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What I have learned from my suicidal patients

theguardian.com

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Re: What I have learned from my suicidal patients

#101

Post by dkersten »

cassowary37 wrote: post #88
dkersten wrote: post #87

Earlier quoted context omitted.

I've always disliked it too. It seems very presumptuous. The people repeating it typically don't know what the person in question is dealing with.

actually that statement is itself rather presumptuous. How would you know that those of us who repeat it don't know? I can state with authority that may of us do.

> How would you know that those of us who repeat it don't know?

Because everybody is different and even if you have been through it yourself, your experience may be nothing like someone else's, and just because it was true for you, doesn't mean it is true for them. Yes, some people get past it, either on their own, with therapy or with medication. Some people are just numbed by it, other people learn to cope even if it never actually gets better. Other people still struggle every day. You cannot know what is going on in someone else's head or the struggles they face.

Its true that many people get better, certainly with treatment, but a large number of people do not (someone else here said that treatment does not work for approx. 1/3 of people).

Re: What I have learned from my suicidal patients

#102

Post by pntnp »

sysbin wrote: post #31
algaeontoast wrote: post #25

Earlier quoted context omitted.

I think this is a uniquely western / American dilemma. I recently had an older relative decide to not proceed with treatment for stage four pancreatic cancer and my family’s response was almost of shame and aghast. It’s still odd to me that my parents were almost offended when I signed forms that indicates I did not want to be on life support if I’m brain dead or forcibly resuscitated if I arrived at a hospital “dead…

I assume correlation with religious ideology. The everyone must live & appreciate the unique gift given to them belief. Never considering the persons wanting to end their life don't consider life a gift but the opposite. Also fear of death is another factor in the equation. In any case I think there will be a change in 60 years.

Which is ironic because Christ willingly committed suicide. You would think christians would be in favor of suicide given the Christ's example.

Re: What I have learned from my suicidal patients

#103

Post by dang »

paulcole wrote: post #21
BuildTheRobots wrote: post #10

Earlier quoted context omitted.

This reads like advertising copy. Prozac has a number of potential side effects as well as needing commitment and a staged withdrawal. This is a dangerous comment and should be burried. edit: this isn't to say I don't think antidepressants are a fantastic tool; just that I don't think you should be going to your doctor and asking for a specific flavour of drugs because you heard about them on the internet. It's a rea…

It’s very likely that Pfizer and other big pharma companies have shill accounts here. They’ve downvoted me before for trying to reveal the truth. Edit: It has happened again.

Your comment has clearly been downvoted because it broke several of the site guidelines.

In particular, it's off topic here to make insinuations about astroturfing, shilling, and so on, without specific evidence. Somebody posting an comment you disagree with is evidence of nothing, except that people have various views.

https://news.ycombinator.com/newsguidelines.html

Re: What I have learned from my suicidal patients

#104

Post by agumonkey »

sysbin wrote: post #46
agumonkey wrote: post #45

Earlier quoted context omitted.

Some people have all that yet have suicidal tendencies I believe. It should be normal to try to fix those bugs.

I see that rhetoric get thrown around once in awhile and I wonder if people that use it in fact work in the healthcare field. Sure, we get anomalies in life but it doesn't make sense to oppose someone of their wish to die because of it.

I am a patient

Re: What I have learned from my suicidal patients

#105

Post by downerending »

hestipod wrote: post #100
downerending wrote: post #94

Earlier quoted context omitted.

The situation with your family sucks, no doubt. What would improve things for you right now?

I am so stressed, distressed, angry, in pain that I don't even know at this point. I need stability so I can assess things. See what the baseline is without all this bullshit here. I need to get back to Warsaw where I lived before and my only friends and reliable doctors are,or at a minimum some European city with dense services, affordable healthcare, and transport so I can live within a small area. This country is…

This is very difficult, to be sure. Betrayal is a very hard pill to swallow, and the death of a loved one likewise.

You mention Warsaw as a place where things might be better. It looks like you could fly there from NY for maybe $300 on a good day. Is this a plan you could shoot for?

Re: What I have learned from my suicidal patients

#106

Post by hestipod »

downerending wrote: post #105
hestipod wrote: post #100

Earlier quoted context omitted.

I am so stressed, distressed, angry, in pain that I don't even know at this point. I need stability so I can assess things. See what the baseline is without all this bullshit here. I need to get back to Warsaw where I lived before and my only friends and reliable doctors are,or at a minimum some European city with dense services, affordable healthcare, and transport so I can live within a small area. This country is…

This is very difficult, to be sure. Betrayal is a very hard pill to swallow, and the death of a loved one likewise. You mention Warsaw as a place where things might be better. It looks like you could fly there from NY for maybe $300 on a good day. Is this a plan you could shoot for?

I am not in NY and it costs a lot more than that as a rule. But that's not even the issue. getting a flight is not a block. It's how to survive long term financially when there. How to legalize without some immigration means which is mostly predicated on money. How to do all that with poor health and people actively fighting you and trying to take away more agency. It's a lot more than just "moving". "Moving" has been my plan since the day I came back from there. I'd have done it then if it was realistic. If money were no object I would have never left, or once here packed up myself and my cat and moved back. Back then my health wasn't good but wasn't as bad and I might have had even some good days. Now it's worse all I want is mostly not miserable days, mostly survivable days. I would accept that. But I cannot even get that.

Re: What I have learned from my suicidal patients

#107

Post by ThrowawayP »

jdietrich wrote: post #74
cassowary37 wrote: post #64

A colleague of mine calls suicide 'a permanent solution to a temporary problem' - not to diminish it, but to recognize that for most people the desire to die is a temporary state. Whenever depression comes up on HN (as it does with surprising frequency), I'm both touched by people's willingness to share their own stories, and frustrated by otherwise very rational and logical people's speed to dismiss data. Initial tr…

STAR*D presents us with a "glass half full" problem. It's absolutely true that the majority of people will recover from depression with suitable treatment, but that leaves us with a minority who won't. I'm not sure how to communicate those facts effectively to a wide audience. It is absolutely imperative that people with depression seek treatment and keep trying even if the first or second or fifth treatment fails, o…

> I do think it's useful for treatment-resistant patients to shift their focus away from recovery and towards symptomatic management

Would be nice but it seems risky for a patient to suggest that to the clinician; depending on the exact symptomatic management being sought and the competence of the clinician (who are not, unfortunately, exempt from Sturgeon's Law), it might get the patient falsely labeled as "drug seeking". That would be problematic, to say the least.

Re: What I have learned from my suicidal patients

#108

Post by solipsism »

whatshisface wrote: post #7
shrimp_emoji wrote: post #2

>The soldier who hiked out on to the moor, lay down in the heather and overdosed. Émile Durkheim, the great sociologist, theorised as to why suicide is so common among military personnel – not simply because of the devastating effects of war, or because of their easy access to weapons, but because of the depersonalising effect of army training: “Military esprit can only be strong if the individual is self-detached, a…

One one hand, we have a growing body of research saying that almost nothing anybody does is rational, and that most "rational explanations" that people deliver are post-hoc rationalizations of something they did on a whim. The popular interpretation is that this represents evidence against free will, but that may be a little overblown. On the other hand, there is a parallel cultural trend of people arguing that suici…

but that may be a little overblown

No, it's quite well established, actually.

Re: What I have learned from my suicidal patients

#109

Post by starpilot »

cassowary37 wrote: post #64

A colleague of mine calls suicide 'a permanent solution to a temporary problem' - not to diminish it, but to recognize that for most people the desire to die is a temporary state. Whenever depression comes up on HN (as it does with surprising frequency), I'm both touched by people's willingness to share their own stories, and frustrated by otherwise very rational and logical people's speed to dismiss data. Initial tr…

I suspect the amount of non-responsive patients is greatly downplayed by most therapists. Obviously they have a strong incentive to do so. From SSC:

> I work in a clinic with about ten therapists. Some are better than others, but all of them are competent. I send my patients to them. In a few hundred patients I’ve worked with, zero have had the sudden, extraordinary, long-lasting change that the therapy books promise. Many have benefited a little. A few would say that, over the course of years, their lives have been turned around. But sudden complete transformations? Not that much.

> When I try all the exciting new therapies on them, they just sort of nod, say that this sounds like an interesting perspective, and then go off and keep having symptoms. It’s very rude!

https://slatestarcodex.com/2019/11/20/book-review-all-therap...

He goes on to talk about how CBT success rates have been falling, seemingly due to the wearing away of its novelty-induced placebo. As a chronic depressive, my "temporary" 20-year-old problem (if you had cancer for 20 years, would you like people to call it "temporary"?), this is the most relatable and reasonable article I've ever read on the subject.

Re: What I have learned from my suicidal patients

#110

Post by leggomylibro »

heavyset_go wrote: post #85
sillysaurusx wrote: post #9

I just wanted to say, if anyone is having a dark time, make an appointment with a doctor and ask them about Prozac. Unlike most antidepressants, the side effects don’t seem very noticeable. I think there’s a sort of stigma against talking about mental health (except in the third person), but it’s one of those things that should probably change. Taking Prozac doesn’t mean you’re somehow broken. It’s like a crutch: why…

Newer antidepressants have less/different side-effects compared to older antidepressants like Prozac. 5-HT1A agonism relieves a lot of symptoms commonly associated with SSRIs, so does antagonism of 5-HT2A, 5-HT2C (Prozac does this), 5-HT3, 5-HT7 and certain adrenergic receptors. Some newer drugs target these receptors.

Are 5-HT2A and 5-HT2C related to 5-HT2B at all? Don't psychedelics like LSD, DMT, and MDMA non-selectively target those receptors?
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