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Can Psychiatry Turn Itself Around?

blogs.scientificamerican.com

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Re: Can Psychiatry Turn Itself Around?

#101

Post by intopieces »

vonmoltke wrote: post #45
intopieces wrote: post #25

Earlier quoted context omitted.

Your profession needs no help from marsrover to find itself under the wheels of a bus. Every other medical revolution -- such as the rise of antibiotics, the pioneering of complex surgeries, and the advancements in medical imaging -- have resulted in a net reduction of people suffering from the ailments those tools are involved in treating. Not so with psychiatry. The more drugs that are developed, the more illnesses…

> You'll have to excuse the skepticism of some us who have seen loved ones suffer through debilitating, sometimes permanent side effects from drugs their psychiatrists prescribed. What debilitating side effects are those? How does their frequency compare to side effects for non-psychiatric drugs and treatments?

You know it's odd: in all those years I spent helping my dad with his knees shot from zoloft induced weight gain or waking my roommate up because she drank too much to counteract the stimulants they prescribed to balance the benzos or sleeping next to a partner with a permanent, random, violent parkinsonian tremor caused by antipsychotics, I never considered doing a frequency analysis against the myriad of unrecommended non-psychiatric drugs and treatments out there.

Unfortunately, neither did any of their doctors, it would seem.

Re: Can Psychiatry Turn Itself Around?

#102

Post by djcjgshjjc »

mattnewport wrote: post #80
phren0logy wrote: post #21

I'm a psychiatrist. It is always amazing to me that despite four years of medical school, six years of residency and fellowships, and four board certifications, the assumption is that I have no idea what I'm talking about and have evil motives. There are fair criticisms of psychiatry, there are bad psychiatrists, but mostly there are crappy generalizations. Good psychiatrists have an understanding of what medications…

I'm curious what you make of the claims Robert Whitaker makes in "Anatomy of an Epidemic" and elsewhere? Psychiatry comes off looking quite bad in his analysis and he is far from the only critic of the profession. My attempts to find convincing rebuttals of his claims from Psychiatrists have so far drawn a blank. In a nutshell for those not familiar with the book, he presents convincing evidence that most psychiatric…

It looks like meta-analyses published after that book support the efficacy of anti-depressants, are you familiar with this evidence?

https://en.m.wikipedia.org/wiki/Selective_serotonin_reuptake...

Re: Can Psychiatry Turn Itself Around?

#103

Post by conanbatt »

nommm-nommm wrote: post #54
alleychnt wrote: post #42

Earlier quoted context omitted.

and as soon as you go off the meds?

WTF does this mean? If you go off your HIV meds you get AIDS and die. If you stay on your HIV meds you have a life expectancy is similar to someone who does not have the virus. (1) Do you then conclude HIV meds are bad? Or HIV patients need to just suck it up? (1) http://www.spectator.co.uk/2014/04/why-id-rather-have-hiv-th...

I think he is implying that if he went off the meds, his life wouldnt go to the can: that the effect can be explained by the placebo effect.

Re: Can Psychiatry Turn Itself Around?

#104

Post by djcjgshjjc »

ksenzee wrote: post #11
alleychnt wrote: post #6

Earlier quoted context omitted.

Psychiatrists are a bit like chiropractors. They want to be seen as "doctors", but none of what they do has any scientific basis. Ever notice how psychiatrists just prescribe you random medications without knowing how, or even if, they work? The most damning fact is that I've never met anyone on psych meds who is doing really great.

> I've never met anyone on psych meds who is doing really great. Of course you have. You just didn't know it. People don't wear placards around their neck announcing "I'm on psych meds!"

We call this "voluntary response bias".

Re: Can Psychiatry Turn Itself Around?

#105

Post by conanbatt »

pc2g4d wrote: post #60

Psychiatry's trouble is that it tries to treat emotional problems using drugs. That's also the entire point of psychiatry. It's in a crisis because "stabilizing" people by numbing their brains does nothing to help them face their problems. A profession of cleaners whose main technique was to sweep everything under the rug would also face crisis at some point.

Thats not the problem, its a tool to solve a situation. If someone is emotionally suffering so much as to not perform a job, not get out of bed, talking with them will not save their lifes. Treating the symptoms is one very legitimate way of dealing with a disease.

Re: Can Psychiatry Turn Itself Around?

#106

Post by force_reboot »

epistasis wrote: post #100
force_reboot wrote: post #83

There seems to be a huge gap between what psychiatrists believe and how psychiatric knowledge is presented to the general public. For example, I'm not aware of any scientific evidence that depression is qualitatively different from being unhappy, or that depression can't be caused by events that would make a typical person unhappy, or cured by the opposite. And I'm fairly certain that very little such evidence exists…

If you'd look you'd find plenty of evidence of the sort that you think doesn't exist. Try a popular book like Against Depression as a starter. I think that the existence of such evidence also invalidates the rest of your prejudices that you express.

I don't have time to read every book out there, so when I look for answers to questions like this I look for sources that are authoritative, that is, sources that summarize the majority opinion in a field. The book you recommend doesn't seem to be that, and so I'm not convinced that it's worth reading. Are there particular studies in the book that specifically address whether depression is qualitatively different from unhappiness? Does the book cite mainstream opinions by psychiatrists and if so, what opinions does it cite?

Re: Can Psychiatry Turn Itself Around?

#107

Post by mattnewport »

djcjgshjjc wrote: post #102
mattnewport wrote: post #80

Earlier quoted context omitted.

I'm curious what you make of the claims Robert Whitaker makes in "Anatomy of an Epidemic" and elsewhere? Psychiatry comes off looking quite bad in his analysis and he is far from the only critic of the profession. My attempts to find convincing rebuttals of his claims from Psychiatrists have so far drawn a blank. In a nutshell for those not familiar with the book, he presents convincing evidence that most psychiatric…

It looks like meta-analyses published after that book support the efficacy of anti-depressants, are you familiar with this evidence? https://en.m.wikipedia.org/wiki/Selective_serotonin_reuptake...

This seems to be a fairly balanced (and pretty long!) review of the evidence from Scott Alexander who is a psychiatrist (I believe) which comes down on the side that the balance of the evidence is that SSRIs do have an effect that can't be explained purely as active placebo: http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo...

Here's another 2014 article leaning the other way by Irving Kirsch, one of the more prominent researchers to question the evidence for anti depressant efficacy: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/

In Anatomy of an Epidemic Robert Whitaker details many of the problems around the published studies that raise real concerns how bias free the remaining positive results of these studies might be. In addition, pretty much all of the discussion above is based around short term effects and perhaps the most worrying part of Whitaker's book for me is the suggestive evidence of devastating long term effects of many psychiatric drugs, SSRIs included.

Personally I think the bar should be rather higher for evidence of short term benefit for any drug than the 'optimistic' view of the evidence for SSRIs and especially in light of evidence of the drug making the condition it is supposed to treat significantly worse over the long term. Given that even proponents of SSRIs seem to accept that talk therapy is equally effective I know I'd rather take the drug and side effect free option but Scott Alexander gives a different take on that in his article, pointing out that drugs are much cheaper (and hence more profitable for both psychiatrists and drug companies as Whitaker points out in his book).

Re: Can Psychiatry Turn Itself Around?

#108

Post by AstralStorm »

derefr wrote: post #74
alleychnt wrote: post #42

Earlier quoted context omitted.

and as soon as you go off the meds?

"You're nearsighted. You need glasses." "But as soon as I take off the glasses...?"

There are more invasive procedures that directly fix nearsightedness. Of course, they're riskier than glasses.

Re: Can Psychiatry Turn Itself Around?

#109

Post by AstralStorm »

nwah1 wrote: post #3

We're all aware that most of the drugs that are common in the profession have serious side effects. I'm glad the author called for his colleagues to focus more on the whole body, since realistically lifestyle and nutritional changes can have as profound effects as drugs, with no side effects. I tend to think subclinical deficiencies in various nutrients can play a big role. Most people are already aware of the impora…

Lithium, uridine... no side effects? You must be joking.

Even at subclinical dosages there are sometimes side effects from those.

Dietary changes have a ton of shoe effects as well. Even the dieteticians cannot really find precise enough consensus on these.

Re: Can Psychiatry Turn Itself Around?

#110

Post by gerby »

serge2k wrote: post #24
Pica_soO wrote: post #17

The basic lie that psychiatry is based upon, is that there is a sickness where there is suffering. Not neural phenotype, that yes can suffer, but have been useful for various enterprises and endeavor of humans kind. Manic-Depressive where our "suicidal" explorers, alcoholics stopped us from being nomadic, gays pressured into churches formed the first institutions and created contract security. The list continues near…

I honestly have no idea what you are talking about here.

Me too.
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