The psychiatric drug crisis

>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 had an immediate effect?

The article has an interesting argument structure. First it undermines the science behind psychiatric drugs by referring to their discovery as serendipitous. Then it proceeds to point out that there is no good theoretical understanding for how the drugs work, even if there is understanding in what neurotransmitter levels are effective. Then the author proceeds to drop the "not better than placebo" results.

Without knowing any psychiatric science, this narrative nevertheless seems suspicious. First of all, it is entirely irrelevant whether a discovery was made serendipitously or as a result of incremental science, as long as the effect is clear enough to be repeatedly found. This is not true in well understood fields, such as physics, where the theories are mostly not changed every now and then, but in complex fields, such as medicine and social sciences, the fact that something matches pre-existing theory is no evidence per se. The problem is "bumpy" enough that any theory is likely to flatten every bump that is not directly observed, even if that bump would be very useful in practice. This leads to most discoveries of any value being serendipitous. It also leads to incremental research failing to advance rapidly most of the time.

So the lack of theory and serendipitous discovery are not problems in themselves. The finding that psychiatric drugs would not be better than placebos is indeed a problem. It does raise the question, of how the serendipitous discovery was ever made. Did it arise out of spurious correlations, so that when the drug was first discovered there happened to be a big incidental recovery in most treated patients? Then in later retrials people managed to trigger a sufficient placebo effect to get the whole thing going. It does seem a little unlikely, but one would have to examine how the first trials were performed.

You say the same thing that doctors say about SSRIs: is certainly effective and fairly well understood in its clinical effects.

Yeah, of course we see the effects, but we still don't really know how exactly it works. For example, no one can tell for sure why Dextroamphetamine and levoamphetamine have different effects (the former is a brain stimulant, while the latter affects mostly the body). Adderall is mostly dextroamphetamine, by the way.

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.

> What evidence does Gary Greenberg provide in his writings that would convince a skeptical onlooker that what he does for his patients is helpful?

The same question could be asked of any psychologist, psychotherapist or psychiatrist, regardless of their publication record. There are no objective, scientific, rigorous evaluation criteria anywhere in the field, which explain why the mental health field has the reputation it does.

No one asked it of Diederik Stapel, and, in spite of his enviable publication record and fame, he turned out the be a total fraud:

Link: http://news.sciencemag.org/people-events/2012/11/final-repor...

Quote: " In their exhaustive final report about the fraud affair that rocked social psychology last year, three investigative panels today collectively find fault with the field itself. They paint an image of a "sloppy" research culture in which some scientists don't understand the essentials of statistics, journal-selected article reviewers encourage researchers to leave unwelcome data out of their papers, and even the most prestigious journals print results that are obviously too good to be true."