Not only we don’t understand the mechanism causing depression, we don’t really understand (as far as I am aware) why medications work or don’t work. I deal with mild depression sometimes, but this scares me off of considering medication for it. I’ve encountered so many horror stories of withdrawal symptoms... you really need to be at a point of desperation to consider drugs for it, imo.
I think a larger problem is that it’s such a crapshoot about which treatments will work for a given individual, pharmaceutical or not. It took me about 10 therapists with varying backgrounds before I finally found one that would help. It also took me trying several different medications to find a combination that’s actually effective. It’s a lot of work and effort, and most people suffering through depression, anxiety, or another debilitating mental health disorder don’t have the energy to keep trying over and over again after failing. For me it was actually a matter of life or death and needing to keep going for my family that drove me to keep trying.
I had a very similar experience to what you’re describing and most other folks I know that have ‘figured out’ a treatment share a similar experience as well (more info in a comment below).
I have bipolar disorder and take a stimulant, a mood stabilizer, and sometimes an antidepressant. I’ve done my best to make my personal and professional work schedule comfortable, do mindful breathing exercises, take almost all my meeting outside and walking, and try to exercize 3 times a week. It’s a lot to manage while having a family but it’s very worth it IMO
I suffer from PTSD due to childhood trauma which is ultimately the cause of my anxiety, depression, mood swings, etc,. Right now I’m seeing a therapist who specializes in trauma and going through EMDR (eye movement desensitization and reprocessing) treatment. I’ve also taken Wellbutrin (anti-depressant) and Lamictal (mood stabilizer) for the last 18 months or so.
I also just have to constantly keep busy. I fill my time with work and activities with my family. I rarely take downtime because if I do the dread and flashbacks rear their ugly heads.
I'm also on Wellbutrin and Lamictal and think it is a very underrated combination.
I highly recommend you read The Body Keeps The Score. Immensely insightful and well researched book that will change the way you think about overcoming trauma
That book is great! I picked it up when I started with EMDR. There are so many things I didn’t even consider until I started seeing a therapist specializing in PTSD and trauma and after reading that book. For the most part I didn’t even recognize my experience as traumatic until it was presented that way to me.
My first experience with an antidepressant left me feeling quite ill. Ironically, its one of the ones that gets prescribed often because it has little side-effects. Turned out that this wasn't true, and I was one of the small percentage who experienced Discontinuation Syndrome (https://www.karger.com/Article/FullText/370338).
Having such a bad reaction to it lead me down a wild goose chase toward finding out the way my body processes serotonin ala a gene test, helped me figure out what was causing the depression to begin with.
Another reply here talks about how it seems to be a crapshoot for finding effective drugs and a lot of trial and error. I think that there may be promise in doing drug targeting genetic tests and possibly microbiome sampling as a way to help people avoid the run-around. In my case, knowing this ahead of time would have helped me avoid a lot of suffering and 3 years of obsessively searching for answers.
I think what s/he's referring to are tests for mutations in certain liver enzymes that are known to interfere with a drugs function. These are cheap and quick tests (these aren't sequencing based tests) and quite good at predicting non-responders
On the other hand it can take 4-6 weeks to see if someone responds to a drug, and the drug can cause adverse events in addition to not treating the disease
So in this case it is cheaper, faster and safer to take the test before prescribing
The side effects of many of the medications can be quite harsh and severely affect your mental state when they don't agree with you.
The most obvious example of such would be the significant number of people who experience suicidal ideation or commit it/make attempts as a result of going on certain medications.
But at the less extreme end, you're likely looking at least a month or two, more likely 3 or 4 for each medication attempt. That's going on, taking it for long enough to have an effect, going back off, repeat.
With how severe the side effects can be for many, that's enough time to lose a job, fail out of college, etc. And you're asking them to potentially spend years in that cycle to maybe fine something that works.
Sadly this is true. "depression", like so many diseases, is named after its symptoms rather than etiology. So if we even have an effective drug, it will only be effective on a subset of the sufferers.
Plus we understand so little macro neurochemistry we don't even understand which apparently correlated biomarkers are causal and which are consequential. The same problem exists with other neurological diseases such as Alzheimers. With depression, as it seems to affect higher function, we even have difficulty (and treatment affordances) with non-chemical stimuli.
Still, it's very much worth working on -- people are suffering such serious debilitation.
I’ve benefited greatly from various medications combined with non-chemical strategies. When I first considered medication I talked with my Doctor, talked with some friends that are Doctors, and did my own research and every resource came up with the same basic info, we don’t actually know that much... Add onto that finding a combination of things that ‘worked’ was a trial and error process that took over a year, all while I was dealing with my mental health issues.
Sadly so many people in a similar situation don’t have the flexibility, access and/or support to go down the path that I did. Often they will opt out because of the stigma associated with having mental health issues.
The fact that we know so little leaves tons of room for improvement in addressing mental health, but I worry that we have a very long road to giant leaps in addressing mental health unless we can destigmatize mental disabilities (and other neurological conditions)
Most medications DON'T work for most people. For example here[1] is a meta-analysis from 2004 of the top 6 antidepressants which finds that 80% of the effect is achieved by placebo, and the remaining effect is statistically, but not clinically, significant (that is, the effect size is tiny). Here[2] is another follow-up that shows that there may be effects only in the most severely-depressed patients. In addition the theoretical foundation of many drugs is lacking - the seratonin theory underlying SSRIs, for example, is now widely rejected (although SSRIs continue to be prescribed for some reason probably relating to drug company profits).
Given the well-known addictive nature of most anti-depressants, I have always advised my friends to steer away from them, or wean themselves off, and favor talking therapies instead. Everyone else should do the same.
> The results reported here conclude the debate on the efficacy of antidepressants and suggest that antidepressants are clearly superior to placebo. They also suggest that baseline severity cannot be utilized to dictate whether the treatment should include medication or not. Suggestions like this, proposed by guidelines or institutions (e.g. the NICE), should be considered mistaken.
I'd expect any paper that shits on an entire field and especially on a massively profitable industry to be controversial. Here is Kirsch's reply to Fountolakis's paper, by the way: https://academic.oup.com/ijnp/article/15/8/1193/659638
Note that in this case it's psychologists calling the paper controversial. Psychologists in BPS, the organisation that put out shit like Understanding Psychosis[0] or Power Threat Meaning Framework[1] - for an anti-psychiatry organisation to call an anti-psychiatry document "controversial" shows the document is pretty poor.
That seems a strange reply to a comment that acknowledged medication only really has a real effect in severe cases.
Even for a friend who is severely depressed, which medication will work? How long does each one need to be tried for? What is meant by ‘work’ exactly? Meanwhile, the serious side effects aren’t even fully understood, and you’ll be buying them from companies that actively denied and hid such information from legislators and the public.
Meaning what you’ve pointed out is clear; the problem was the statement and not material discrimination. “No blacks allowed”, in America at least, was no idle threat.
While I'd never condone being rude, combative, or unnecessarily offensive, I think there's a time and a place to make waves.
And while the person doing so often personally suffers the consequences, it is a healthy signal to an organization that those opinions could be shared by others.
If nobody ever heard anything counter to the group-think, the organization itself would very quickly become stuck by momentum.
> If nobody ever heard anything counter to the group-think, the organization itself would very quickly become stuck by momentum.
Indeed, that's a great reason not to fire people when they're honest. And yet, here we are.
At least in SV tech companies, in my experience, people really get their feelings hurt over small amounts of honesty. More importantly, the conversations you'll have to have afterward and the way people will sit on it for months until it comes up in your review make it just not worth it.
I agree, but when you do that, you need to actually make an accounting of the costs/benefits. If you look among programmers and security specialists on say HN there is not even a debate or discussion about this, but rather an absolutist position that this is good and that the only reason to think this is bad is if you are a totalitarian government wanting to oppress your people.
I think you're conflating two different positions, which do admittedly co-occur in many people: 1. The technical, that any such "backdoor" is necessarily a backdoor, with all that implies, and thus to be eschewed on a "fundamental principles of good security" basis, and 2. The moral, that any such backdoor is crime against humanity, or whatever, because some of the people who have the technical capability will be leveraging it in order to oppress, and all of them will be doing so in order to act in a manner contrary to the user's interests.
Who do our tools serve? Is it just that they should be made to serve someone else, against us? Where, exactly, is the line on one side of which it's justified, but on the other it's abuse? How do you build a system that prevents abusive uses, but allows appropriate ones?
Decrying absolutist positions is all well and good, but it is a nigh-on tautology-level truth that a system with a flaw or backdoor, will be exploited — usually in multiple ways, and well beyond any potentially intended such.
Yeah yeah, but ultimately this all comes down to whether you think government interception of private messages is ultimately better than the messages staying private. People here obviously don't feel the same way you do about that.
Myself, I'm not quite so convinced as you seem to be of the harm of "absolutist" positions. Maybe the truth isn't always somewhere in the middle
The main reason I like the story is that it's good fodder for discussion about priorities in software development. After all, counting words isn't exactly an interesting problem in 2018, but deciding the effective use of libraries and programmer time is still very interesting.
I don’t understand the focus specifically on water bottles when this comes up, seems like any drink bottle would be just as problematic. I understand we don’t all have pipes that bring Coca-Cola to our homes, but when you’re out and need something to drink that ship has sailed.
I don’t understand the focus specifically on water bottles when this comes up.... I understand we don’t all have pipes that bring Coca-Cola to our homes
It sounds like you do understand the focus on the bottle that's easily replaced by opening a tap or using the water fountain that's found in most public places.
Likewise there's a lot of focus on replacing light bulbs with energy efficient alternatives, and less focus on replacing electric space heaters because light bulbs are easily replaced with little impact on the user (and indeed, save money over the long run) and are more common than electric space heaters.
The "everyone should change their way of life" approach to environmentalism hasn't worked and has been quite divisive, why do people continue to think it is an effective strategy?
Because the alternative is ultimately "Everyone probably won't get to stay alive". Which is a pretty big change in one's way of life.
Also, using cans instead of bottles isn't exactly a major shift in most people's life. It's infinitely recyclable (unlike plastic), something nature knows how to deal with (unlike plastic) and often better for the beverage (in the case of beer at the very least).
The alternative is the government intervening to internalize externalities. For example, a revenue neutral carbon tax or deposits on food/drink containers.
One way to encourage just that sort of city planning is, in fact, to price externalities appropriately. It's not actually cheaper to build and live in sprawl, it's fantastically expensive. But we don't charge those costs based on usage.
I can spend 400k to buy a nice four bedroom house with a garage and a basement on half an acre sixty miles from work, or 400k to buy a beat down 1 bedroom condo ten miles from work (nothing near the area where I work is under 900k)...
That's not really a city planning issue, it's just the way things are in hyper-urban areas.
I hope so much that I can pull off a remote job in the next year or so -- believe me, I'd rather never drive if I could.
If you had read the OP I was replying to, you would see they were suggesting everyone should buy and carry a Nalgene water bottle with them at all times, in case they needed water.
If you read further down this thread, many commenters in this thread are convinced that we should never package water.
Packaged water is useful when stockpiling for or responding to natural disasters (hurricanes, wildfire, tornadoes, earthquakes), emergency evacuation camps, places where safe, clean water and filters aren't easily accessible or used. Everywhere else, it's really unnecessary.
Ah, the answer I was looking for when I posted! I've long preferred cans (they seem to get and stay colder to me, although that may not be true), but wasn't sure about the environmental impact.
It's not exactly a crazy change to one's way of life. As recently as when I was a kid, people drank water out of cups. When we were out in public, we'd use a water fountain.
Carrying a water bottle with you everywhere you go is another option, but probably not strictly necessary unless you're currently trying to pass a kidney stone.
It's irrational, but people still talk about corporate responsibility in the same language they use to talk about the morality of their own and other people's behavior. Changes like these help establish the cultural consensus that environmental damage is a bad thing that should be avoided even if it means we have to invest cost and effort in change.
That's useful, however, that's not even close to the order of magnitude of lifestyle change required to counter climate change. Instead of not littering, think not using a car; instead of banning disposable bags, think banning beef; one could go on - restructuring cities to use less transportation, drastic reduction in air transport (so, no overseas travel for most people), etc. Sure, such lifestyle change is possible as well, however, instead of a fraction of people who currently volunteer to do it, we need to ensure that the vast majority of global population do so, and we need to ensure that they do it quickly enough. Which is unlikely to happen without massive coercion.
This sort of thinking is the exact problem. It works from the point of "what should we do if we think environmental concerns are the biggest priority". IMo the correct lense should be "what is the minimal amount of change/political capital we need to achieve our objectives for the environment", for different targets.
I agree that "what is the minimal amount of change/political capital we need to achieve our objectives for the environment" is a very good perspective to apply.
However, from that perspective is obvious that "littering, disposable bags" isn't even in the same ballpark. IMHO it would be counterproductive to motivate people with such goals, since if the end result is that they stop littering, switch to reusable bags and think "yeah, now I've done my part"... it's wrong, they're still contributing about 99% of the damage that they used to do, it's nowhere close to sufficient. Right now (unlike, say, the 1980s) the minimal amount of change is very, very large - currently, achieving our objectives for the environment requires changes that would be considered radical by pretty much everyone, and political capital that no current leader has.
Raise the gas price by a few percent, and you get rioting in the streets. Would anyone have enough political capital to double the gas price, so that people actually burn significantly less oil? And would the transport reduction achieved by merely doubling the gas price be sufficient to reduce the emissions? IMHO the answer to both these answers is a clear NO, the minimal amount of change needed is larger than the maximal amount of change for which we have political capital.
But all of the things you advocate for in your previous post are things that could be achieved with less pain.
Even the fuel tax, while the goal is to drive change, you can drive change by rewarding the desired behaviour (e.g. a revenue-neutral gas/carbon tax that paid back to low income folks), rather than punishing people. Maybe not as drastic a change since you don't get people not driving because they can't afford it, but it would incentivize doing something else to the same extent.
Or we could be much more aggressive about moving people to electric cars. Or we could simply invest more money/energy into making public transport better.
We could say try and convince people to fly less, or we could legislate carbon offsets for air travel.
So while, yes, serious change is needed, I think we really need to think about this from a political angle, rather than a moralising angle.
I would avoid even touching the diet angle if you want people to listen to you and not write you off. Meat does contribute noticeably to global warming, but food is culture, it is the hardest change to achieve, so we should really leave it to last, politically. It would be far better to deal with meat in an overall carbon tax solution, rather than singling it out as a thing people have to change.
We used to just use public drinking fountains. Or paper cups at the office water cooler. And kids drank out of water fountains in parks, or out of random garden hoses they found.
Yesterday I saw a kid with a fancy Nalgene... at church!
I have a pill that I take which has dry cough as a side-effect, and even I don't bring a water bottle to church. The kid's not going to shrivel up and blow away because he can't have a sip of water for 45 minutes.
I think it's really important for people to carry their own plate/bowl, cup, and utensils that they can use and wash on their own that they carry around with them wherever they go. The whole disposable plate/utensil industry could be removed if everyone just brought their own!
I can't tell if you're being serious or not, but I actually do this. I've got a spork, a glass cup, a metal straw, and a fabric napkin that I bring with me everywhere. If I'm going somewhere I know that I'll want to bring food home I'll also bring one of my metal lunch containers.
I'm carrying a backpack anyway and this is a really small amount of things to bring around. It's a very small impact from a single person, but every few times someone will say "ooh, that's a good idea" or something like that and it makes me feel like the idea is spreading.
The ADA forced the designs for water fountains to change and they have been unreliable, low-to-no flow, and too short for most people ever since. People had to learn to carry water with them when before they just drank out of a fountain when they were thirsty. At least there has been a rise in the bottle filling dispensers so that filling up your bottle is not such a pain.
Probably because it’s a relatively new problem. People drink more water than other drinks like Coke, so the impact factor is high. We also have infrastructure to deliver water without bottles (the tap), but we don’t for other drinks.
Right, I see water as particularly egregious as it's a natural product (literally pumped straight from the ground) and should be accessible in clean form anywhere in the developed world (aka most places where water bottles are commonly bought and thrown away). The solution to dirty water shouldn't be putting clean water in plastic bottles and shipping it around the world, it should be making sure water is clean enough that anywhere you go you can drink the local water without needing to buy a one-time-use plastic bottle.
It doesn't help that our solution to dirty water (plastic bottles) is making even clean water unusable (microplastic).
The infrastructure to deliver other drinks without bottles is easy and has existed since the 19th century. Just ship the flavoring agents in some sort of syrup form, and mix it with water at the dispensation site. Force-carbonate it onsite, if you like.
Compared to bottles, it has the added advantage of being really inexpensive. So much so that, when places like gas stations and convenience stores sell the same beverage in both fountain and bottled forms, the fountain version is typically sold at a steep discount relative to the bottled one.
on the other hand, this method has the substantial disadvantage that beverages delivered this way usually taste significantly worse than their bottled counterparts.
I suspect "natural" products like fruit juice necessarily suffer from being made into concentrates and reconstituted on demand. I'm not sure why it should be this way with soda, but in my experience soda from a bottle always tastes way better than from a fountain.
>beverages delivered this way usually taste significantly worse
As someone who prefers fountain soda and avoids bottle sodas due to taste (i believe it is level of carbonation), this is highly subjective and I urge you to look beyond your personal tastes (heh) on this subject.
The article talks exactly about this, and it still doesn’t address the fact that waste is still generated when we have better infrastructure for moving clean water.
Because water is fungible, can be produced locally, is piped into homes, and is the most abundant liquid on the planet. Shipping it around in tiny little bottles is phenomenally inefficient. A total waste. There is no reason why we cannot fill reusable water bottles on the go rather than purchase flimsy containers.
Besides clean sources of water not being everywhere. Then again, drinks fountains are much more of a thing than e.g. over here. Of course, over here most if not all taps provide clean drinking water.
Bottled water is the number one selling packaged beverage in America. That's fucking stupid considering clean safe drinking water is abundant and ubiquitous in America.
I'll buy that it's the top seller, but are the majority of bottled drinks water? Because when I go to a convenience store there is usually one fridge for bottled water and several for all the other stuff (soda, tea, juice, Gatorade etc).
I don't think all of that really matters anyway, because the point I'm making is: anything that's bad about a plastic bottle filled with water surely must be just as bad for a plastic bottle filled with water and a little bit of sugar and coloring. Nobody has really addressed this, and I just think it's strange.
I'm fine with the idea that we should address this by drinking tap water instead of bottled water. All I'm saying is that surely the same goes for other bottled drinks as well.
Yes. As the top comment says, we need to switch to fully reusable & easily recyclable (eg not plastic) bottles, but water is the most obvious fucking stupid thing to put in a bottle, so we can start there.
Sprite isn't shipped very much in bottles. The soda companies are very good at shipping concentrate and then adding water locally. Bottled water is different in that the entire transport occurs as water.
I don’t believe your last sentence is correct in the case of brands like Dasani that are just filtered tap water. And for drinks other than water the bottles still have to get made and disposed of. Again, they are all just bottled water with a little bit of extra stuff in them, so whatever impact bottled water has, they all must have as well.
No, they're not. When someone says "I need a drink," reasonable people do not interpret that as "I literally cannot continue without immediate hydration."
>I don’t understand the focus specifically on water bottles when this comes up, seems like any drink bottle would be just as problematic.
I suspect people drink far more bottles of water than soda, simply based on the price of an entire flat of water compared to a 6-pack of 20 ounce sodas.
I did something similar once but failed to glean such a valuable lesson from the experience. My takeaway was, those people are touchy so leave their shit alone. Not because it’s right but because I’m just trying to get through my day, and i don’t need more politics in my working life. People can be assholes, it’s just how it is sometimes so let them be.
Among my own team, if I raise points or ideas that get disregarded in this manner (as opposed to more thoughtful demurrals), I let it go and don’t push the issue. I’ll speak up if I think I have something worth considering, but I’m not going to beat you over the head to see things my way.
Still, the takeaway regarding being on the other side of that table is really important. Once you start feeling that indignant reaction or “yeah right newbie”, listen harder.
I've fallen in the same trap. And you're right, you can't fight every battle. But I think the best approach is not to make it a battle in the first place. Sometimes bringing things up in the right way and with the right energy helps people be more receptive to your advice.
I don’t want to fight battles, at all. At least not in my working life but really not anywhere else either.
I’ve seen a lot and done a lot in my career, and I don’t feel I have anything to prove to anyone anymore. On the other hand I do find it enjoyable to discuss ideas in a collegial environment where people really are trying to figure out what’s best.
If we can agree on ideas as equals and proceed then great. If not, I’ll live. If someone gets mad because I had an idea to improve something I’m not going to get too twisted up about it. Life is too short for all this stuff, and it isn’t important in the scheme of things.
To be a bit glib, unit tests don’t catch security vulnerabilities. Maybe I’d agree this can happen to any project, but my example might be something more like OpenBSD
In this specific case, a unit test that checked this integer overflow seeems to prevent the vulnerability.
To be clear: This is not to admonish sqlite. They have taken testing further than any other project i've heard of, except maybe the NASA software that might cost lives if it fails.
