DanBC's recent activity

  1. Comment on <deleted topic> in ~talk

    DanBC
    Link Parent
    What about OP's description makes you think the severe mental illness of bipolar is likely?

    Is there any chance she has bipolar disorder

    What about OP's description makes you think the severe mental illness of bipolar is likely?

    2 votes
  2. Comment on <deleted topic> in ~talk

    DanBC
    Link Parent
    This is one of the reasons why the US spends so much on healthcare but gets terrible results.

    And not referring the patient to a Psychiatrist was also somewhat questionable as well, IMO.

    This is one of the reasons why the US spends so much on healthcare but gets terrible results.

    3 votes
  3. Comment on <deleted topic> in ~talk

    DanBC
    Link Parent
    I have a choice. I can listen to internationally recognised evidence-based healthcare organisations, or I can listen to someone on the Internet. Which should I pick, and why?

    My point is that, as someone who has been through a ton of different meds (nothing works for my depression, not even duloxitine. Even that only helps with the panic attacks), I dont think duloxitine is suitable as a first antidepressant to go on.

    I have a choice. I can listen to internationally recognised evidence-based healthcare organisations, or I can listen to someone on the Internet. Which should I pick, and why?

    1 vote
  4. Comment on <deleted topic> in ~talk

    DanBC
    Link Parent
    I don't understand the worry. OP's girlfriend was given treatment that conforms to best practice in many places. She's provided all the information she needs, and has access to two qualified...

    We only have OP's word to go on for any of this, and OP is a secondary source. However, I see no reason not to give them the benefit of the doubt. They are clearly stressed and worried (understandably), but once you strip away the hyperbole,

    I don't understand the worry. OP's girlfriend was given treatment that conforms to best practice in many places. She's provided all the information she needs, and has access to two qualified registered healthcare professionals that she can ask questions of (the doctor and the pharmacist).

    I'm unable to strip away the hyperbole, because that hyperbole caused OP to tell their GF to ignore medical advice.

    2 votes
  5. Comment on Should Tildes have rules for healthcare advice? in ~tildes

    DanBC
    Link Parent
    The national guidelines bit isn't to make sure that advice is applicable in every country where Tildes is used, it's to slow people down a bit before posting inflammatory and incorrect advice....

    The national guidelines bit isn't to make sure that advice is applicable in every country where Tildes is used, it's to slow people down a bit before posting inflammatory and incorrect advice.

    There's a big difference between "here's what I reckon" and "here's what I reckon, and that's supported by this national standards organisation here".

    3 votes
  6. Comment on <deleted topic> in ~talk

    DanBC
    (edited )
    Link Parent
    This is absolutely untrue. (Not a great source, but the person quoted is credible) https://brevardhealth.org/can-family-medicine-doctors-prescribe-anti-depressants/

    This is absolutely untrue.

    (Not a great source, but the person quoted is credible) https://brevardhealth.org/can-family-medicine-doctors-prescribe-anti-depressants/

    Dr. John Greden is a psychiatrist and director of the University of Michigan’s Depression Center has expressed the fact that many patients with mild to moderate depression often receive appropriate treatment from their general practitioners. He says, “The notion that everybody with depression should be treated by a mental health professional is ridiculous.” He later added that with depression that is intractable or severe, a referral to a psychologist or psychiatrist is often in the best interest of the patient.

    5 votes
  7. Comment on <deleted topic> in ~talk

    DanBC
    (edited )
    Link Parent
    But if OP had read the leaflet they would have seen that these meds are licensed and used for anxiety, and that may have calmed some of their fears. Don't forget we're also only getting OP's side,...

    But if OP had read the leaflet they would have seen that these meds are licensed and used for anxiety, and that may have calmed some of their fears.

    Don't forget we're also only getting OP's side, and OP wasn't in the appointment.

    And the answer to "we didn't get enough information" is "go back and ask for more information", it isn't "you're right, this doctor nearly killed your GF, go find another doctor immediately".

    4 votes
  8. Comment on <deleted topic> in ~talk

    DanBC
    Link Parent
    In the US family doctors prescribe a lot of mental health meds. https://www.reuters.com/article/us-drugs-mental-idUSTRE58T0NE20090930 You're right that the doctor should have mentioned...

    In the US family doctors prescribe a lot of mental health meds. https://www.reuters.com/article/us-drugs-mental-idUSTRE58T0NE20090930

    You're right that the doctor should have mentioned discontinuation effects. But all meds come with a patient information leaflet. You must always read and understand those leaflets before taking your meds.

    I'm trying to find the US national guidance (and struggling a bit), but here's Canada's advice - use SSRIs /SNRIs rather than benzos, only use benzos short term while waiting for SSRIs to take effect.

    https://bmcpsychiatry.biomedcentral.com/track/pdf/10.1186/1471-244X-14-S1-S1.pdf

    Table 10 shows medications that have Health Canada approved indications for use in different anxiety and related disorders [84], and dosing suggestions are shown in Additional file 1. Various antidepressants including selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), noradrenergic and specific serotonergic antidepressants (NaSSAs), tricyc-lic antidepressants (TCAs), monoamine oxidase inhibitors(MAOIs), and reversible inhibitors of monoamine oxidaseA (RIMAs) have demonstrated some efficacy in the treatment of anxiety and related disorders (see Sections 3–9for evidence and references). SSRIs and SNRIs are usually preferred as initial treatments, since they are generally safer and better tolerated than TCAs or MAOIs [32].

    Benzodiazepines may be useful as adjunctive therapy early in treatment, particularly for acute anxiety or agitation, to help patients in times of acute crises, or while waiting for onset of adequate efficacy of SSRIs or other antidepressants [32]. Due to concerns about possible dependency, sedation, cognitive impairment, and other side effects, benzodiazepines should usually be restricted to short-term use, and generally dosed regularly rather than as-needed

    Here's more advice: https://www.wfsbp.org/fileadmin/user_upload/Treatment_Guidelines/Bandelow_et_al_01.pdf

    Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and pregabalin are recommended as first-line drugs due to their favorable risk-benefi t ratio, with some differentiation regarding the various anxiety disorders (Table III).

    If OP was saying "they should have tried a more intensive therapy first" I'd agree, but OP seems to be saying that an SNRI is a bad med. That's wrong, SSRIs/SNRIs are widely recognised as a good first line choice of med.

    5 votes
  9. Should Tildes have rules for healthcare advice?

    Sometimes Tildes users give people healthcare advice. Sometimes that advice disagrees with the advice already given by a qualified registered healthcare professional. That might be okay if the...

    Sometimes Tildes users give people healthcare advice. Sometimes that advice disagrees with the advice already given by a qualified registered healthcare professional. That might be okay if the tildes advice was compliant with national guidance, but sometimes it isn't. Sometimes it's bad, dangerous, advice.

    Should Tildes have rules about this?

    16 votes
  10. Comment on <deleted topic> in ~talk

    DanBC
    Link Parent
    Duloxetine is a safe and well known med. This entire thread is baffling. https://bnf.nice.org.uk/drug/duloxetine.html#indicationsAndDoses

    Duloxetine is a safe and well known med. This entire thread is baffling.

    https://bnf.nice.org.uk/drug/duloxetine.html#indicationsAndDoses

    Generalised anxiety disorder

    By mouth

    For Adult

    Initially 30 mg once daily, increased if necessary to 60 mg once daily; maximum 120 mg per day.

    2 votes
  11. Comment on <deleted topic> in ~talk

    DanBC
    Link Parent
    This was not reckless. Why do you think it was? Duloxetine is licensed for use in generalised anxiety disorder. It's far safer to give an snri than benzos.

    This was not reckless. Why do you think it was? Duloxetine is licensed for use in generalised anxiety disorder. It's far safer to give an snri than benzos.

    5 votes
  12. Comment on <deleted topic> in ~talk

    DanBC
    Link
    I'm a bit confused. SNRIs are far safer than benzos. They do have discontinuation effects for some (but not all) people, but they're not addictive. Benzos are addictive. SNRIs are also more...

    I'm a bit confused. SNRIs are far safer than benzos. They do have discontinuation effects for some (but not all) people, but they're not addictive. Benzos are addictive. SNRIs are also more effective than benzos.

    https://www.nice.org.uk/guidance/cg113/chapter/1-Guidance

    STEP 4: Complex treatment-refractory GAD and very marked functional impairment, such as self-neglect or a high risk of self-harm

    Highly specialist treatment, such as complex drug and/or psychological treatment regimens; input from
    multi-agency teams, crisis services, day hospitals or inpatient care

    STEP 3: GAD with an inadequate response to step 2 interventions or marked functional impairment

    Choice of a high-intensity psychological intervention (CBT/applied relaxation) or a drug treatment

    STEP 2: Diagnosed GAD that has not improved after education and active monitoring in primary care

    Low-intensity psychological interventions: individual non-facilitated self-help, individual guided self-help and psychoeducational groups

    STEP 1: All known and suspected presentations of GAD

    Identification and assessment; education about GAD and treatment options; active monitoring

    And for medication:

    Drug treatment

    1.2.22 If a person with GAD chooses drug treatment, offer a selective serotonin reuptake inhibitor (SSRI). Consider offering sertraline first because it is the most cost-effective drug, but note that at the time of publication (January 2011) sertraline did not have UK marketing authorisation for this indication. Informed consent should be obtained and documented. Monitor the person carefully for adverse reactions.

    Note that this is an off-label use for some SSRIs. See prescribing medicines for more information. [2011, amended 2020]

    1.2.23 If sertraline is ineffective, offer an alternative SSRI or a serotonin–noradrenaline reuptake inhibitor (SNRI), taking into account the following factors:

    tendency to produce a withdrawal syndrome (especially with paroxetine and venlafaxine)

    the side-effect profile and the potential for drug interactions

    the risk of suicide and likelihood of toxicity in overdose (especially with venlafaxine)

    the person's prior experience of treatment with individual drugs (particularly adherence, effectiveness, side effects, experience of withdrawal syndrome and the person's preference).

    Note that this is an off-label use for some SSRIs. See prescribing medicines for more information. [2011, amended 2020]

    1.2.24 If the person cannot tolerate SSRIs or SNRIs, consider offering pregabalin.

    As of 1 April 2019, pregabalin is a Class C controlled substance (under the Misuse of Drugs Act 1971) and scheduled under the Misuse of Drugs Regulations 2001 as Schedule 3. Evaluate patients carefully for a history of drug abuse before prescribing and observe patients for development of signs of abuse and dependence (MHRA, Drug Safety Update April 2019). [2011, amended 2020]

    1.2.25 Do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises. Follow the advice in the 'British national formulary' on the use of a benzodiazepine in this context. [2011] [Bold added]

    1.2.26 Do not offer an antipsychotic for the treatment of GAD in primary care. [2011, amended 2020]

    1.2.27 Before prescribing any medication, discuss the treatment options and any concerns the person with GAD has about taking medication. Explain fully the reasons for prescribing and provide written and verbal information on:

    the likely benefits of different treatments
    

    the different propensities of each drug for side effects, withdrawal syndromes and drug interactions (consult the interactions section of the British National Formulary)

    the risk of activation with SSRIs and SNRIs, with symptoms such as increased anxiety, agitation and problems sleeping

    the gradual development, over 1 week or more, of the full anxiolytic effect

    the importance of taking medication as prescribed and the need to continue treatment after remission to avoid relapse. [2011, amended 2020]

    1.2.28 Take into account the increased risk of bleeding associated with SSRIs, particularly for older people or people taking other drugs that can damage the gastrointestinal mucosa or interfere with clotting (for example, NSAIDS or aspirin). Consider prescribing a gastroprotective drug in these circumstances. [2011]

    1.2.29 For people aged under 30 who are offered an SSRI or SNRI:

    warn them that these drugs are associated with an increased risk of suicidal thinking and self-harm in a minority of people under 30 and

    see them within 1 week of first prescribing and

    monitor the risk of suicidal thinking and self-harm weekly for the first month. [2011]

    1.2.30 For people who develop side effects soon after starting drug treatment, provide information and consider one of the following strategies:

    monitoring the person's symptoms closely (if the side effects are mild and acceptable to the person) or

    reducing the dose of the drug or

    stopping the drug and, according to the person's preference, offering either

    an alternative drug (see recommendations 1.2.23 to 1.2.24) or

    a high-intensity psychological intervention (see recommendations 1.2.17 to 1.2.21). [2011]

    1.2.31 Review the effectiveness and side effects of the drug every 2–4 weeks during the first 3 months of treatment and every 3 months thereafter. [2011]

    1.2.32 If the drug is effective, advise the person to continue taking it for at least a year as the likelihood of relapse is high. [2011]

    8 votes
  13. Comment on Why QAnon is disappearing from online view in ~tech

  14. Comment on Life at disaster's edge: What it means to start over - again and again in ~life

    DanBC
    (edited )
    Link
    Here's a link to the Google Map for Basan Char - an island off Bangladesh that's being used to rehome Rohingya people. It's not great....

    Here's a link to the Google Map for Basan Char - an island off Bangladesh that's being used to rehome Rohingya people. It's not great. https://www.google.co.uk/maps/place/Bhasan+Char/@22.3852548,91.4000273,13z/data=!3m1!4b1!4m5!3m4!1s0x30acbaf98825055d:0x43dfb5f8eb1d5e29!8m2!3d22.3778018!4d91.3951045

    EDIT: Here's a couple of videos of the island. It's not great.

    https://www.youtube.com/watch?v=VxLM2bYXt6g

    https://www.youtube.com/watch?v=6FvaBN1ClZ8

    1 vote
  15. Comment on Vaccines: A measured response in ~science

    DanBC
    Link
    I cannot stress enough to people living outside the UK just how FUCKING SHIT TIER all the UK media is. Like he says, we spent years losing our minds over MMR based on a study that was so obviously...

    I cannot stress enough to people living outside the UK just how FUCKING SHIT TIER all the UK media is. Like he says, we spent years losing our minds over MMR based on a study that was so obviously bogus, in the face of overwhelming science that vaccinations are safe.

    And I don't just mean the newspapers that went all in on the "MMR causes" angle either. For me, the worst papers are the ones who were both-sidesing this. There were papers who were putting up scientists saying "there isn't any problem, we know vaccines are safe" and then putting up a charismatic crank saying whatever garbage the cranks were saying, and then finishing with a perky "well, who knows, maybe they're safe, but maybe they are KILLING ALL YOUR BABIES and we really do need more information".

    See also MRSA, things that cause or protect against cancer, anything to do with gay people, anything to do with trans people, global warming, crime stats, Europe, etc etc etc.

    12 votes
  16. Comment on TV Tuesdays Free Talk in ~tv

  17. Comment on Florida has passed an unconstitutional law to allow suing and fining social media companies (except ones that also own theme parks) for censoring users or de-platforming politicians in ~tech

    DanBC
    Link
    Something similar is going to happen in the UK. https://www.gov.uk/government/news/landmark-laws-to-keep-children-safe-stop-racial-hate-and-protect-democracy-online-published ---begin quote

    Something similar is going to happen in the UK. https://www.gov.uk/government/news/landmark-laws-to-keep-children-safe-stop-racial-hate-and-protect-democracy-online-published

    ---begin quote

    Freedom of expression

    The Bill will ensure people in the UK can express themselves freely online and participate in pluralistic and robust debate.

    All in-scope companies will need to consider and put in place safeguards for freedom of expression when fulfilling their duties. These safeguards will be set out by Ofcom in codes of practice but, for example, might include having human moderators take decisions in complex cases where context is important.

    People using their services will need to have access to effective routes of appeal for content removed without good reason and companies must reinstate that content if it has been removed unfairly. Users will also be able to appeal to Ofcom and these complaints will form an essential part of Ofcom’s horizon-scanning, research and enforcement activity.

    Category 1 services will have additional duties. They will need to conduct and publish up-to-date assessments of their impact on freedom of expression and demonstrate they have taken steps to mitigate any adverse effects.

    These measures remove the risk that online companies adopt restrictive measures or over-remove content in their efforts to meet their new online safety duties. An example of this could be AI moderation technologies falsely flagging innocuous content as harmful, such as satire.

    Democratic content

    Ministers have added new and specific duties to the Bill for Category 1 services to protect content defined as ‘democratically important’. This will include content promoting or opposing government policy or a political party ahead of a vote in Parliament, election or referendum, or campaigning on a live political issue.

    Companies will also be forbidden from discriminating against particular political viewpoints and will need to apply protections equally to a range of political opinions, no matter their affiliation. Policies to protect such content will need to be set out in clear and accessible terms and conditions and firms will need to stick to them or face enforcement action from Ofcom.

    When moderating content, companies will need to take into account the political context around why the content is being shared and give it a high level of protection if it is democratically important.

    For example, a major social media company may choose to prohibit all deadly or graphic violence. A campaign group could release violent footage to raise awareness about violence against a specific group. Given its importance to democratic debate, the company might choose to keep that content up, subject to warnings, but it would need to be upfront about the policy and ensure it is applied consistently.

    4 votes
  18. Comment on TV Tuesdays Free Talk in ~tv

    DanBC
    (edited )
    Link Parent
    Grey's Anatomy is ridiculous because every episode someone does something that in real life would be a career-ending felony, but in GA it's just a bit of a talking to. It's enjoyable though, and I...

    This has to be the most action packed hospital in the world and I'm only a season 7

    Grey's Anatomy is ridiculous because every episode someone does something that in real life would be a career-ending felony, but in GA it's just a bit of a talking to.

    It's enjoyable though, and I can understand why it's been running so long.

    EDIT: I forgot to mention that one of the things I really liked about GA at the time, and which was unusual, was their approach to casting. I'm very pleased that this approach is now common.

    2 votes