UK. Cocaine is still used as a local anesthetic. Obviously the medical uses have been reduced throughout the years due to the serious side effects these drugs can cause, including permanent psychological damage, physical dependence, and death.

Can you die from self-medicating with marijuana? Nope. Can you cause permanent psychological damage? Nope. Can you become physically dependent on marijuana? Nope.

Apples & oranges.

Listen.

I made the analogy. I set the standard of comparison. I did not make any distinction between addiction, death, or anything else. Marijuana is potentially harmful if you, like many other people do, buy from a dealer that you don't know well and it's laced with shit without your knowledge. I've seen it happen. That's potentially harmful. Also

Well technically smoking poorly maintained weed can lead to growing fungus in your lungs and you dying, so kinda similiar?

You don't get to decide what standard of comparison I was making.

I don't give a fuck what your opinion is.

I don't give a fuck what your position is.

I don't give a fuck about anything you wrote above this.

None of it is fucking valid for the comparison I made which was that they were unregulated, illegal, and potentially harmful narcotics.

Marijuana is ILLEGAL if you are using it to treat OCD. Period.

Now shut the fuck up and let Byrn get data from uninformed idiots who think their opinion matters more than fact.

Um, I would just like to point out that in many states, Marijuana posession may be illegal, but only in cases or large amount will it land you in jail. Posession of a couple of joints or the equivalent is a misdemeanor and a fine and many don't go on your record if it's a first time offense. How did they say it, decriminalization?

Fine.

They are all ILLEGAL but may not always LAND YOU IN JAIL depending on how much or little you have.

Should we get into country regulations for every state regarding minimum weight to be classified as misdemeanor?

It's fucking illegal.

[Byrthnoth]

Well, I was aiming to only talk about the Fifth group, which I didn't make particularly clear.

I graduated undergrad with a BS in Biochemistry and a BA interdepartmental between Psychology/Biology because the Psych department can't give BSs at my school. Now I'm in graduate school for neuroscience (I should have just gone to med school, orz).
Edit: Eh, I should note here that I took as little psychology as possible. Developmental Psych can kiss my ass. Deal with intervening variables less, noobs.

"Strict guidelines for meeting criteria for a diagnosis" ...well, not so much. You've said yourself that everyone meets criteria for a disorder, but may not be at the extreme end. I started this thread pointing out that 95% of the people that go in for counseling come away with a diagnosis. Severity is fairly arbitrary (depends on who is diagnosing) and may not be constant across days. If the patient seems like they want it, some psychiatrists find that everyone meets the criteria for medication.
http://en.wikipedia.org/wiki/Diagnos...nd_reliability
If you talk to practicing psychiatrists, they'll tell you the real way to test if someone has ADHD is to put them on Ritalin and see if they get better. Not actually joking, the psychiatrist told this to my parents before they put my sister on Ritalin.

[Effluo]

Fine.

They are all ILLEGAL but may not always LAND YOU IN JAIL depending on how much or little you have.

Should we get into country regulations for every state regarding minimum weight to be classified as misdemeanor?

It's fucking illegal.

As much as I am not a fan of California, I will say bravo for possibly being the first state to allow ... RECRATIONAL USE. Well, I guess second technically, as you're allowed up to 1 oz in your private residence, and less than 25 plants which is protected under the Alaska Constitution’s right to privacy.

[BerenTebogo]

Well, I was aiming to only talk about the Fifth group, which I didn't make particularly clear.

I graduated undergrad with a BS in Biochemistry and a BA interdepartmental between Psychology/Biology because the Psych department can't give BSs at my school. Now I'm in graduate school for neuroscience (I should have just gone to med school, orz).

"Strict guidelines for meeting criteria for a diagnosis" ...well, not so much. You've said yourself that everyone meets criteria for a disorder, but may not be at the extreme end. I started this thread pointing out that 95% of the people that go in for counseling come away with a diagnosis. Severity is fairly arbitrary (depends on who is diagnosing) and may not be constant across days. If the patient seems like they want it, some psychiatrists find that everyone meets the criteria for medication.
http://en.wikipedia.org/wiki/Diagnos...nd_reliability
If you talk to practicing psychiatrists, they'll tell you the real way to test if someone has ADHD is to put them on Ritalin and see if they get better. Not actually joking, the psychiatrist told this to my parents before they put my sister on Ritalin.

Happened to me too. That's how I ended up on Ritalin.

Honest question since you're in the field, not trying to start another hyperbolic analogy war, what would the differences on the brain be between a child taking 20mg Methylphenidate AM and 10mg Methyl after lunch daily for 8 years and a person drinking 3 cups of caffeinated coffee per day for 20?

If there is even a standard for comparison, I don't really know. Ritalin in kids without ADHD is just basically like giving them a stimulant though, so unless I'm missing something you should be able to quantify it somehow.

(not trying to broad base this, we already talked about lithium and etc)

[CDF]

Randomization takes care of most everything when you make the best effort you can to control all variables that you don't want to interfere with the results. Randomization is less effective when you just kinda say "fuck it, let's do it!" which sounds like a rare situation, and I'd like to think it's a very rare situation, but from my experience (anecdotal, I know a few psych grad students) it isn't. Especially not if there is a bias in regards to funding or a lack of documentation on similar studies that produced results that weren't what we wanted to see and go thrown out.

The design of Phase III clinical trials (since the topic is about FDA-approved prescription drugs indicated for mental disorders) isn't going to be that loose considering the costs involved (even with a low threshold such as a superiority trial with placebo control). It's in the funding entity's best interest to support a trial that will yield statistical significance and it can help to be as specific as possible in the definition of the study population and inclusion/exclusion criteria to maximize the power of the statistical procedures applied to the study data. (Part of the reason is that most pharmacological treatments save the likes of imatinib tend to have small clinical effects especially compared to common-sense non-pharmacological measures.) Of course, because of funding there can be "pressure" to avoid highlighting negative findings that would scuttle FDA approval (see the history of COX-2 inhibitors in the U.S.), and it doesn't stop drug marketers from attempting to expand indications either formally or by "wining and dining" prescribers to promote off-label indications as you or others already said (again COX-2 inhibitors).

Edit: To be more specific, it's hard to recreate the same study with the same people under the same conditions and using different people will always yield different results. If you want to test the diameter of the crater made when you drop a sphere with r=10m^3 weighing 100lbs from a height of 100ft you're gonna have an easy time recreating the experiment no matter what the color of the sphere is or what type of plane you're flying, etc.

People are the problem.

If only the effect of any pharmacological intervention on a particular human being could be predicted with near-100% certainty.

Heterogeneity of subjects itself is theoretically not really a problem if multiple studies, which are of high quality (which can be a reach) show a positive effect. Even if the mean efficacy of a treatment is small (still, it can be clinically important from a population/public health perspective), that treatment could help greatly a few individuals of a defined study population. Unfortunately, it can be difficult, if not impossible (makes sense where treatment for mental illness is involved), for clinicians to know a priori that a given treatment will be highly efficacious for a particular patient.

imma use bold here so people read it, because this thread has gotten bogged down by crap that I could care less about.

In a world with a questionable working definition of depression and equally questionably efficacious drugs to treat it, is it worth the risk of prescribing drugs that we know cross the blood-brain barrier and have widespread neural effects?

If you want a drug to treat a mental disorder, I think one should expect it to be "designed" so it (or the prodrug anyway) can cross the blood-brain barrier.

"Worth the risk" from a public health perspective, maybe not. For individuals, maybe, but it wouldn't hurt to respect narrowly defined indications to begin with (prescribers and patients alike; drug companies are mainly interested in maximizing profit, which they can do by expanding indications) the so that the benefits actually outweigh potential adverse effects.

[Byrthnoth]

Honest question since you're in the field, not trying to start another hyperbolic analogy war, what would the differences on the brain be between a child taking 20mg Methylphenidate AM and 10mg Methyl after lunch daily for 8 years and a person drinking 3 cups of caffeinated coffee for 20?

Superficial answer is that they do entirely different things.

So, the longer you're awake the more adenosine builds up in your CNS. It binds to receptors in brain centers that encourage sleep. Caffeine also binds to those receptors but doesn't have the same effect as adenosine. So when you take caffeine, you feel more awake because there's less adenosine receptor activation.
You can think of it like an apartment building door. Your key (adenosine) can go into your lock, turn, and open the door. Your neighbor's key (caffeine) may also be able to fit into your lock, but it won't be able to turn and open the door. If your neighbor has his key in there, you can't get into your apartment.

Ritalin increases dopamine levels in the brain somehow, which is what people point to as its mechanism of action. It's a stimulant in the sense that it inhibits sleepiness. It blocks the Dopamine transporter, which makes the dopamine spend more time in the synaptic cleft and is responsible for the increase in brain levels. It preferentially blocks the Norepinephrine transporter. It doesn't have a nice clean mechanism like Caffeine. Acts everywhere, changes everything. It's hard to tell why it works. (Also, Ritalin is similar to Cocaine. Speed is Meth.)

Whether or not tolerance occurs in both cases will depend upon the consumption level. Ideally, no tolerance occurs and there's essentially no long-term changes in the brain. In cases of ab/use, it's likely some tolerance will occur. The brain pushes towards sort of a natural equilibrium. What sets this equilibrium is not well understood. Anyway, basically if you develop tolerance to a drug, then whatever was excited by that drug is down-regulated so that it's at sub-normal levels without the drug, and whatever was depressed by the drug is up-regulated so it's at super-normal levels without the drug. I would generally avoid tolerance to anything given the choice, including alcohol.

[Weiing]

"Strict guidelines for meeting criteria for a diagnosis" ...well, not so much. You've said yourself that everyone meets criteria for a disorder, but may not be at the extreme end. I started this thread pointing out that 95% of the people that go in for counseling come away with a diagnosis. Severity is fairly arbitrary (depends on who is diagnosing) and may not be constant across days. If the patient seems like they want it, some psychiatrists find that everyone meets the criteria for medication.
http://en.wikipedia.org/wiki/Diagnos...nd_reliability
If you talk to practicing psychiatrists, they'll tell you the real way to test if someone has ADHD is to put them on Ritalin and see if they get better. Not actually joking, the psychiatrist told this to my parents before they put my sister on Ritalin.

Mental health is on a spectrum/continuum, yes. However, severity is only somewhat arbitrary. It is arbitrary in the fact that the DSM guidelines were constructed by people. I guess that's why every diagnosis has the cop-out of NOS. For instance, you need AT LEAST 3-5 symptoms listed (out of 10, let's say), been unable to function in one or more of the areas: social, work, or life, and have been experiencing this for more than 6 months. Difference in time duration is what separates Acute Stress Disorder from PTSD, for instance.

However, getting side-tracked.

Like I've said, I think it's wrong to indiscriminately prescribe medication to people. But for most insurance companies and psychiatrists, meds is the easiest and fastest way to get people out of their offices. It's why I don't much enjoy psychiatry and psychiatrists in general.

However, going back to the posted article, there are a few explanations as to why college students are being diagnosed more and are being prescribed more meds:
1) Younger generations are actually developing more psychopathology.
2) Counselors are better at diagnosing now than they were before.
3) Counselors just love to overdiagnose or because the college centers are required by the insurance company to have a diagnosis.
4) Younger generations have access to the internet and can read the DSM and are able to "fake" symptoms to get meds because they really just want them for other reasons.
5) All of the above?

tl;dr - DSM-IV-TR can be pretty handy and has decent diagnostic criteria. Properly administered, prescribed, and monitered medication is helpful for some, especially SPMI population, to be able to function in our current society. There will always be side-effects to drugs, no matter what, just need to ensure that side effects are minimal and pros outweigh cons.

[BerenTebogo]

These last 3 posts are all good. Wasn't aware there was that much of a difference in how ritalin and caffeine worked.

I agree with the sentiment that seems to be under riding the biggest problem here (or how I'm reading into it anyway) that the standards are set by people, measured by people, and the treatments are applied on people, and people are just unreliable standards of measurement.

We're never going to have the precision we want with pharmacology and honestly, I'll be surprised if we make any radical breakthroughs in neuropsychology in our lifetimes (big breakthroughs anyways).

[Byrthnoth]

Okay, but the other article I cited implied that there was no "pro" to outweigh the "cons" of the depression medications.

Off-topic, but:
The reliability of anything that is purely self-reported is questionable, as you mentioned. Still, lets look at the case of PTSD. Popularized post-Vietnam, but cases of it can be found even in post-WW1 literature. Recently this is a spot Psychology and Physiology have been clashing on in the popular press, stupidly in my opinion.
Physiologists have claimed that they've found a new problem called mild traumatic brain injuries. It happens to have symptoms very similar to PTSD.
Psychologists are insist that mild TBIs are not distinguishable from PTSD.

Now, I don't know why psychologists would even complain about this or insist that it's a different disorder. Assuming it's true and inclusive, it's finally verification that a classification they've made is based on a real phenomenon. Of course, it does make the treatments given for PTSD for the last century seem pretty stupid, but that's what happens when you're prescribing something for a disorder you don't understand the basis of.

[Gadritan]

Listen.

I made the analogy. I set the standard of comparison.

Listen.

It was a shitty analogy. The legal consequences are as different as the physical/mental risk involved.

You can't just flat out say marijuana is "fucking illegal," because it's not. It's been decriminalized to some degree by about a dozen states in addition to the states that allow the use of medical marijuana. The same cannot be said for heroin and cocaine.

The scenario in which you state marijuana is potentially harmful is rare and ultimately a result of the user being ignorant. Yes, it is a risk that's involved when buying an unregulated substance, but is a result of the user's ignorance. It can EASILY be avoided with a little "monitored," prior experience or education. Most people that would consider self medicating with marijuana have prior experience with it. So as a matter of semantics, marijuana isn't potentially "horribly unsafe," though purchasing it without educating yourself can be.

In contrast, heroin and cocaine can be horribly unsafe even when regulated. You can suffer severe side effects from the drugs themselves, not from getting some "bunk," shit.

Essentially it comes down to the fact that they're illegal and unregulated is irrelevant. Self prescribing any sort of narcotics (even regulated, hello Oxycontin) that can cause severe side effects or have severe legal consequences is stupid. Small amounts of marijuana do not fall into either category.