The psychiatric drug crisis • Hacker News Board

Re: The psychiatric drug crisis

#111

Post by pyre » Sun, Sep 08, 2013, 3:05 PM UTC

freyr wrote: post #29

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? Placebo effect is certainly an effect. But the claim is not that the drugs don't have an effect (though it's true, some work no more effective than a placebo), but that we have no sound explanation for their effects.

> though it's true, some work no more effective than a placebo

Do you have a citation for this? What drugs on the market today are "no more effective than placebo?"

Re: The psychiatric drug crisis

#112

Post by chimeracoder » Sun, Sep 08, 2013, 3:11 PM UTC

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…

> 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.

First, you're very lucky! From what I understand, those psychiatrists are not only expensive (usually they are not on insurance plans), but also hard even to schedule (as they are rare, and in high demand)

Slightly OT, but were you diagnosed as a child or as an adult? If the former, did your treatments change as you grew older? If the latter, what was your impetus in getting diagnosed/treated?

Re: The psychiatric drug crisis

#113

Post by pyre » Sun, Sep 08, 2013, 3:18 PM UTC

lutusp wrote: post #97

cdjk wrote: post #89

Earlier quoted context omitted.

Prospective study was probably not the correct term, since that's an epidemiological study. "Placebo controlled study" is probably a better term. And a placebo controlled study is the best evidence for a medical treatment - doing epidemiological studies to determine medication effectiveness doesn't seem right. Consider an SSRI study for depression. I want to know if someone who is depressed and takes it does better t…

> And a placebo controlled study is the best evidence for a medical treatment ... Yes, and with respect to the drugs we're talking about, subsequent meta-analyses show that the original studies were all biased in favor of their sponsors and all the drugs produce the same results, which argues for a massive placebo effect. For years, studies were published that appeared to support various drug approaches to mental ill…

If SSRIs are no more effective than placebo, then:

* Why do some SSRIs work for some people while others don't?

* Why does increasing the dose of a specific SSRI have an increased effect?

Is it not possible that the real reason that SSRIs might be no more effective than placebo in clinical trials is that we don't quite understand the reasons that they work yet? (i.e. a specific SSRI might only have a real effect on 15% of the non-control group)

Re: The psychiatric drug crisis

#114

Post by chimeracoder » Sun, Sep 08, 2013, 3:21 PM UTC

xxpor wrote: post #36

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…

Both are effective on the same people? Otherwise, it kind of makes sense. If depression is just an imbalance, it may be that there is either too much serotonin or too little.

> If depression is just an imbalance, it may be that there is either too much serotonin or too little.

Depression is a heterogeneous condition. The "truth" is that it's probably not one, but several conditions with similar symptoms; we just don't have the means to distinguish between them yet. So, we (ie, psychiatrists) try different medications that are known to work on some subset of depression patients, and hope that we find one that fits.

I think this is part of why psychiatry gets a bad reputation - even when practiced well, it's an attempt to develop a model for one of the most complicated systems in existence: the human mind & body. When you think about it like that, it's almost a miracle that we're able to do anything given our limited understanding of the way the mind works.

(With many medications, we know what chemical effect the medicine has, and we know what subjective effect the medicine has, but we actually don't have a solid understanding of the link between those two).

But that's not an indictment of the field as a whole, just an observation of how much more we have yet to learn.

Re: The psychiatric drug crisis

#115

Post by phren0logy » Sun, Sep 08, 2013, 3:32 PM UTC

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'm a psychiatrist, and I disagree with much of your post. I see below you mentioned going to a psychiatry conference many times, but if it was with the same docs why did you expect a higher level of scientific discourse? It's true that there are crummy psychiatrists, but please don't throw the rest of us under a bus. At our patient conferences, not being to cite articles to back up your treatment plan would be considered an embarrassment.

I think this article puts psychiatry's dilemma into some good perspective: http://www.sciencebasedmedicine.org/dsm-5-and-the-fight-for-...

I do think that it's interesting how people conceive of psychiatry. We cannot really objectively measure or test pain. There's no blood test or scan that confirms it. But as everyone has experienced it, nobody doubts it exists. There's migraine headaches, which are, like psychiatric illness, diagnosed based on history and symptoms. It's pretty uncontroversial. Yet, as everyone believes themselves to be an expert in behavior, if they have not experienced or known someone with mental illness, it's suddenly all invented.

Re: The psychiatric drug crisis

#116

Post by [deleted] » Sun, Sep 08, 2013, 3:35 PM UTC

neurotech1 wrote: post #78

kyro wrote: post #64

Earlier quoted context omitted.

1. I've sat in on multiple psych conferences. If you compare them with conferences in other specialties, you'll soon realize that there is a severe lack of scientific discourse happening. As I said, there is a belief that the field is an art and that the practitioners within are artists who rely heavily on their experience and preferences. Literature is hardly discussed. The DSM is the bible. 2. Yes, the best and mos…

The Quantitative EEG(qEEG) can determine more than seizure type disorders. The EEG relative signal amplitude is compared to a database. This can sometimes provide a useful differential diagnosis, but not substitute for good clinical assessment and lab work. Unlike psychiatrists, I do not believe the DSM criteria can substitute for actual clinical diagnostic skills.

[deleted]

Re: The psychiatric drug crisis

#117

Post by pyre » Sun, Sep 08, 2013, 3:35 PM UTC

snowwrestler wrote: post #77

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…

Some kids who act hyperactive can be calmed by giving them a depressant. Other kids who act hyperactive get more hyperactive if given depressants. Giving them stimulants calms them down. Or Some people with heat stroke will improve if given water. Others will get worse. All these paradoxical effects prove is that the human perception of symptoms does not have a direct connection to the root causes of those symptoms.…

You could easily write at length on the efficacy of water in putting out fires:

  You can put out a campfire with water, but adding
  water to a grease fire does the opposite. So obviously
  the use of water to put out fires is nothing but hokum!

Re: The psychiatric drug crisis

#118

Post by DenisM » Sun, Sep 08, 2013, 3:52 PM UTC

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…

>Psychiatry by and large is a sham field

>Now, I don't want to discredit the entire field.

Looks like that's exactly what you want to do. Luckily, you're not doing a good job of it.

>What needs to happen first is that we need to attain a much deeper understanding of how the brain works

Yes, and until then what? Do nothing and let the suffers suffer? Per your own admission many people are helped. Perhaps that should be your clue to lay off the righteous indignation at lack of precision. Yes, we all want something that works in all cases, but in the mean time we should use something that works occasionally.

Re: The psychiatric drug crisis

#119

Post by freyr » Sun, Sep 08, 2013, 4:01 PM UTC

pyre wrote: post #111

freyr wrote: post #29

Earlier quoted context omitted.

>If the drugs had no effect, then why are people (ab)using drugs like Adderall to improve cognition, etc? Placebo effect is certainly an effect. But the claim is not that the drugs don't have an effect (though it's true, some work no more effective than a placebo), but that we have no sound explanation for their effects.

> though it's true, some work no more effective than a placebo Do you have a citation for this? What drugs on the market today are "no more effective than placebo?"

There are many studies. Here's one:

http://jama.jamanetwork.com/article.aspx?articleid=185157

This study found that SSRIs provided little to no benefit over placebo for patients suffering from mild to moderate depression. SSRIs did provide a benefit to patients suffering from severe depression.

This raises the question, how many of the 30+ million Americans currently prescribed anti-depressants actually suffer from severe depression and benefit from the drugs? How many are taking it unnecessarily, subjecting themselves to unintended side effects and eventual withdrawal symptoms.

Re: The psychiatric drug crisis

#120

Post by gohrt » Sun, Sep 08, 2013, 4:19 PM UTC

kirubakaran wrote: post #34

guard-of-terra wrote: post #20

Earlier quoted context omitted.

http://blog.wilshipley.com/2005/05/on-being-crazy.html is a very insightful read on that subject, from a successful but unstable person. Is mankind only so smart because if we get any smarter, we cease to function correctly? Maybe it's just not evolutionarily advantageous to be smarter than we are; it makes us mopey, and we end up cutting our ears off when we're trying to woo girls, which rarely results in offspring.

Disproof : Richard Feynman

How many offspring did Feynman have?