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The psychiatric drug crisis

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Re: The psychiatric drug crisis

#141

Post by dragonwriter »

lutusp wrote: post #132
dragonwriter wrote: post #128

Earlier quoted context omitted.

> If a medical drug were proven ineffective as anti-depression drugs have, doctors would have to stop prescribing it or be sued for malpractice. Anti-depressive (and other psychiatric) drugs are a subset of "medical drugs". > You can't sue psychologists for malpractice, because there's no such thing as good psychological practice for comparison. You can, in fact, sue a psyschologist for malpractice [1], but a psychol…

> Anti-depressive (and other psychiatric) drugs are a subset of "medical drugs". No, they are not. Medical drugs are prescribed by doctors to treat medical conditions, not psychological ones. There are some medical drugs that are prescribed off-label to treat mental conditions, but that's a shady practice (albeit a common one). > You can, in fact, sue a psyschologist for malpractice ... Yes, but you can't compare wha…

> Medical drugs are prescribed by doctors to treat medical conditions, not psychological ones.

There is no such thing as a "medical condition". There are physical conditions (of which psychiatric conditions are a subset) and medical (as opposed to, e.g., surgical) treatments for physical conditions.

For psychiatric conditions not to be physical would involve mystical mind-body dualism, which is an anti-scientific proposition.

> Yes, but you can't compare what he does to effective practices, because there aren't any.

Psychological malpractice is generally a subset of medical malpractice, whose standard isn't about "effective practices" but, like all professional malpractice, is about accepted standards within the profession.

> This is why such cases are so rare

Psychological malpractice cases aren't that rare. It's probably somewhat harder to establish causality in psychological malpractice cases than, say, some of the more obvious kinds of surgical malpractice cases, but that's not a matter of standards but of the difficulty in tracing particular harms to particular failures to meet the professional standard of care.

> why malpractice insurance is nearly unheard of among psychiatrists and psychologists.

Malpractice insurance is a practical necessity for psychiatrists -- who are, after all, medical doctors -- and is not at all uncommon for psychologists in clinical practice.

> Many psychologists and psychiatrists have ruined the lives of their clients but proved immune to prosecution

And many medical doctors in specialties other than psychiatry have killed patients and yet not been successfully prosecuted. That doesn't mean that medical doctors are, as a class, immune to malpractice claims, it just means that not every thing that they do that ends up causing harm ends up resulting in legal liability. Psychiatrists are no different.

> unless by the term "psychologist" we mean anyone practicing clinical psychology

Psychiatry isn't clinical psychology, it is medicine, and its practiced by medical doctors with a particular specialty, not psychologists. Making up your own non-standard definitions of terms to justify your completely inaccurate rants isn't helpful.

Re: The psychiatric drug crisis

#142

Post by DannyBee »

chimeracoder wrote: post #112
DannyBee wrote: post #90

Earlier quoted context omitted.

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 a…

It is true my psychiatrists are not on insurance plans. This is a larger problem with how mental illness treatment is funded/supported.

I was diagnosed as a child about 27 years ago (IE well before the current "popularity").

My treatments did change. I learned to cope with some aspects, the medications I used changed (I am on a non-stimulant now, Straterra, that works as well as my stimulants did).

Besides being able to be more introspective and self-aware as I got older, I also chose a path that would set me up for success.

I have a job that has multiple roles, and essentially requires me to pay short amounts of attention to a large number of things at once, which is somewhat ideal for my ADHD. The things that require longer amounts of focus tend to be lower priority.

Re: The psychiatric drug crisis

#143

Post by chimeracoder »

DannyBee wrote: post #142
chimeracoder wrote: post #112

Earlier quoted context omitted.

> 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 a…

It is true my psychiatrists are not on insurance plans. This is a larger problem with how mental illness treatment is funded/supported. I was diagnosed as a child about 27 years ago (IE well before the current "popularity"). My treatments did change. I learned to cope with some aspects, the medications I used changed (I am on a non-stimulant now, Straterra, that works as well as my stimulants did). Besides being able…

> I am on a non-stimulant now, Straterra, that works as well as my stimulants did

That's interesting - thanks for sharing. IIRC Strattera is relatively new; I wonder if the drugs themselves are getting more effective, or if the most effective drug for a person changes over time based on physiological changes or external factors.

I don't have any personal experience to compare it with, but of my friends who have been treated for ADHD for more than 15 years, it seems all have had to switch medications multiple times.

I don't see your email address on your profile, but mine is my username at gmail - mind dropping me a line?

Re: The psychiatric drug crisis

#144

Post by lutusp »

dragonwriter wrote: post #141
lutusp wrote: post #132

Earlier quoted context omitted.

> Anti-depressive (and other psychiatric) drugs are a subset of "medical drugs". No, they are not. Medical drugs are prescribed by doctors to treat medical conditions, not psychological ones. There are some medical drugs that are prescribed off-label to treat mental conditions, but that's a shady practice (albeit a common one). > You can, in fact, sue a psyschologist for malpractice ... Yes, but you can't compare wha…

> Medical drugs are prescribed by doctors to treat medical conditions, not psychological ones. There is no such thing as a "medical condition". There are physical conditions (of which psychiatric conditions are a subset) and medical (as opposed to, e.g., surgical) treatments for physical conditions. For psychiatric conditions not to be physical would involve mystical mind-body dualism, which is an anti-scientific pro…

>> Medical drugs are prescribed by doctors to treat medical conditions, not psychological ones.

> There is no such thing as a "medical condition".

Are you sure you want to go down that road? Cancer is a medical condition. ADHD is not. Psychologists are not doctors and cannot treat medial conditions -- they are neither trained or licensed to do that.

Psychiatrists are psychologists with an M.D. degree. When you call a psychiatrist "doctor" , you are acknowledging his medical training, not his psychological training. There is no mental doctor, and there is no mental specialty in medicine.

The reason? Modern medicine is evidence based, and psychological treatments are not evidence-based.

> Psychological malpractice cases aren't that rare.

They are very rare. Public records show that, when something goes wrong in psychological treatment of children, the parents are more likely to face charges than the psychologist or psychiatrist, and I already gave one well-known example of a psychiatrist still practicing after being involved in a case that led to murder charges against the parents, who administered the drugs the psychiatrist prescribed.

> Psychiatrists are no different.

The public record shows that this is false. There are cases, but they represent a small fraction of those in medical fields, and the behaviors tend to be more egregious -- sexual abuse, damage to the patient through outright incompetence or prescribing the wrong drug. There are fewer cases such as one sees in medical specialties that have established procedures based on long clinical experience -- and scientific evidence to support clinical practice.

> Psychiatry isn't clinical psychology, it is medicine

A psychiatrist is a psychologist with an M.D. degree. The M.D. degree is acquired before the person begins psychiatric training, for a number of reasons including the fact that psychiatry is not a medical field in the modern sense of the word -- fields based on science, and on evidence.

The only reason psychiatry exists is to confer an unearned status on psychologists and psychology. And recent changes will make this obvious even to those who have been avoiding reality. One of those changes is the NIMH's recent decision to abandon the DSM, psychiatry's "Bible" and primary diagnostic guide. The reason? It's not reliable enough to be useful in research. About this decision, NIMH director Thomas Insel said "While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity."

Source: http://www.nimh.nih.gov/about/director/2013/transforming-dia...

Now - imagine someone in authority deciding to throw out an influential oncology textbook on the ground that it's not valid. Imagine the uproar. But in this case, it caused some comment but no great surprise -- most people in the field saw this coming. The reason for that muted reaction is that psychiatry isn't evidence-based and it is not medicine, all public claims to the contrary.

> Making up your own non-standard definitions of terms to justify your completely inaccurate rants isn't helpful.

Shall I give you Insel's email address so you can complain to the source of my views about how inaccurate he is?

Re: The psychiatric drug crisis

#145

Post by Dylan16807 »

lutusp wrote: post #140
Dylan16807 wrote: post #138

Earlier quoted context omitted.

Honest question, what's the difference between 'appear' and 'apparently' to you? As far as I use the words, one of their meanings is identical.

> Honest question, what's the difference between 'appear' and 'apparently' to you? They have similar etymologies, but their current meanings are diverging. An apparent difference may not be visual -- at least, not to the degree that an examination of the word's history would lead one to believe. An appearance of difference still is primarily visual. And yes -- this is to some degree splitting hairs.

Interesting. I don't focus on visuals at all when I say 'appear'. Well, certainly not more than with 'apparent' or other similar words.

Re: The psychiatric drug crisis

#146

Post by taway2012 »

jes5199 wrote: post #35
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…

I've been meditating on this fact for a while. (I take an SSRI, and I believe that it helps me, but I would love to know why .) I think one possible understanding of depression is that it is a feedback loop - it's a sort of standing wave or Nash equilibrium of patterns of thought causing patterns of behavior causing patterns of sensation causing patterns of emotion that cause patterns of thought, etc. And, perhaps, t…

Hmm, check out 'Autopilot' by Andrew Smart. It has some sections about equilibrium etc. And 'On Intelligence' by Jeff Hawkins (very under-rated book imho). Good luck!

Re: The psychiatric drug crisis

#147

Post by carbocation »

beagle3 wrote: post #136
phren0logy wrote: post #115

Earlier quoted context omitted.

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 consi…

There's a way to objectively measure subjective pain. At least, these guys[1] claimed to have done it, and i've been told by someone who examined them as part of investment due-diligence, that it actually works (better than the cartoon face scale, anyway) [1] http://www.medasense.com/

In clinical medicine, "we cannot measure pain" is true, or at least "at [this institution], we cannot measure pain" is true, where [this institution] is every institution I've ever seen.

What's happening in the research world takes time to translate into practice, especially if it's not been validated in a large multi-center trial.

Re: The psychiatric drug crisis

#148

Post by slurry »

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.

The hypothesis that depression comes from a deficiency of serotonin is, from what I understand, no longer considered viable among research psychiatrists[0], although it's still widely believed by practitioners and the general public. Which isn't to say that serotonin-dousing couldn't still be a viable treatment, but your brain doesn't have an ibuprofen deficiency just because Advil takes care of your headaches.

[0] http://www.npr.org/blogs/health/2012/01/23/145525853/when-it...

Re: The psychiatric drug crisis

#149

Post by refurb »

lutusp wrote: post #129
refurb wrote: post #122

Earlier quoted context omitted.

Wait a second, "prospective" trial does not mean that you draw patients from a pool who have no interest in treatment. Prospective simply means you have decided what the endpoints will be before the trial begins. The inverse of a prospective trial is a retrospective trial where you have a set of data and you go looking for signals.

> Wait a second, "prospective" trial does not mean that you draw patients from a pool who have no interest in treatment. Then it's a good thing that I never said or implied that. The subjects must be drawn from a uniform population, not from a population that have already come forward for treatment -- otherwise the result is biased by the experimental population at the outset. > Prospective simply means you have deci…

Well you did a much better job describing how you define retrospective vs. prospective trial design. I still think the way you are defining it is not accurate, since retrospective trial designs have nothing to do with self-selection. That is a separate matter. All retrospective means is "looks back in time" at data that has already been collected.

However, you argument stills doesn't hold much water. How can a psychiatric drug be used retrospectively unless it has already been approved for use? If you're complaining about trial data on off-label use, then I won't argue, but the FDA does not accept retrospective trials to support drug approval.

Re: The psychiatric drug crisis

#150

Post by jes5199 »

taway2012 wrote: post #146
jes5199 wrote: post #35

Earlier quoted context omitted.

I've been meditating on this fact for a while. (I take an SSRI, and I believe that it helps me, but I would love to know why .) I think one possible understanding of depression is that it is a feedback loop - it's a sort of standing wave or Nash equilibrium of patterns of thought causing patterns of behavior causing patterns of sensation causing patterns of emotion that cause patterns of thought, etc. And, perhaps, t…

Hmm, check out 'Autopilot' by Andrew Smart. It has some sections about equilibrium etc. And 'On Intelligence' by Jeff Hawkins (very under-rated book imho). Good luck!

Will do, thanks!
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