Antidepressants not as effective as claimed..

[publius]

Well, well. There's a new study out in the New England Journal of Medicine showing that SSRI and similiar antidepressants aren't quite as effective as the drug companies have led us to believe. I'm shocked, shocked, of course. :lol: And for a really cynical view, many of them are coming off patent, the money has been made, and it doesn't matter any more. Clear your conscience now the money has been made, IOW. The truth eventually comes out.

http://www.medicalnewstoday.com/articles/94267.php


Specifically, the results showed that:
31 per cent of 74 FDA-registered studies (accounting for 3,449 participants) were not published.

37 of the studies seen by the FDA as having a positive outcome were published, and 1 study viewed as positive was not.

Studies viewed by the FDA as having a negative outcome were, except in 3 cases, either not published (22 studies), or published in such a way that the outcome was presented as positive (11 studies). These 33 studies accounted for a total of 5,212 participants.

Collectively, according to the published literature, it appeared that 94 per cent of the trials conducted were positive.

This contrasted sharply with the FDA view, which showed that only 51 per cent of the trials were positive.

The meta-analysis revealed that the increase in effect size from FDA to journal data sets ranged from 11 to 69 per cent for individual drugs and came to 32 per cent across all 12 drugs.


Keep these shenigans in mind with current and future drug company claims. And remember that I posted about them hiring cheerleaders as sales reps. Hot babes whispering sweet little fudged data in the ears of your doctor, whom you're supposed to ask about whatever crap they're pushing.

And also ponder why the FDA, supposed to be such a good watchdog lets this stuff slide......money, money, money.

-Richard

[crosscountry]

pretty typical in our for profit government.

[GeorgeLeRoyTirebiter]

The Last Psychiatrist has posted about this article, and in a stunning twist, he places the blame on academia and its journals:

Are Drug Companies Hiding Negative Studies? (http://thelastpsychiatrist.com/2008/01/are_drug_companies_hiding_nega.html)
...This is bad, obviously, which is why we need a website for all raw data. But let's be clear: this was a review of studies found in the FDA registry. The FDA had this data, and used it to evaluate the meds. No one hid the data-- they gave the data to the FDA, all of it. What didn't happen was publication.

So the real question is why didn't they get published.

Certainly, Pharma doesn't want negative studies published. But these are Phase 2 and 3 clincial trials. They're not done down at Lilly HQ-- these are done at universities. Pharma didn't block their publication-- they were blocked by the academics who did them, and the journals themselves.

[emphasis in original]

I suppose it's more fun to pin this on the drug companies. After all, they are "big, and, um, corporate-y."

[torque of the town]

Keep these shenigans in mind with current and future drug company claims. And remember that I posted about them hiring cheerleaders as sales reps. Hot babes whispering sweet little fudged data in the ears of your doctor, whom you're supposed to ask about whatever crap they're pushing.


Pretty much the same in the UK.

[toejam]

The Last Psychiatrist has posted about this article, and in a stunning twist, he places the blame on academia and its journals:

Are Drug Companies Hiding Negative Studies? (http://thelastpsychiatrist.com/2008/01/are_drug_companies_hiding_nega.html)


I suppose it's more fun to pin this on the drug companies. After all, they are "big, and, um, corporate-y."


Big Pharma, research & ethics (from the Canadian Medical Association Journal):

http://www.cmaj.ca/cgi/content/full/178/2/138



The American pharmaceutical industry's lobbying arm, PhRMA, lays some of the blame for that lost confidence at the feet of the media, for having sensationalized "criticisms of clinical trials."

But others argue the industry is the author of its own misfortunes and can't easily shake allegations that, like shoe and clothing companies, it is lured offshore by the equivalent of clinical "sweatshops." In the developing world, companies can take advantage of loose regulations, low costs, rubber-stamp ethics boards and easy access to desperate and often illiterate trial subjects in order to speed up the costly trial process.

"It's been said that (Big Pharma's reputation) is worse than the tobacco industry at the moment," says Dr. Michael Goodyear, an assistant professor of medicine at Dalhousie University. "It's scary stuff. I mean, no matter how much the drug industry protests and complains, they get caught out once a week doing something they shouldn't have done, because there's a lot of money involved and marketing takes precedence."

MARKETING TAKES PRECEDENCE over everything, truth, ethics, simple human decency and such other "garbage".

[Noclevername]

So what else is new? That's Advertising/Show Business.

[toejam]

So what else is new? That's Advertising/Show Business.


Does that imply that you approve?

[Noclevername]

Does that imply that you approve?

:confused: No, where the heck did you get that??

[Noclevername]

Okay, let me try again...

"So? A company exaggerated its product to make a profit. So do the majority of others, quite often. It's not unique to this one specific topic, therefore not particularly noteworthy."

[toejam]

Okay, let me try again...

"So? A company exaggerated its product to make a profit. So do the majority of others, quite often. It's not unique to this one specific topic, therefore not particularly noteworthy."

It's unique in that it directly affects human well-being and may well be a life-and-death question. You don't think that's different from advertising or submitting to trials of cars, make-up, toilet paper, diapers, toothpaste, shoes,skis, etc, etc, etc?

[Noclevername]

It's unique in that it directly affects human well-being and may well be a life-and-death question. You don't think that's different from advertising or submitting to trials of cars, make-up, toilet paper, diapers, toothpaste, shoes,skis, etc, etc, etc?

Lies about the safety or efficacy of cars, of medications, medical equipment, firefighting equipment, window-washing harnesses, ladders, smoke alarms, and thousands of other products, can kill people, yes. And do. Being dead counts as an effect to your well-being, I think.

[Gillianren]

People with serious mental illnesses have known for years when the medicines don't work, and to a certain extent, we don't care. They work for some people; eventually, we hope, there will be one that works for us.

Not everyone medicated needs to be. But I'm so tired of that being taken to mean that no one needs to be medicated. I try very, very hard not to let serious, obvious examples of my mental illness show around here, so I doubt any of you know how bad it is. But I need the medication to work someday, so I keep trying until I find one that does. Gods know I'm not an apologist for the pharmaceutical industry; I could cite you chapter and verse about their failings. However, I wouldn't put what they're doing with antidepressants at the top of the list. At least they're doing something, which society doesn't seem interested in doing. Nobody wants to hear about studies that might be helpful in alleviating mental illness, because it's all in people's heads anyway, and they can just get over it on their own. I have gone through five psychiatrists (actually, four and one nurse practitioner) in the last three years. I've only had two therapists in that same time, but that's because, for most of that time, I couldn't get a therapist. The local clinic had initially decided that only people with short-term problems could see the therapist.

When you're really mentally ill but still coherent, it's pretty easy to come to the conclusion that you're just in everyone's way. When I see tirades about how evil antidepressants are, that just confirms it.

[Maha Vailo]

Well, then, what does work better than drugs for a mental patient, and how would you know what works best for a particular patient? As a person from a very slightly dysfunctional family (one of whom works w/mental health), I'd like to know.

- Maha "nothing to go crazy over?" Vailo

[toejam]

People with serious mental illnesses have known for years when the medicines don't work, and to a certain extent, we don't care. They work for some people; eventually, we hope, there will be one that works for us.

When you're really mentally ill but still coherent, it's pretty easy to come to the conclusion that you're just in everyone's way. When I see tirades about how evil antidepressants are, that just confirms it.

Entirely agree. Antidepressants, with all their present crudeness and side-effects are a huge boon to those who need them, people with a true depressive illness. But then you have doctors prescribing them for things like reactive "depression", grief, sadness for any reason etc, and they don't work and still have the unpleasant/dangerous side-effects, and that is how they get a bad name. It is clearly the doctors' fault of mistaken diagnosis, mistaken ideas about the indications for these drugs, ignorance and, let's face it, plain ordinary stupidity in a few (we hope) cases.

[Noclevername]

Well, then, what does work better than drugs for a mental patient, and how would you know what works best for a particular patient?

Only experience. I've tried drugs that made me worse, some that did nothing, some that made me vomit, some that made me sleep all the time, and one that made me become violent. All of them messed up my emotions to some degree, incuding what I'm on now. And different dosages had different effects, sometimes radically different. Everyone's chemistry is different. Just gotta keep trying until you find what works.

[Jens]

Just a comment on this, but in fact this is an issiue not only with anti-depressants. Journals tend to public positive studies rather than negative studies. If somebody does a study that finds that shark oil cures cancer or what not, it's big news. But if the study concludes that it doesn't, the editor is like "so what"? It's partly the same problem that we have with plane crashes. Every time there's a big crash, it gets all over the news, but if a study comes out mentioning that there hasn't been a major crash in a year, it's buried at the bottom of page 3,892 of the newspaper.

So yes, the money angle may have something to do with it, but it's not just that.

Actually, there's another issue with anti-depressants. Incredibly (or not incredibly, depending on what you'd expect), 30% or so of people with depression get better from receiving sugar tablets (placebo, in the jargon). There are lots of explanations for why that happens. One important one is that simply talking to a doctor may help depression. So as a result, it's very difficult to get a statistically significant advantage for a drug over placebo, because placebo is so darned good!

[Noclevername]

Actually, there's another issue with anti-depressants. Incredibly (or not incredibly, depending on what you'd expect), 30% or so of people with depression get better from receiving sugar tablets (placebo, in the jargon). There are lots of explanations for why that happens. One important one is that simply talking to a doctor may help depression. So as a result, it's very difficult to get a statistically significant advantage for a drug over placebo, because placebo is so darned good!

It's good for some people. Assuming it actually cures the depression and doesn't just mask the symptoms like many drugs do.

Actually, I'd like to know where that 30% number came from-- a study funded by placebo manufacturers? ;)

[Gillianren]

I go into every new drug thinking, "Maybe this is the one." My earliest experiences, however, involved a doctor who's about 157 and refused to entertain a possible diagnosis of bipolar disorder. He was treating me like a straight depressive, so the drugs were directly contraindicated for my condition unless you are also on a mood stabilizer, which of course I was not. And then a second doctor who didn't think I was bipolar. The nurse practitioner finally entered the diagnosis in my files. The third doctor wanted to rule it out. The fourth doctor has finally asked me how anyone could think I have anything else. Clearly, in this case, my problem is not with the pharmaceutical industry! All of these people were seeing patients for maybe 30 minutes every month or so; they were all seeing low-income patients, so it was exceedingly rare for them to have a patient who was in treatment because they really wanted treatment. My clinic has been unable to keep a steady doctor, presumably for just that reason.

The whole mental health system in the US needs an overhaul. In my area, it's impossible to get any help--meds or therapy--if you're not actually destitute but still too poor to afford insurance. Like any chronic condition, however, if people with mental illness need continual treatment or their condition can deteriorate. I'm probably worse now than I could be due to the years wherein I was uninsured.

[publius]

Actually, I'd like to know where that 30% number came from-- a study funded by placebo manufacturers? ;)


Actually, if they could find a way to get away with charging $3/pill for sugar pills, you'd see the same clinical trials being used as evidence in favor of them. "Sucrozat: works as good as Prozac!"

Here's the way it works basically with these trials. You have control group given the placebo and another group given the drug. At the end of the test period you compare the groups by some measures to see who improved and by how much. In roughly half of the studies mentioned in this report, the drug group did not do any better than placebo group by any statistically significant margin.

And in those statistics is where some games will be played, as well. With depression and other mental illness, how do you define getting better? There is not much of an objective definition there, other than what the test subject *says* in response to various questions. They have these batteries of standard pyschological tests that are used as indicators how depressed a person is, etc, etc.

So getting better and by how much is measured according to those tests, which are simply the subjects answering questions.

In quite a few cases where SSRIs were reported to have a positive effect over placebo, it turned out the "primary indicators" weren't used, but only secondary indicators. That is, they couldn't get a statistical difference out of the main data, so they switched to something else, considered only secondary where they did manage to find a statistical difference. And they touted that as some amazing result.

Overall, the studies that find SSRIs do better than placebo will be touted, while those that fail to find a difference don't get mentioned.

And all that was used to fuel what is today a $21 billion per year market.

-Richard

[Jens]

Actually, I'd like to know where that 30% number came from-- a study funded by placebo manufacturers? ;)

Here's a link to an article (http://www.psychiatrictimes.com/showArticle.jhtml;jsessionid=JEM0UA1O4X2LCQSNDLPSK H0CJUNN2JVN?articleId=175802296)that mentions about 30%. There is a fair amount of information on it.

[Noclevername]

Here's a link to an article (http://www.psychiatrictimes.com/showArticle.jhtml;jsessionid=JEM0UA1O4X2LCQSNDLPSK H0CJUNN2JVN?articleId=175802296)that mentions about 30%. There is a fair amount of information on it.

Thanks. I'll point out the obvious, that we shouldn't rely on any one single study but on the overall weight of evidence. The article even says

Critics of the study attributed these results to insufficient assay sensitivity; while those critical of antidepressant pharmacotherapy found the results supported their view that medication contributes little more than side effects to depression treatment.

so there's already controversy, and already people hurting their feet by jumping to conclusions with insufficient ankle and arch support.

[Jens]

Yes, but I think the controversy in that case is that the effects of Zoloft may have been underestimated. I don't think people are really questioning the fact that placebo works. Actually, here is a better article (http://jama.ama-assn.org/cgi/content/full/287/14/1840), which is a meta-analysis. It also seems to show something like 30%.

[publius]

Yes, but I think the controversy in that case is that the effects of Zoloft may have been underestimated. I don't think people are really questioning the fact that placebo works. Actually, here is a better article (http://jama.ama-assn.org/cgi/content/full/287/14/1840), which is a meta-analysis. It also seems to show something like 30%.


I just read that, and discovered a most prescient comment near the end:


Our study has several limitations. We examined only published data. For a number of reasons, including the fact that most placebo-controlled trials of antidepressant medications are supported by the pharmaceutical industry, studies in which a significant drug-placebo difference is detected are presumably much more likely to be published than ones in which the responses to placebo and active medication are statistically indistinguishable. Therefore, it seems probable that the placebo response rates in the published studies we examined are lower, and the medication response rates higher, than those in unpublished studies.


Ding, ding, ding! They only used the published studies in finding the
~30% placebo response.

-Richard

[Jens]

Ding, ding, ding! They only used the published studies in finding the
~30% placebo response.

That's true, though my point is not that the placebo response is only 30%. I'm saying that the placebo rate may be quite high, in agreement with you, and if the authors of the study suggest that it may actually be 40% or 50%, I would find that interesting as well. In any case, I think we're basically in agreement that "antidepressants may not be as effective as claimed."

[Whirlpool]

Only experience. I've tried drugs that made me worse, some that did nothing, some that made me vomit, some that made me sleep all the time, and one that made me become violent. All of them messed up my emotions to some degree, incuding what I'm on now. And different dosages had different effects, sometimes radically different. Everyone's chemistry is different. Just gotta keep trying until you find what works.

Are you talking about the OTC drugs?

It's dangerous if you try different kinds of drugs without the doctors prescription.

[Moose]

The thing with placebos is that the reported improvement isn't actually improvement. It's perceived improvement. It has absolutely no effect on the underlying condition. (That's why it's called a placebo.)

The other thing is this: you cannot conclude, based on susceptibility to the placebo effect, that the "condition" is non-existent. People with broken limbs will frequently (although I don't have numbers to hand) report lessened pain if given a sugar pill (and told it's codeine, for example.)

[publius]

That's true, though my point is not that the placebo response is only 30%. I'm saying that the placebo rate may be quite high, in agreement with you, and if the authors of the study suggest that it may actually be 40% or 50%, I would find that interesting as well. In any case, I think we're basically in agreement that "antidepressants may not be as effective as claimed."

Jens,

Oh no, I didn't think you were in disagreement, I was just fascinated to note that this study which finds the high placebo response was itself based on the "cherry picked" studies where the active agents did better. And it's important to note the authors here were well aware of this "cherry picking" behavior.

Also fascinating is how the placebo response (and active repsonse) is increasing with time. Later studies have higher responses than earlier studies.

-Richard

[Argos]

[B]Keep these shenigans in mind with current and future drug company claims. And remember that I posted about them hiring cheerleaders as sales reps.

Well, down here they hire [the equivalent of] cheerleaders and fashion models to advertise private universities...

[korjik]

I go into every new drug thinking, "Maybe this is the one." My earliest experiences, however, involved a doctor who's about 157 and refused to entertain a possible diagnosis of bipolar disorder. He was treating me like a straight depressive, so the drugs were directly contraindicated for my condition unless you are also on a mood stabilizer, which of course I was not. And then a second doctor who didn't think I was bipolar. The nurse practitioner finally entered the diagnosis in my files. The third doctor wanted to rule it out. The fourth doctor has finally asked me how anyone could think I have anything else. Clearly, in this case, my problem is not with the pharmaceutical industry! All of these people were seeing patients for maybe 30 minutes every month or so; they were all seeing low-income patients, so it was exceedingly rare for them to have a patient who was in treatment because they really wanted treatment. My clinic has been unable to keep a steady doctor, presumably for just that reason.

The whole mental health system in the US needs an overhaul. In my area, it's impossible to get any help--meds or therapy--if you're not actually destitute but still too poor to afford insurance. Like any chronic condition, however, if people with mental illness need continual treatment or their condition can deteriorate. I'm probably worse now than I could be due to the years wherein I was uninsured.

Heck, I can second both of Gillianren's posts. The only reason I am still a grad student is cause basically every Prof in the physics department at UH knows I can get the degree, but my academic record says I cant. I found out the hard way that depression runs in the family (failed 2 of 3 classes) then found out that the meds werent really working (failed 2 of 3 classes). My GPA is too low right now for me to stay in the program, and I have to get that changed before I can get a degree.

My diagnosis was roughly similar to Gillianren's also. I had 4 doctors tell me it was just stress, until I finally went off on the 4th and pointed out that I was a desert storm vet, who never even blinked when dumped on the side of the road, who never even blinked when stuff got blown up around me, and who considers test days to be a nice break from the drudgery of normal class days. She finally thought that it may be something else.

Even then tho, I was bad enough off that just the placebo effect helped. It got me up to the barely functional level.

The thing is, some drugs help some people. The problem is that you have to match the drug to the person. Then there are people who arent constantly depressed. My depression comes and goes and I dont usually know it came until it leaves. If there are people like me in a double blind study, the placebo could have just as much effect as the drug, while there may be some who go from nearly suicidal to functional from the same drug. The study may show little effect in general, but some people may get extremely good results.

[Noclevername]

Are you talking about the OTC drugs?

It's dangerous if you try different kinds of drugs without the doctors prescription.

Nope, psychiatrist-perscribed only.

[Gillianren]

Well, psychiatrist, anyway.

I know people whose lives have been changed--who still have lives, when you get right down to it--because they've been medicated. Yes, I've known people who were medicated when they shouldn't've been. But there's this persistent attitude of throwing the baby out with the bathwater, and it's really worrisome to me.

[Noclevername]

Well, psychiatrist, anyway.


:doh::doh::doh:

That's what I meant! I corrected it. (For the non-crazy or undiagnosed crazy out there, psychologists can't perscribe meds, they aren't MDs.)

I'm getting a dent from smacking my head so much!:rolleyes:

[Whirlpool]

Nope, psychiatrist-perscribed only.

Last edited by Noclevername : Today at 03:50 PM. Reason: D'oh again! I seem to be d'ohing a lot lately.


:confused: What did you edit in your post?

[Noclevername]

:confused: What did you edit in your post?

I had originally mistakenly written psychologist instead of psychiatrist.

[publius]

This NEJM story has been the making the news rounds, and a story NPR did on it focused on the supressing negative data aspects, and mentioned the Traci Johnson story. Here's an older Slate article on that little story:

http://www.slate.com/id/2126918/

Ms. Johnson was a 19 year old college student, serving as "healthy volunteer" for a Lily clinical trial involving Cymbalta, an antidepressant. However, they weren't testing Cymbalta for depression or any other mental conditon, but for "stress urinary incontinence", the clinical language for a problem among women of leaking urine with they laugh or sneeze.

Ponder that a bit. Someone had the idea of using a pyschoactive drug to treat peeing your pants. Drug makes money. Let's find even more things to prescribe it for to make even more money. Also, if a new, approved use of a drug is found, it can stay on patent longer. So if you can find a new use for a given drug, you can extend the patent and keep profits high.

At any rate, Ms. Johnson committed suicide, hanging herself from a shower rod, right in an Eli Lilly lab. Getting that information out of even the FDA was like pulling teeth.

While the Slate article didn't go into the details, IIRC, she was on a very high dose, then abrubtly switched to placebo. A sudden change in dose of these things can be dangerous, experience has shown -- it's a big jolt to the system, and it can oscillate wildly so to speak. Wildly enough to lead to suicide and other violent episodes.

One of the arguments about a higher suicide rate with antidepressants is "they were depressed anyway". Well, if you're giving the drug to people who aren't depressed, merely peeing their pants, and you find a higher suicide rate that argument goes out the window. So that's why Lilly didn't want this "data" out.

Anyway, this is a particularly egregious example of monkey business with clinical trials.

-Richard

[Jens]

One of the arguments about a higher suicide rate with antidepressants is "they were depressed anyway". Well, if you're giving the drug to people who aren't depressed, merely peeing their pants, and you find a higher suicide rate that argument goes out the window. So that's why Lilly didn't want this "data" out.


Actually, I have my own theory aboutt that, those this is just idle speculation. But I think it's something to explore at least. What does an anti-depressant do? Basically, I think it gives people more courage to live. Which is probably why it also can be effective for anxiety. OK, now think about this. I don't know if anybody else has ever experienced this, but I remember when I was a kid (and not depressed!) I was hiking in the mountains, and we came to the edge of a cliff and I sort of wondered what it would be like to fling myself over the edge. I think it was kind of morbid curiosity, or perhaps a feeling of awe at how close I could be to death. So the hypothesis is, if anti-depressants give one the courage to go on, the might give one the courage to die in certain situations. For example, there could be a person who is seriously depressed but not courageous enough to go through with it. And perhaps the drug could boost the courage at the same time that it lifts the mood, and give the person the courage to carry out the act. I did read an intriguing paper somewhere (I can't find it anymore) that suggested that the wide prescription of SSRIs in the US may have led to greater volatility in the stock market. So I may not be that far off the mark.

Also, just as an aside, the use of "peeing in their pants" seems a bit crude to me for incontinence. It seems like something you use toward children or frightened people, and (though I'm not afflicted with the particular disorder) my uninformed opinion is that it's often minor leakage and not what I tend to associate with "peeing".

[publius]

Well, actually I meant it to be crude. :) The crude humor was an expression of my disgust at the idea of using a pyschoactive drug to treat such a complaint.

And I got to digging from more info on Johnson. She was not incontinent, but was part of group of healthy volunteers. The FDA wanted data on the effects on the drug on heart rhythm and she was part of a number given 5 - 6 times the normal dosage of the drug to test cardiac effects. At the end of the period they were quicky weaned off the high dose down to zero over just 4 days. That's when she killed herself.

She was a "starving college student', and entered the trial to help pay the bills. They were paying about $150/day, which is some good money for college kid on a shoestring budget.

-Richard

[publius]

You know, all in all, there may be reason to be optimistic. It will take a while, but I think the tide may be turning, as the public in general, and more importantly, the rank and file in the medical profession, become aware of Pharma shenanigans. Here is an example:

http://www.usatoday.com/news/health/2008-01-19-drug-trinket-roundup_N.htm?POE=click-refer

Note 20 shopping carts to haul all the "loot" of Pharma gifts and trinkets out of the clinics. This is a part of a growing backlash after a 2006 JAMA study that showed all these little gifts were very effective at manipulating doctors' prescribing patterns.

It will take a while, but I think the tide is turning. It finally reached the zenith (or nadir, better) and people are looking in the mirror and getting rightly ashamed of themselves.

-Richard

[korjik]

This NEJM story has been the making the news rounds, and a story NPR did on it focused on the supressing negative data aspects, and mentioned the Traci Johnson story. Here's an older Slate article on that little story:

http://www.slate.com/id/2126918/

Ms. Johnson was a 19 year old college student, serving as "healthy volunteer" for a Lily clinical trial involving Cymbalta, an antidepressant. However, they weren't testing Cymbalta for depression or any other mental conditon, but for "stress urinary incontinence", the clinical language for a problem among women of leaking urine with they laugh or sneeze.

Ponder that a bit. Someone had the idea of using a pyschoactive drug to treat peeing your pants. Drug makes money. Let's find even more things to prescribe it for to make even more money. Also, if a new, approved use of a drug is found, it can stay on patent longer. So if you can find a new use for a given drug, you can extend the patent and keep profits high.

At any rate, Ms. Johnson committed suicide, hanging herself from a shower rod, right in an Eli Lilly lab. Getting that information out of even the FDA was like pulling teeth.

While the Slate article didn't go into the details, IIRC, she was on a very high dose, then abrubtly switched to placebo. A sudden change in dose of these things can be dangerous, experience has shown -- it's a big jolt to the system, and it can oscillate wildly so to speak. Wildly enough to lead to suicide and other violent episodes.

One of the arguments about a higher suicide rate with antidepressants is "they were depressed anyway". Well, if you're giving the drug to people who aren't depressed, merely peeing their pants, and you find a higher suicide rate that argument goes out the window. So that's why Lilly didn't want this "data" out.

Anyway, this is a particularly egregious example of monkey business with clinical trials.

-Richard

Technically, that is the way every drug there is was first tested. I am not really trying to disprove your point tho. Tests should be fully transparent after a drug is approved for human use, if not before.

[korjik]

Actually, I have my own theory aboutt that, those this is just idle speculation. But I think it's something to explore at least. What does an anti-depressant do? Basically, I think it gives people more courage to live. Which is probably why it also can be effective for anxiety. OK, now think about this. I don't know if anybody else has ever experienced this, but I remember when I was a kid (and not depressed!) I was hiking in the mountains, and we came to the edge of a cliff and I sort of wondered what it would be like to fling myself over the edge. I think it was kind of morbid curiosity, or perhaps a feeling of awe at how close I could be to death. So the hypothesis is, if anti-depressants give one the courage to go on, the might give one the courage to die in certain situations. For example, there could be a person who is seriously depressed but not courageous enough to go through with it. And perhaps the drug could boost the courage at the same time that it lifts the mood, and give the person the courage to carry out the act. I did read an intriguing paper somewhere (I can't find it anymore) that suggested that the wide prescription of SSRIs in the US may have led to greater volatility in the stock market. So I may not be that far off the mark.

Also, just as an aside, the use of "peeing in their pants" seems a bit crude to me for incontinence. It seems like something you use toward children or frightened people, and (though I'm not afflicted with the particular disorder) my uninformed opinion is that it's often minor leakage and not what I tend to associate with "peeing".

Courage isnt the right word, but I think you are correct.

[publius]

Technically, that is the way every drug there is was first tested. I am not really trying to disprove your point tho. Tests should be fully transparent after a drug is approved for human use, if not before.

There's an important distinction here. During those trials, this was not some highly experimental new drug that had never been used in the human population. These were tests for an *existing approved drug*, already on the market, to be approved for a new use.

So "negative safety data" has important implications there beyond that for a truly new drug because it's already out there being used. That's especially true when there are already suspicions about safety, and you have an event during the trial that supports it.

-Richard

[publius]

Here's some more encouraging news from the "tide is turning" front. The American Medical Students Association has launched a "Pharma free" effort:

http://www.amsa.org/prof/pharmfree.cfm

If you follow all the info there, you'll find a lot of interesting info on Pharma influence, etc.


I am committed to the practice of medicine in the best interests of patients and to the pursuit of an education that is based on the best available evidence, rather than on advertising or promotion.

I, therefore, pledge to accept no money, gifts, or hospitality from the pharmaceutical industry; to seek unbiased sources of information and not rely on information disseminated by drug companies; and to avoid conflicts of interest in my medical education and practice.


They even do some "direct action" type of stunts, such as having medical students go through hospitals looking for drug advertising and all the free goodies, and stamping a big "Pharma free" sticker on it.


-Richard

[Noclevername]

Here's some more encouraging news from the "tide is turning" front. The American Medical Students Association has launched a "Pharma free" effort:

http://www.amsa.org/prof/pharmfree.cfm

If you follow all the info there, you'll find a lot of interesting info on Pharma influence, etc.



They even do some "direct action" type of stunts, such as having medical students go through hospitals looking for drug advertising and all the free goodies, and stamping a big "Pharma free" sticker on it.



Well, as much as I wish them luck, the cynic in me can't help but note that, despite all those years of anti-smoking ads and stunts, people still smoke. Temptation is called that because, well, it's tempting.

[publius]

As many of you have probably guessed, this is a big pet peeve of mine. :lol: For those who are interested, here's an article by a psychiatrist detailing how Pharma works its magic. He was recruited to push Effexor, and tells the story:

http://www.nytimes.com/2007/11/25/magazine/25memoir-t.html?pagewanted=1&_r=1&ref=magazine

I encourage you all to read it, as it illustrates how they operate.

ETA: From the article, I can't resist quoting this little ditty:


The drug rep who arranged the lunch was always there, usually an attractive, vivacious woman with platters of gourmet sandwiches in tow. Hungry doctors and their staff of nurses and receptionists would filter into the lunch room, grateful for free food.


The hot babe drug rep phenomenon is well known. Well known, indeed.

-Richard

[publius]

Speaking of the general placebo effect, they are apparently used to some extent in actual clinical practice. One doctor and a pharmacist I know have told me about this. Apparently, there's a little code on scripts that tells the pharmacist to give a sugar pill and pretend it's a real drug. And apparently that helps ease the minds of some patients. :)

And here's a paper on this very practice:

http://www.springerlink.com/content/y2272414px6j7067/?p=b0f90f365e7e4223bc11274c63496419&pi=1


Background The placebo and the placebo effect are often investigated in the context of clinical trials. Little data exist on the use of placebos in the course of routine health care.
Objective The aim of this study is to describe a group of academic physicians’ use of placebos and their knowledge, attitudes, and beliefs about placebos and the placebo effect.
Design A 16-question anonymous web-based survey of physicians from Internal Medicine departments of 3 Chicago-area medical schools was used.
Results There were 231/466 (50%) physicians who responded; of these, 45% reported they had used a placebo in clinical practice. The most common reasons for placebo use were to calm the patient and as supplemental treatment. Physicians did not widely agree on the definition of a placebo and had a variety of explanations for its mechanism of action. Ninety-six percent of the respondents believed that placebos can have therapeutic effects, and up to 40% of the physicians reported that placebos could benefit patients physiologically for certain health problems. Only 12% of the respondents said that placebo use in routine medical care should be categorically prohibited. Regarding “placebo-like” treatment, 48% of respondents reported giving at least 1 type of treatment in a situation where there was no evidence of clinical efficacy.
Conclusion Nearly half of the respondents use placebos in clinical practice and most believe in the mind–body connection. The results of this study, based on retrospective self-reported behavior, are subject to recall bias and may not be representative of American physicians.


-Richard

[idav]

Okay, let me try again...

"So? A company exaggerated its product to make a profit. So do the majority of others, quite often. It's not unique to this one specific topic, therefore not particularly noteworthy."
It's a little deeper than that. The FDA was a tool in this. Ya know, the same people that the Executive branch of the government uses vicariously to wage the War on Drugs.

Guys, if you haven't noticed yet. Nothing surprises Noclevername, I've been here for a short time, banned for some of it, and even I can tell that. I guess we can't expect rage or revolution from someone without a clever name.:eh:

[publius]

Placebo come from the Latin "I will please". The opposite is nocebo, "I will harm". The nocebo effect is well documented as well. Give a patient a real drug and tell him it's a sugar pill or tell him it obviously won't work, or if he otherwise has a bad attitude, and lo and behold, the effects are less. :) Attitude and belief plays a big role, indeed.

It's very fascinating and there is much debate and argument over exactly what goes on and what it is the mechanism. One position is it entirely a matter of perception, as was said above. A disconnect between objective reality and the perception of that reality by the mind.

However, others are of the opinion that the mind's beliefs have a real physiological effect.

And that latter has some currency. Above the placebo response to pain was mentioned, and that has been the subject of research. Give a sugar pill to a patient in pain and tell him it is a pain killer, and he believe it works and perceives less pain.

A Sauro did a very interesting study with that published in 2005. Sauro injected placebo responders with a drug that blocks the effects of opiates, and the *placebo response went away*, just like with the real opiates. Something magical there? No.

Sauro's theory was that the belief that a pain killer was being given caused the brain to release its own natural opiates, endorphins, and if this were the case, the placebo effect should be as diminished by the opiate blocker as a real opiate drug. And indeed it was.

So the expectation that pain is going to be relieved causes the brain, to well, relieve pain on its own somewhat.

-Richard

[publius]

And, believe it or not, researchers have managed to make people drunk, or at least act drunk, off of drinks made to taste alcoholic, but with no alcohol or any intoxicating substance at all. :lol: They act tipsy and stupid, just like with the real thing.

Imagine how you'd feel when you learned the truth! No excuse at all for your behavior. That was really you acting that way. :) And I've known that every since the first time I got drunk.

-Richard

[toejam]

And, believe it or not, researchers have managed to make people drunk, or at least act drunk, off of drinks made to taste alcoholic, but with no alcohol or any intoxicating substance at all. :lol: They act tipsy and stupid, just like with the real thing.

Imagine how you'd feel when you learned the truth! No excuse at all for your behavior. That was really you acting that way. :) And I've known that every since the first time I got drunk.

-Richard

It's really you when you're drunk, too. Just less inhibited.

In vino veritas.

[Noclevername]

It's really you when you're drunk, too. Just less inhibited.

In vino veritas.

Yup. Alcohol doesn't add anything to you that wasn't already there.

[publius]

Well, now I'm on a placebo effect kick :rolleyes:-- it's darn interesting.

There are big ethical questions, and I imagine a lawyer would have a field day. Yet, physicians in practice will do it.

One case I just read was of a woman suffering from panic attacks and going to the emegency room many times. A severe panic attack can make one think you're having a heart attack. Her doctor tried to tell her she could control it, but to no avail. So the doctor gives her a pill that he says is a powerful new anti-anxiety drug which will do the trick. It's so powerful he was loathe to use it, so you be careful and take only when you're having a severe attack. But it will do the trick.

It was a sugar pill. And it worked. Now, the doctor after a few weeks told her the truth. And he used that as proof that she could indeed control it if she wanted to. And that did the trick as well.

Is that ethical? Me, I say yes indeed. But, what if it doesn't work? These things are judgement calls, indeed.

-Richard

[Noclevername]

It's a little deeper than that. The FDA was a tool in this.
As is the case with many regulatory agencies. Wherever massive amounts of money are involved, some corruption is sure to exist.
Guys, if you haven't noticed yet. Nothing surprises Noclevername, I've been here for a short time, banned for some of it, and even I can tell that. I guess we can't expect rage or revolution from someone without a clever name.:eh:
So? This isn't the "rage and revolution" forum.

And judging someone by some posts on a chat board is really not an accurate way to know them at all.

[publius]

"Obecalp" used to be common code word. Cebocap is another one:

http://www.walgreens.com/library/finddrug/druginfo.jsp?particularDrug=Cebocap

Note it comes in three pretty colors.

There is fine ethical line there. A fine one indeed. And they've indeed gotten in trouble for doing it.

-Richard

[Gillianren]

One case I just read was of a woman suffering from panic attacks and going to the emegency room many times. A severe panic attack can make one think you're having a heart attack. Her doctor tried to tell her she could control it, but to no avail.

That's a doctor who's never had a panic attack.

[publius]

That's a doctor who's never had a panic attack.

Actually, it was a doctor very familiar with panic attacks and the clinical research done on it. The placebo response to panic disorder is very high, so much so that in some studies just about the entire placebo control group was reduced to no panic attacks. {ETA: The typical placebo response rate in panic disorder studies is 40 - 50%, apparently}

And was that doctor some cold, callous SOB who believed the patient to be merely hysterical and the heck with her?. No, that was a doctor who cared, and who knew that patient had the power within to control that run amok flight or fight response. And he proved it to her.

Emotions and the physiological responses they produce are indeed entirely internal. You don't have to react to the stimulus the way you normally do. If someone insults, you get mad and may loose your temper. The getting mad and loosing the temper is all of your own making. The insult is not, but your response to it is.

One can control it. It's hard and takes practice, but one can indeed control it. Sometimes a sugar pill is all the catalyst that is needed.

And I suppose you're going to think ol' Publius here is the cold callous SOB. Well, Publius has had panic attacks of his own. I know all about it. Mine were brought on by severe withdrawal from, you guessed it, an SSRI. I know all about it, waking up in the middle of night thinking my heart was going to explode, fear looming so large I couldn't stand it.

-Richard

[publius]

Here's another good one:

http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=349

They are observing, MRIs and all, placebo response effects right in the old brain. There's such stuff as placebo response in *Parkinson's disease*, showing the brain increasing dopamine secretion.


-Richard

[publius]

See this Onion story for a nice satirical take:

http://www.theonion.com/content/node/39082


The side effects of placebo are no joke either. When the subject believes he's getting a drug, he'll sometimes develop the side effects he read about the drug.

-Richard

[Gillianren]

Actually, it was a doctor very familiar with panic attacks and the clinical research done on it. The placebo response to panic disorder is very high, so much so that in some studies just about the entire placebo control group was reduced to no panic attacks. {ETA: The typical placebo response rate in panic disorder studies is 40 - 50%, apparently}

Right. Which is, in fact, completely different than "just get over it." The placebo effect works on all kinds of things; does that mean people can "just get over" those things as well? Or is it that there is some completely different chemical situation at hand.

And I maintain that knowing about panic attacks is different from experiencing them. Telling someone in the middle of a panic attack so severe that the person thinks they're having a heart attack (though, to be fair, you should know after the first few times what's going on) how to deal with it is ludicrous. It is possible to work some reduction. It is possible to calm yourself down some. If and only if you are able to control your situation more than you necessarily can in mid-panic attack.

And was that doctor some cold, callous SOB who believed the patient to be merely hysterical and the heck with her?. No, that was a doctor who cared, and who knew that patient had the power within to control that run amok flight or fight response. And he proved it to her.

"The power within her"? She responded to a placebo. So do people in extreme physical pain. That doesn't mean they can just manipulate their brains to shut off their own pain sensors.

Emotions and the physiological responses they produce are indeed entirely internal. You don't have to react to the stimulus the way you normally do. If someone insults, you get mad and may loose your temper. The getting mad and loosing the temper is all of your own making. The insult is not, but your response to it is.

"Entirely internal" and "something you can control" are not the same thing. The production of bile is entirely internal as well. The production of growth hormones is entirely internal as well.

One can control it. It's hard and takes practice, but one can indeed control it. Sometimes a sugar pill is all the catalyst that is needed.

How do you know? You've stated, repeatedly, that all your problems are from being incorrectly prescribed an SSRI in the first place (which is not medically possible), which means you have no actual experience with what it's actually like to be mentally ill. You don't know what it's like to be a sociopath, for example. Can they just grow a conscience? Are you telling me to just stop being depressed? Are you aware how utterly ridiculous that is?

And I suppose you're going to think ol' Publius here is the cold callous SOB. Well, Publius has had panic attacks of his own. I know all about it. Mine were brought on by severe withdrawal from, you guessed it, an SSRI. I know all about it, waking up in the middle of night thinking my heart was going to explode, fear looming so large I couldn't stand it.

If it was caused by an external stimulus, it was an anxiety attack, not a panic attack. So no, you haven't had them. Your problem, and I've maintained this since you first told me your story, is that you had an incompetent doctor. That isn't the fault of the pharmaceutical company. They didn't tell your doctor not to wean you off your medication properly. That was your doctor's incompetence. They may have suggested that your doctor provide you with a medication that you didn't need, but it isn't their fault if he went against his own medical judgement to do it.

You didn't need the meds. We know; you've made that abundantly clear. Why are you making it your crusade to keep those of us who do need the meds from actually getting them? Why are you so determined that no one is helped by them?

[Neverfly]

Right. Which is, in fact, completely different than "just get over it." The placebo effect works on all kinds of things; does that mean people can "just get over" those things as well? Or is it that there is some completely different chemical situation at hand.

How so when a Sugar Pill is involved?:neutral:
Is there medical evidence that Sucrose causes a chemical reaction that helps people snap out of it?

And I maintain that knowing about panic attacks is different from experiencing them. Telling someone in the middle of a panic attack so severe that the person thinks they're having a heart attack (though, to be fair, you should know after the first few times what's going on) how to deal with it is ludicrous. It is possible to work some reduction. It is possible to calm yourself down some. If and only if you are able to control your situation more than you necessarily can in mid-panic attack.

The doctor had to try. Regardless about how 'you feel' about that situation- what was the doctor supposed to do? He had to try- when that didn't work, he tried the next alternative.

"The power within her"? She responded to a placebo. So do people in extreme physical pain. That doesn't mean they can just manipulate their brains to shut off their own pain sensors.

Exactly. A Placebo. She responded to a placebo- not actual medication. Therefore- the power within her was the cure. It was the only thing it could have been considering that she took a placebo.

It was just that she needed a placebo to prove it to her.
MentalAvenger had a thread recently about how the brain, mind, can block out pain etc. It's a natural product of our development. One that has been necessary before the days of medicine and first aid and EMT's.

"Entirely internal" and "something you can control" are not the same thing. The production of bile is entirely internal as well. The production of growth hormones is entirely internal as well.
How do you know? You've stated, repeatedly, that all your problems are from being incorrectly prescribed an SSRI in the first place (which is not medically possible),
Ummm, Gillianren you are always complaining about being mis-medicated and misdiagnosed... How is it not medically possible?
which means you have no actual experience with what it's actually like to be mentally ill. You don't know what it's like to be a sociopath, for example. Can they just grow a conscience? Are you telling me to just stop being depressed? Are you aware how utterly ridiculous that is?

I read absolutely nothing in any of Publius posts that suggested this nor that directed any comments toward you. He cited one specific example and backed it up with the conclusion to the events.
Perhaps you can not personally relate to the story- but that does not remove merit from the story. Nor does your case apply to everyone.
For that woman- the placebo worked. After she learned it was a placebo- she gained greater self control. Admire her for that.

If it was caused by an external stimulus, it was an anxiety attack, not a panic attack. So no, you haven't had them. Your problem, and I've maintained this since you first told me your story, is that you had an incompetent doctor.
Medically impossible?

Bold Mine:
That isn't the fault of the pharmaceutical company. They didn't tell your doctor not to wean you off your medication properly. That was your doctor's incompetence. They may have suggested that your doctor provide you with a medication that you didn't need, but it isn't their fault if he went against his own medical judgement to do it.

You didn't need the meds. We know; you've made that abundantly clear. Why are you making it your crusade to keep those of us who do need the meds from actually getting them? Why are you so determined that no one is helped by them?

I have read nothing in any of Publius' posts that indicates that this accusation is warranted by any means.:neutral:

[sarongsong]

Another recent study:
Genetic difference predicts antidepressant response (http://physorg.com/news120312663.html)
---physorg.com

[EricM407]

Well, now I'm on a placebo effect kick :rolleyes:-- it's darn interesting.

There are big ethical questions, and I imagine a lawyer would have a field day. Yet, physicians in practice will do it.

One case I just read was of a woman suffering from panic attacks and going to the emegency room many times. A severe panic attack can make one think you're having a heart attack. Her doctor tried to tell her she could control it, but to no avail. So the doctor gives her a pill that he says is a powerful new anti-anxiety drug which will do the trick. It's so powerful he was loathe to use it, so you be careful and take only when you're having a severe attack. But it will do the trick.

It was a sugar pill. And it worked. Now, the doctor after a few weeks told her the truth. And he used that as proof that she could indeed control it if she wanted to. And that did the trick as well.

Is that ethical? Me, I say yes indeed.


Would it be ethical to go the other way? That is, say a person had some mystery illness with a variety of physical symptoms that actually stemmed from a mental disorder, and there existed a proven treatment for the disorder. I'm thinking of something like Morgellons (if it's truly delusional parasitosis) here. Would it be okay for a doctor to humor the patient by telling them they had a rare disease and then prescribe an anti-psychotic on the sly as the "new powerful medicine" that would "cure" their disease?

I'm thinking it's not. But on the other hand, possibly because of the nature of the illness itself, a lot of people like this might not believe the diagnosis if the doctor was honest, and then they wouldn't get the treatment they really need. Could lying to the patient be considered a necessary part of the treatment?

And when it comes to placebo effect, why is that the people who turn to various snake oil cures on the internet after rejecting whatever diagnosis and treatment legitimate doctors have given them usually don't see their suffering relieved? It seems like they would be prime candidates for an actual placebo effect to show itself, since they already have the built in belief that it's going to help them. And if it did work, then would there really be anything wrong with selling snake oil?

[Noclevername]

Lying to a patient is never justified. A patient has the right to know what's really happening to them.

[Douglas J. Bender]

One of the issues is what really causes depression, and the relationship between the mind and the brain. The theory behind antidepressants assumes that the brain and its behavior is antecedent to the mind and its mental state. Essentially, the antidepressant model assumes what amounts to a materialistic worldview. (At least, if antidepressant proponents claim that antidepressants treat the cause rather than the effect. Much like an engineer might remotely cut off the gas to a car driven by a lead-foot, causing the car to slow to a stop, but failing to address the actual cause of the speeding.)

I have had personal experience over a number of years with antidepressants and depression theories, and various psychiatrists and their preferred psychological models - the last such experience being in 1988. From experience, I can say that practically all of it is not far removed from shamanism. (Technically speaking.)

[publius]

Why are you making it your crusade to keep those of us who do need the meds from actually getting them? Why are you so determined that no one is helped by them?

Your post gives me the perfect opportunity to illustrate one of my points. I could get very angry and respond accordingly, or I could have a very different reaction. I choose the latter. And, so, I'm sorry that what I say upsets you so. I stand by everything I've said, but I am sorry it upsets you so.

The above quote shows why you get so upset. You see my position as a strong threat that must be fought. It must be discounted at all costs.

One of your complaints is apparently people telling you what you do and don't have, and what might and might not the root cause of it all. And, out of anger, you turn right around and tell me that I didn't have what I had.

That's the defense mechanism at work: No one could experience what I've experienced and come to such a different conclusion that mine. No one could do that. Therefore, anyone who holds a contrary view obviously didn't experience it.

"I can't" is a powerful little pathological thought pattern, a little mental state software virus of sorts, that gets in there and fights any attempt to counter it. "Nobody knows how I feel" is another one of those little buggers.


-Richard

[Noclevername]

How many times does it need to be said? Everyone is different. When it comes to psychiatric meds, everyone's responses are different. Every individual has to have their own tailored treatments.

The singular of "anecdote" isn't "data", either.

[EricM407]

Lying to a patient is never justified. A patient has the right to know what's really happening to them.

That sounds really good, but how does it benefit a patient to know what's really happening to them if they reject that reality?

[Noclevername]

That sounds really good, but how does it benefit a patient to know what's really happening to them if they reject that reality?

So if the patient is stubborn*, it's okay to lie to them? No. A doctor isn't in the business of enabling mental illness for the sake of a dubious lessening of symptoms of a physical illness.


*See post 75.

[Moose]

I very much agree with Noclevername on this. It's sometimes necessary for a doctor to not tell the patient the whole truth so as not to cause undue anxiety, but it's reprehensible for a doctor to actively mislead their patient. First, do no harm.

There's also the trust issue when the truth comes out. A patient has to be able to trust their doctor implicitly. Even a single lie makes that impossible.

Publius, I'm not 100% in love with your tone right now. Nor the direction you're taking this discussion. Don't you think that before you offer medical advice that isn't "see a doctor", such as "oh, don't worry, placebos work fine for all of that that", you should at least have an ,MD behind your name?

[EricM407]

So if the patient is stubborn, it's okay to lie to them?

Stubborn and mentally ill aren't the same thing, I think. But if a patient's ill enough to completely reject what their doctor (let's say any legitimate doctor) tells them, then I don't see any other way for them to get immediate treatment, short of force.

No. A doctor isn't in the business of enabling mental illness for the sake of a dubious lessening of symptoms of a physical illness.

If the doctor is in reality treating the mental illness, then how is that enabling it? Just because it's being treated in a (temporarily) deceptive manner? What if the alternative is no treatment, or bad treatment, because the patient walks out and goes looking for a doctor who will agree with their self-diagnosed but imaginary physical illness?

Of course no doctor will do this. I know what does happen, because I have a neighbor like this. I wish one of the dozen or so doctors she saw a couple years ago had lied to her and got her on anti-psychotics. Of course, she doesn't see real doctors any more because they all told her the truth, which had the effect of convincing her that they were all liars.

[Gillianren]

How so when a Sugar Pill is involved?:neutral:
Is there medical evidence that Sucrose causes a chemical reaction that helps people snap out of it?

There is medical evidence that some people respond to a placebo in the same way that they respond to proper medical treatment if they believe it works. It still isn't proper medical treatment.

The doctor had to try. Regardless about how 'you feel' about that situation- what was the doctor supposed to do? He had to try- when that didn't work, he tried the next alternative.

"The next alternative"? The next alternative, if this woman had a real medical problem, was an anti-anxiety medication. If relaxing techniques had worked, great. However, they don't work for me--and, yes, I've given them a fair try. I still do, every time I have a panic attack. They don't work, no matter how serious I am about making them work. Maybe a placebo would work for me. But that's entirely different than my being at fault for having them in the first place.

Exactly. A Placebo. She responded to a placebo- not actual medication. Therefore- the power within her was the cure. It was the only thing it could have been considering that she took a placebo.

It was just that she needed a placebo to prove it to her.
MentalAvenger had a thread recently about how the brain, mind, can block out pain etc. It's a natural product of our development. One that has been necessary before the days of medicine and first aid and EMT's.

No. There is medical evidence that placebos can actually affect some people. This is not "the power within her." This is "the brain fooling itself," an entirely different phenomenon. And I've never believed that willpower can block more than minor pain, no matter what MentalAvenger claims to be able to do. Sorry, but I don't. I'd like some evidence. I have evidence, however, that "before the days of medicine and first aid [and do you know how long ago that was?] and EMT's," people suffered an awful lot of pain. Because, you see, they wrote about it.

Ummm, Gillianren you are always complaining about being mis-medicated and misdiagnosed... How is it not medically possible?

It's not medically possible for all the problems he's described in the past to be the fault of mis-prescribed medication. Depending on how long the drugs were taken (by previous descriptions, not terribly long), the drugs work out of your system a lot faster than they'd have needed to in order for the descriptions of problems to have been a result. Getting misdiagnosed happens, though I'm not sure how often--more often than I'd like, surely. (Really, once is more often than I'd like.) I'd also like to note that, of late, my medications have not actually been mis-prescribed, not since they stopped treating me for straight depression. They haven't worked, but that's entirely different. My brain chemistry is set up differently; really, everyone's is, slightly. None of the meds I've tried yet work, but that doesn't mean none of them will.

I read absolutely nothing in any of Publius posts that suggested this nor that directed any comments toward you. He cited one specific example and backed it up with the conclusion to the events.

Yes. One example. As he has, in the past, cited the example of his personal experience to indicate that everyone on meds should be taken off them. He hasn't said so in this particular thread, not in so many words, but this is not the first thread he's started talking about the evils of the pharmaceutical industry in bilking all these nice people who don't really have problems they can't overcome, and I'm tired of it. Not just from him, but from, for example, my sister, who wants me to get well. She wants me, in fact, to promise that I'll stop being bipolar.

Perhaps you can not personally relate to the story- but that does not remove merit from the story. Nor does your case apply to everyone.
For that woman- the placebo worked. After she learned it was a placebo- she gained greater self control. Admire her for that.

And good for her. However, should we take this as evidence that everyone with mental health problems can "just get over them"? Ridiculous.

I have read nothing in any of Publius' posts that indicates that this accusation is warranted by any means.:neutral:

That's because you are clearly unaware of his posting history on the subject, I assure you.

[Moose]

Stubborn and mentally ill aren't the same thing, I think. But if a patient's ill enough to completely reject what their doctor (let's say any legitimate doctor) tells them, then I don't see any other way for them to get immediate treatment, short of force.

Any legally competent patient above the age of majority has the right to refuse treatment for any reason they consider valid.

The issue gets thorny when the patient is below the age of majority or otherwise legally incompetent and the guardian is making harmful decisions on their behalf, or when there's a risk of contagion. And these nearly always come down to case-by-case judicial rulings.

But in none of these exceptional scenarios does the doctor have the authority to deliberately mislead the patient, guardian, or court.

[publius]

Publius, I'm not 100% in love with your tone right now. Nor the direction you're taking this discussion. Don't you think that before you offer medical advice that isn't "see a doctor", such as "oh, don't worry, placebos work fine for all of that that", you should at least have an ,MD behind your name?

The love percentage is mutual, I assure you. Caveman? :lol: I've been called worse, far worse. Have I in any way represented myself as being a medical authority? No, I'm expressing my opinion and pointing out things, right there in the research that I base my opinions on.

How many of the celebrities you see on TV pushing various drugs have MDs (or any relevant degrees or other credentials) after the names? And worse, turns out that degrees and credentials of those who actually write articles in medical journals is not even known. It's called ghostwriting, the following article being one of many on this practice:

http://observer.guardian.co.uk/uk_news/story/0,6903,1101680,00.html

So I'll make you a deal. I'll stop banging my club and grunting out my opinions when they stop using celebrities to give medical advice and actually ensure that the authors of various journal articles actually have the MDs or other relevant degrees.

It ain't me that's the problem with "playing doctors on TV", here.

-Richard

[Moose]

How many of the celebrities you see on TV pushing various drugs have MDs (or any relevant degrees or other credentials) after the names?

None at all. At least not on Canadian media. Pharma isn't allowed to advertise prescription medication directly to patients here. They're under far more restriction than tobacco. The US affiliates still bombard us with it, but that's your country's problem to fix, not mine. I unsubscribed my cable years ago in any case.

So I'll make you a deal. I'll stop banging my club and grunting out my opinions when they stop using celebrities to give medical advice and actually ensure that the authors of various journal articles actually have the MDs or other relevant degrees.

Peer-reviewed journal articles aren't at issue because they're being peer-reviewed. It's the whole point of evidence-based science. A child could (and did) publish science if it's good enough to pass peer-review.

Opinion stated as fact simply won't cut it. Even more so when you can't even commit appeal to authority.

So if you're willing to have your non-expert opinion peer-reviewed and published in a reputable journal, I'll be happy to read it given the opportunity. Otherwise, I consider this the moral equivalent to promotion of unsupported ATM out of ATM.

[Moose]

Caveman? :lol: I've been called worse, far worse.

That's nice, but adding "caveman" to your collection is somewhat premature. Hint (http://www.youtube.com/watch?v=cRRlEyplGQ8&feature=related). (Link goes to short SFW clip on youtube.)

[Noclevername]

I misworded that post (#67). I should have said, "stubborn or delusional". Delusion is a mental illness. (I think being stubborn to the point where it endangers your health is too, but I don't make the definitions of mental illness.)

[korjik]

Your post gives me the perfect opportunity to illustrate one of my points. I could get very angry and respond accordingly, or I could have a very different reaction. I choose the latter. And, so, I'm sorry that what I say upsets you so. I stand by everything I've said, but I am sorry it upsets you so.

The above quote shows why you get so upset. You see my position as a strong threat that must be fought. It must be discounted at all costs.

One of your complaints is apparently people telling you what you do and don't have, and what might and might not the root cause of it all. And, out of anger, you turn right around and tell me that I didn't have what I had.

That's the defense mechanism at work: No one could experience what I've experienced and come to such a different conclusion that mine. No one could do that. Therefore, anyone who holds a contrary view obviously didn't experience it.

"I can't" is a powerful little pathological thought pattern, a little mental state software virus of sorts, that gets in there and fights any attempt to counter it. "Nobody knows how I feel" is another one of those little buggers.


-Richard

"I can't" can also come out of nowhere and mess you up. I am, to put it bluntly, an arrogant SOB who's self-confidence is such that there are thing where the rest of the world should do what I want, cause I'm right and you all are wrong. That didnt stop me from sitting there one day not writing a paper that I needed to pass a class. Ended up with an F cause it was one of the 2 grades in that class. I couldnt write it. Just sat there looking at it.

Before you start thinking that that was just an "I can't" that was all in my head, a year later I was in the class again, but this time healthy. Took me one evening to write the paper and was the reason I passed the class.

The "its all in their head" attitude is one of the worst things there is to someone who is mentally ill. It was an attitude I shared before depression took me out. Two years of not being able to pass classes I knew I should be aceing shook that out of me. I quite literally had classes where I knew the material the best in the class, or was close to it, but also had the worst grade in the class.

Dont get me wrong, I am not boosting for the drug companies. You have shown alot of there excesses that are just as bad as the "its all in their head" attitude. Just it isnt all in the head of ther people who have the problem.

[publius]

None at all. At least not on Canadian media. Pharma isn't allowed to advertise prescription medication directly to patients here. They're under far more restriction than tobacco. The US affiliates still bombard us with it, but that's your country's problem to fix, not mine. I unsubscribed my cable years ago in any case.

Well, good, I'm glad we agree this is bad.



Peer-reviewed journal articles aren't at issue because they're being peer-reviewed. It's the whole point of evidence-based science. A child could (and did) publish science if it's good enough to pass peer-review.

Surely you see just a little teensie problem with Pharma (or anyone) writing up articles and then paying big names in various fields to put their names on said articles, giving it more weight than it otherwise would have? Surely you realize that if the big names didn't really matter, they wouldn't waste money trying to buy them. Here's a recent case involving a blood pressure drug:

http://blogs.wsj.com/health/2007/11/21/odd-ghostwriting-offer-raises-researchers-blood-pressure/



So if you're willing to have your non-expert opinion peer-reviewed and published in a reputable journal, I'll be happy to read it given the opportunity. Otherwise, I consider this the moral equivalent to promotion of unsupported ATM out of ATM.

Fair enough. And I trust that in the future you'll apply that same standard when you feel the urge to render an opinion welling up.

Then you seem to be of the opinion that there is little support for this. Well, way back in '98, Irving Kirsch, Ph.D, a bona fide expert, submitted to and survived peer review of the following article in a bona fide reputable journal:

http://content.apa.org/journals/pre/1/2/2

The title, "Listening to Prozac but Hearing Placebo". There he argues that most of the efficacy of antidepressants is due to the placebo effect. That was, of course controversial, producing replies with titles along the lines of "listening to Kirsch, but hearing noise", and so forth, to which he replied with a follow up entitled "Reducing the noise and hearing placebo more clearly".

And in 2002, he published another one, arguing the same:

http://content.apa.org/journals/pre/5/1/23

The high placebo response and the modest difference in active agent efficacy above that response is well known. They argue over why and what conclusions should be drawn. This lastest study I posted in the OP only narrows that gap and heats up the arguments.

Larry E. Beutler, Ph.D, another bona fide expert with peer reviewed publication status, wrote a good commentary on Kirsch entitled "Prozac and Placebo: There's a Pony in There Somewhere." which also appeared in the same journal. That commentary includes such as this:


To put these figures in perspective, one can refer to a table of normative values. If one does so, it becomes evident that the moderate effect size of .39 found by Kirsch and Sapirstein (1998) could seriously lead to an exaggeration of the power of the treatment. With a d of this magnitude, one can determine that in Kirsch and Sapirstein's analysis, the average (median) patient among those who received an antidepressant was better off than 65% of those who received a placebo, only a 15% gain in number of patients benefitted by antidepressants over placebo alone. More telling, translating the mean placebo response effect size of 1.16 in a similar way reveals that 88% of patients who received only placebos experienced improvement (12% stayed the same or got worse). This is a remarkably high percentage and is the basis for Kirsch and Sapirstein's conclusion that placebo accounts for 75%of the total response to the antidepressant medications. To some, it might appear obvious that the front line treatment of choice is placebo, not antidepressants.


And in his conclusion, "Why does everyone believe drugs are so good?" he states this:


If the treatment effects associated with antidepressants are so poor, to what can we attribute the widely held faith in the efficacy and effectiveness of these medications? In contemplating this important question, several nonexclusive possibilities reveal themselves. First and most likely, the failure to identify the actual magnitude of treatment response before the effects of placebo are extracted may have led many to misinterpret the amount of support provided by research studies for the efficacy of antidepressants. When one is presented only with the net effect of antidepressant treatment, in the form of an effect size or significance level, the fact that placebo response both is three times as large and accounts for over three times as many improved patients as the active medication is likely to be ignored.

...................

These three possibilities may work together to leave the public with a false expectation and hope for the amount of benefit and the degree of promise offered by chemical solutions to depression. But, it is difficult to believe that the strength of the lobby and enthusiasm generated by psychopharmaceutical solutions can be accounted for by these three simple possibilities alone. At the very least, the provocative results reported by Kirsch and Sapirstein (1998) call on scientists to include in their search for specific biological mechanisms and sites of action a broader view of the psychosocial context in which medication responses occur.............



IOW, there's a pony in there somewhere, but it's hard to find and different from you think.

-Richard

[Moose]

Surely you see just a little teensie problem with Pharma (or anyone) writing up articles and then paying big names in various fields to put their names on said articles, giving it more weight than it otherwise would have?

P-E-E-R R-E-V-I-E-W. It's there for a reason. Unless you're suggesting Pharma owns the literature?

You can't swing a cat in ATM without clawing up someone who'll never get published. That's because peer-review works. Pharma wants to pay for junk articles that could only get published in a People Magazine ad, let them. So long as the peer-review process itself is intact, and there are journals of repute, we're good.

Surely you realize that if the big names didn't really matter, they wouldn't waste money trying to buy them. Here's a recent case involving a blood pressure drug:

*shrug* Newsies will fall for anything if it sounds uplifting or horrifying.

http://blogs.wsj.com/health/2007/11/21/odd-ghostwriting-offer-raises-researchers-blood-pressure/ (http://blogs.wsj.com/health/2007/11/21/odd-ghostwriting-offer-raises-researchers-blood-pressure/)

... Speaking of sensationalism. Now, if we were talking about the price of gold, a cite from a WSJ sponsored blog might be appropriate. Medical advice? From a newsie? No thanks.

Fair enough. And I trust that in the future you'll apply that same standard when you feel the urge to render an opinion welling up.

I never give medical advice that doesn't read: "Consult your doctor". You've known me long enough to know better, publius.

Then you seem to be of the opinion that there is little support for this. Well, way back in '98, Irving Kirsch, Ph.D, a bona fide expert, submitted to and survived peer review of the following article in a bona fide reputable journal:

http://content.apa.org/journals/pre/1/2/2

A meta-analysis, and all but the abstract hidden behind registration for APA members only. And Prevention & Treatment is "a peer-reviewed, rapid publication, electronic journal" (aka a blog) that went under at the end of 2003. So there's no reasonable way to verify his modality. Convenient.

Come on, publius. You know better than to present something that's only a half-step from ATM garbage. That's worthless. You might as well cite Hoagland as published and peer-reviewed.


In any case, are you going to tell me to my face (so to speak) that this (http://www.bautforum.com/off-topic-babbling/45142-need-little-help.html) was placebo (or more correctly nocebo)?

What if I told you that I tend to understate severely when I most need help and that "really messed up" meant curled up in a fetal ball in the computer chair, barely able to read the screen through the tears, certain I was going to die alone without help despite knowing full well I was suffering withdrawal from having forgotten a pill?

And that an hour or so after I took the pill, I was feeling functional again? "Zombified", but trembling almost uncontrollably from head to toe?

Placebo? No. The drug had plenty of effects. It simply turns out my near-suicidal depression had a physical source that had nothing to do with brain chemistry or life troubles but rather severe sleep apnea.

[publius]

Seriously, you're claiming that something under the imprimatur of the APA is a "half step away from ATM garbage"? Seriously? The CV of the editor of that "ATM garbage", Dr. Martin Seligman, can be found here:

http://www.ppc.sas.upenn.edu/vitae.htm

Now, seriously, that guy, a freakin' past president of the APA itself, is running some "ATM garbage" thing?


It's also apparent you haven't been reading much of the links I posted.

The ghostwriting problem is not about publication in "People", it's about publication in the medical journals themselves.

-Richard

[publius]

One last time, I'm going to try to describe the problem here. Here's a 2004 article from the Washington Monthly. Please read it.

http://www.washingtonmonthly.com/features/2004/0404.brownlee.html

In there, we find this quote:


This is all about bypassing science. Medicine is becoming a sort of Cloud Cuckoo Land, where doctors don't know what papers they can trust in the journals, and the public doesn't know what to believe."


Why, there's that crazy ol' Hoagland again, spewing his garbage. Ooops, no, that's Dr. Drummond Rennie, deputy editor of JAMA who said that.


Clinicians know privately that results can be jiggered. You can design studies to come out the way you want them to. You can control what data you look at, control the analysis, and then shade your interpretation of the results....


That's got to be Hoagie, right? No, that's Dr. Marcia Angell, former editor in chief of the NEJM, (and author of the book, "The Truth about Drug Companies": http://www.nybooks.com/articles/17244).


The more I became convinced that the commercialization of medical practice and medical research, and the use of the information for commercial purposes, was a major threat to the integrity of the whole system


That's Dr. Arnold Relman, another former editor in chief of NEJM.

This article starts out with the story of an Emory professor of pyschiatry and dept. head who has to hold some sort of world record for total number of conflicts of interest. He published a review of various treatments in the journal Nature Neuroscience, thumbs up for these, thumbs down for those.

However, a reader and doctor in CA, noticed something. Three of the positive reviews were for treatments the Emory doctor would profit from, including one for which he actually owned the patent. He sent a letter of concern to the journal, which did nothing forcing that reader to go public.

And after the above article was written, the same Emory doctor got caught doing the same thing in several other journals, most notably one he himself edited, Neuropsychopharmacology, and was forced to resign.

http://www.postgazette.com/pg/06200/706933-114.stm


-Richard

[Moose]

Now, seriously, that guy, a freakin' past president of the APA itself, is running some "ATM garbage" thing?

Appeal to authority, and yes, it's entirely possible that it is. We'll never know, because we're not members of the APA and can't examine the data, modality, or criticisms, just the abstracts.

Speaking of appeal to authority, did I ever mention I did two years of pre-med (heading towards psychiatry) before I realized I greatly prefer relaxation and time-off to stress and that I frequently hate people before I like them rather than the other way around?

It seemed I was especially good at the objective classes relating to pharmacology. I don't consider myself much more than a layperson, but I do have some experience recognizing weaknesses in papers.

Meta-studies are like turkey soup. It's the data's very last chance to get eaten before you throw it all out.

And you can't evaluate a paper by it's abstract. Period.

It's also apparent you haven't been reading much of the links I posted.

I've ignored the wall street journal blog as non-peer-reviewed mass-market sensationalist garbage, yes. I've read the abstracts to the papers APA non-members cannot access.

Here's a hint, publius, abstracts are about as useful as executive summaries. They're good for refining searches, but you have to actually read the article in order to evaluate its quality. The most flawed experiment in the world has an abstract with impressive claims. But until those claims are supported and the methodology examined, they're absolutely worthless.

And yes, a meta-study on an obscure, non-functional, never-actually-published blog one cannot actually read is not persuasive.

The ghostwriting problem is not about publication in "People", it's about publication in the medical journals themselves.

It's not necessarily wrong for pharma to sponsor studies, heck, they need those studies done to introduce new product. And yes, I'm aware of (some of) the meta-studies that suggest a generally linearly higher rate of "positive" or exaggerated outcomes among pharma-sponsored studies vs independently-funded studies.

The fact that Pharma sponsors studies doesn't mean that antidepressants are placebos. They may not be as effective as advertised, or the side-effects glossed-over, but that's a very long way from proving (or even supporting) your claim.

In any case, if appeal to authority applied to a non-sequitor means a lick, I can point out that Scientologists like Tom Cruise think antidepressants are placebos too. I bet a few of them even have PhDs.

[Moose]

One last time, I'm going to try to describe the problem here.

As I said, I've been aware of the meta-studies that confirm that conflict of interests tends to bias results for a while now. (non-sequitor)

And yes, JAMA and NEJM have good reputations as publications. (appeal to authority)

This still doesn't prove your assertion that antidepressants are placebos.

[Neverfly]

The thread title is "Antidepressants not as effective as claimed."

Not, "All antidepressants are placebos."

Meanwhile, the objective evidence suggests the title is true.

However, it is noteworthy that not all are placebos.

My sons mom was on Zoloft. When she suddenly stopped taking Zoloft, she became a walking nightmare for at least two weeks. She described her ability to think as like looking through fractured glass.

But there is merit in the statement that for many people, they have the ability already, to use their own brain to overcome certain mental issues without the need for drugs.

The difference is in that they are convinced that they cannot.

For many other people, they truly cannot. They have a mental illness or a chemical imbalance that prevents it.

Having effective medication for them is important.

Having effective diagnoses as well.

Handing out antidepressants like candy isn't the answer either. Many people are prescribed them that don't belong on them.

So the issue here is not all black and white. It is not that all antidepressants are good or bad--- It is that, like anything, they must be understood, used properly, prescribed properly and meet up with medical standards.

If they are falling short of the claims- then yes, it needs to be addressed.

[torque of the town]

So the issue here is not all black and white. It is not that all antidepressants are good or bad--- It is that, like anything, they must be understood, used properly, prescribed properly and meet up with medical standards.


In a nutshell.

[Moose]

This appeared on James Randi's newsletter today:

I’m addicted to placebos. I could quit, but it wouldn’t matter.

[Gillianren]

The thing is, no one here is advocating "handing antidepressants out like candy." (And Zoloft gets out of your system in much less than two weeks, but no one should quit antidepressants cold turkey, because they do alter your brain chemistry, and you need to change that gradually. That's why I've been on Lamictal for, what, three months now and still haven't built up to the dosage my psychiatrist wants me to try before we try something else if needed.) Even those of us who have been most adamant in statements that they are needed in certain cases. I think antidepressants are overprescribed, and I've never said anything different. However, it took me years to get medicated even though I need to be, because the system is very bad at getting any kind of mental health care for anyone who isn't actually destitute but cannot afford insurance. And there are people whose lives have benefited enormously from medication, people who can't just get better.

But the problem with overprescribing cannot just be attributed to the pharmaceutical industries. After all, antidepressants are not the only drug that the pharmaceutical companies hype; the clinic I go to for my physical health problems has a clock in its lobby--the only clock in its lobby, in fact--that advertises a drug, and they don't do mental health there. I don't remember what drug it's for, because it irritates me no matter what, but I assure you, it's not for an antidepressant. A doctor that prescribes any drug that a patient doesn't need is doing a bad job.

[Douglas J. Bender]

A few years ago, here in northern Indiana, there was a commercial for a drug called "Happizat" (pronounced "Happy/Happih zat") making the rounds on several rock and contemporary radio stations. It was supposedly a wonderful "mood lifter". I don't recall if one could get it over the counter or not (I think so), but I couldn't believe anyone would willingly advertise such an obviously bogus drug. (After a few months, the commercials ceased, by the way.) Drug companies have conditioned people to think their problems are all due to an improper chemical make-up, and thus that the solution to all, or most, problems would be some combination of drugs. Pretty handy for the drug companies. Personally, I've found A&W Root Beer to be more effective than antidepressants. I eagerly await the "anti-anti-antidepressant pill". (The phrase in quotes is not a typo, by the way.)

[Gillianren]

Personally, I've found A&W Root Beer to be more effective than antidepressants.

Good for you! You're not mentally ill. Count your blessings.

[Noclevername]

Drug companies have conditioned people to think their problems are all due to an improper chemical make-up, and thus that the solution to all, or most, problems would be some combination of drugs.


When, in fact, it's only true of those who actually have an improper chemical makeup, not all people. Not even all with mental illnesses.

The solutions for those people, however, is sometimes not yet invented.

[Douglas J. Bender]

Gillianren,

Good for you! You're not mentally ill. Count your blessings.
Thank you. I would tend to agree with you. And I try to remember to do so every chance I get.

However, as several here have pointed out, antidepressants are not as effective as they are generally made out to be. Plus, were you aware that several (perhaps many?) antidepressants are now required to have a label which warns that they increase the risk of suicide? Odd, don't you think? (And I am quite aware of the theory that this is due to the antidepressants alleviating the depression, then the person feeling sufficiently energetic to actually act on their suicidal feelings. A convenient little brushing aside, in my opinion.)

Can you direct me to even ONE solid, scientific test which reliably and medically identifies "mental illness"? I believe there might be something sort of like this for schizophrenia, but I'm not sure.

In any case, Gillian (I assume this shortened form is acceptable; if not, let me know), as I said earlier, one of the key points in all of this is the cause/effect relationship between the brain and mind, and if the mind is reducible to the physical activities and states of the brain. I suggest that the relationship of the brain to the mind is similar to that of a car engine (or, nowadays, of a car's computer) to a driver, and that the mind is not reducible to the physical states and activities of the brain.

Antidepressants, Gillian, are effectively based on the premise that there is no soul, no spirit, and that there is no spiritual reality. A dangerous, and false, premise, actually, which has led, and will lead, to numerous errors, and unnecessary confusion and suffering.

[Douglas J. Bender]

Frontal lobotomy and the Nobel Peace Prize (http://nobelprize.org/nobel_prizes/medicine/articles/moniz/index.html) . Butchers in a china shop.

[Van Rijn]

Antidepressants, Gillian, are effectively based on the premise that there is no soul, no spirit, and that there is no spiritual reality. A dangerous, and false, premise, actually, which has led, and will lead, to numerous errors, and unnecessary confusion and suffering.

Three things:

(1) This reminds me of the erroneous "only Atheists can accept the science of evolution" argument. The premise of behavior altering drugs is that certain drugs can alter behavior. This concept neither requires nor precludes religious beliefs.

(2) I'm sure you could get a lot of argument about what beliefs are or are not dangerous, but the rules of board are pretty strict on religious debate. I'd suggest you read up on the rules if you haven't already.

(3) Is there some reason you post in the Times New Roman font? It's smaller and harder to read than regular font.

[sarongsong]

...Drug companies have conditioned people......through ma$$ive media advertising. Sure would be nice if they were banned/restricted as much as cigarette/alcohol ads are, television-wise, at least. :)
(Oh, no need to specify a font on BAUT unless a special effect is desired; New Roman Times comes out noticeably smaller---squint-squint.)

[Neverfly]

Frontal lobotomy and the Nobel Peace Prize (http://nobelprize.org/nobel_prizes/medicine/articles/moniz/index.html) . Butchers in a china shop.

At a time when few alternatives and treatments were available, and seriously mentally ill patients were treated rather poorly (locked up like criminals), the surgeries offered at least some hope. It was treatment when there really wasn't much treatment going on.

[korjik]

Gillianren,


Thank you. I would tend to agree with you. And I try to remember to do so every chance I get.

However, as several here have pointed out, antidepressants are not as effective as they are generally made out to be. Plus, were you aware that several (perhaps many?) antidepressants are now required to have a label which warns that they increase the risk of suicide? Odd, don't you think? (And I am quite aware of the theory that this is due to the antidepressants alleviating the depression, then the person feeling sufficiently energetic to actually act on their suicidal feelings. A convenient little brushing aside, in my opinion.)

Can you direct me to even ONE solid, scientific test which reliably and medically identifies "mental illness"? I believe there might be something sort of like this for schizophrenia, but I'm not sure.

In any case, Gillian (I assume this shortened form is acceptable; if not, let me know), as I said earlier, one of the key points in all of this is the cause/effect relationship between the brain and mind, and if the mind is reducible to the physical activities and states of the brain. I suggest that the relationship of the brain to the mind is similar to that of a car engine (or, nowadays, of a car's computer) to a driver, and that the mind is not reducible to the physical states and activities of the brain.

Antidepressants, Gillian, are effectively based on the premise that there is no soul, no spirit, and that there is no spiritual reality. A dangerous, and false, premise, actually, which has led, and will lead, to numerous errors, and unnecessary confusion and suffering.

You are very very wrong, and just as much of a problem as too much drugs. There is plenty of evidence that hallucinations and delusions occur, and if nothing else that indicates that there is mental illness. Or are you seriously suggesting that the people who have these problems are weak minded fools? or liars looking for sympathy?

My soul, my spirit, and my spiritual reality have never had a problem. However, my brain has had problems. I wonder if you have ever been in the situation where you know what the problem is, know what the solution is, and know how to get to that solution but simply cant.

It isnt as simple as just snap out of it.

[Neverfly]

You are very very wrong, and just as much of a problem as too much drugs. There is plenty of evidence that hallucinations and delusions occur, and if nothing else that indicates that there is mental illness. Or are you seriously suggesting that the people who have these problems are weak minded fools? or liars looking for sympathy?

My soul, my spirit, and my spiritual reality have never had a problem. However, my brain has had problems. I wonder if you have ever been in the situation where you know what the problem is, know what the solution is, and know how to get to that solution but simply cant.

It isnt as simple as just snap out of it.

This is exactly the case.
I decided not to reply to Douglas Bender- but yes.

The brain is not made of Divine Substance and souls, it is made out of physical matter with certain properties, complex chemical and electrical reactions- it is like a very powerful organic computer.

And sometimes things don't work quite right.

There is a big difference between mentally ill and a person who is having emotional issues.

A true chemical imbalance etc will not be able to just willfully over come it all the time.

For a great many people, they confuse mental illness with the normal problems in life. And for those people, they need strength, support, counseling- whatever. But not drugs.

But there are a great many people too that have a true issue. A real problem where something in the brain is mis-wired. They require a pill just the same as a person with faulty vision needs corrective lenses.
Or a person with crooked teeth needs braces.

The issue in this thread is what about when The Drugs prescribed are not doing the job claimed?
For those with a chemical imbalance- they need real corrective medication. Not a facade.
Sadly, until we learn more and more about the brain, all we can do is wait.

[Noclevername]

However, as several here have pointed out, antidepressants are not as effective as they are generally made out to be. since the effects are different for different people, sometimes they are less effective than stated, sometimes more than stated.

Each patient is different.


Plus, were you aware that several (perhaps many?) antidepressants are now required to have a label which warns that they increase the risk of suicide? Odd, don't you think?
Yes, that's because some people react poorly, while others respond positively to the exact same medications.

Because each patient is different.


Can you direct me to even ONE solid, scientific test which reliably and medically identifies "mental illness"? I believe there might be something sort of like this for schizophrenia, but I'm not sure.



Right here. (http://en.wikipedia.org/wiki/Causes_of_mental_disorders) See the sections marked "Genetics", "Pregnancy and birth", "Disease, injury and infection".



I suggest that the relationship of the brain to the mind is similar to that of a car engine (or, nowadays, of a car's computer) to a driver, and that the mind is not reducible to the physical states and activities of the brain.

Despite the fact that all the evidence supports the mind-brain connection. You know, evidence? What science is based on?

[publius]

FYI, here's a later article by (Joanna Moncrieff and) Kirsch on this subject in the BMJ which is available for free:

http://www.bmj.com/cgi/reprint/331/7509/155

And, Kirsch's page at his university, showing his most recent list of publications is here:

http://psy.hull.ac.uk/Staff/i.kirsch/

He was a bit hard to find because he moved across the pond since he wrote those APA articles where he was at the U of Connecticut. {And ETA: BTW, this is not appeal to authority, saying we should believe Kirsch because of his credentials. This is showing the credentials of someone whose credentials were called into question by comparison to the likes of Hoagland}

Attached is a graph from that paper showing the typical aggregate distribution of the SSRI response vs the placebo over the trials included for a mean difference of 1 point on the standard depression scale. The actual mean trial difference is about 1.7 points.

[publius]

Kirsch's main point is this. In a typical trial, a "treatment response" will be defined as an improvement of so many points on that standard scale, which will be about the mean of the drug response. So, roughly, the right half of that red drug response curve will be included as a response, for about 50% of the drug population. The upper tail of the placebo response will make it as well, giving about ~30% of the placebo population.

So there we have a 50% drug response and a 30% placebo response. But the actual drug curve is just slightly shifted to the right.

[Douglas J. Bender]

Van Rijn,

(1) This reminds me of the erroneous "only Atheists can accept the science of evolution" argument.
Cool.

The premise of behavior-altering drugs is that certain drugs can alter behavior. This concept neither requires nor precludes religious beliefs.
I never said that behavior-altering drugs don't alter behavior. Did you not notice my "engineer/car/driver" analogy?

(2) I'm sure you could get a lot of argument about what beliefs are or are not dangerous, but the rules of [this] board are pretty strict on religious debate. I'd suggest you read up on the rules if you haven't already.
Oh, sorry about that. Where's the button that changes the board's rules?

(3) Is there some reason you post in the Times New Roman font? It's smaller and harder to read than regular font.
I think you answered your own question. :) Actually, the reason is that it's like my "calling card", my superhero Internet outfit. That, or I'm just used to it and like its look. For the benefit of you and the others here at the board who are severely near-sighted ( :) ), I will increase the size of the text from now on.

[Douglas J. Bender]

Neverfly,

At a time when few alternatives and treatments were available, and seriously mentally ill patients were treated rather poorly (locked up like criminals), the surgeries offered at least some hope. It was treatment when there really wasn't much treatment going on.
Perhaps. But my point was more that the doctors and "experts" didn't really know what they were doing, or why the "treatment" seemed to work. Even butchers in a china shop can accidentally succeed in stacking delicate china with their butcher knives, but in doing so they will typically knock over just as many. (And, maybe I should have used "marauding Vikings" and "surgery" as an analogy instead.)

[publius]

And finally, the second of Kirsch's points was he found correlation between the drug and placebo curves, the one was a predictor of the other. If you knew the placebo curve, you could predict the drug curve. What this means is that if subject was a placebo responder, he would likely be a drug responder as well. And if a subject didn't respond to placebo, he wouldn't likely respond to the drug. IOW, he would likely occupy the same spot on the drug curve as he did the placebo curve, shifted slightly to the right. And that was the basis of his claim that most of the drug effect was due to placebo effect. The drug just gives a slight 1 - 2 point push to the right over the placebo effect.

However, his critics said this was just a sampling artificat, and there was no such correlation. Placebo response does not predict drug response.

-Richard

[toejam]

Rather than listen to anecdotal personal stories, which are interesting but unreliable, and often told by people pushing some private agenda, people interested in mental health matters could well start with some reliable information from sites like:

http://www.medicinenet.com/mental_illness/index.htm


There are plenty of references there to other sites. And it would serve as an easy gateway to articles on particular diseases.
The general medical articles in medicinenet.com on any subject are good & reliable.

[toejam]

Neverfly,


Perhaps. But my point was more that the doctors and "experts" didn't really know what they were doing, or why the "treatment" seemed to work. Even butchers in a china shop can accidentally succeed in stacking delicate china with their butcher knives, but in doing so they will typically knock over just as many. (And, maybe I should have used "marauding Vikings" and "surgery" as an analogy instead.)

Yes, yes. And 2 centuries ago doctors did not know about the pharmacology of digitalis in heart failure, beyond the fact that one of them was told by an old lady from Shropshire that the Foxglove was good for the dropsy. They used foxglove extracts & gradually improved them and it worked for an amazing number of patients. You would have preferred them not to use it until all the biochemistry was known & proven? It is not used nearly as much now as even a few years ago. There are better treatments, medical and surgical. Does that prove that its use in the past was wrong?
They used quinine bark to treat malaria, when, as its name suggests, they thought that its cause were the "bad vapours" of swamps, and it worked. There are better drugs now. So what? Was its use then evil? Quinine is still useful in some situations in types of malaria resistant to the modern drugs.

And so? Why don't you declare your agenda openly? What is it? Why beat about the bush? Why leave us breathlessly guessing?

[Douglas J. Bender]

toejam,

And so? Why don't you declare your agenda openly? What is it? Why beat about the bush? Why leave us breathlessly guessing?
I thought I already "declared" it. I want to persecute the mentally ill, just because. No, wait, that wasn't it....Actually, I forgot what it was.

[Douglas J. Bender]

toejam,

Rather than listen to anecdotal personal stories, which are interesting but unreliable, and often told by people pushing some private agenda,....
Yes, yes - ignore those who do not toe the line, who trouble the waters, who share things that don't align with popular theory. Blasphemers! Who do I think we are, anyway? On the other hand, obviously it's perfectly fine to listen to anecdotal personal stories if they support, say, the information at the link you provided, because of course they would have no "private agenda", unlike all others who are most likely pushing some personal agenda. It's never about truth for those who disagree with the currently popular mental health paradigm - no, it's about a "private agenda". And we know that truth is never a "private agenda", right?

[Neverfly]

Douglas J Bender, I wonder if a personal bias on your part is influencing your take on this?

You compared neurosurgeons to Butchers in a china shop- citing that even butchers would stack fine china by accident.
Hardly.

The success rates are totally different.
Those surgeons were trying to help people during a time when the most favored approach was to lock them up and toss the key.

Secondly, folks may not comment on personal anecdotes when they agree with the conclusion- does not mean that they weigh it more favorably as evidence. They just don't necessarily have a reason to speak up about it when they agree.

Lastly, although your personal faith is entirely your own business and I respect that, you cited Spirituality as the basic premise behind understanding our minds earlier.
Can you give that claim scientific merit?
Would it be better for doctors and scientists to rely on Spiritual guidance instead?
Witch doctors etc... I seem to recall their success rate was quite a bit lower- and their personal agenda... well...

[closetgeek]

I don't know how it is world wide but it has been my experience, here in the US that doctors have become a drive-through medication service. I also think that it is a major contributer to the problem that Gillianren was addressing regarding the validity of true clinical depression. Gillianren obviously sees Dr. who have expertise in the field of psychatrics which I honestly think puts you in a more justified medication process, but you can get antidepressants from your physician. Drug companies are going to advertise, just like fast food. The difference between the two is; the only way you can get an Rx is through a doctor. They want you in and out, fast, and want a reason for you to come back. I think that a more thorough diagnosis should be required for prescribing certain drugs.

As I have said before, my son was diagnosed with ADHD. He was in therapy for a few months first, because I was concerned for his safety. He was diagnosed and medicated after being under observation for a weeklong stay. I know I have shared this before but what I am struggling with now is finding a doctor that takes the time with us. Unfortunately, the clinic that gave us the time closed down their childrens section. We were all clear on the fact that Concerta was a temporary solution, so he could stay in school and function but they knew how I felt and worked with me. Since then I have been bouncing around doctors that I just don't like. The first one I found spent an hour and a half with us. I really like the fact that he didn't want to just rest on the fact that he was adhd, he wanted to explore the possibility of anxiety and depression. I stopped seeing him, though, because for no reason he began messing with the dosage. He uped the dosage, my son stopped eating and began to hallucinate. The doctors I have seen since, however, seem to rush me through despite the fact that I have always asserted that I was never fully comfortable with the original diagnosis in the first place.

My doubt comes more from the same issues as the amount of people who are diagnosed as being clinically depressed. Can there really be that many people who suffer from depression? Can there really be that many children with ADHD? Should a physician even be in the position to be prescribing mind altering substances in the first place? I don't know if calling for govt control for prescribing medications in those areas is the answer but I would certainly like to see more thorough investigations before they actually do prescribe.


Entirely agree. Antidepressants, with all their present crudeness and side-effects are a huge boon to those who need them, people with a true depressive illness. But then you have doctors prescribing them for things like reactive "depression", grief, sadness for any reason etc, and they don't work and still have the unpleasant/dangerous side-effects, and that is how they get a bad name. It is clearly the doctors' fault of mistaken diagnosis, mistaken ideas about the indications for these drugs, ignorance and, let's face it, plain ordinary stupidity in a few (we hope) cases.

[Gillianren]

My doubt comes more from the same issues as the amount of people who are diagnosed as being clinically depressed. Can there really be that many people who suffer from depression? Can there really be that many children with ADHD? Should a physician even be in the position to be prescribing mind altering substances in the first place? I don't know if calling for govt control for prescribing medications in those areas is the answer but I would certainly like to see more thorough investigations before they actually do prescribe.

It depends on how you define "that many people," naturally. But yes, there are an awful lot of clinically depressed people out there. I can't speak to ADHD, as I haven't studied it as much, for obvious reasons. I'm sure that both diagnoses get applied when they're not right a fair amount, but I think a solid majority of the diagnoses of both are correct. It's not fun to think about, but it's probably true nonetheless.

As to who prescribes mind-altering medications, who would you want to? I'm happiest when someone with medical training does it. Now, I'd like to limit it to psychiatrists. However, as I'm sure you can attest to, there simply aren't enough of them around. It used to be possible to actually get therapy from a psychiatrist; that hasn't been true for years. They're too busy, and not enough new doctors are selecting that specialty; the malpractice insurance, to my understanding, is pretty prohibitive. So people get stuck with GPs. Or pediatricians, I assume, in your son's case. And while a GP is a good doctor to have around, there are some things for which you should see a specialist; everyone knows that.

I was diagnosed after two solid days of psychiatric testing back when I was in seventh grade. I've taken practically every test they've got. Unfortunately, it was a long time ago and I was a minor, so I don't think the results are still in my file, hence the repeated misdiagnosis. However, if your son's diagnosis was after a week of observation and you're still not sure it's valid, how long do you think they should have taken? I understand that the situation is frustrating to you, and I'm sure it must be much worse for him. However, I do think that, no matter how hard it is, you should try to understand the system that's put you in that place. If it's wrong, by all means, try to improve it. But start by learning why it's wrong, so you know what to fix.

[toejam]

Gillian

Agree wiyh your ideas on Rx for mind-altering drugs, & also with the practical impossibility of this at present. But it should be possible to have at least one consultation with a psychiatrist, before embarking on a prolonged, or sometimes lifelong, course of drug tratment.

[toejam]

toejam,


Yes, yes - ignore those who do not toe the line, who trouble the waters, who share things that don't align with popular theory. Blasphemers! Who do I think we are, anyway? On the other hand, obviously it's perfectly fine to listen to anecdotal personal stories if they support, say, the information at the link you provided, because of course they would have no "private agenda", unlike all others who are most likely pushing some personal agenda. It's never about truth for those who disagree with the currently popular mental health paradigm - no, it's about a "private agenda". And we know that truth is never a "private agenda", right?

No. Just ignore those who raise a lot of bulldust.

[Douglas J. Bender]

toejam,

No. Just ignore those who raise a lot of bulldust.
Gotcha. Since all opinions or anecdotes which differ from the popular mental health paradigm are "bulldust", they should be ignored. Isn't science wonderful?

[Douglas J. Bender]

Neverfly,

Douglas J Bender, I wonder if a personal bias on your part is influencing your take on this?
It's possible, but I'd have preferred you not mentioning it.

You compared neurosurgeons to Butchers in a china shop- citing that even butchers would stack fine china by accident.
Hardly.
It was an analogy. It wasn't meant to be taken as a scientific or realistic scenario.

The success rates are totally different.
Those surgeons were trying to help people during a time when the most favored approach was to lock them up and toss the key.
My point was that the surgeons DIDN'T KNOW WHY OR HOW THEIR TREATMENT SEEMINGLY WORKED, not that in some cases it might have alleviated some symptoms.

Secondly, [the fact that some] folks may not comment on personal anecdotes when they agree with the conclusion- does not mean that they weigh it more favorably as evidence. They just don't necessarily have a reason to speak up about it when they agree.
Okay.

Lastly, although your personal faith is entirely your own business and I respect that, you cited Spirituality as the basic premise behind understanding our minds earlier.
In a way, yes, I did. The current mental health paradigm, the "chemical imbalance" theory, is based on the premise of materialistic naturalism, that there is no spiritual reality, only matter. The implication of this premise which affects the mental health paradigm is that since all is matter, and there is no spiritual reality, the mind does not exist separately from the brain - that is, all causes, even mental, are material in nature. Even within a materialistic paradigm, this is a potentially dangerous, faulty premise, since certain complex systems are now known to have "top-down" influence ("emergent systems"), and their properties are not reducible to their physical "substrates".

Can you give that claim scientific merit?

Perhaps, but I don't have time today or tomorrow to do a relatively thorough Internet search on the medical evidence of spirituality. There is, of course, the entire area of "Intelligent Design", and there is the issue of historical evidence (which in many cases, which I could share later, points to an "unseen" guiding Hand). Beyond this, I have personal anecdotes, which of course are utterly less than worthless, obviously. Thus, my experiences with demons mean absolutely nothing, and I shouldn't mention them.

Would it be better for doctors and scientists to rely on Spiritual guidance instead?

If by "spiritual guidance" one means "man's nature as revealed in the Bible", then yes, at least in the case of understanding the mind and man's being. As a foundational principle or premise, of course, not as specific scientific or medical instruction.

Witch doctors etc... I seem to recall their success rate was quite a bit lower- and their personal agenda... well....

Witch doctors are a whole other issue. They have no sound reason for their "theory", they have no historical basis for their beliefs (no objective history which would lend credence to their beliefs), and they are not comparable to scientists or doctors who believe that a spiritual reality exists and that the mind is not reducible to matter. Actually, your "witch doctor" comparison better fits psychiatrists who prescribe mind-altering drugs as a "treatment" for various nebulously-defined "mental illnesses".

You should try reading the book, "Prozac Backlash" by Joseph Glenmullen, M.D. (a "clinical instructor in psychiatry at Harvard Medical School"). Here's a quote from the inside jacket of the book (my emphases):

Prozac Backlash provides authoritative, balanced information on the efficacy of [serotonin-boosting drugs like Prozac, Zoloft, and Paxil], explaining how they react chemically in the body, and what risks they present. Equally important, the book informs readers of the many safe, effective alternatives to using such drugs - alternatives that can restore your spirits, keep your weight down, and make your sex life as vital as ever. Dr. Glenmullen argues that antidepressant drug therapy is justified only in moderate to severe cases - no more than 25 percent of patients currently taking these drugs - and that we should avoid patients' exposure to these drugs whenever possible. The dangerous side effects, he points out, are caused by Prozac backlash, which is the brain's reaction to artificially elevated levels of serotonin.

Using vivid real-life stories from his work at Harvard, his private practice, and the latest medical research, Dr. Glenmullen explains the real role of serotonin in depression and challenges the popular, hypothetical notion of a "serotonin defficiency" allegedly corrected by the drugs. He relates the research history of Prozac and similar drugs, and includes disturbing facts about the influence of drug companies and HMOs on media representation of that research.

The book itself is quite eye-opening. And, I was one of the first (either in the nation, or in northern Indiana) to be prescribed Prozac when it came out "publicly" (at least, that's what my psychiatrist at the time indicated, though perhaps he just meant I was one of the first that he personally was aware of at that center). This was in 1986 or 1987 (I think it was 1987), I believe. I recall being told that the initial dosage was mostly just a wild guess, and to be aware of any possible reactions I might have to the drug. Well, I had quite a reaction, and felt I had been poisoned - as I lay down on my sofa, feeling quite sick and almost as though I might die (seriously), I suddenly had a waking "mental" vision (the vision was in my mind, not as though it was in 3-D physical space) of Jesus, though I could only make out His form, since there was a thick cloud or fog surrounding me and Him, and He approached me and touched my forehead and said, "Learn to love". Immediately, my awareness shifted to my surroundings (the vision ended), and I felt completely well. (I wasn't a Christian at the time, by the way.) Later, after sharing my "poisoned" reaction with the psychiatrist, he quickly reduced the dosage by half or more.

I'd be curious to know of any "materialistic" or chemical explanation for my clear overdosage with Prozac, entailing a (perhaps mild) poison reaction, and its complete alleviation within a few seconds of its peak. That should be interesting.

[Noclevername]

Gotcha. Since all opinions or anecdotes which differ from the popular mental health paradigm are "bulldust", they should be ignored.

No, only those based on little evidence, and contradicted by a great deal of evidence.

Isn't science wonderful?

When you actually start using some, I'll let you know.

[Douglas J. Bender]

On a related note (specifically, in regards to some here implying I have an "agenda"), I would like to point out that if the currently popular "mental health paradigm" - the "chemical imbalance" theory - is correct, then the Bible's description of man and God, and of man's relationship to God, is false. The Bible says that the "fruit of the Spirit is love joy, peace,...", things which are said to be available, immediately and directly from God, to any and all Christians. If the "chemical imbalance" theory is correct, then that passage would not have been true for nearly 2000 years, since there would have been Christians who would have "needed" (if the "ci" theory is true) their supposed "chemical imbalances" adjusted in order to be able to experience "love" or "joy" or "peace". And this would effectively undercut the entire authority of the Bible.

Now, I mention all this so that others here can see the issues more clearly. I also want to make it clear that I am not arguing that some of these drugs can't boost moods, nor that they can't have an effect on behavior. I am arguing that the premise of those drugs is faulty, and that the drugs don't address the causes of the problems which they supposedly alleviate.

And, my "agenda" in this thread is primarily to share the truth. It's not necessarily to defend or promote Christianity or a "spiritual worldview" (although I am a Christian and thus have a "spiritual worldview"). I have had numerous personal experiences with "psychoactive drugs", and so this is an issue I take personally (that I have a personal interest in). Just as in any other thread dealing with an area that interests me, I don't remain silent when I believe that errors are being disseminated or promoted.

[Douglas J. Bender]

Noclevername,

When you actually start using some, I'll let you know.
Likewise. However, you might want to read Prozac Backlash, for some science regarding antidepressants. In the meantime, I won't waste my breath sharing with you any of my "anecdotal" experiences, and I assume you won't waste your time reading any I might post.

[Neverfly]

Neverfly,


It's possible, but I'd have preferred you not mentioning it.
Ummmm... I'm sorry?http://us.i1.yimg.com/us.yimg.com/i/mesg/emoticons7/106.gif

It was an analogy. It wasn't meant to be taken as a scientific or realistic scenario.
The point of an analogy is to BE realistic though.

What would be the point of using a totally unrealistic one that doesn't apply?


My point was that the surgeons DIDN'T KNOW WHY OR HOW THEIR TREATMENT SEEMINGLY WORKED, not that in some cases it might have alleviated some symptoms.

There is much we do not know still. We only know it shows a positive effect but are not sure why. Does that mean don't use it?
I really don't understand what you are trying to claim here. It makes no sense.

It's like.. We don't KNOW exactly how gravity works- but we sure use it!


Okay.
:)


In a way, yes, I did. The current mental health paradigm, the "chemical imbalance" theory, is based on the premise of materialistic naturalism, that there is no spiritual reality, only matter. The implication of this premise which affects the mental health paradigm is that since all is matter, and there is no spiritual reality, the mind does not exist separately from the brain - that is, all causes, even mental, are material in nature. Even within a materialistic paradigm, this is a potentially dangerous, faulty premise, since certain complex systems are now known to have "top-down" influence ("emergent systems"), and their properties are not reducible to their physical "substrates".

But see, this really is the problem. You are claiming that there is a divine enrgy- or spirit- outside of the brain. Outside of the material organic matter.
Do you have any evidence whatsoever to back up this claim?
Why even HAVE a brain if we don't need it? If our mind is somewhere else?

You then refer to science as
a potentially dangerous, faulty premise, Knowing that you have zero evidence of your claim and knowing that there is a great deal of evidence in favor of the material organic process that is the brain.

Your spiritual assumptions are your own business- and that is fine. But we are talking about Science here.

I'm not trying to be mean, I'm just being blunt.

Perhaps, but I don't have time today or tomorrow to do a relatively thorough Internet search on the medical evidence of spirituality. There is, of course, the entire area of "Intelligent Design", and there is the issue of historical evidence (which in many cases, which I could share later, points to an "unseen" guiding Hand). Beyond this, I have personal anecdotes, which of course are utterly less than worthless, obviously. Thus, my experiences with demons mean absolutely nothing, and I shouldn't mention them.

As far as I am concerned- you can take all the time you need.
I will listen to every anecdote too.
And I will be happy to discuss it with you. You can PM me if the thread dies and you feel wont to re-awaken it.

I think the intention is to increase understanding- maybe we can help eachother out.



If by "spiritual guidance" one means "man's nature as revealed in the Bible", then yes, at least in the case of understanding the mind and man's being. As a foundational principle or premise, of course, not as specific scientific or medical instruction.
You mention the bible again in a following post to the one which I'm replying to now. I will address both on this line though.
When In the science you need to know the science.

According to BAUT rules, religion is rather shunned in discussions because it has a tendency to get folks pretty hot headed- as I'm sure you know.
So please try to PM folks with Religion- and leave the bible off the threads- We are talking about science- so use Science to discuss science:)
I'm just a Jr. Grade member here, but trying to help you keep your feet from tripping. I'm not telling you what to do.


Witch doctors are a whole other issue. They have no sound reason for their "theory",
Uhhh... Do you?:neutral:
they have no historical basis for their beliefs (no objective history which would lend credence to their beliefs),
Uhhh.. Do you?
and they are not comparable to scientists or doctors who believe that a spiritual reality exists and that the mind is not reducible to matter. Actually, your "witch doctor" comparison better fits psychiatrists who prescribe mind-altering drugs as a "treatment" for various nebulously-defined "mental illnesses".
Peoples personal beliefs- even as doctors are their own choices. However, in practicing medicine- one must stick to evidence and fact.
I have THOROUGHLY researched Healing By Prayer for many years.
I am a former Bible Thumper- I had a Ministry even.

I found no evidence. I'm fairly confident that I can, through experience, debunk whatever evidence you bring to the table, however, I will gladly listen to and and discuss it with you.

You should try reading the book, "Prozac Backlash" by Joseph Glenmullen, M.D. (a "clinical instructor in psychiatry at Harvard Medical School"). Here's a quote from the inside jacket of the book (my emphases):



The book itself is quite eye-opening. And, I was one of the first (either in the nation, or in northern Indiana) to be prescribed Prozac when it came out "publicly" (at least, that's what my psychiatrist at the time indicated, though perhaps he just meant I was one of the first that he personally was aware of at that center). This was in 1986 or 1987 (I think it was 1987), I believe. I recall being told that the initial dosage was mostly just a wild guess, and to be aware of any possible reactions I might have to the drug. Well, I had quite a reaction, and felt I had been poisoned - as I lay down on my sofa, feeling quite sick and almost as though I might die (seriously), I suddenly had a waking "mental" vision (the vision was in my mind, not as though it was in 3-D physical space) of Jesus, though I could only make out His form, since there was a thick cloud or fog surrounding me and Him, and He approached me and touched my forehead and said, "Learn to love". Immediately, my awareness shifted to my surroundings (the vision ended), and I felt completely well. (I wasn't a Christian at the time, by the way.) Later, after sharing my "poisoned" reaction with the psychiatrist, he quickly reduced the dosage by half or more.

I'd be curious to know of any "materialistic" or chemical explanation for my clear overdosage with Prozac, entailing a (perhaps mild) poison reaction, and its complete alleviation within a few seconds of its peak. That should be interesting.[/SIZE][/FONT]

I don't understand.
How can you even claim that when a chemical was introduced to a Material System that is run by a process of chemical and electrical reactions- that the fact the man experienced some of the "goofies" makes no sense?
Isn't that what drugs do?
Mess with the brain?
I would say you just provided evidence against yourself there:doh:

[closetgeek]

Well three out of the four teachers my son has had also have sons with adhd, the vice principal, as well as more than half of the students, mostly boys, but two girls in his class last year. I went to a school function and the most popular discussion was the likability of their children's psychiatrist. As for depression, I can't back the numbers, there was just a radio show that was discussing depression in America. The numbers he read were 3 out of 5 Americans suffer from some form of depression. That was two years ago and I don't know what has changed but IMHO if more than half the nation is depressed we are either doing something wrong or overdiagnosing depression. Let me be clear, Gillianren, in no way am I questioning the validity of your diagnosis. You stated that it was a long time ago, before the depression train left the station. Even if you were diagnosed yesterday I would be in no position to question it. More so, after two days of diagnosis, don't you think it cheapens the case of honestly depressed people when now, all you have to do is fill out a questionaire?

I have to find my copy of the ADHD questionaire and give some examples. By that paper, every child between the ages of three and 18 are ADHD. I know the discussion is not about ADHD and my intent is not to bring that in, I am just comparing the two. ADHD treatment is practically advertised in schools but depression treatment is advertised everywhere. I just used them for comparison because both are now decided by filling out a piece of paper rather than time in counceling. It took my Neuropsychologist 7 or 8 yrs to give my behavior a name.

As for who is prescribing them, I feel that depression is a very dangerous and potentially deadly condition that should not be treated lightly. When a physician discovers you have cancer, they generally send you to an oncologist. If you are diagnosed with Hep C, they send you to a GI. They send you to experts because they did not get advanced degrees in the area, why is depression treated like its an allergy? a monthy 15 minute visit with the doctor is not thorough and cannot help the doctor monitor behavior patterns they way a weekly or biweekly visit with a Psychiatrist would. A psychiatrist takes notes and shares them with a board, who in turn, could pick up warning signals should the depression start to transgress into a form of psychosis. I just think it is a dangerous field that is taken too lightly. Because it is taken too lightly, you say you have had difficulty with doctors diagnosing you when, perhaps you have been just catagorized with the depression ad-watchers that have become the doctors new cashcows. Am I just ranting now?


It depends on how you define "that many people," naturally. But yes, there are an awful lot of clinically depressed people out there. I can't speak to ADHD, as I haven't studied it as much, for obvious reasons. I'm sure that both diagnoses get applied when they're not right a fair amount, but I think a solid majority of the diagnoses of both are correct. It's not fun to think about, but it's probably true nonetheless.

As to who prescribes mind-altering medications, who would you want to? I'm happiest when someone with medical training does it. Now, I'd like to limit it to psychiatrists. However, as I'm sure you can attest to, there simply aren't enough of them around. It used to be possible to actually get therapy from a psychiatrist; that hasn't been true for years. They're too busy, and not enough new doctors are selecting that specialty; the malpractice insurance, to my understanding, is pretty prohibitive. So people get stuck with GPs. Or pediatricians, I assume, in your son's case. And while a GP is a good doctor to have around, there are some things for which you should see a specialist; everyone knows that.

I was diagnosed after two solid days of psychiatric testing back when I was in seventh grade. I've taken practically every test they've got. Unfortunately, it was a long time ago and I was a minor, so I don't think the results are still in my file, hence the repeated misdiagnosis. However, if your son's diagnosis was after a week of observation and you're still not sure it's valid, how long do you think they should have taken? I understand that the situation is frustrating to you, and I'm sure it must be much worse for him. However, I do think that, no matter how hard it is, you should try to understand the system that's put you in that place. If it's wrong, by all means, try to improve it. But start by learning why it's wrong, so you know what to fix.

[Douglas J. Bender]

Briefly (as I must be elsewhere shortly), I believe "mental illnesses" are the only "illnesses" that aren't physically or medically diagnosed or observed. (I'm not sure, but I think schizophrenia might have some physical clues to its presence.) Does that not make any seeming "scientific" arguments for drugs and their effectiveness somewhat suspect, or at least give one pause in thinking about the "chemical imbalance" paradigm?

[Neverfly]

Briefly (as I must be elsewhere shortly), I believe "mental illnesses" are the only "illnesses" that aren't physically or medically diagnosed or observed. (I'm not sure, but I think schizophrenia might have some physical clues to its presence.) Does that not make any seeming "scientific" arguments for drugs and their effectiveness somewhat suspect, or at least give one pause in thinking about the "chemical imbalance" paradigm?

Your belief does not make the reality suspect.

You do not know how or why the PC you are typing on works, completely through and through. But the reality is that it does work- you are using it, after-all.

The PC is not powered by the divine either- it just currently- has you stumped as to how exactly it works.

Bear in mind, even the worlds computer wizards get stumped on the "why it works" question sometimes too.

[Gillianren]

If by "spiritual guidance" one means "man's nature as revealed in the Bible", then yes, at least in the case of understanding the mind and man's being. As a foundational principle or premise, of course, not as specific scientific or medical instruction.

Aaaaand that's where science goes out the window. I don't think you have the slightest awareness of the history of mental illness. Or medicine. Or science in general. Because you are blinded to it by your assumption that the Bible must be right and science must be wrong where it's in conflict. Further, my Catholic mother's the one who got me in therapy in the first place. The whole stance of many religious faiths is that mental illness is real and needs to be treated, and atonement must be made for the historical errors of calling such people possessed by demons.

Well three out of the four teachers my son has had also have sons with adhd, the vice principal, as well as more than half of the students, mostly boys, but two girls in his class last year. I went to a school function and the most popular discussion was the likability of their children's psychiatrist. As for depression, I can't back the numbers, there was just a radio show that was discussing depression in America. The numbers he read were 3 out of 5 Americans suffer from some form of depression. That was two years ago and I don't know what has changed but IMHO if more than half the nation is depressed we are either doing something wrong or overdiagnosing depression. Let me be clear, Gillianren, in no way am I questioning the validity of your diagnosis. You stated that it was a long time ago, before the depression train left the station. Even if you were diagnosed yesterday I would be in no position to question it. More so, after two days of diagnosis, don't you think it cheapens the case of honestly depressed people when now, all you have to do is fill out a questionaire?

First, I suspect that the "questionaire" you speak of is in fact the MMPI, which is a diagnostic tool. Actually, it's the diagnostic tool most recently used on me, come to that. (About nine months ago by the SSA.) Obviously, I cannot say for sure, and obviously, it is possible for the MMPI to be read wrong by the doctor using it. However, it is actually more than just a questionaire.

Second, while I don't believe that 60% of Americans are clinically depressed, and I would like to know where he got those numbers, I think it entirely possible that 60% of Americans undergo a period of depression, which is an entirely different thing. A lot of people undergo severe, probably clinical, depression once in their lives and never again. It is usually undiagnosed and untreated, though I strongly suspect that's less true than it used to be. Is that enough, along with the genuinely ill, to bump numbers up to 60%? I don't know; I have no way of knowing. But I do think it's a bigger problem than most people realize.

I have to find my copy of the ADHD questionaire and give some examples. By that paper, every child between the ages of three and 18 are ADHD. I know the discussion is not about ADHD and my intent is not to bring that in, I am just comparing the two. ADHD treatment is practically advertised in schools but depression treatment is advertised everywhere. I just used them for comparison because both are now decided by filling out a piece of paper rather than time in counceling. It took my Neuropsychologist 7 or 8 yrs to give my behavior a name.

Yes, depression treatment is advertised everywhere, and no, I don't think that's right. However, I do think that it's a fallacy to focus on the omnipresence of depression medication and ignore the omnipresence of, say, blood pressure medications and so forth. In my opinion, people focus on depression medication because they believe in high blood pressure and so forth. It is--and this is not intended as an insult to anyone--not possible for the non-mentally ill to truly understand the mentally ill. I love my therapist. She's a great person, and she's genuinely helping me. But there are some things she doesn't understand and cannot understand, because she has not experienced them. You can understand my physical pain. You can understand many other things about me, and it may well be possible that you'd come pretty close with the bipolar disorder. But, by its very nature, it sets me apart and makes me different in a way that you are not.

I strongly suspect, though I have no evidence, that there are a fair number of people who are diagnosed with depression or ADD or the like because their (bad) doctors want to get them out of the office, and medicating people is indeed faster than treating people with non-chemical problems. However, I am not overly alarmed by the rise in diagnoses. The simple fact is, there was a time when there was an astonishing rise in diagnoses of a lot of physical problems, simply because the diagnostic tools got a lot better. Did you know, for example, that there was a time when the diagnostic tool for diabetes was tasting the patient's urine for sweetness? Blessedly for doctors, they don't have to do that anymore.

Yeah. I'd like to have people only get diagnosed if they only have the problem. But too many people use that as a jumping-off point for "no one needs the medication, because there's nothing really wrong with any of them," and as I'm sure you can imagine, I'm a little sensitive on that subject.

As for who is prescribing them, I feel that depression is a very dangerous and potentially deadly condition that should not be treated lightly. When a physician discovers you have cancer, they generally send you to an oncologist. If you are diagnosed with Hep C, they send you to a GI. They send you to experts because they did not get advanced degrees in the area, why is depression treated like its an allergy? a monthy 15 minute visit with the doctor is not thorough and cannot help the doctor monitor behavior patterns they way a weekly or biweekly visit with a Psychiatrist would. A psychiatrist takes notes and shares them with a board, who in turn, could pick up warning signals should the depression start to transgress into a form of psychosis. I just think it is a dangerous field that is taken too lightly. Because it is taken too lightly, you say you have had difficulty with doctors diagnosing you when, perhaps you have been just catagorized with the depression ad-watchers that have become the doctors new cashcows. Am I just ranting now?

At my clinic, you cannot recieve treatment from their psychiatrist without also receiving treatment from one of their therapists. I don't think either of them are actually psychologists; I know mine is not. However, I do think that you're absolutely right that good talk therapy is essential to proper treatment. I have never, as you may know, disputed this. I do understand the bind GPs are in regarding medicating the mentally ill, however. Do you refuse needed treatment to someone whose insurance, like many, does not cover mental health, simply because they cannot afford to see a psychiatrist and a therapist? Or do you make what may be the wrong diagnosis, because you had one six-month rotation in psychiatry twenty years ago, rather than risk letting someone truly ill get away without treatment?

As for me . . . no. They didn't consider me someone who just watched the ads and thought I was depressed. You have to remember that all of my doctors have been in some way part of the disability system. I have been approved for disability solely on mental health issues, and that wouldn't've happened were my mentally illness not pretty obvious. I'm legally considered too crazy to work, a dubious distinction at best. The problem, actually, was that bipolar disorder was a bit of a catchall when I was diagnosed, as schizophrenia has been in the past. Now, I imagine, the catchall is depression. This should not be taken as an implication that all those people misdiagnosed into a catchall weren't genuinely sick; it's just that a lot of people didn't know what illness they actually had, or perhaps it didn't have a name. Ergo, various doctors have mistrusted my original diagnosis despite the time put into it.

[closetgeek]

Gillian, I think I was just jumping to conclusions, 60% of people considered depressed = 60% on depression medication. Taking that a bit further, of that 60%, the rate of people that don't really need medication would distort the success rate.

[Gillianren]

Gillian, I think I was just jumping to conclusions, 60% of people considered depressed = 60% on depression medication. Taking that a bit further, of that 60%, the rate of people that don't really need medication would distort the success rate.

Again, I'd want documentation on those numbers. That sound awfully high.

[closetgeek]

Again, I'd want documentation on those numbers. That sound awfully high.

I did specify in the post that originally contained those numbers, it is unconfirmed as I heard it on a radio show three years ago. This is what I came up when I googled:

http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america.shtml

An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year.

Of course that is overall mental disorders, only 9.5% being mood disorders, but others are listed as having a tendency to appear with mood disorders.

It's a bit harder to find numbers in people under 18 as I am sure it gets a bit tricker. It is quite possible, to make the point, the speaker manipulated the numbers. It is not all that uncommon to do in a rant. Possibly adding the highest year in numbers of adolescent cases with the highest number year in numbers of adult cases. Who knows?

[Gillianren]

I did specify in the post that originally contained those numbers, it is unconfirmed as I heard it on a radio show three years ago. [snip!]

Of course that is overall mental disorders, only 9.5% being mood disorders, but others are listed as having a tendency to appear with mood disorders.

It's a bit harder to find numbers in people under 18 as I am sure it gets a bit tricker. It is quite possible, to make the point, the speaker manipulated the numbers. It is not all that uncommon to do in a rant. Possibly adding the highest year in numbers of adolescent cases with the highest number year in numbers of adult cases. Who knows?

Well, yes; I wasn't necessarily expecting you to have documentation for those numbers, since it wasn't you who claimed it. However, I'd insist on documentation from anyone actually using them as an argument of, um, anything. Further, if he did add them together, that's faulty math. Even I know that. You'd have to do something more complicated than that to make the numbers work out right.

I would also suggest that a fair number of people (translated, I have no idea how many) with diagnosable mood disorders aren't medicated. I wasn't until relatively recently, and I'm diagnosed, not merely diagnosable. There is still an awful lot of people who don't seek mental help even when they need it; I've known several untreated schizophrenics, for example, and they'd go into those figures as well.