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I cannot stress this enough: I live for the day these cruel bastards get gulaged. This shit is why I'm a leftist.
I'm actually surprised to seeing people here apparently being cool with restricting life saving meds from people. Are we for real?
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 proscribing 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
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?
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.
RFK wants more people to be treated like his aunt.
so do half the people in this thread apparently
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.
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:
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
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.
yeah pretty much my opinion
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.
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.
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.
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 cheaper and 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.
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.
