Diet/sleep/exercise/sunlight are always the first step, and if you don’t at least get those, you’ll be hard-pressed to feel decent no matter what else you do, regardless of whether you have other medication-dependent conditions.

That said, there are way too many people out there who have no experience with conditions which require medication, who seem to think that those things are a substitute for medication rather than a baseline that must be kept up alongside medication.

I’m no psychologist, but I tend to assume that a driver to thinking this way might be the sense of safety that comes with self-righteousness. Similar to victim-blaming in crimes, where people pick at the personal faults of crime victims (however slight) in order to reassure themselves that a similar thing couldn’t happen to them. Imo it’s a coping mechanism for a world where long-term suffering can be brought on totally at random.

> That said, there are way too many people out there who have no experience with conditions which require medication, who seem to think that those things are a substitute for medication rather than a baseline that must be kept up alongside medication.

It is complicated. Some people have mental health conditions which are always going to require medication. Some people have mental health conditions which are never going to require medication. And some people have mental health conditions where it depends on environmental circumstances. For that last group, lack of sleep/diet/exercise/etc can be part of the environmental circumstances which makes medication required, so fixing that can make medication less required, and may even go some way towards making it no longer required. Even if certain other things can make medication no longer required, sometimes it is still helpful in the short-to-medium term to give you the space to implement those things

> but I tend to assume that a driver to thinking this way might be the sense of safety that comes with self-righteousness

There are serious concerns about iatrogenic harm in mental health due to overdiagnosis, misdiagnosis and overprescribing. Some people who are critical of medication are approaching the issue, not from some sense of superiority, but rather from negative personal experiences with the topic, for themselves and/or family members.

Taking psychiatric medication and being critical of it are not mutually exclusive-I myself do both. Given my current situation, medication is the least worst thing for me right now, but I hope one day I can solve some other problems in my life and remove some stressors and I may eventually wean myself off it. And simultaneously I believe a lot of people out there are being harmed by being prescribed the wrong medications. For example, the widespread prescribing of antipsychotics to adults and children without psychosis, by prescribers who are ignorant of the risks of brain atrophy [0] and who don’t communicate those risks to patients/parents. If you have schizophrenia, those risks may be the lesser evil; if you have a kindergartener with Aspergian traits and mild violent behaviour, I’m not convinced it is. Maybe as a last resort once you’ve exhausted every alternative, but I know clinicians for whom risperidone is their first resort not their last

[0] https://journals.sagepub.com/doi/10.1177/0004867418797419

I was hospitalized for two severe manic episodes in my late teens and was told I would have to take lithium for the rest of my life or I would inevitably end up back in the hospital. I did take it (and Zyprexa) for about nine months during my freshman year of college, got the fattest I've ever been, and spent almost the entirety of my free downtime zoned out in my dorm room.

That summer after my first year of college, I spent my days moving stuff around in a furniture store and golfing 9 holes after work was done, and weaned myself off of it. I haven't relapsed into the hospital in two decades since, despite more than a few high risk periods I've gone through over that time, and a lapse during fatherhood in my ability to keep up with exercise as much as would be ideal. I don't know whether my brain was sufficiently re-wired by those 9 months of pills or what, but it's a bit strange to me that essentially every psychiatrist would have insisted something like this was impossible.

> I don't know whether my brain was sufficiently re-wired by those 9 months of pills or what, but it's a bit strange to me that essentially every psychiatrist would have insisted something like this was impossible.

Bipolar disorder disappears in some people spontaneously. Around 10% of people who have a first bipolar episode will not go on to have a second one, even if they permanently discontinue medication. And some people who have a second episode will never have a third, even if they stop taking medication, although I don't have an actual statistic on that. Let's suppose it is 1% of all bipolar cases – which is a figure I just made up, but probably in the right ballpark. Since bipolar is around 1% of the population, people like you would be around 0.01% of the population. That sounds insignificant, but in a country like the US there would be over 30,000 people like you, and worldwide could be over 700,000.

I think the psychiatrists who told you this is "impossible" probably knew that it actually wasn't. It is just that it is rare, and they don't want to give patients and their families false hope or encourage non-compliance with treatment, so instead of telling you the truth that it is 10% or 1% or whatever of all cases, they tell you a "white lie"/"simplification" that it is 0%. 90-99% of the time, their lie turns out to be true for the person they told it to.

In terms of whether 9 months of medication "rewired your brain" – it is impossible to say. It is possible that without medication you would not have gone into remission, and would have had further episodes. It is also possible that you were always going to remit anyway, and still would have even without medication. Nobody really knows. The fact is, for just about all psychiatric disorders, our knowledge of what causes them, and how the medications work, is extremely incomplete, and we don't know enough to answer those questions in individual cases.

Yeah, as someone with ADHD, good diet, exercise, sleep, etc. are critical for managing symptoms. They're also effectively impossible to maintain consistently without medication.

> They're also effectively impossible to maintain consistently without medication.

This is key. As someone with bipolar disorder, I'm forever stuck in a cycle of stable with good habits -> episode happens -> can't keep the habits -> get worse -> medication changes/episode passes on its own -> I go back to good habits -> stable...

With mental illness you never know when it's going to act up and ruin your life, so the least you can do is use your energy - when you have it - to keep your body in a decent baseline.

Thankfully, this cycle takes many months to start again, so I live a decent life most of the time.

This sort of stuff always reminds me of this passage:

> To this day

> He is a stick of TNT lit from both ends

> Could describe to you in detail the way the sky bends

> In the moments before it’s about to fall

> And despite an army of friends

> Who all call him an inspiration

> He remains a conversation piece between people

> Who can’t understand

> Sometimes becoming drug free

> Has less to do with addiction

> And more to do with sanity

  - To this day, Shane Koyczan

Who are you to say that spending your millions is foolish this way or that way? We all end up as dirt. Why not live eccentrically and take risks? It makes for a good story which you have conveniently cast as horrible. I bet that story is plenty interesting and worthwhile as is yours.

You clearly never met anyone with BPD.

When you say BPD are you referring to borderline or bipolar? Because borderline is usually treated with therapy as the first-line treatment, while meds are definitely the norm and most effective for bipolar.

OPs description of his friend ruining his life by not taking his meds seems more like bipolar.

Eh, could be either really

But they are very different in their presentations

> Why not live eccentrically and take risks?

Maybe because there are dependents that needed that money for school, shelter, clothing, or food.

There was a story in the news recently about a guy who spontaneously gave away $200k by throwing bills out of his car window. Seemed like a feel-good story, at first. It turns out that he gave away his family's life-savings and they're now destitute.[1]

Money can absolutely be wasted and spent foolishly.

[1] https://www.nbc15.com/2023/04/13/man-throws-200k-cash-out-ca...

That was exactly what I’m talking about. What an interesting story and we have only heard it from a single perspective. Imagine the stories of the people it affected, I’m sure it made someone better off.

You are a fascist control freak.

You've been breaking the site guidelines repeatedly and badly. We ban accounts that do that, so please stop.

If you'd please review https://news.ycombinator.com/newsguidelines.html and stick to the rules when posting here, we'd appreciate it.

You can't just hand wave "you've been breaking the rules badly". I haven't done anything of the sort, you know me I can break the rules as I have in the past and stopped doing.

I am expressing myself and sometimes I use sarcasm or reductio ad absurdum and people don't understand. By time they have flagged and downvoted it is too late to edit and give context.

The end result is... they downvote me and no one reads it. The system works. I really don't know what you are talking about, but this wouldn't be my first misunderstanding. Thanks for listening but thread has turned into a waste of people meta-analyzing the comments and it's not worth our time. Life is too short.

My suggetion to you: whoever flagged my comment is wasting your time and should be punished for pearl clutching.

When you post "You are a fascist control freak", there's no need to explain how that's breaking the rules—it should be obvious to anyone who has read https://news.ycombinator.com/newsguidelines.html. You could hardly have broken them more blatantly—for example, the one against name-calling.

If you say you meant something else by it, I believe you, but that sort of intent unfortunately doesn't communicate itself—you have to encode it explicitly in your comment or else it will land with most readers as a garden-variety attack. I realize it sucks to have to do that—it's a constraint on expression—but there are constraints we have to live with in order to have a large, open internet forum that doesn't destroy itself.

If you'd just calibrate your comments to be more substantive and thoughtful, things should be fine.

For the record, this isn't an attack or accusation, it is a thought experiment via reductio ad absurdum.

Good fellow, perhaps you've wandered in here from another time? Maybe in 2011 this would've been a level-headed take on this platform -- but not now! Spontaneity, eclecticism, originality? No no, we're all Big Corp workers here, and we must all fall in line into our predefined paths. Hackers and rogues, best ye not speak; lest the hounds of conformity catch a whiff.

Money should only be spent reasonably. That is, put into a retirement fund, into savings, and other well-regarded things. Your life must be lived reasonably -- else we will tell you otherwise!

I.e. many other people only see one "good" way to live a life; only one "good" form of morality; only one "good" mindset.

And as much as I've enjoyed the originality of your posts, may I recommend ceasing? Share these morsels of a not-yet-snuffed-out humanity with your intimates, rather than strangers who don't care about the consequences of their words on others?

He spent it on gorging himself on fried chicken delivery and electronics he piles around his horde room. His parents have to manage him to keep him from suicide. It's not a funny situation.

As tactless as it is: that is amusing.

I have been in similar places, even the whole “stronger than the disorder, I don't need to take my meds.”

There’s a way out if he wants to get out. But many times the will is weak: toxic shame for one’s actions in less rational times; a crippling lack of meaningful and intimate relationships; and a life devoid of any pleasure as you slink into self-induced hermitage.

My unasked for recommendation? If I were interested in his recovery I would throw a CPTSD skills book (BPD can be caused by and reinforce chronic trauma) and a box of nicotine gum his way (the gum will numb him out enough to start thinking clearly).

Nonetheless, it’s still an amusing story that has given me the giddies.

Yeah, I don't think people realize how many conditions exist that are highly treatable now but were prolonged, miserable death sentences less than thirty years ago. Taking "too many pills" sounds bad on the face of it, but it's an infinitely better alternative than letting your intestines slowly rot inside your body or your nervous system fray itself to pieces.

Exactly. Nuance is the missing ingredient here, no pun intended.

I currently have untreated inappropriate sinus tach where my heart rate is continually 100+ BPM. This will require a cardiologist to sign-off, probably for ivabradine since beta blockers are giving me depression. And it's my understanding that node ablation has a low success rate and I'm not interested in a pacemaker.

There is no guarantee that pills would've helped your friend.

In fact, these medications can worsen a patient's condition.

As far as I know, there is no evidence-based treatment for BPD based in medication, except for basically what amounts to tranquilizers.

What's common is to prescribe SSRIs and similar medication for all kinds of psychiatric illnesses, including BPD. The evidence that this would help in the long-term is vague to non-existant, and I'd avoid trusting it (as with almost all research on anti depressants).

The best-researched facts about SSRI antidepressants are the increase in suicide rates and the "side effects", which are still often underreported, and include problems with basically all bodily systems, because serotonine is an importat t neurotransmitter. Not to forget about

https://en.wikipedia.org/wiki/Post-SSRI_sexual_dysfunction

SSRIs can also reduce life expectancy.

Personally, after being on an antidepressant (Effexor) for 6 years, I can also say that they massively reduced mental stability and self-awareness for me.

There are many meta-studies about this by now, somehow ADs are still seen aa evidende-based medicine comparable to insuline for diabetes. This is far from the truth, the mechanisms of action are poorly understood and effectiveness has been painted in an unrealistic way by pharma companies who make these pills.

https://www.bmj.com/content/370/bmj.m3200

Reminds me of Steve Jobs. He had the extremely rare TREATABLE form of pancreatic cancer, and the money for the best treatments, but died because he chose green smoothies over medicine.