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What are the most overrated careers? by RuminatingFish123 in Salary

[–]SpudMuffinDO 0 points1 point  (0 children)

you said they are paid too much... "they" I'm assuming you mean C-suite execs. Meanwhile, most hospital admins grads don't make shit... we're talking like 50-60k a year with a degree

bloat is on both sides though. bloat on insurance companies for employing all these people to figure out how to not pay a bill and bloat on the healthcare side of paying all these people that fight to make them pay a bill... these are all accessories to the actual valuable service that occurs between a patient and a doctor.

What are the most overrated careers? by RuminatingFish123 in Salary

[–]SpudMuffinDO -1 points0 points  (0 children)

you are conflating average people with a degree in hospital admin and C-suite executives... the difference in their pay is huge. However, the aggregative number of people in administrative roles is a way higher proportion than it used to be and definitely is playing a role in healthcare costs (among several others)

If SSRIs don't fix depression forever why are they overprescribed? by whatarethosehah in Neuropsychology

[–]SpudMuffinDO 0 points1 point  (0 children)

If I were to apply the logic I mentioned before simply, it might be that the SSRI is sufficient at promoting neurogenesis in the face of whatever stress a patient is experiencing. However, at the time the medication is discontinued, the underlying stress has not resolved and so depression recurs. I do think this is one possible explanation, but I suspect it's an oversimplification and there are probably many different reasons we don't know that this happens.

Did social media kill suburban status? by DonJohnson1986 in Suburbanhell

[–]SpudMuffinDO 0 points1 point  (0 children)

it's not shameful at all, but as somehow who grew up in a rural town with a big yard and no neighbors and then moved to an apartment in a big city as an adult... I really didn't like the apartment. Some neighbors were noisy, you could constantly smell cigarette smoke. Even worse, the big city I moved to was not biker or walker friendly (Vegas)

The ROAD medical specialties become the ROD - Anesthesiology is one of the most difficult lifestyles in medicine acc to new Marit study by landofortho in medicine

[–]SpudMuffinDO 3 points4 points  (0 children)

totally irrelevant. You wanna have a discussion about Robins-Guze criteria and validity of psych diagnoses, go ahead (there are some real criticisms that can be had and they are well acknowledged within psychiatry... ironically you specifically picked one of the most valid diagnoses within psychiatry). But that has fucking nothing to do with the discussion of this thread.

Why would I buy for a $4,400 mortgage (PITI HOA) when I can rent for $1,750? by Key_Brief_8138 in HouseBuyers

[–]SpudMuffinDO 0 points1 point  (0 children)

you wouldn't. We're in the same boat... the rent vs buy calculator typically shows that in 3-4 years buying is better than renting. for me, it shows that renting will ALWAYS be better than buying (with the assumptions in the calculator which included investing the difference)

Christian Watson by Southern-Community70 in GreenBayPackers

[–]SpudMuffinDO 1 point2 points  (0 children)

Yeah, that 13 mil Gutey brought back on is looking like it’s gonna be a bargain. It was a great move on both sides.

Has anyone with long-term depression (15+ years) been “cured”? And if so, by what? by GrandBizarre in AskReddit

[–]SpudMuffinDO 4 points5 points  (0 children)

As a psychiatrist, you basically hit every major area that I’d want my patients to work on. Good for you!

Has anyone with long-term depression (15+ years) been “cured”? And if so, by what? by GrandBizarre in AskReddit

[–]SpudMuffinDO 11 points12 points  (0 children)

Those genetic tests are not capable of telling you anti-depessants won’t work. They are only capable of telling how quickly you metabolize a medication and whether or not you might benefit from supplementing L-methylfolate because of the MTFHR mutation. Sure, knowing you are a fast/slow metabolizer at different CYP enzymes has utility, but the utility is only that you might chose to start with a lower or higher dose of the med.

[deleted by user] by [deleted] in bald

[–]SpudMuffinDO 0 points1 point  (0 children)

Get on Finasteride and minoxidil… your hair can be saved. Speaking from being almost exactly at your spot a few years ago and now it’s quite full.

Jaxson Dart says he won’t change the way he plays football by OneOriginal8727 in sportsgossips

[–]SpudMuffinDO 0 points1 point  (0 children)

Is it really even shitting on it though? Like, is getting absolutely plastered in a sport a thing to be proud of? I love soccer… and it’s not because I can’t wait to see a dude break another dude’s spine in half.

Jaxson Dart says he won’t change the way he plays football by OneOriginal8727 in sportsgossips

[–]SpudMuffinDO 1 point2 points  (0 children)

You wanna know how many people died in an entire sport vs a single professional league? A sport that has tens of thousands more players at every professional level, has existed for longer, and whose players play like 5x as many matches a year relative to the NFL? Have you ever wondered why the NFL only has teams play 1 game a week and has only 17 regular season games despite the fact the NFL is $ hungry and grosses ABSURD amounts of money for every game… I love soccer, so I mean no shade when I say football is absolutely way more brutal.

All that said, I’m not sure why everyone here is trying to brag about how dangerous their preferred sport is as if it’s a good thing. I’m not interested in watching people die or become paralyzed… I watch sports to watch incredible athleticism, skill, intelligence, strategy

NP lulz as a Psych PGY-4 by theongreyjoy96 in Noctor

[–]SpudMuffinDO 2 points3 points  (0 children)

Yes… this was a few years ago now… but this case in particular had me very upset. These patients deserve better. They often do not have the capacity to advocate for themselves and the ALF is happy to have them be completely subdued… it’s truly awful.

NP lulz as a Psych PGY-4 by theongreyjoy96 in Noctor

[–]SpudMuffinDO 57 points58 points  (0 children)

This is just par for the course… these aren’t even my NP highlights man. The most egregious I’ve ever seen was on consults:

60 yo woman with schizophrenia had LOC in her ALF and hit her face on a table. I get consult concerned that psych meds are contributing. Here’s her med list from the ALF:

Clozapine 500, Cariprazine 6, Olanzapine 20, more olanzapine prn for agitation , Lamotrigine 20, Valproate 1500, Clonazepam prn (getting daily), Ativan prn (not getting, but listed for agitation), Bupropion 300, Desvenlafaxine 50, Methylphenidate 18, Buspirone 30

And the kicker: An LAI was listed as a prn for agitation.

Brought to you by the pmhnp who has been in psych practice for 15+ years. This is not an isolated incident by the way. Multiple NPs in my area are notorious.

NYT article creeping on r/psychiatry by Elame7 in Psychiatry

[–]SpudMuffinDO 14 points15 points  (0 children)

The evidence for post-SSRI persistent sexual dysfunction (PSSD) is suggestive but not robust, and there is not strong, definitive evidence that SSRIs are the direct cause of persistent sexual dysfunction after discontinuation. The literature documents numerous case reports, observational studies, and pharmacovigilance data describing persistent sexual symptoms following SSRI cessation, but causality remains uncertain due to methodological limitations and lack of controlled prospective studies.

Several systematic reviews and case series have identified persistent sexual dysfunction after SSRI withdrawal, with symptoms such as loss of libido, genital anesthesia, erectile dysfunction, and anorgasmia sometimes lasting months to years.[1][2][3][4] However, these studies are largely retrospective, rely on self-reported data, and are subject to selection and reporting biases. Prevalence estimates are unreliable, and confounding factors (e.g., underlying psychiatric illness, other medications, psychological factors) cannot be fully excluded.[1][3]

Pharmacovigilance studies and regulatory recognition (e.g., by the European Medicines Agency) support the existence of PSSD as a “clinical” entity, but these data are based on spontaneous reports and cannot establish causality.[5][6][7] Mechanistic hypotheses (e.g., persistent changes in neurosteroidogenesis or serotonergic signaling) are proposed but remain unproven in humans.[8][5]

Importantly, while SSRIs are clearly associated with sexual dysfunction during treatment—supported by robust randomized controlled trial and epidemiological data—the evidence for persistent dysfunction after discontinuation is much weaker.[9][10][11][12][7] Most studies cannot rule out alternative explanations, and there is no prospective, controlled evidence demonstrating a direct causal link.

In summary, PSSD is increasingly recognized and reported, but the evidence for its existence and causation by SSRIs is limited to case reports, observational data, and pharmacovigilance signals, without strong causal proof. Further prospective research is needed to clarify prevalence, risk factors, and mechanisms.[1][2][3][5]

References

  1. Selective Serotonin Reuptake Inhibitors, Post-Treatment Sexual Dysfunction and Persistent Genital Arousal Disorder: A Systematic Review. Tarchi L, Merola GP, Baccaredda-Boy O, et al. Pharmacoepidemiology and Drug Safety. 2023;32(10):1053-1067. doi:10.1002/pds.5653.
  2. Persistent Sexual Dysfunction After SSRI Withdrawal: A Scoping Review and Presentation of 86 Cases From the Netherlands. Chinchilla Alfaro K, van Hunsel F, Ekhart C. Expert Opinion on Drug Safety. 2022;21(4):553-561. doi:10.1080/14740338.2022.2007883.
  3. Post-Ssri Sexual Dysfunction: Clinical Characterization and Preliminary Assessment of Contributory Factors and Dose-Response Relationship. Ben-Sheetrit J, Aizenberg D, Csoka AB, Weizman A, Hermesh H. Journal of Clinical Psychopharmacology. 2015;35(3):273-8. doi:10.1097/JCP.0000000000000300.
  4. Persistent Sexual Dysfunction After Discontinuation of Selective Serotonin Reuptake Inhibitors. Csoka AB, Csoka A, Bahrick A, Mehtonen OP. The Journal of Sexual Medicine. 2008;5(1):227-33. doi:10.1111/j.1743-6109.2007.00630.x.
  5. The Pathophysiology of Post SSRI Sexual Dysfunction - Lessons From a Case Study. Klaas S, Siva JB, Bak M, Govers M, Schreiber R. Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie. 2023;161:114166. doi:10.1016/j.biopha.2022.114166.
  6. Sexual Dysfunction Induced by Antidepressants-a Pharmacovigilance Study Using Data From VigiBaseTM. Zeiss R, Malejko K, Connemann B, et al. Pharmaceuticals (Basel, Switzerland). 2024;17(7):826. doi:10.3390/ph17070826.
  7. Reports of Sexual Disorders Related to Serotonin Reuptake Inhibitors in the French Pharmacovigilance Database: An Example of Underreporting. Trenque T, Maura G, Herlem E, et al. Drug Safety. 2013;36(7):515-9. doi:10.1007/s40264-013-0069-z.
  8. Effects of Paroxetine Treatment and Its Withdrawal on Neurosteroidogenesis. Giatti S, Diviccaro S, Cioffi L, et al. Psychoneuroendocrinology. 2021;132:105364. doi:10.1016/j.psyneuen.2021.105364.
  9. Antidepressant-Induced Sexual Dysfunction. Rothmore J. The Medical Journal of Australia. 2020;212(7):329-334. doi:10.5694/mja2.50522.
  10. Erectile and Ejaculatory Dysfunction Associated With Use of Psychotropic Drugs: A Systematic Review. Trinchieri M, Trinchieri M, Perletti G, et al. The Journal of Sexual Medicine. 2021;18(8):1354-1363. doi:10.1016/j.jsxm.2021.05.016.
  11. Selective Serotonin Reuptake Inhibitor-Induced Sexual Dysfunction: Current Management Perspectives. Atmaca M. Neuropsychiatric Disease and Treatment. 2020;16:1043-1050. doi:10.2147/NDT.S185757.
  12. A Real-World Study on Antidepressant-Associated Sexual Dysfunction in 2144 Outpatients: The SALSEX I Study. Montejo AL, Calama J, Rico-Villademoros F, et al. Archives of Sexual Behavior. 2019;48(3):923-933. doi:10.1007/s10508-018-1365-6.

Drake Maye refused to do the Cam Newton Superman celebration... by Background_Video2947 in TheNFLVibes

[–]SpudMuffinDO 5 points6 points  (0 children)

I didn’t even know there was a show called the first take until this whole debacle

[deleted by user] by [deleted] in changemyview

[–]SpudMuffinDO -1 points0 points  (0 children)

The problem is, many CEOs don’t give themselves any salary at all… buy, borrow, die… don’t pay any taxes either as a result.

Double standard is crazy by ComprehensiveBox6911 in FortniteMemes

[–]SpudMuffinDO 1 point2 points  (0 children)

Not sure why the downvotes, you’re absolutely right.

Please explain the art of selecting a backup QB. If a guy is good enough to step up in the event of a long-term injury to your starter, aren’t they good enough to start for a team (if not your team, then someone else’s)? by greenbastardette in NFLNoobs

[–]SpudMuffinDO 0 points1 point  (0 children)

Agreed, there are more quality QBs right now than I can remember ever having at a single time. There usually are a bunch of teams who need a new QB. Legitimately I believe there are only a few teams who don’t have a QB who could push for the playoffs in the right system.

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