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Antidepressants: Why the ‘Overmedicated America’ Narrative Is Harmful

We're in an epidemic of mental illness and in an epidemic of misinformation about mental illness. The myth that America is "overmedicated" regarding antidepressants only furthers the stigma that stops people from seeking help.

Drew Ramsey:  I think the big question in people's minds is who can they trust for their information about mental health? On the one hand we have big pharma, and there have been some incredible breakthroughs. I'm a psychiatrist. I prescribe medications and I find some people really it saves their lives. And you don't hear that in the media. This week I've heard a number of antidepressants called a miracle drug, a miracle cure and I don't take any money from big pharma I've just used these medications for over a decade now. For some people they're lifesavers. Then there's the supplement industry. And the supplement industry is really largely unregulated. They make a number of claims that really aren't supported by the evidence and it gets people into a notion, this happens a lot where instead of taking a medicine that's been closely studied and brought to market and closely monitored, they'll be taking five, ten, 15 different supplements. It's hard to know as a physician whether that's safe or not and whether that's really warranted. There's a lot of delay in terms of people getting appropriate treatment. Then, of course, we have talk therapies, which tend to take a longer time and cost more money.

So this is where I think food comes into the picture. One is we all can agree we trust. For the most part if it's a whole food it grows on a farm. There are concerns about big pharma out but I've never heard a concern about little farmers so that's where I try to direct people. And I also like it as a psychiatrist that it's one of my interventions that is absolutely delicious, that people like, that people can do for themselves. We're in an epidemic of mental illness and we're also in an epidemic of misinformation about mental illness. The amount of stigma that we see still and the embarrassment that my patients have for a victory over some of the most debilitating and disabling illnesses and deadly illnesses in the world, it's concerning as a doctor. I see people just profoundly ashamed by how they're feeling and the illness that they have. So I think we have a long way to go. I think we're getting there. I think more and more - I've been a psychiatrist for 16 years, there's a change in the conversation. People talk about having bipolar illness. People talk about being treated for depression. Men talk about being treated for depression really for the first time in history in a way that it gives me some hope that if we can have a more open conversation we can make a bigger dent. Now it's what more than 40,000 suicides a year in America. We have 600,000 veterans with severe traumatic brain injuries. We have a lot of work to be done.

And on the front lines of mental health I think I just try to remind myself to sit with my patients, to do no harm and to give them a menu of options. I think that's one of the things that's gotten missed in this whole discussion about mental health. People talk about how many people are kind of overmedicated in America and I always like to point out that ten percent of Americans that take antidepressants in the morning, they do that voluntarily because it's something that helps them. And I think that when we talk about an overmedicated society sometimes we miss the point. I would say that we're a mis-medicated society. I've seen a lot of people in my practice who are just on the wrong meds for the wrong reasons and I've met even more people who've never ever had a trial of even something natural like St. John's wort that has incredible evidence that it's a very, very good antidepressant. And I think that's the part, the folks who aren't getting any help that's the most concerning part to me because that's when people end up in real, real trouble.

Big Pharma has got itself a bad, bad name. Many people become nervous at the mention of pharmaceutical intervention for mental illness, but there's another solution that may bring ease to some: it's called little farmer, quips psychiatrist Drew Ramsey. For how food can control conditions like anxiety and depression, look through Ramsey's previous videos on Big Think. But here, Ramsey wants to address the popular notion that America is overprescribed. "I always like to point out that the ten percent of Americans who take antidepressants in the morning, they do that voluntarily because it's something that helps them." In his 16 years of psychiatric practice, Ramsey has more often seen mis-prescription rather than overprescription. But at least mis-prescribed people are on the path to finding the right treatment – much worse is the people who aren't getting any help at all whether it be diet, or therapy, or pharmaceuticals. Psychiatric medication isn't right for everyone, but in many cases it truly saves lives, says Ramsey. If we continue to propagate the over-prescription myth for this kind of medication (opiates are another issue), it may alienate those who need help from seeking it at all. Stigma doesn't help in the effort to reduce severe life disruption and suicide, which for the latter totaled 42,773 Americans in 2014, a steep rise from 29,199 people in 1999. Drew Ramsey's book is Eat Complete: The 21 Nutrients That Fuel Brainpower, Boost Weight Loss, and Transform Your Health.


Drew Ramsey's book is Eat Complete.

Does conscious AI deserve rights?

If machines develop consciousness, or if we manage to give it to them, the human-robot dynamic will forever be different.

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  • Does AI—and, more specifically, conscious AI—deserve moral rights? In this thought exploration, evolutionary biologist Richard Dawkins, ethics and tech professor Joanna Bryson, philosopher and cognitive scientist Susan Schneider, physicist Max Tegmark, philosopher Peter Singer, and bioethicist Glenn Cohen all weigh in on the question of AI rights.
  • Given the grave tragedy of slavery throughout human history, philosophers and technologists must answer this question ahead of technological development to avoid humanity creating a slave class of conscious beings.
  • One potential safeguard against that? Regulation. Once we define the context in which AI requires rights, the simplest solution may be to not build that thing.

A new hydrogel might be strong enough for knee replacements

Duke University researchers might have solved a half-century old problem.

Photo by Alexander Hassenstein/Getty Images
Technology & Innovation
  • Duke University researchers created a hydrogel that appears to be as strong and flexible as human cartilage.
  • The blend of three polymers provides enough flexibility and durability to mimic the knee.
  • The next step is to test this hydrogel in sheep; human use can take at least three years.
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Hints of the 4th dimension have been detected by physicists

What would it be like to experience the 4th dimension?

Two different experiments show hints of a 4th spatial dimension. Credit: Zilberberg Group / ETH Zürich
Technology & Innovation

Physicists have understood at least theoretically, that there may be higher dimensions, besides our normal three. The first clue came in 1905 when Einstein developed his theory of special relativity. Of course, by dimensions we’re talking about length, width, and height. Generally speaking, when we talk about a fourth dimension, it’s considered space-time. But here, physicists mean a spatial dimension beyond the normal three, not a parallel universe, as such dimensions are mistaken for in popular sci-fi shows.

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Predicting PTSD symptoms becomes possible with a new test

An algorithm may allow doctors to assess PTSD candidates for early intervention after traumatic ER visits.

Image source: camillo jimenez/Unsplash
Technology & Innovation
  • 10-15% of people visiting emergency rooms eventually develop symptoms of long-lasting PTSD.
  • Early treatment is available but there's been no way to tell who needs it.
  • Using clinical data already being collected, machine learning can identify who's at risk.

The psychological scars a traumatic experience can leave behind may have a more profound effect on a person than the original traumatic experience. Long after an acute emergency is resolved, victims of post-traumatic stress disorder (PTSD) continue to suffer its consequences.

In the U.S. some 30 million patients are annually treated in emergency departments (EDs) for a range of traumatic injuries. Add to that urgent admissions to the ED with the onset of COVID-19 symptoms. Health experts predict that some 10 percent to 15 percent of these people will develop long-lasting PTSD within a year of the initial incident. While there are interventions that can help individuals avoid PTSD, there's been no reliable way to identify those most likely to need it.

That may now have changed. A multi-disciplinary team of researchers has developed a method for predicting who is most likely to develop PTSD after a traumatic emergency-room experience. Their study is published in the journal Nature Medicine.

70 data points and machine learning

nurse wrapping patient's arm

Image source: Creators Collective/Unsplash

Study lead author Katharina Schultebraucks of Columbia University's Department Vagelos College of Physicians and Surgeons says:

"For many trauma patients, the ED visit is often their sole contact with the health care system. The time immediately after a traumatic injury is a critical window for identifying people at risk for PTSD and arranging appropriate follow-up treatment. The earlier we can treat those at risk, the better the likely outcomes."

The new PTSD test uses machine learning and 70 clinical data points plus a clinical stress-level assessment to develop a PTSD score for an individual that identifies their risk of acquiring the condition.

Among the 70 data points are stress hormone levels, inflammatory signals, high blood pressure, and an anxiety-level assessment. Says Schultebraucks, "We selected measures that are routinely collected in the ED and logged in the electronic medical record, plus answers to a few short questions about the psychological stress response. The idea was to create a tool that would be universally available and would add little burden to ED personnel."

Researchers used data from adult trauma survivors in Atlanta, Georgia (377 individuals) and New York City (221 individuals) to test their system.

Of this cohort, 90 percent of those predicted to be at high risk developed long-lasting PTSD symptoms within a year of the initial traumatic event — just 5 percent of people who never developed PTSD symptoms had been erroneously identified as being at risk.

On the other side of the coin, 29 percent of individuals were 'false negatives," tagged by the algorithm as not being at risk of PTSD, but then developing symptoms.

Going forward

person leaning their head on another's shoulder

Image source: Külli Kittus/Unsplash

Schultebraucks looks forward to more testing as the researchers continue to refine their algorithm and to instill confidence in the approach among ED clinicians: "Because previous models for predicting PTSD risk have not been validated in independent samples like our model, they haven't been adopted in clinical practice." She expects that, "Testing and validation of our model in larger samples will be necessary for the algorithm to be ready-to-use in the general population."

"Currently only 7% of level-1 trauma centers routinely screen for PTSD," notes Schultebraucks. "We hope that the algorithm will provide ED clinicians with a rapid, automatic readout that they could use for discharge planning and the prevention of PTSD." She envisions the algorithm being implemented in the future as a feature of electronic medical records.

The researchers also plan to test their algorithm at predicting PTSD in people whose traumatic experiences come in the form of health events such as heart attacks and strokes, as opposed to visits to the emergency department.

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