Medical systems are set up to put people on drugs, not take them off
As a pharmacist in a big hospital in Adelaide, Emily Reeve would often see patients overwhelmed by the number of drugs they took each day. “They’d say ‘I take so many medicines that I rattle when I walk’,” she recalls. And she worried that some of the medications these patients were on seemed useless, or even harmful.
Dr Reeve’s patients are not unusual, at least in the rich world. About 15% of people in England take five or more prescription drugs every day. So do 20% of Americans and Canadians aged 40-79. Since the old tend to be sicker, the number of pills a person pops tends to rise over time. Of Americans who are 65 or older, two-thirds take at least five medications each day. In Canada, a quarter of over-65s take ten or more.
Not all those prescriptions are beneficial. Half of older Canadians take at least one that is, in some way, inappropriate. A review of overprescribing in England in 2021 concluded that at least 10% of prescriptions handed out by family doctors, pharmacists and the like should probably not have been issued. And even properly prescribed drugs have side effects. The more medicines someone takes, the more they will experience.
“Polypharmacy”, as doctors call it, imposes a big drag on health. A recent study at a hospital in Liverpool found that nearly one in five hospital admissions was caused by adverse reactions to drugs. The Lown Institute, an American think-tank, reckons that, between 2020 and 2030, medication overload in America could cause more than 150,000 premature deaths and 4.5m hospital admissions.
Getting people off drugs is unfamiliar terrain for modern health systems, which are mostly set up to put patients on them. But that is beginning to change. Doctors, pharmacists and nurses are setting up “deprescribing networks” to try to spread the word. (Dr Reeve, now at Monash University, in Melbourne, runs one in Australia.) England’s National Health Service published a plan to reduce overprescribing in 2021. The first international conference on it took place last year, in Denmark.
Excessive pill-popping burdens patients in several ways. One is the sheer logistics of it all. “People feel like their entire lives revolve around their medications,” says Michael Steinman, a professor of medicine at the University of California, San Francisco. The more drugs someone takes, the greater the chances are that some of them will be taken wrongly.
Other problems are more straightforwardly medical. Some patients end up taking several drugs that affect the same biological pathway. One example is anticholinergics, which suppress the activity of acetylcholine, a neurotransmitter. Several drugs, including some anti-allergy pills, anti-incontinence drugs and tricyclic antidepressants, work this way. But doctors are not always aware of that, says Dr Reeve.
The pills won’t help you now
That can cause overdosing. Loading up on anticholinergics can suppress acetylcholine so strongly that it can leave patients stupefied or confused. Often such effects are wrongly ascribed to old age, or to disease. By cutting away problematic drugs, “we’ve had incidents where we have been able to reverse the [incorrect] diagnosis of dementia,” says Barbara Farrell, an academic and pharmacist at the Bruyere Research Institute in Canada.
Overprescribing can become self-reinforcing, says Dr Steinman. Several common drugs block reabsorption of serotonin, another neurotransmitter. Taking too many can cause tremors, insomnia and jerky movements of the arms and legs. Those symptoms are often mistaken for Parkinson’s disease. So drugs for Parkinson’s are added, in what is known as a “prescribing cascade”. These, in turn, can cause low blood pressure and delirium–which are, of course, treated with yet more drugs.
The problems compound in other way, too. The more pills someone takes, the more likely it becomes that some of them will interact in harmful ways. Pharmacists have reference databases which they check for nasty drug interactions. But knowledge is limited because clinical trials tend to test only one drug at a time. Pharmacists cannot catch problematic combinations when different prescriptions are dispensed at different pharmacies. And anything bought over the counter is “completely invisible”, says Dr Steinman.
All these effects are compounded yet again in the elderly, whose bodies are less efficient at metabolising drugs. Sleeping pills, for example, might make a youngster a bit drowsy the next morning. In an elderly individual they can cause “brain fog” that makes everyday tasks impossible. Getting the dose right is difficult, says Dr Farrell, “because [old people] are usually excluded from clinical trials for new drugs”.
Medication overload persists for several reasons. One, particularly in America, is advertising, which oversells the benefits of medicines, says Dr Farrell. Lack of unified personal health records is another. A cardiologist may prescribe drugs for a patient without knowing what the doctor treating his lungs may have put him on.
Perhaps the most common reason is that patients are not told when to stop taking a drug, or forget. In America one in five patients who are given gabapentin, a potent painkiller, after surgery are still taking it 90 days later (the recommended maximum is four weeks). Often prescriptions are renewed automatically by other doctors, who see them on a patient’s notes and assume they have to be continued.
Many doctors presume that, in any case, patients are not particularly interested in stopping their medicines. That is probably wrong: studies from a number of countries show that eight out of ten patients are willing to give up a drug if their doctor advises them to do so. But those doctors face problems of their own. Money for de-prescribing studies is scant. Drug firms, the main sponsors of clinical trials, are not interested, for obvious reasons.
Evidence about how to proceed is nevertheless starting to build up. Brochures have been developed in Canada to help patients wean themselves off a number of common drugs. They explain, among other things, what alternatives are available—such as cognitive behavioural therapy rather than sleeping pills for insomnia. Trials suggest they work.
Automated de-prescribing tools and guidelines for some medicines have also been developed in recent years. Medsafer, one such electronic tool, increased the share of hospital patients for whom drugs were de-prescribed from 30% to 55%, according to a study published earlier this year in JAMA Internal Medicine. The Drug Burden Index, another tool, tallies the cumulative doses of drugs with anticholinergic or sedative effects.
A medical movement, in other words, is beginning. Its potential impact could be considerable. Keith Ridge, England’s chief pharmaceutical officer, drew an ironic but telling comparison in 2021: “With well over a billion items dispensed each year”, he wrote, “there is a huge prize to be gained in improving the health of millions of people—comparable to a new ‘blockbuster’ medicine—if we can only get this right.” ■
Illustration: Timo Lenzen
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Comments
By irsagent 2023-04-2815:30 Slightly related: https://news.ycombinator.com/item?id=16252372
I noticed that taking pain-killers is a very common thing in american TV shows. The main protagonist (male hero) gets hurt, goes to the bathroom, hastily pours a handful of pills into his hand and pops them into the mouth. Not one, but a hand full of pills, cleary too many. I've seen it so much, I'm starting to wonder if it's a TV trope.
I'm wondering if pharmaceutical companies are sponsoring this. It's akin to product placement.
I think this can be one of several subvariants.
A version of the drug habit/self abuse trope that used to be demonstrated with late nights alone with booze bottles in some depressing living room.
A blazing modern signal that the protagonist is hurt but continues anyway, to distinguish him from some impervious Superman or unfeeling Terminator clone.
The writers are mildly concerned about the plot discontinuity and rushing him to the next scene. See also the bullet wound self-care with improvised extraction and bandage from ripped clothing, which leads to miraculous physical rebound. No debilitating blood loss, nerve damage, or torn connective tissue in this plot!
It's a dramatic trope. I'm an american, born and raised as they say, and I've never seen that. It probably happens sometimes in places I'm not familiar with, but ... come on, it's absurd, anyone would be incapacitated by that many pills.
I was thinking about this when watching The Shape of Water, Michael Shannon's character is in his car, arms shaking, pouring the whole pill bottle on his face ...
It's a dramatic trope.
I wonder how much these tropes and storytelling techniques shifts the baselines of cultural norms. For example, a sitcom would often find it convenient to have friends meet daily in a bar and somehow drinking almost daily is perceived to be a normal thing to do.
By pfannkuchen 2023-04-3014:34 For this particular example, if anything I think drinking frequently with friends and family was much more frequent in times prior to television. But agree that television has this effect in general, shaping perception around social norms. I suspect it is used this way intentionally in some cases.
By lubujackson 2023-04-3015:181 reply In the 80s there was a show called Cheers centered around the same people being at a bar every day. I don't think it is a new phenomenon and it has actually been going the other way - it used to be typical to hit the bar after work every day (and still is in a lot of places) and was generally more about winding down/socializing than consuming alcohol.
By WorldMaker 2023-05-0118:50 It's a "problem" nearly as old as America. One of the scapegoats much touted in handbills and pamphlets of the "ills of society" that led to Prohibition in the US was that "fathers spend too much time in the pubs drinking alcohol after work rather than at home raising children".
It was the source of many jokes in sitcoms in the 1960s, too, not just the 80s, including notably what we think of today as a "kid's show" (despite being a primetime show when aired) in that it was a recurring thing in The Flintstones.
By sublinear 2023-04-306:29 Haha no offense, but I don't think that's as abnormal as you're imagining.
By tacotime 2023-04-303:55 The relevant tvtropes.org page seems to be "Bottled Heroic Resolve": https://tvtropes.org/pmwiki/pmwiki.php/Main/BottledHeroicRes...
By SturgeonsLaw 2023-04-290:401 reply Like the way toothpaste ads show them squirting 3x as much paste as you actually need onto the toothbrush
By quintushoratius 2023-04-2919:484 reply That's just like how shampoo companies advise you to "lather, rinse, repeat". It's a great way to boost sales, but besides being unnecessary it's terrible for your hair, your water bill, fish living downstream, and your wallet.
By gs17 2023-04-2921:09 Personally, I've had much better results with repeating, but I haven't bothered to experiment enough to see if it's from "rinse, lather, rinse" or the full "lather, rinse, lather, rinse".
By gumby 2023-04-301:09 > That's just like how shampoo companies advise you to "lather, rinse, repeat". It's a great way to boost sales.
It’s no accident that they code a loop with no termination condition (except the implicit emptying of the bottle). Really boosts sales!
I do occasionally repeat and it does make a difference, but you only need 1/10th as much shampoo the second time.
I’m curious. What does the second iteration accomplish? Is it dirt and grease that is embedded in your skin? What kind of job do you have if you feel comfortable answering?
It's not usually needed, but if I'm really sweaty and sticky the first washing removs dirt, and the second washing adds "squeak" is the best way I can put it.
It just feels cleaner. I assume it's because the additives in the shampoo become overloaded on the first use, and are active on the second.
By guidoism 2023-05-0118:30 I like the squeak too. I recently moved to a place with hard water and so everyone has water softeners. With this super soft water I can't get the squeak ever. It just feels slimy to me.
By bart_spoon 2023-04-3015:55 It’s definitely a trope, but it’s not product placement. It’s just old fashioned over-embellishment by Hollywood for the sake of drama. They do it for everything else, why wouldn’t they for self-medication?
This does not logically make sense. It's TV. On TV, a guy can shoot an automatic and not reload for a full ten minutes. He can get shot at by 20 people with rifles and they all miss, while he kllls them all with a handgun that holds 10 bullets.
That is not sponsorship by gun companies. It is TV.
By taskforcegemini 2023-05-027:561 reply it's still advertisment though
By usernew 2023-05-037:41 I'm sorry - you actually think the movies with a lot of shooting is an advertisement for guns, and when someone chugs pills out of the bottle is an ad for big pharma?
if I may ask - and this is very much on topic - who won the 2020 election, and do covid vaccines contain nanobots?
By blacksmith_tb 2023-04-2920:271 reply Hmm, well I wouldn't recommend taking a whole handful of ibuprofen, but it probably shouldn't kill you (unlike a handful of acetaminophen/paracetamol, or opioids), it would be hell on your stomach, but I suppose fast-paced drama doesn't have time for realism.
By seattle_spring 2023-04-303:421 reply Great way to get kidney failure.
By qwytw 2023-05-019:28 I think chronic over-usage is a more serious concern. Taking even handful of pills is not that likely to result in permanent damage (unlike paracetamol). Up to 100 mg/kg shouldn't be that risky (so 20 400mg pills for somebody who weighs 80kg)
Is this true? I can’t actually think of any examples of this off the top of my head. I can think of examples of popping anxiety pills to show weakness and lack of resolve, pills that suppress their acuity in some way, or some sort of amphetamine because they need energy.
But pain pills don’t ring a bell. The classic move is strongly taking a swig of hard alcohol and then pouring it over a wound and wincing.
In my opinion, people shown to be taking pills are usually portrayed as weak or digging themselves into a hole.
Perhaps with some exceptions to people shown taking pills which I interpreted as a display of competence and experience more than anything.
By shalmanese 2023-04-2918:08 I think it's video game logic imported into films. Pills are a common health pack symbol so more pills = more health regained = more return to normal stats.
By slowmovintarget 2023-04-2920:281 reply With the toxin they put in Tylenol (to prevent abuse), you'd blow out your liver if you did that.
In books, you get "chewing asprin without the water." So yes, it's dramatic, but not realistic. It's just a way of conveying through action "Ouch, that really freaking hurts."
> With the toxin they put in Tylenol (to prevent abuse)
...acetaminophen itself is what kills your liver in an overdose, there is no "toxin they put in tylenol"
Got it upside down. Acetaminophen is added to opioids to prevent rec use and abuse.
By DontchaKnowit 2023-04-300:31 The confusion here is that "tylenol" in the US basically means just Acetaminophen - technically tylenol 3s have opiods, but most americans know tylenol as the over the counter tylenols, which are just acetaminophen.
In other places tylenol must mean what we think of as tylenol 3
By DANmode 2023-04-3017:31 That explains...a lot actually.
Some studies out there linking acetaminophen to reduced empathy.
By local_crmdgeon 2023-04-2815:068 reply I hate these articles. While yes, this is true, it's also true that _many_ people have severe, untreated illness that they're just "toughing it out." My friend with BPD ruined his life because he's "stronger than the disorder, I don't need to take my meds"
Spent millions foolishly, genius engineer - horrible story. Easily fixed.
By asdfman123 2023-04-2816:563 reply There is a fine and very important distinction to be made here.
If you have a health problem, you should do your best to get exercise, eat healthy, etc. However, that doesn't mean medicines are wasteful or pointless. People often greatly benefit from them.
I've struggled with ADHD, depression, and anxiety my whole life. And indeed, yes, the best treatment I've found is diet, weight training, and long-duration cardio. Which I do.
But people who are "in the hole" need medicines to dig them out. And also, people with kids/multiple jobs don't have as much time as I do. And these habits take years to finally stick. And I still need ADHD medication.
And the best treatment for things like this is to try every treatment you can together, but don't overwhelm yourself in the process (and it takes wisdom to not overwhelm yourself).
People on Twitter opine about this kind of stuff piss me off. They think their vague notions about what is right for society--that they have no experience with--should take precedence over my decades of (informal) research and lived experience. It's okay to have opinions and discuss things, but don't try to bully the people who actually know what they're talking about.
By escapedmoose 2023-04-2918:461 reply 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. 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 mildly 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 for such a patient 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.
By skissane 2023-04-3015:27 > 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.
By maleldil 2023-04-2923:50 > 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.
By Doxin 2023-05-0111:18 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
By schwartzworld 2023-04-3011:41 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.
By spondylosaurus 2023-04-301:37 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.
By moritzwarhier 2023-04-3010:331 reply 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.
By jvm_fan 2023-04-3020:46 [flagged]
By 1letterunixname 2023-04-305:50 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.
By valachio 2023-04-3010:11 There is no guarantee that pills would've helped your friend.
In fact, these medications can worsen a patient's condition.
By birdyrooster 2023-04-2918:133 reply 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.
By quintushoratius 2023-04-2919:542 reply > 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...
By birdyrooster 2023-04-303:402 reply [flagged]
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.
By birdyrooster 2023-05-0220:311 reply 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.
By dang 2023-05-0221:14 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.
By birdyrooster 2023-05-0220:42 For the record, this isn't an attack or accusation, it is a thought experiment via reductio ad absurdum.
By birdyrooster 2023-04-2922:49 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.
By doodlesdev 2023-04-2918:151 reply 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.
By throwaway743 2023-04-2921:541 reply Eh, could be either really
By kevviiinn 2023-04-300:03 But they are very different in their presentations
By trollthrowaway4 2023-04-2920:301 reply [flagged]
By local_crmdgeon 2023-04-3013:191 reply 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.
By trollthrowaway4 2023-04-3015:17 [flagged]
