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The psychiatric drug crisis

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Re: The psychiatric drug crisis

#101

Post by jdietrich »

011011100 wrote: post #92
jdietrich wrote: post #84

Earlier quoted context omitted.

Homeopaths and faith healers say exactly the same thing. Personal anecdotes are not data. Most mental health disorders are inherently self-limiting and will disappear without any treatment, which makes psychiatry look far more effective than it really is. If you're depressed, you're statistically likely to not be depressed in six months time, regardless of whether you seek treatment or not. In these circumstances, it…

>Personal anecdotes are not data. Um, yes they are. Are they reliable data? I'm not convinced they're not. >If you're depressed, you're statistically likely to not be depressed in six months time, regardless of whether you seek treatment or not. In these circumstances, it's easy for a completely ineffective treatment to look like a miracle cure. Because never in the history of medicine has a treatment for depression…

No depression treatment is claimed to have an immediate effect. If you start taking SSRIs and immediately feel better, it's pure placebo - the marketers of those drugs say that SSRIs take weeks to show any noticeable effect.

Re: The psychiatric drug crisis

#102

Post by marvin »

kyro wrote: post #49
sliverstorm wrote: post #47

Earlier quoted context omitted.

What needs to happen first is that we need to attain a much deeper understanding of how the brain works on the low and high levels, mechanically and abstractly. I like this idea. I have one question; in the meantime, while we spend the next five hundred years figuring out the brain (because as we already know, it is wildly complex and we know almost nothing about it), what do we do with the people who really need psy…

Look, if you have debilitating schizophrenia refractory to any therapy because the demons in your ears tell you the FBI is after you, then the benefits of symptomatic treatment may outweigh whatever unknown side-effects there are. For the millions of those with 'psychiatric' disorders that are diagnosed using incredibly vague guidelines [0] -- do you ever feel tired? do you ever lose attention? do you ever feel reall…

The problem you are pointing out is related to doctors' excessive eagerness to prescribe medicines, not any inherent flaw in the field of psychiatry. This is a problem with the culture among MDs in the US, it is not a global problem of psychiatry.

I've been in first-hand contact with a fair number of doctors, psychiatrists, psychologists and their patients in Scandinavia, and I haven't seen the rampant prescription of drugs to treat vague diagnoses that you describe. If you're in psychotic and in a mental hospital, they'll prescribe drugs, ditto if you have a mood disorder that is severely affecting your functioning. If you have something that reminds of ME or a similar poorly-understood conditions, the meds usually remain off the table and other forms of therapy attempted. Regardless of the situation, if meds are attempted, it's an ongoing experiment to figure out if something works.

Psychiatry would benefit tremendously from a better understanding of brain chemistry. But you're suggeating that we shut down our interim attempts at improving the lives of patients who are suffering greatly today. Psychiatry uses our best guesses yet, and is the best option we have. Its similarities to quack medicine are superficial and incidental.

Re: The psychiatric drug crisis

#103

Post by marvin »

jlgreco wrote: post #59
mathattack wrote: post #40

Earlier quoted context omitted.

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.

This and similar comments in this thread is a plausible guess, but it's fascinating how so many of the computer programmers here are domain experts that have thought of things that all the psychiatrists in the world haven't thought of yet. All psychiatrists have six years of basic scientific education before starting their specialization. They're not the unwashed idiots that people here seem to think.

Re: The psychiatric drug crisis

#104

Post by marvin »

DannyBee wrote: post #90
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…

I used to think much the same thing. I have, however, had the wonderful experience of being treated (for ADHD) by two very science oriented psychiatrists. They know the research articles cold, suggest approaches based on actual research, can explain the best scientific understanding of why something should work, and when it doesn't, why that theory may be wrong, etc. Now, as for " What needs to happen first is that w…

Nice to see someone who has noticed that a good doctor actually bases his opinions of science. You could be fooled by the massive disdain for medicine in this thread, or at the very least be led to believe that no one here has ever talked to a doctor.

Re: The psychiatric drug crisis

#106

Post by nwh »

paul9290 wrote: post #22

I haven't read this entire article, but my experiences with a handful of anti-depressants is that they all are a placebo. Though not for profits. Sell people hope and promise of becoming "normal," and they buy it in the million. Again this is my own personal experience in taking various anti-depressants for a few years. Overall what helped me was talking to other people and realizing were all nuts (deal with same iss…

I'm sure your anecdotal experience with a handful of drugs is representative of everybody else's experience.

(It's not)

Re: The psychiatric drug crisis

#107

Post by shubb »

vacri wrote: post #61
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…

I sat in on a psychiatry conference one afternoon where the docs discussed the treatment of several patients. Never was a scientific article or concept uttered. It was all "well, let's try him on seroquel and olanzapine, let's also throw Paxil in there." One data point? You're talking about the 'how are we going to treat our current patients' conferences? I've been in a couple of those myself, and you're expecting so…

I find your comparison with engineers interesting. There is rigorous work on 'which agile methodology delivers most benefit' or 'what is the best way to architect a system', but largely that stays in academia. I don't think many programmers refer to high quality studies when choosing to do extreme programming over scrum.

The reason for that is the complexity and uniqueness of projects (Does that study at IBM really apply to my small company? If this is a good way for NASA to make hardware, is it a good way to design android aps?). But also because engineers are focused on doing a job using a body of knowledge they draw from school, experience, and a bit of reading. They are not academic engineers. This is probably a good thing.

Similarly, I think doctors are not academic researchers. They apply treatment algorithms, bending them to the patients specific situation is so far as won't get them sued.

If the algorithm doesn't say EEG, then why would they believe they know better than the professors that signed off on it?

If the insurer requires a diagnosis, they will look in the DSM and find something they could justify at an inquest. Then they will treat the diagnosis, according to the algorithm, fitted to the patient.

I think doctoring has more defined procedures than engineering. These are not academics, and I think expecting them to be is based on an assumption that 'dr means phd'. It doesn't for medical people.

Re: The psychiatric drug crisis

#108

Post by mtdewcmu »

xijuan wrote: post #98
WalterGR wrote: post #88

Earlier quoted context omitted.

> Most mental health disorders are inherently self-limiting and will disappear without any treatment Source?

From Wiki http://en.wikipedia.org/wiki/Major_depressive_episode : If left untreated, a typical major depressive episode may last for about six months, while about 20% of these episodes can last two years or more, with 50% of depressive episodes ending spontaneously. I can probably find you an article reference if you want. But I have learned this kind of research findings in psychology class.

There's also a such thing as chronic depression, and reason to think that major depression follows a relapsing-remitting course, at least in some people, and may turn into or be a warning sign of developing chronic depression.

Which says nothing about the effectiveness of psychiatric treatments. But it does argue for aggressive early treatment, whatever that might mean, in the hope of halting the progression before it could become chronic.

Mental illness is fundamentally hard to study scientifically, and I'm not convinced that any of the treatments we have actually work. But it's humane to make the attempt.

Re: The psychiatric drug crisis

#109

Post by totierne »

unono wrote: post #41
sillysaurus2 wrote: post #31

Earlier quoted context omitted.

I'm trying to understand what you're saying, but honestly I have no idea what you just said. Would you clarify your meaning? edit to reply to your edit: no, you'll have to do much better than that if you want to actually communicate with people and not be ignored or dismissed as crazy. Would you please spend at least 10 minutes typing an explanation of (a) what are you talking about, and (b) why is it valuable? Maybe…

OK. I try to see articles and find a positive spin where I can say "hackers could ...". To some people it would be obvious, but to young or non-tech people it might not be, so it could be helpful to them. As other commenters have said, psychiatry/psychology is an ineffective field and also expensive. The self-help industry is kind of related to psychology/psyciatry, is unregulated, and a $11 billion a year field. I g…

I would pay folding money for this software+usage data - and I am just an affected individual (bipolar for 20 years). I went through a phase of asking for survey information (after they had published their paper article etc.)- no one would give it up.

Re: The psychiatric drug crisis

#110

Post by chimeracoder »

aweisberg wrote: post #11
TheLegace wrote: post #6

My ADHD medication Strattera costs $170 a month and since the generic version only saves me $20 causes serious nausea and vomiting I don't have any choice. And its one of the only medications you can't develop a tolerance for. Luckily I'm Canadian, working part time at a Canadian university where health insurance covers the costs.

For the last 18 years or so I have been taking some form of low cost Ritalin with a co-pay between 15-25 dollars. This ancient medication that is a generic costs 130 dollars a month and that is the negotiated rate! The money isn't going to research and it isn't going to manufacturing so where does it go?

> The money isn't going to research and it isn't going to manufacturing so where does it go?

I don't know about Ritalin, but with Adderall, the reason for inflated prices is that the DEA artificially restricts the supply (hence the 2011 disaster[0][1]).

It's simple economics: if it were possible for new companies to enter the market (or for existing companies to produce more), supply would increase, prices would fall, and markets would clear at a (lower) equilibrium price. However, because the US is waging a war on drugs (including psychiatric medicine!), ADHD patients have to suffer the burden of increased prices (that is, when they're lucky enough to even find any in stock).

[0] https://encrypted.google.com/search?hl=en&q=adderall%20short...

[1] http://www.google.com/trends/explore?q=adderall#q=adderall%2...

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