The last time I saw my NP she had me fill out a depression/anxiety scale. I don’t have depression or anxiety so when I finished I had a zero score. When she came in and saw the scale she re-asked some of the questions with clarifications, I still had a zero score. She looked at me flabbergasted and said “you’re the first person I’ve seen…
The last time I saw my NP she had me fill out a depression/anxiety scale. I don’t have depression or anxiety so when I finished I had a zero score. When she came in and saw the scale she re-asked some of the questions with clarifications, I still had a zero score. She looked at me flabbergasted and said “you’re the first person I’ve seen in weeks that doesn’t have significant depression or anxiety, the first one in months with a zero score.” What’s really sad is that even though she’s in family medicine most of her patients are children. I think it’s also telling that she didn’t ask me why I thought it was that I didn’t have either depression or anxiety.
On a similar note I recently had a baby and every two weeks someone called me to screen for post partum depression and every baby’s visit to the doctor I got screened. Understandable, PPD is terrible and wasn’t talked about for far too long, post partum psychosis can have tragic outcomes. So I understand the screening. But thank God I don’t have PPD. It has been quite difficult to convince nurses and doctors that I’m not lying, I’m simply not depressed.
I can’t help but wonder how many people with very low levels of depression have been talked into thinking their problem is worse than it is by doctors and nurses (who I think do have the best of intentions) and that it must be medicated. Maybe worse I wonder how many people whose depression or anxiety is normal and even healthy have been zombified through medication.
When one of the nurses was asking me further questions about PPD she asked if I had any anxiety at all? I said yeah when the doctor called me and said my baby had a hole in her heart and she didn’t know how bad it was or not so we needed to see a pediatric cardiologist I had some anxiety and distress. But I know that such things are common and generally not a big deal so while I read up on her condition so I would be prepared we also gave it to God and have an army of people praying for her so we will just wait and hope it’s no big deal. (It’s likely not, PFO and VSD that seem to be resolving.) The nurse’s response was that “well if the anxiety gets out of control make sure and call us so we can get you some medicine”. I’m sorry but if the news that your baby has a whole in her heart of unknown size or location doesn’t give you at least momentary anxiety then there’s probably something wrong with you. Short lived anxiety is a completely reasonable and normal response to that news and drugging yourself numb to that cannot be beneficial. The same is true with depression. If your pet dies that is a legitimate reason to be depressed for a time or a season, mourning is a healthy coping mechanism. Drugging someone numb so they don’t experience normal and vital emotions is the opposite of “do no harm”.
I have a friend undergoing treatment for head and neck cancer. They provided him with a psychologist. He's angry about what he's going through. The psych tried to push antidepressants and benzos at him and he told her to leave him alone.
A few visits later the PA assisting the chemo doc encountered his anger at the slow progress in his treatment. Once again, pills offered. And refused.
We now know there's no biochemical basis for depression. The pills are destructive garbage that numb and blunt. Wondering if/when practitioners are going to apply this knowledge to treatment.
Without interference from big pharma it would probably take 10-20 years for the realization that these “conditions” don’t have a brain chemical imbalance and that treatments must change. But with the current interference it might be 100 years maybe longer.
One huge problem is that there is no recognition of the difference between a normal response and a pathological response. If you’re angry because you are fighting cancer and it’s not going well that’s a pretty normal response. If you wake up and you have your health, a job, money in the bank, a roof over head, the sky is blue, the birds are singing and you’re so depressed you can’t leave bed then that’s more likely to be an issue that might truly need medical management. Although I suspect hormones and not just neurotransmitters play a large role, I suspect physical damage and trauma is also under diagnosed. (I wonder how many men with true depression or anxiety have low testosterone levels for example.)
I do have sympathy for doctors and nurses trying to help people though. Too many people want a pill to fix the problem. They don’t want to go to therapy or heaven forbid have to turn to religion to help with their problems. Nope, give me a pill. Exercise so I get a natural dopamine hit? Nope, give me a pill. It’s incredibly disheartening to come up with an extensive “treatment plan” for someone that includes changes in diet, exercise, and screen habits, some recommendation to address spiritual needs without going far enough or being specific enough to get yourself fired or sued, not to mention therapeutic exercises only to have them stare at you glassy eyed and say “can’t I just have some Prozac?” Or even better for them just to smile and nod and then leave nasty reviews all over the internet because you “refused to help them”. Until the average American patient is more interested in avoiding big pharma than financing it not only do doctors have no incentive to change, they are actively incentivized against it on multiple levels.
You're right. Patients need to educate themselves and so many won't bother. So many seem to welcome the numbness that psych meds inflict. I can see how tough it would be to face a patient who is unwilling to take measures to address his real problems and thinks a pill will do the trick, and then abuses the doctor who won't go along with his self-destructive plans.
It's vicious circle now: drug company control of research and testing, control of their data, control of what gets into "prestigious" medical journals, pressure on MDs, coupled with direct to consumer marketing of their swill. Doctors get squeezed from both sides. Really up to the patients not to be such trusting complacent sheep.
I think it’s somewhat more complicated than being complacent sheep although there’s certainly a component of that. I think much of it is a time/energy/effort factor. American culture has a tendency toward pushing toward doing more, accomplishing more, having more all the time.
I saw some ads a few years ago that have stuck with me ever since. A company had produced a new rotary milking parlor that significantly reduced the amount of time needed to milk cows. If you went to the European website all the ads discussed how the time savings greatly improved the quality of life of the farmers. They were able to get done in time to go watch the grandkids at school events, meet friends for dinner. They talked about how the time saved helped encourage younger people and families to go into dairy farming the lack of which has been a real problem. The ads on the American website were all about how with the significant time savings you could buy more cows because you could milk more cows in the same amount of time with the same number of workers. The attitude wasn’t one of greed though it was one of efficiency, I have more time thus I do more work.
It takes a few seconds to take a pill, but exercising, eating a healthy diet, working through issues, all take time and energy which is something that most Americans don’t have much of, or at least don’t think they do.
It's lack of self discipline, passivity and contentment with the easy way out, which seems to be taking a shot or a pill. Conditioned by the direct to consumer commercials, these are the people who don't want to question or educate themselves. I am loath to defend it as some type of Yankee efficiency. It's something my parents and grandparents could not understand. Like the stampede for semaglutide...a shot or pill for the rest of your life beats out changing your diet and exercising. Maybe the hours spend immobile with a phone or in front of a screen could be used for a walk around the neighborhood. We have the time. We don't have the will.
That’s certainly true for some. But the people I know who turn to these pills generally don’t spend hours in front of a screen unless it’s for work. Generally speaking they work full time, go to church and are active in church and the community, have kids that are active outside of school which means hauling kids around to practices, games, recitals, competitions, camps, and more. I’m not saying there’s no possible way for them to make time for healthier living, but that’s the thing, they would have to prioritize and make time. That might mean having to give up other past times or it might mean having to decrease the amount of extracurriculars your kid is involved in so you don’t have to spend as much time going from place to place. Healthy living for most people is low on the priority list which is usually something along the lines of work, family, church, hobby, then maybe health. Americans spend more time at work than most of our European counterparts (longer days, fewer holidays, fewer vacation days). That directly impacts the amount of time available for other things, like preparing healthy foods and getting a decent amount of exercise.
There are definitely people who just sit in front of the couch all day and play video games and want the easy way out. (I’m guessing those people are also mostly single and childless.) But a good many of the people who are also looking for the magic pill are extremely busy with careers and families. Maybe this is in part a coping mechanism, stay busy so you don’t think about how depressed you are. The solution is to move healthy living up the priority list. But sometimes that’s easier said than done. It isn’t easy to tell your kid that you are limiting them to one after school sport or event a season because you don’t want to spend all your time hauling them to various practices and events and need time to work out. It isn’t easy to tell your church that you can’t help with that event because you need to meal prep that day. At least in my experience most people are very busy, they are just busy with the wrong things.
You make good points. But I didn't see this drug taking in my elders. It seems to be something that has been heavily cultivated since the 50s and 60s with tranquilizers for housewives, then SSRIs from the early 80s onward. Americans didn't pump school boys full of ADHD meds when I was growing up. "Diet pills"existed but were not commonly used. I think we're living in a culture that's been heavily influenced by pharma and the fallout makes us very different from even our recent ancestors.
It seems to me that it’s human nature to want an easy button. A healthy culture should allow someone to identify when the easy button isn’t the best option and it should encourage the better option. Unfortunately American culture instead encourages the easy button. This is worsened by the fact that technology has actually made the easy button available where it wasn’t to previous generations. But those generations still had their go to pharma easy buttons. From the thirties to the seventies the abuse of amphetamines by housewives was a common problem. In the late 1800s and early 1900s laudanum was frequently abused and snake oil salesmen made mints with their various cures. Of course there’s history’s favorite pharmaceutical, alcohol. It seems to me that the culture is the problem and that big pharma is simply supplying the most popular solution.
We see this in other areas too. Screen time didn’t become a problem in children because Apple invested heavily in advertising in Paw Patrol and Sesame Street. It became a problem because it is a parenting easy button. Processed and fast foods are mostly advertised to convince you they are the best fast food or processed food option, not to convince you to eat fast food rather than cook at home. It’s quicker and easier than cooking fresh meals at home and that’s for the most part why people eat it. The culture demands an easy button and big pharma is happy to supply it.
Where I live the buses only run to and from school for regular hours and expecting my kids to bike 10 miles to town one way might be a little excessive although I’m sure ADD and obesity wouldn’t be an issue. I’m sure though there are lots of kids being chauffeured that should be getting places on their own.
Crazy as it seems, the schoolbus is one of the most harmful innovations ever… it destroyed the local small neighborhood school by allowing for children from huge swaths of the city to be transported miles away from home to one gigantic thousand-student-big inhuman mass educational factory, divorced from their streets, their neighbors, their small community.
Thank you for mentioning diet. It might be the bubble I'm in, but there's increasing awareness that what you eat affects how you feel. It's not a silver bullet by any means, but then, most things are multi-factorial.
The last time I saw my NP she had me fill out a depression/anxiety scale. I don’t have depression or anxiety so when I finished I had a zero score. When she came in and saw the scale she re-asked some of the questions with clarifications, I still had a zero score. She looked at me flabbergasted and said “you’re the first person I’ve seen in weeks that doesn’t have significant depression or anxiety, the first one in months with a zero score.” What’s really sad is that even though she’s in family medicine most of her patients are children. I think it’s also telling that she didn’t ask me why I thought it was that I didn’t have either depression or anxiety.
On a similar note I recently had a baby and every two weeks someone called me to screen for post partum depression and every baby’s visit to the doctor I got screened. Understandable, PPD is terrible and wasn’t talked about for far too long, post partum psychosis can have tragic outcomes. So I understand the screening. But thank God I don’t have PPD. It has been quite difficult to convince nurses and doctors that I’m not lying, I’m simply not depressed.
I can’t help but wonder how many people with very low levels of depression have been talked into thinking their problem is worse than it is by doctors and nurses (who I think do have the best of intentions) and that it must be medicated. Maybe worse I wonder how many people whose depression or anxiety is normal and even healthy have been zombified through medication.
When one of the nurses was asking me further questions about PPD she asked if I had any anxiety at all? I said yeah when the doctor called me and said my baby had a hole in her heart and she didn’t know how bad it was or not so we needed to see a pediatric cardiologist I had some anxiety and distress. But I know that such things are common and generally not a big deal so while I read up on her condition so I would be prepared we also gave it to God and have an army of people praying for her so we will just wait and hope it’s no big deal. (It’s likely not, PFO and VSD that seem to be resolving.) The nurse’s response was that “well if the anxiety gets out of control make sure and call us so we can get you some medicine”. I’m sorry but if the news that your baby has a whole in her heart of unknown size or location doesn’t give you at least momentary anxiety then there’s probably something wrong with you. Short lived anxiety is a completely reasonable and normal response to that news and drugging yourself numb to that cannot be beneficial. The same is true with depression. If your pet dies that is a legitimate reason to be depressed for a time or a season, mourning is a healthy coping mechanism. Drugging someone numb so they don’t experience normal and vital emotions is the opposite of “do no harm”.
what a fantastic comment, thank you! and, most of all, congratulations on the baby!!
I have a friend undergoing treatment for head and neck cancer. They provided him with a psychologist. He's angry about what he's going through. The psych tried to push antidepressants and benzos at him and he told her to leave him alone.
A few visits later the PA assisting the chemo doc encountered his anger at the slow progress in his treatment. Once again, pills offered. And refused.
We now know there's no biochemical basis for depression. The pills are destructive garbage that numb and blunt. Wondering if/when practitioners are going to apply this knowledge to treatment.
Without interference from big pharma it would probably take 10-20 years for the realization that these “conditions” don’t have a brain chemical imbalance and that treatments must change. But with the current interference it might be 100 years maybe longer.
One huge problem is that there is no recognition of the difference between a normal response and a pathological response. If you’re angry because you are fighting cancer and it’s not going well that’s a pretty normal response. If you wake up and you have your health, a job, money in the bank, a roof over head, the sky is blue, the birds are singing and you’re so depressed you can’t leave bed then that’s more likely to be an issue that might truly need medical management. Although I suspect hormones and not just neurotransmitters play a large role, I suspect physical damage and trauma is also under diagnosed. (I wonder how many men with true depression or anxiety have low testosterone levels for example.)
I do have sympathy for doctors and nurses trying to help people though. Too many people want a pill to fix the problem. They don’t want to go to therapy or heaven forbid have to turn to religion to help with their problems. Nope, give me a pill. Exercise so I get a natural dopamine hit? Nope, give me a pill. It’s incredibly disheartening to come up with an extensive “treatment plan” for someone that includes changes in diet, exercise, and screen habits, some recommendation to address spiritual needs without going far enough or being specific enough to get yourself fired or sued, not to mention therapeutic exercises only to have them stare at you glassy eyed and say “can’t I just have some Prozac?” Or even better for them just to smile and nod and then leave nasty reviews all over the internet because you “refused to help them”. Until the average American patient is more interested in avoiding big pharma than financing it not only do doctors have no incentive to change, they are actively incentivized against it on multiple levels.
You're right. Patients need to educate themselves and so many won't bother. So many seem to welcome the numbness that psych meds inflict. I can see how tough it would be to face a patient who is unwilling to take measures to address his real problems and thinks a pill will do the trick, and then abuses the doctor who won't go along with his self-destructive plans.
It's vicious circle now: drug company control of research and testing, control of their data, control of what gets into "prestigious" medical journals, pressure on MDs, coupled with direct to consumer marketing of their swill. Doctors get squeezed from both sides. Really up to the patients not to be such trusting complacent sheep.
I think it’s somewhat more complicated than being complacent sheep although there’s certainly a component of that. I think much of it is a time/energy/effort factor. American culture has a tendency toward pushing toward doing more, accomplishing more, having more all the time.
I saw some ads a few years ago that have stuck with me ever since. A company had produced a new rotary milking parlor that significantly reduced the amount of time needed to milk cows. If you went to the European website all the ads discussed how the time savings greatly improved the quality of life of the farmers. They were able to get done in time to go watch the grandkids at school events, meet friends for dinner. They talked about how the time saved helped encourage younger people and families to go into dairy farming the lack of which has been a real problem. The ads on the American website were all about how with the significant time savings you could buy more cows because you could milk more cows in the same amount of time with the same number of workers. The attitude wasn’t one of greed though it was one of efficiency, I have more time thus I do more work.
It takes a few seconds to take a pill, but exercising, eating a healthy diet, working through issues, all take time and energy which is something that most Americans don’t have much of, or at least don’t think they do.
It's lack of self discipline, passivity and contentment with the easy way out, which seems to be taking a shot or a pill. Conditioned by the direct to consumer commercials, these are the people who don't want to question or educate themselves. I am loath to defend it as some type of Yankee efficiency. It's something my parents and grandparents could not understand. Like the stampede for semaglutide...a shot or pill for the rest of your life beats out changing your diet and exercising. Maybe the hours spend immobile with a phone or in front of a screen could be used for a walk around the neighborhood. We have the time. We don't have the will.
That’s certainly true for some. But the people I know who turn to these pills generally don’t spend hours in front of a screen unless it’s for work. Generally speaking they work full time, go to church and are active in church and the community, have kids that are active outside of school which means hauling kids around to practices, games, recitals, competitions, camps, and more. I’m not saying there’s no possible way for them to make time for healthier living, but that’s the thing, they would have to prioritize and make time. That might mean having to give up other past times or it might mean having to decrease the amount of extracurriculars your kid is involved in so you don’t have to spend as much time going from place to place. Healthy living for most people is low on the priority list which is usually something along the lines of work, family, church, hobby, then maybe health. Americans spend more time at work than most of our European counterparts (longer days, fewer holidays, fewer vacation days). That directly impacts the amount of time available for other things, like preparing healthy foods and getting a decent amount of exercise.
There are definitely people who just sit in front of the couch all day and play video games and want the easy way out. (I’m guessing those people are also mostly single and childless.) But a good many of the people who are also looking for the magic pill are extremely busy with careers and families. Maybe this is in part a coping mechanism, stay busy so you don’t think about how depressed you are. The solution is to move healthy living up the priority list. But sometimes that’s easier said than done. It isn’t easy to tell your kid that you are limiting them to one after school sport or event a season because you don’t want to spend all your time hauling them to various practices and events and need time to work out. It isn’t easy to tell your church that you can’t help with that event because you need to meal prep that day. At least in my experience most people are very busy, they are just busy with the wrong things.
You make good points. But I didn't see this drug taking in my elders. It seems to be something that has been heavily cultivated since the 50s and 60s with tranquilizers for housewives, then SSRIs from the early 80s onward. Americans didn't pump school boys full of ADHD meds when I was growing up. "Diet pills"existed but were not commonly used. I think we're living in a culture that's been heavily influenced by pharma and the fallout makes us very different from even our recent ancestors.
It seems to me that it’s human nature to want an easy button. A healthy culture should allow someone to identify when the easy button isn’t the best option and it should encourage the better option. Unfortunately American culture instead encourages the easy button. This is worsened by the fact that technology has actually made the easy button available where it wasn’t to previous generations. But those generations still had their go to pharma easy buttons. From the thirties to the seventies the abuse of amphetamines by housewives was a common problem. In the late 1800s and early 1900s laudanum was frequently abused and snake oil salesmen made mints with their various cures. Of course there’s history’s favorite pharmaceutical, alcohol. It seems to me that the culture is the problem and that big pharma is simply supplying the most popular solution.
We see this in other areas too. Screen time didn’t become a problem in children because Apple invested heavily in advertising in Paw Patrol and Sesame Street. It became a problem because it is a parenting easy button. Processed and fast foods are mostly advertised to convince you they are the best fast food or processed food option, not to convince you to eat fast food rather than cook at home. It’s quicker and easier than cooking fresh meals at home and that’s for the most part why people eat it. The culture demands an easy button and big pharma is happy to supply it.
Oh for the days when kids got themselves to their activities on bikes or buses. OK Boomer, that's me.
Where I live the buses only run to and from school for regular hours and expecting my kids to bike 10 miles to town one way might be a little excessive although I’m sure ADD and obesity wouldn’t be an issue. I’m sure though there are lots of kids being chauffeured that should be getting places on their own.
Crazy as it seems, the schoolbus is one of the most harmful innovations ever… it destroyed the local small neighborhood school by allowing for children from huge swaths of the city to be transported miles away from home to one gigantic thousand-student-big inhuman mass educational factory, divorced from their streets, their neighbors, their small community.
Yes, of course my comment wasn't meant to apply to everybody. But we did ride our bikes quite long distances, even in the city.
Thank you for mentioning diet. It might be the bubble I'm in, but there's increasing awareness that what you eat affects how you feel. It's not a silver bullet by any means, but then, most things are multi-factorial.