Lorien Psychiatry

For anyone who is looking for information on the different kinds of antidepressants mentioned in this game (which I failed most completely despite being broadly familiar), here is a great article from Dr. Scott Siskind (aka Scott Alexander of SlateStarCodex/AstralCodexTen): https://lorienpsych.com/2021/06/05/depression/ I am not a huge fan of Siskind on all things but he has a great ability to explain complex topics simply when he is an expert, and he is on this.

I'm sorry, I misunderstood your post. I hope you do not hurt yourself. I don't know your circumstances but there are hotlines you can call to talk to someone. In case you have not seen it, Scott Alexander (a psychiatrist) has a resource on antidepressent supplements here: https://lorienpsych.com/ also here: https://slatestarcodex.com/2014/06/16/things-that-sometimes-help-if-yo… Wherever you live there are also suicide prevention hotlines you can try calling.

> If one day I open up my own psychiatric practice, I am half-seriously considering using a picture of a hair dryer as the logo, just to let everyone know where I stand on this issue. He didn't, as it turns out. https://lorienpsych.com/

Right...cause the man isn't taking appointments. Oh wait, he is still practicing. https://lorienpsych.com/

A lot of people seem to be wanting to discuss ADHD medication and Adderall in particular. I highly recommend this writeup: https://lorienpsych.com/2020/10/30/adderall/ It covers a few common myths and misconceptions (eg, around addictiveness).

Hard to answer precisely without knowing what conventional wisdom didn't stick. The common levers I know and that worked at least a bit for me: - start by having a fixed waking time, and get sunlight or bright light quickly after waking up. Normally relatively fixed sleep time is supposed to follow. For me waking up is the easy part, transforming that into getting up and going outside is harder. Another option here is a strong (like, really strong) lamp on a timer, or letting the morning light in your bedroom (this one is usually not recommended I think, most people seem to be blackout curtains style, but for me it gave me a nice 6am waking time with good sleep last summer). - melatonin. Two main ways: using it as a kind of hypnotic, so ~30 minutes before sleep, experimenting with 0.3mg to ~2mg doses ; then using it as a circadian regulator, this is a good resource https://lorienpsych.com/2020/12/20/melatonin/, search for "TO TREAT" in the page. - app timers, for me it was mostly no twitter and no youtube, or a very low time for each. - light, ie reduc light before sleeping. Not just blue light and not just screens, if I'm on my phone in bed I'll reduce the luminosity a lot, same with computer, same with e-reader. I also try to avoid using too much the lights in my room. More light tend to make me feel more "wired" and less ready to sleep. - "meditation" to cut rumination, by which I mean "lay down in my bed, gently try to find sensations in the body and to stay…

> Ideally, a professional will prescribe them as a necessary helper to becoming (more) mentally healthy whilst tackling the root cause. I wish people would stop saying this. Our understanding of the brain is not sufficiently sophisticated to allow us to identify the "root cause" (whatever that means) of depression in most people. Indeed we have no reason to believe that there even is a root cause to most people's depression. If you take antidepressants, go to therapy (or meditate or exercise or whatever), then go off them and still feel good, that's great. And if you take antidepressants indefinitely because doing so improves your life, that's also great! Your life is improved! This isn't an "abuse" of the drugs. No psychiatrist is making you do anything. They're advising you based on their clinical judgement and experience, but ultimately it's your decision to take the pills or not. If your goal is to go on antidepressants temporarily, any decent psychiatrist will support you in that (because, again, they understand that they can't make you take the pills one day longer than you want to). I've been on Lexapro and done evidence-based therapy for years. They both have been helpful, but if I had to pick one, I'd immediately pick Lexapro. For me it is a miracle drug. And the miracle is, I can choose how I feel. (I also added a small dose of Buspar to help with the sexual side-effects.) If you're on the fence about trying an antidepressant, I really encourage you…

Counterpoint: SSRIs were transformative for my depression. Side effects were minor and manageable (eg, Wellbutrin worked well to prevent any sexual dysfunction). I was on them for several years and had no problem tapering off. My understanding is that this is a pretty typical experience. Rhetoric like this was actively harmful in dissuading me for years from trying what ended up being by far the most effective treatment for me. (yes, I've tried psychedelics; they're fascinating and super promising, but at least for me, not transformative in the way that fluoxetine was) No individual depression treatment works for everyone. SSRIs are not a magic bullet. Neither are psychedelics. But if you're depressed and haven't tried SSRIs, you owe it to yourself and everyone in your life to at least test the hypothesis that they might help. Scott Alexander's page on SSRIs is a great, relatively objective resource, from a psychiatrist who regularly prescribes them: https://lorienpsych.com/2020/10/25/ssris/

You don't understand one thing: we actually care. Like, we really, really care :) (at least that's my perception of many fellow EAs) People behind those charities have diverse backgrounds in social sciences, philosophy, economics, and welcome better ways to do more good, better. If we are not reducing suffering, we will investigate, and try to do better. If we're only decreasing malaria death statistics and increasing death by other means, if we're not effective, we really want to know. Some very skilled social scientists are working on this problem -- many in the field, talking to people, going to poor places where things like tropical diseases happen. I think giving more weight to the psychological and broader human side is a fundamentally important point as well (which I agree with and have voiced opinions about), but we also have to remember the basic realities of the diseases (like malaria or diseases that cause lifelong blindness!), and the reality of living in extreme poverty. In the end I recommend that you see documentaries about people living in poverty, visit them if you can, to solidify your decision (and tell it to others -- communication is real and important!) I have just heard of the Happy Lives Institute which seems to be looking at the global mental wellbeing perspective (note: I have done 0 research on them, but the idea seems good!), and I admire Scott Suskind's free website that gives evidence-based treatment guides for mental health issues[1]. Maybe…

Interesting. I love Scott, but I didn't know there was a draft on ACX. The official page is on his website: https://lorienpsych.com/2021/06/05/depression/ I'll have to see how the articles differ... 1. Yea. It was hard to find someone with availability period, and our insurance isn't very good. You're probably right that I should just pay out of pocket, but I'm honestly pretty convinced that I have an actual brain chemical issue, so I'm dubious of the benefits to therapy 2. I think I do a decent enough job at this. I don't necessarily eat the best food, but at least I'm eating some fruits and vegetables and not Doritos all of the time. I don't really exercise much, but at least I go on 30+ minute walks every other day or so. I probably sit in my chair to much, but I imagine most on HN do that... What led you to getting better? How were you able to function in such suffering for 10 years? Not to turn it into talking about me again, but I'm increasingly worried that I've wasted a year and may waste many more to this nothingness, which is quite concerning. How do you look back on your 10 years and say "it's OK, I needed to go through that/I'm happy I'm better now"?

You may have a circadian rhythm disorder, e.g., delayed sleep-wake phase disorder (DSWPD) [1]. It is rare in the general population (<1%) but my intuition is that software engineers are overrepresented. Irrespective of whether you do, there are likely concomitant behavioral issues that are exacerbating the issue. I struggled with sleep for years. I had difficulty falling asleep before 2am or so, difficulty getting out of bed, and any multi-day period without obligations (e.g. holiday) inevitably resulted in my bedtime shifting by an hour or more each consecutive night. Tried everything. Described symptoms to several somnologists, primary care doctors, psychiatrist, psychologist, etc. Last couple of years I saw improvement. What helped was: - 0.5mg melatonin 7 hours before bedtime [2] [3] - Do a CBT-I program with a psychologist --- Taking melatonin near bedtime did absolutely nothing for me. Taking melatonin at 5pm was magic. Symptoms that had persisted for years evaporated within two weeks. CBT-I is very effective for behavioral issues but it's not magic. It is expensive and take a lot of time and effort. Don't use a self-directed app or book. Find a psychologist who specializes in CBT-I. Insurance may not cover it. It will require a couple of months of effort and cost $2,000 or so. It is worth every penny. Everyone knows that light can affect your circadian rhythm, but body temperature can as well. Cold = sleep, warmth = wake. Consider investing in something that…

we don't know. https://lorienpsych.com/2021/11/02/ketamine/#11_How_does_ketamine_work the opiate receptor interaction might be important, but it seems that the antidepressant effect persists even if the opiate pathway is blocked (via naltrexone) https://pmc.ncbi.nlm.nih.gov/articles/PMC6439824/ (though it's an open-label super small study ... n=4)

I know you've probably already tried lots of things, and you're also inundated with ideas from others, but: Here's a psychiatrist's guide to solving insomnia: https://lorienpsych.com/2021/01/02/insomnia/ And here's a psychiatrist's guide to solving nightmares: https://www.astralcodexten.com/p/peer-review-nightmares Prazosin is the standard drug for PTSD-related nightmares: https://en.wikipedia.org/wiki/Prazosin

Not a lot of people know this, but depression also has a collection of effects on the body. https://lorienpsych.com/2021/06/05/depression/

A psychiatrist has written about it. https://lorienpsych.com/2020/10/30/adderall/#8_If_I_keep_taking_Addera…

If the light box isn’t working the problem may be that you’re just using enough. People go up to 90,000 lux. https://lorienpsych.com/2020/12/19/light-therapy/#:~:text=Eliezer%20Yu…

I've actually moved into management because it's very on-demand in many ways, which means I don't need as much self motivation and deep focus as an engineer. People I have to see in meetings are expecting me and the scope and diversity of stuff I work on is significantly increased. People would think it's the other way around as a manager, but it's not as much as you think. I still rely on writing a lot of things down to keep myself structured and make plans too. So far my reports and my manager are pretty happy with me as far as I can tell. Also going into therapy and getting meds will also help you a bunch. I think that will be more effective than necessarily trying to find the right kind of company. Try looking at this guide about adderal by a psychiatrist: https://lorienpsych.com/2020/10/30/adderall/

My 2c (not a Dr.): * ADHD diagnosis could be useful for self-knowledge and for maybe acquiring medication; * not sure what the neurological tests give you above and beyond a psychiatrist's expert judgement. Seems like they've got incentives to run expensive tests/use expensive machinery that don't necessarily align with the patient's. I benefited from Concerta at a job but the self-knowledge gained from looking hard at my own abilities and disabilities was much more valuable. You might find the same. Here's a resource on adderall you might find valuable: https://lorienpsych.com/2020/10/30/adderall/

"According to this study[1], morning exercise might be more helpful; there is no sign that evening exercise disrupts sleep, but it might not help as much either." From https://lorienpsych.com/2021/01/02/insomnia/ which also has other advice [1] https://sci-hub.st/https://www.sciencedirect.com/science/article/abs/p…

Details are on the site: https://lorienpsych.com/schedule-payment/

The evidence for antidepressants is not based on the serotonin theory of depression. It's based on blinded placebo studies. The serotonin theory was posited after MAOI antidepressants were discovered. It's been argued that antidepressants aren't significantly better than placebo. There's a good discussion of that here: https://lorienpsych.com/2020/10/25/ssris/#3_How_effective_are_SSRIs There's also a background debate here over whether depression should be seen as biological/chemical or environmental. This comes up in the article toward the end: > Although viewing depression as a biological disorder may seem like it would reduce stigma, in fact, research has shown the opposite, and also that people who believe their own depression is due to a chemical imbalance are more pessimistic about their chances of recovery. The thing is, if you're not a dualist, there's no reason depression can't be chemical and environmental. Clearly life circumstances can lead to depression and making changes (diet, exercise, leaving a job, leaving a relationship, undertaking therapy) can be a way out. Most doctors understand this and that doesn't discredit medication as a potential option.