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The psychiatric drug crisis

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Re: The psychiatric drug crisis

#51

Post by kyro »

mathattack wrote: post #40
kyro wrote: post #23

Good riddance. Psychiatry by and large is a sham field. Physicians who practice it love seeing themselves as artists who are experts in identifying the subtleties of human behavior. That's their way of saying there's very little underlying science guiding their practice. Many of the diagnoses given are pulled out of thin air and made to justify a patient's admission, or to appease a patient's desire to feel as if the…

Let's play the devil's advocate here... I've known people who have lost their marbles once they stopped taking their meds. Are we rally saying that their grip on sanity was a placebo effect? Or are we saying that we're just treating the symptom? If it's just the symptom, who cares, as long as the drugs help people? For context, I'm not on any psychiatric drugs, have never been on any, and think they're largely being…

> If it's just the symptom, who cares, as long as the drugs help people?

Because for many, these symptoms are not adequately addressed through more conservative means. There are numerous ways to attack an unusual disposition that do not involve medication -- exercising, weight loss, meditation, psychotherapy, cognitive behavioral therapy, rectifying family issues, finding a job. Many of these options are not adequately pursued. I have never seen a psychiatrist refer a patient to see a psychologist or a cognitive behavioral therapist, and they have no incentive to really.

Re: The psychiatric drug crisis

#52

Post by lutusp »

pyre wrote: post #27
kyro wrote: post #23

Good riddance. Psychiatry by and large is a sham field. Physicians who practice it love seeing themselves as artists who are experts in identifying the subtleties of human behavior. That's their way of saying there's very little underlying science guiding their practice. Many of the diagnoses given are pulled out of thin air and made to justify a patient's admission, or to appease a patient's desire to feel as if the…

> although that could entirely be due to placebo effect If the drugs had no effect, then why are people (ab)using drugs like Adderall to improve cognition, etc? A big problem with trying to make a science out of the brain, is that it can be very unique to the person. For example, in people that are blind since birth, the pathways in the brain that are normally used for visual processing can get re-purposed over a lif…

> If the drugs had no effect, then why are people (ab)using drugs like Adderall to improve cognition, etc?

You're making an assumption here -- that people's trust in, and use of, drugs argues that it's not a mere placebo effect. But there are any number of accounts of people persuading themselves that a drug is reliable, for a drug that is in fact a placebo. In fact, that's how the placebo effect is defined.

The only way to sort out these issues is with a double-blind prospective trial. Unfortunately, such trials are nearly nonexistent for this class of drugs, and those trials that have been conducted, are often run badly or published in very selective ways, creating the impression that the drugs are more effective than they really are.

Reference (PDF warning): http://alphachoices.com/repository/assets/pdf/EmperorsNewDru...

Re: The psychiatric drug crisis

#53

Post by neurotech1 »

OldSchool wrote: post #46
kyro wrote: post #23

Good riddance. Psychiatry by and large is a sham field. Physicians who practice it love seeing themselves as artists who are experts in identifying the subtleties of human behavior. That's their way of saying there's very little underlying science guiding their practice. Many of the diagnoses given are pulled out of thin air and made to justify a patient's admission, or to appease a patient's desire to feel as if the…

As a young engineer-type with no exposure to the psych field, I had about the same opinion when I was in my early 20's. However, a few decades of real life later I've seen first-hand, successes and turnarounds for people who either found themselves in bad situations or were just plain genetically vulnerable. In fact, I'll go as far as saying that counseling or therapy are nothing compared to the difference that the r…

As a programmer and former EEG tech, all I can do is nod quietly. They could be way more scientific about their medication selection if they wanted to be [1][2] but most psychiatrists are overconfident in their own judgement.

[1] http://www.ncneurocenter.com/eeg/eeg_reference.html

[2] http://en.wikipedia.org/wiki/Quantitative_electroencephalogr...

Re: The psychiatric drug crisis

#54

Post by lutusp »

md224 wrote: post #26

Fun Fact: Selective Serotonin Reuptake Inhibitors, the class of drugs used to treat depression and anxiety disorders by increasing the availability of serotonin, have a mirror opposite: Tianeptine ( http://en.wikipedia.org/wiki/Tianeptine ), which acts as a Selective Serotonin Reuptake Enhancer. Incredibly, this drug has also been effective at treating depression . That's right: two classes of drugs with polar opposi…

> and both of them apparently work.

I would have said they both appear to work. Recent findings cast doubt on that appearance (PDF warning): http://alphachoices.com/repository/assets/pdf/EmperorsNewDru...

Re: The psychiatric drug crisis

#55

Post by puma1 »

kyro wrote: post #23

Good riddance. Psychiatry by and large is a sham field. Physicians who practice it love seeing themselves as artists who are experts in identifying the subtleties of human behavior. That's their way of saying there's very little underlying science guiding their practice. Many of the diagnoses given are pulled out of thin air and made to justify a patient's admission, or to appease a patient's desire to feel as if the…

Just.. wow. You must be a very smart person.

Re: The psychiatric drug crisis

#56

Post by [deleted] »

OldSchool wrote: post #46
kyro wrote: post #23

Good riddance. Psychiatry by and large is a sham field. Physicians who practice it love seeing themselves as artists who are experts in identifying the subtleties of human behavior. That's their way of saying there's very little underlying science guiding their practice. Many of the diagnoses given are pulled out of thin air and made to justify a patient's admission, or to appease a patient's desire to feel as if the…

As a young engineer-type with no exposure to the psych field, I had about the same opinion when I was in my early 20's. However, a few decades of real life later I've seen first-hand, successes and turnarounds for people who either found themselves in bad situations or were just plain genetically vulnerable. In fact, I'll go as far as saying that counseling or therapy are nothing compared to the difference that the r…

[deleted]

Re: The psychiatric drug crisis

#57

Post by kvb »

whalemaker wrote: post #2

Obscure psychiatric drugs are also ridiculously expensive sometimes. A friend of mine switched from a brand name anti-psychotic to a generic version. He went from paying over $1200 a month to $22 for 30 pills, for something as important as preventing his psychotic episodes.

Note that generics are not identical to branded drugs; I believe the FDA has a +/-20% bioavailability tolerance. For medications with broad dose-response curves (e.g. most painkillers, probably lots of other classes of drugs) this isn't a big deal, but for other medications it can be. As I understand it, psychiatric medications often have narrower dose-response curves (disclaimer - IANAD).

Re: The psychiatric drug crisis

#58

Post by refurb »

lutusp wrote: post #52
pyre wrote: post #27

Earlier quoted context omitted.

> although that could entirely be due to placebo effect If the drugs had no effect, then why are people (ab)using drugs like Adderall to improve cognition, etc? A big problem with trying to make a science out of the brain, is that it can be very unique to the person. For example, in people that are blind since birth, the pathways in the brain that are normally used for visual processing can get re-purposed over a lif…

> If the drugs had no effect, then why are people (ab)using drugs like Adderall to improve cognition, etc? You're making an assumption here -- that people's trust in, and use of, drugs argues that it's not a mere placebo effect. But there are any number of accounts of people persuading themselves that a drug is reliable, for a drug that is in fact a placebo. In fact, that's how the placebo effect is defined. The only…

Whoa, wait a second here. Your reference article is arguing that there isn't any difference between these drugs and placebos, so by definition it was a "placebo controlled trial". To say that "double-blind prospective trials are nearly non-existent" is very wrong. Unless you are referring to very old psychiatric drugs, most of them have gone through such trials.

There was a lot of disagreement about the paper you referenced. CNS drug are notoriously hard to get positive clinical trial data for. The reasons are: (1) placebo effect is notoriously difficult to control for in psychiatric trials, (2) the clinical trial endpoints are very blunt measures of efficacy.

But you know what? That's the best we have right now. There certainly is a strong requirement for efficacy in psychiatric drugs as evidenced by how many have failed to get approved by the FDA.

The sad thing is that most big drug companies have completely pulled out of doing R&D for new CNS drugs. They are just too hard to get approved. The end result is that patients with psychiatric illnesses will end up with fewer treatments options unless this changes.

Re: The psychiatric drug crisis

#59

Post by jlgreco »

mathattack wrote: post #40
kyro wrote: post #23

Good riddance. Psychiatry by and large is a sham field. Physicians who practice it love seeing themselves as artists who are experts in identifying the subtleties of human behavior. That's their way of saying there's very little underlying science guiding their practice. Many of the diagnoses given are pulled out of thin air and made to justify a patient's admission, or to appease a patient's desire to feel as if the…

Let's play the devil's advocate here... I've known people who have lost their marbles once they stopped taking their meds. Are we rally saying that their grip on sanity was a placebo effect? Or are we saying that we're just treating the symptom? If it's just the symptom, who cares, as long as the drugs help people? For context, I'm not on any psychiatric drugs, have never been on any, and think they're largely being…

I'm not saying that I think it is the case, but a possible other hypothesis might be that they stopped taking their drugs because they began to lose their marbles again.

Re: The psychiatric drug crisis

#60

Post by refurb »

md224 wrote: post #26

Fun Fact: Selective Serotonin Reuptake Inhibitors, the class of drugs used to treat depression and anxiety disorders by increasing the availability of serotonin, have a mirror opposite: Tianeptine ( http://en.wikipedia.org/wiki/Tianeptine ), which acts as a Selective Serotonin Reuptake Enhancer. Incredibly, this drug has also been effective at treating depression . That's right: two classes of drugs with polar opposi…

It is interesting that two drugs with the opposite mechanisms of action produce the same clinical response.

However, you might want to take the description of "reuptake enhancer" with a grain of salt. The mechanism of action (MOA) for drugs is notoriously difficult to determine.

The best example of this is Lyrica (Pfizer). The drug was designed to be a GABAase enzyme inhibitor (prevents GABA from being metabolized, increasing it's action). This MOA was pushed during the entire development of Lyrica. It wasn't until the drug hit the market that a researcher finally figured out that it works by modulating the glutamate neurotransmitter. It's effectiveness has nothing at all to do with GABA.

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