When is Psychiatry Effective?

[drkitten]

I was after an alternative to the NSAIDs that wouldn't put holes in my gut. I was not seeking cheer-up pills. I'm Scottish. I'm meant to be dour.

My neuropeptide levels may, or may not be odd, but I see living with that as my responsibility- indeed as being "me". Fixing knees, I had supposed, was the doctor's job.
If I take a flat tyre to a garage for repair, I do not require counselling about the age of my car. I require a puncture repair.

Well, this may be part of the issue under discussion.

From the doctor's perspective, he's responsible for treating you in your entirety. I'm sure that your insulin levels are also part of being "you," but that doesn't mean that an ethical physician shouldn't be alert for the signs of diabetes and be prepared to intervene if necessary.

Would you have objected as much if the doctor had noticed that your insulin levels were out of whack and suggested treatment for that? What would you say if he had spotted a possibly-malignant melanoma on your back? Would you have complained that you just wanted an NSAID-alternative and not a potentially life-saving lifestyle intervention?

 

[Skeptic Ginger]

As far as bad docs, the problem is most often specialties. We tend to do better in areas which are more specific. So if you are diagnosed with something serious or complex, see a specialist and if your GP isn't figuring it out fast enough, see a specialist. Otherwise, I think most providers give competent care.

In my field though, they get it wrong at least half the time. I work in the post-exposure pre-infection field of infectious disease. I think most medical schools must include all of a paragraph to read in this area. I have to believe they get it right if you actually are infected but many providers except in the public health field are clueless about the details of the spread of infectious disease.

 

[hopping llama]

An interesting case study - my friend Sarah.

Diagnosed as suffering depression. Was on the meds merry go round for a while - Try this. Stop. Try that. Found a solution that helped. Also diagnosed as suffering from Bi polar.

Then had a massive car crash and then had an aquired brain injury. No brain damage noticable. No longer suffers from the mental illnesses she was diagnosed as having.

Raises a few questions - was the diagnosis accurate? She definately seemed to be more in control and more rational in her decision making. She said it was amazing to feel in control of her life.

Did the brain injury change the chemistry of her brain?
Was the crash a big wake up for her to change her lifestyle?

 

[TobiasTheViking]

Don't do that. don't stop, not without agreement from your MD or specialist. don't ever do that. That is as bad as self medicating

 

[Soapy Sam]

Well, this may be part of the issue under discussion.

From the doctor's perspective, he's responsible for treating you in your entirety. I'm sure that your insulin levels are also part of being "you," but that doesn't mean that an ethical physician shouldn't be alert for the signs of diabetes and be prepared to intervene if necessary.

Would you have objected as much if the doctor had noticed that your insulin levels were out of whack and suggested treatment for that? What would you say if he had spotted a possibly-malignant melanoma on your back? Would you have complained that you just wanted an NSAID-alternative and not a potentially life-saving lifestyle intervention?

I think it's germane to the overprescription issue, Drkitten.
Diabetes is not caused by sore knees. Depression might be.

Despite evidence (blood tests , x rays and internal photographs (yech) ) of conditions 1 (osteoarthritis), 2 (internal bleeding probably caused by treatment for condition 1) and 3 (blood and urinary tract infections arising within days of treatment for 2 and probably as a result thereof), my GP, given the time constraints any NHS GP works under, chose to effectively ignore all the hard data and go after a will-o-the-wisp possibility of depression.
Whether he was right or wrong is less relevant to this thread than the question Why was he thinking this way at all?

I'm all for treating the patient as a whole, but treating depression, imaginary or real, is not going to help osteoarthritis or internal bleeding or infection. Had he found me diabetic as a result of urinalysis, yes I would expect him to act on that data, but in this case, acting on hard, known data is exactly what he did not do. He chose to ask a sceptic about his mental state. I still find this funny in both senses of the word and I wonder what prompted him to do so. Could it be that he had just read a paper on some new psychoactive drug? Now I'm speculating.

 

[Dancing David]

How often can mental illness(say psychosis) be detected in such absolute manors, instead of saying "you know the guy running around ranting about the turkeys is probably not all that sane"?

Still there is a lot of woo in this, but discounting everything not measureable is also hard. Are there such tests for full autism and such instead of descriptive tests?

The tests for autism are also observational as are most developmental tests, you can use science to gauge a lack of language development prior to the age of three. If you have the child in front of you at the time, you can observe word counts and word usage, but usualy parent don't notice the more mild forms of autism until three or four, 'they were just a quiet child'.

With mental illness it is all going to be by the subjective report of the identified person seeking treatment or observation of some things.

the observation thing is usually beetr for psychosis than depression, response time to questions can be 20 secs. to a minute or longer, there are the 'apparent response to internal stimuli' and the 'expression of delusional beliefs'.

But just as in all medical conditions, subjective report is an imporatant part of determining diagnosis and treatment.

 

[Dancing David]

My primary concern is with diagnoses of chronic mental illness which entail a lifetime of pharmaceutical treatment, off of what can be as little as a 1 hour interview using a checklist.

People don't usally take life long medications unless they have tried the medicine and then gone off it and had a re-emergence of symptoms.
In my five teen years as a social service provider almost no one takes the medicine because some body else tells them to. and in fact with most people with the most severe symptoms there are frequent episodes of 'non-compliance'. increasing symptoms and then life stress before the person makes the personal dexcision to take the medicine regularly. And even then most people try lowering the dosage after a while.

 

[Dancing David]

I wonder if, as neural disorders which long proved wholly untreatable by psychoanalysis are seen to be amenable to drug therapy - possibly GPs are starting to think they know rather more about the mind than they actually do?

Well, it may or may not be that you have depression, chronic pain kind of wears down the body and many people will develop secondary depression, then there is the whole confusing use of ADs to treat pain.

 

[Dave1001]

People don't usally take life long medications unless they have tried the medicine and then gone off it and had a re-emergence of symptoms.
In my five teen years as a social service provider almost no one takes the medicine because some body else tells them to. and in fact with most people with the most severe symptoms there are frequent episodes of 'non-compliance'. increasing symptoms and then life stress before the person makes the personal dexcision to take the medicine regularly. And even then most people try lowering the dosage after a while.

Here I'm talking more about medical practice than what people actually do. I'm sure a significant number of people are diagnosed as bipolar off a checklist, are presecribed a pharmacuetical and are told they will have to take it the rest of their lives, but unilaterally decide, without doctor input, to stop taking the drug when their life situation & mood improves. Some of these folks never need to take pharmacueticals again -they were probably incorrectly diagnosed as having a chronic mental illness instead of a temporary depression.

However, others have "relapses". They may indeed have chronic illnesses. I think it would be prudent for psychiatric medicine to have an in-built mechanism to reappraise people diagnosed as having chronic mental illnesses as actually having suffered from temporary mental illness, and to take them off medication. Otherwise, the more authority dependant types may end up taking pharmacueticals, often with significant side effects and costs, for decades, without a true need to do so.

 

[jskowron]

calebprime asks

When is psychiatry effective?

the quick and dirty answer is, "Pyschiatry is effective when it works." There are published studies on the uses of all psychiatric medications. I am not aware of any where:

a)100% of the experimental subjects responded favorably to the medication (i.e. practically or clinically significant symptom reduction),
b)100% of the control subjects didn't respond favorably to the placebo
c)100% of the control subjects were negative side-effect free.

What can be concluded from these studies is this:
-Subjects receiving the medication experienced greater improvement than those not receiving the medication and/or receiving a placebo control. The difference between the medication group and the control group would only be expected to occur 5 times out of 100 (for p=.05) if there were no effect of the medication.

This is a long way from saying that SSRIs always cure depression. Often, the subjects in experiments are not representative of the general population of individuals who may be prescribed the drugs. For example, if the drug being studied is meant to treat psychosis, the experimental protocol may rule out as subjects anybody who has comorbid diagnoses of depression, PTSD, or anxiety. The clinician prescribing the medication in the "real world" clinic, may not subscribe to those rule-outs.

Differential diagnosis of psychiatric disorders can be extremely difficult, and somewhat misleading, if not misunderstood. The Diagnostic and Statistical Manual of Mental Disorder, fourth edition (DSM-IV) is the most commonly used diagnostic system by psychiatrist. Most of your "common" psychiatric disorders (e.g. major depression, autism, bipolar disorder) have polythetic criteria- That is, there are several different collections of symptoms that can receive the same diagnostic label. For example, part of the diagnostic criteria for major depression include the individual demonstrating 5 or more of the following symptoms (simplified for presentation here)
1. depressed mood
2. diminished interest or pleasure in activities
3.more than a 5% change in body weight (gain or loss) or decrease in apetite
4. insomnia or hypersomnia
5. psychomotor agitation or retardation
6. fatigue or loss of energy
7. feelings of worthlessness or guilt
8. diminished ability to think or concentrate, or indecisiveness
9. recurrent thoughts of death, suicidal ideas, or suicide attempts

Within these criteria, a person presenting with a 10% weight gain, who couldn't sleep, was physically agitated, felt worthless, and attempted suicide could receive the same diagnosis as someone with a decreased apetite, who slept all day long, felt guilty, was indecisive, and though about death but had no plan to kill themself. It is not a stretch to think that these two individuals may have different responses to the same medication. For insurance purpose, these diagnosis may have to be given after the first appointment, which may only consist of a 50 minute interview. Not a great system.

Diagnosing autism can be very tricky, and diagnosed individuals can display highly disparate behaviors and symptoms. To illustrate, in the first criteria for Autistic Disorder listed in DSM-IV:

"A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3)."

Now that's confusing! In case you're wondering, the "(1), (2), and (3)" refer to 3 separate list of four symptoms each, consisting of impairment in social interaction, impairment in communication, and differing degrees of repetitive behaviors, interests, and/or activities. Speaking from experience, this can get real confusing for the clinician, parent, and individual with autism.

While a diagnostic systems is invaluable for assuring that researchers, clincians, and patients are, in general, referring to similar things when they give a diagnosis, the psychiatric disorders should not be looked upon as a being "natural categories." Thus the need for trial and error with medications, as well as other interventions.

 

[calebprime]

calebprime's "Reader's Digest" Thread summary

Hope this is helpful. I've tried to select the "best" of the posts. Just my opinion!

Even if we rule out weird quack therapies, there are a lot of tough choices to be made about what treatments we would choose for ourselves or those close to us.

Even if we believe in critical thinking and relying on well-designed studies, there seems to be a lot of contradictory information and philosophies.

While I'm certain that unicorns don't exist and that 9/11 wasn't an "inside job", I'm not so certain about what to believe about psychiatric treatment.


The relevant writers here are people like Appleton, Breggin, J. Glenmullen, David Karp, Alice Flaherty, Peter Kramer. I'd put Szasz at the extreme end of skepticism about whether mental illness really exists, for present purposes.

How to proceed? If your kid had ADHD, would you consider Ritalin? If you were a little blue, would you consider taking an anti-depressant? What if you were a little shy? What if you (like me) are just insanely sensitive to noise and have an excessive startle reflex?

One should be quite skeptical, in particular, about claims that people have chronic mental illnesses due to chemical imbalances in the brain, when those chemical balances can't specifically be measured (the way one can measure insulin levels, etc. in a diabetic). Similarly, when one can't detect the mental illness via brain scan, genetic profile, etc., I think a level of skepticism is warranted. It seems to me the only remaining way for folks to be diagnosed for these type illnesses is by checklist. Hardly authoritative.

Modern psychiatry may have gotten off to a slower start when it comes to evidence based medicine, but the role of neurotransmitters in the brain has been under careful study for at least the last 40 years.

...

There are thousands of studies looking at direct and indirect effects of neurotransmitters and their role in depression. Specific patients are diagnosed with symptoms which correlate with neurotransmitter and receptor deficiencies, but the deficiencies and resulting symptoms have been verified with actual measurements.

I don't have to culture you cold virus to diagnose your infection. I diagnose it based on symptoms that correlate with people who did have the cultures. I can on rare occasions be wrong because I'm not measuring the virus directly. But that doesn't mean the approach of using correlating symptoms is a poor approach. It isn't practical to culture everyone who has symptoms. Instead you develop algorithms.

Why would you think the pancreas capable of deficient insulin production but the brain infallible in serotonin production? The brain is an organ. It has a physical structure. It has electro-chemical activity and is made of proteins. How we think, consciousness, and emotions are the result of physical processes the same way digesting food, storing it, using it and disposing of the byproducts are physical processes.

Given my perspective, what I see in your post may not be that the field is lacking as much as the individual providers are. That is true in medicine in a big way.

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A few providers believe ADHD is overdiagnosed in kids but very few evidence based providers believe it doesn't exist at all and that Ritalin isn't a very useful treatment.

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Even truly depressed people can benefit from lifestyle changes and learning coping methods. We don't teach people how to get along in school. Instead, we assume they will pick that up from social interactions alone. We don't teach parenting skills. So there are often many things unhappy people can do to improve their lives without drugs.

OTOH, better to take an SSRI than to self medicate with alcohol, a frequent substitute.

...

That may be a big part of it. I'm curious what reasonable, skeptical members of the pyschiatric field are estimating to be the instance of misdiagnoses and overdiagnoses in the field. My sense, from the number of people who have told me they've been diagnosed with bipolar disorder alone off of what appears to be nothing more than a checklist, is that overdiagnoses o people as having chronic, lifelong mental illness and overprescription of psychiatric pharmaceuticals for an unending period of time is rampant.

What i do have is a few observations.

The following is my personal opinion.
Psychiatry alone and in and off itself is often not the solution. Psychiatry is a stopgap measure that will eliviate or halt the problem. But not solve it.

Psychiatry should be used to give the individual the time and resources needed to solve the problem at the core. A few times, yes, that isn't possible. But in many cases it is.

For almost all the autistic people who take SSRIs they can be abandoned later. IF the person properly works with the underlying problem. For autism, specificly, stress is a much bigger issue than for NTs(Neurological Typical)*, which results in individuals with autism having depressions longer, harder, and with a higher frequency then NTs.

So what should be done in that case is find the proper SSRI to remove the depression. This gives the person enough space and resources to actually do something during the day instead of just lying in bed all day.(NOTE: not saying that everyone who lies in bed all day have a depression or have autism).

Once the person have resources again one can start talking to a psychologist, and work to have less stress, work to cope with the stress in life, and work to find solutions for that stress, so it doesn't result in a depression. After that is done, the person can stop the SSRI.

I know that this is often the case for autism, and that is what i base my opinion on. I assume that it is the same for many other problems. But not all, for instance epilepsia can, afaik, not be solved with anything but pills.

....


For anything but chronic depression i believe(untill i find contradicting evidence) that psychiatry can solve it while psychiatry keeps it at bay.

ETA: also, i do believe that psychiatry is being used too much as a solution, and too much in general.

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Tobias, you are autistic? Fascinating.

...

Well, you're a very bright guy, so it makes me wonder who in my graduate school/professional sphere may be autistic too.

In my 41 years, I've had my share of painful experiences, and they have been more or less stressful - some very stressful indeed. But nothing - nothing - like the two episodes of major depression I've had. This wasn't simply a matter of degree; it was qualitatively different. An analogy for those who have been lucky enough to not know firsthand: pain/sadness are to depression as ordinary fatigue is to a really, really nasty virus. (Awkward metaphor, I know, but the best I could do on the spur of the moment.) In his book "The Noonday Demon" (excellent, btw), Andrew Solomon quotes someone who says they know when they're slipping into a depression: you can "feel the chemistry going." Maybe not technically correct, but an accurate description of the experience. So many somatic and mental signals send the message that something is very wrong. And then you can't get up in the morning. For months.

In my case, the diagnoses were certainly the usual checklist ones. But with each episode, there was absolutely no doubt in my mind that something was really, truly, horribly wrong. (There was no doubt in the minds of friends and family, either.) I'm reasonably sure that if we'd progressed to the point where a more objective test was available, it would have registered a big fat positive.

And I did go through the painful process of finding medications that worked. (Harder the second time.) It can - and in my case did - take a while. But ultimately a combination of meds and therapy helped. Enormously.

So, my take on this is that we do know a lot, and we still need to know much more. So it's hard to state categorically when psychiatry is effective (and the word itself, as I understand it, includes talk therapy as well as psychopharmacology). It certainly isn't as exact a science as I wish it was....yet. But I'm so thankful for the degree to which it is already effective.

The main over prescription is not by psychiatrists but by general practioners.

The mainly over prescribed drugs are the anxyiolitics, most people will not medicate themselves for pleasure with the ADs or APs or mood stabilizers. there are very few soporiphic or sedative effects that people enjoy with those drugs unlike the anxyiolitics.

The second source of over prescription is treatment for situational situations, esp. when it comes to children. If a child or adult victim is living with domestic violence then they will have depression or will manifest depression from the situation, medication will have a palliative effect but not be the best treatment. Children who live in chaotic situations will manifest the symptoms of ADHD although they don't have it.

The third source of overperscription is substance abuse, use of stimulants, especially cocaine and methamphetamine cause people to have a very depressed and anxious mood after a while, so they often seek treatment to counteract their substance abuse. But then there is also a very high co-morbidity for substance abuse and mental illness.

BUT in my fifteen year experience as a social service provider there is a massive under treatment for mental illness.
First off, most people don't seek help until their life has collapsed and it really very painful, and even then the vast majority of people are reluctant to seek help.

...

Second is family and societal pressure, this thread demonstrates the subtle pressure that people are under to not seek treatment. Then in many cultures people are just set against mental health treatment, so there is self stigma as well as societal stigma.
Third is the just plain reluctance to admit that mental illness exists, the nervous system is as much physical and part of the body as the circulatory system, and every body has seen an increase in the treatment for heart disease and diabetes, but people don’t say the same things about them that they say about mental illness, people are just reluctant to even believe that mental illness exists.

I think there is both undertreatment and overtreatment of mental illness in American society.

I think there is overdiagnoses of chronic mental illness and overprescription of endless pharmaceutical treatment in the populations of people who do go to the medical community for psychological treatment. But in the population as a whole, due to continuing stigma of mental health treatment, I suspect there is underdiagnoses and hence undertreatment of all types of mental illness, including chronic mental illnesses.

How often can mental illness(say psychosis) be detected in such (an) absolute (manner), instead of saying "you know the guy running around ranting about the turkeys is probably not all that sane"?

Still there is a lot of woo in this, but discounting everything not measureable is also hard. Are there such tests for full autism and such instead of descriptive tests?

Very rarely. "Mental illness" is usually diagnosed on behavioural criteria, not biological ones. So althouth we know that there's a strong correlation between serotonin levels and schizophrenia, we also know that unusual levels of serotonin can be related to many other behavioural disorders. We also know that there are a number of people with unusual serotonin levels that behave normally, and there are some people with schizophrenia that have normal levels.

But Dave1001's complaint about diagnosis-by-checklist is hardly valid. What else would you use to diagnose mental states?

...

... the ultimate test of whether someone has depression is whether they feel depressed. ...

...My primary concern is with diagnoses of chronic mental illness which entail a lifetime of pharmaceutical treatment, off of what can be as little as a 1 hour interview using a checklist. I think that's signficantly different than treating a temporary depression for a few months using a combination of talk therapy and pharmaceutical treatment. Checklists may be our best form of mental illness diagnoses currently, but I think they'll be supplanted in the coming decades as our brain imaging, genetic evaluation, and other technologies improve.

After taking NSAIDs for osteoarthritis , I wound up in a Finnish hospital with a bleeding esophagus, then in a Scottish one with gut & urinary tract problems caused by internal bleeding. I stopped taking the anti inflammatories and went to see my GP.
After hearing my litany of complaints, he asked (apparently sincerely) if I felt I might be depressed...

This struck me as amusing.
I was just about to turn fifty and apparently falling to bits. Was I supposed to be excited about it? Of course I was depressed. Fix the damn knees and I'll cheer up!

I was after an alternative to the NSAIDs that wouldn't put holes in my gut. I was not seeking cheer-up pills. I'm Scottish. I'm meant to be dour.

...

I wonder if, as neural disorders which long proved wholly untreatable by psychoanalysis are seen to be amenable to drug therapy - possibly GPs are starting to think they know rather more about the mind than they actually do?

...
...

Would you have objected as much if the doctor had noticed that your insulin levels were out of whack and suggested treatment for that? What would you say if he had spotted a possibly-malignant melanoma on your back? Would you have complained that you just wanted an NSAID-alternative and not a potentially life-saving lifestyle intervention?

... We tend to do better in areas which are more specific. So if you are diagnosed with something serious or complex, see a specialist and if your GP isn't figuring it out fast enough, see a specialist. Otherwise, I think most providers give competent care.

...

An interesting case study - my friend Sarah.

Diagnosed as suffering depression. Was on the meds merry go round for a while - Try this. Stop. Try that. Found a solution that helped. Also diagnosed as suffering from Bi polar.

Then had a massive car crash and then had an aquired brain injury. No brain damage noticable. No longer suffers from the mental illnesses she was diagnosed as having.

Raises a few questions - was the diagnosis accurate? She definately seemed to be more in control and more rational in her decision making. She said it was amazing to feel in control of her life.

Did the brain injury change the chemistry of her brain?
Was the crash a big wake up for her to change her lifestyle?

Don't do that. don't stop, not without agreement from your MD or specialist. don't ever do that. That is as bad as self medicating

I think it's germane to the overprescription issue, Drkitten.
Diabetes is not caused by sore knees. Depression might be.

...
my GP, given the time constraints any NHS GP works under, chose to effectively ignore all the hard data and go after a will-o-the-wisp possibility of depression.
Whether he was right or wrong is less relevant to this thread than the question Why was he thinking this way at all?

...He chose to ask a sceptic about his mental state. I still find this funny in both senses of the word and I wonder what prompted him to do so. Could it be that he had just read a paper on some new psychoactive drug? Now I'm speculating.

...

With mental illness it is all going to be by the subjective report of the identified person seeking treatment or observation of some things.

the observation thing is usually beetr for psychosis than depression, response time to questions can be 20 secs. to a minute or longer, there are the 'apparent response to internal stimuli' and the 'expression of delusional beliefs'.

But just as in all medical conditions, subjective report is an imporatant part of determining diagnosis and treatment.

People don't usally take life long medications unless they have tried the medicine and then gone off it and had a re-emergence of symptoms.
In my five teen years as a social service provider almost no one takes the medicine because some body else tells them to. and in fact with most people with the most severe symptoms there are frequent episodes of 'non-compliance'. increasing symptoms and then life stress before the person makes the personal dexcision to take the medicine regularly. And even then most people try lowering the dosage after a while.

Well, it may or may not be that you have depression, chronic pain kind of wears down the body and many people will develop secondary depression, then there is the whole confusing use of ADs to treat pain.

Here I'm talking more about medical practice than what people actually do. I'm sure a significant number of people are diagnosed as bipolar off a checklist, are presecribed a pharmacuetical and are told they will have to take it the rest of their lives, but unilaterally decide, without doctor input, to stop taking the drug when their life situation & mood improves. Some of these folks never need to take pharmacueticals again -they were probably incorrectly diagnosed as having a chronic mental illness instead of a temporary depression.

However, others have "relapses". They may indeed have chronic illnesses. I think it would be prudent for psychiatric medicine to have an in-built mechanism to reappraise people diagnosed as having chronic mental illnesses as actually having suffered from temporary mental illness, and to take them off medication. Otherwise, the more authority dependant types may end up taking pharmacueticals, often with significant side effects and costs, for decades, without a true need to do so.

 

[blutoski]

That may be a big part of it. I'm curious what reasonable, skeptical members of the pyschiatric field are estimating to be the instance of misdiagnoses and overdiagnoses in the field. My sense, from the number of people who have told me they've been diagnosed with bipolar disorder alone off of what appears to be nothing more than a checklist, is that overdiagnoses o people as having chronic, lifelong mental illness and overprescription of psychiatric pharmaceuticals for an unending period of time is rampant.

Two problems:

1. GPs do a lot of psychiatric diagnosis and prescription, when they should really be referring to a psychiatrist. I think this contributes to overdiagnosis and overprescription. It is not, however, a reflection on the specialty. In some states, non-MDs are empowered to diagnose and prescribe, and we find that this is a huge problem (eg: school nurses).

2. Patients do a lot of 'doctor-shopping,' such that there are a few MDs who are doing the majority of misdiagnosis and overprescribing.

It should also be noted that misdiagnosis works both ways: there are people whose MDs are too conservative in their diagnoses, and miss opportunities to treat patients who would benefit.

 

[snooziums]

As a general reply to this topic:

I have personally lost THREE relatives to suicide because they were on anti-depressent medications that caused SEVERE mental side effects. If they were referred to counselors rather than psychiatrists, there is a good chance they might be alive today.

You have no idea, none at all, how hard it is to bury three love ones that took their own lives. You have no idea of the emotional pain that brings, or the frustration of wondering why this happened. Was there even any medical reviews into the various psychiatrists that prescribed the medications and were treating them, no.

However, if we just want to drive everyone to suicide, then I guess that it is okay to prescribe these medications. Why not, I suppose one could argue that there are too many people on this world anyways. Or maybe since they had mental problems in the first place that they deserved to die.

*sigh* Oh well. I guess that if a few people die, it is all in the name of progressive medicine.

 

[snooziums]

Sorry for that side rant. That is just a rather emotional subject for me.

I am curious about what sources show this information that antidepressants are that effective? I am not saying that you are wrong, although from what I can find through medical journals and other "offical" medical information (avoiding non-medical-scientific-endorced) "studies," that the benefits of antidepressants over placebos is rather small. The Royal College of Psychiatrists (in England) shows that "after three months, the proportions of people with depression who will be improved are 50 percent taking antidepressants and 30 percent taking placebos." According to a debate at the Critical Psychiatry Network, it was found that "Placebos are found to be approximately 75% as effective as antidepressant medications across all outcome studies in which it is possible to measure pre-post effect sizes." In Prevention and Treatment July 15, 2002, Vol. 5., "On the average, the placebo groups improved by eight points on the 50-point Hamilton Depression Scale, while those given the active ingredient improved by an average of 10 points. This difference, argues Kirsch, is "clinically negligible" (quotes theirs)."

Overall, antidepressant pills worked 18 percent better than placebos, a statistically significant difference, "but not meaningful for people in clinical settings," says University of Connecticut psychologist Irving Kirsch. He and co-author Thomas Moore released their findings in "Prevention and Treatment," an e-journal of the American Psychological Association.More than half of the 47 studies found that patients on antidepressants improved no more than those on placebos, Kirsch says.

So while there seems to be some benefit of taking antidepressants compared to taking placebos, the difference seems to be rather small. At least, that was what I kept finding when going through published medical information.

Maybe there are studies that point otherwise. However, I did not find them. If anyone finds a study that shows a larger gap between antidepressants and placebos, please post it (or a link to it) as a reply. Thanks.

 

[calebprime]

I'm sorry for your loss. I know you weren't addressing me personally, but no, I have no idea. I have seen people close to me turned into somewhat zombified versions of themselves. (Like DancingDavid said, the problem here relates to overprescription of "benzos"--halcion, ativan, xanax) When it comes to suicide, it's hard to know in general whether the cause is depression/unhappiness or whether it's the medication. In your case, you may be right. At the very least, the treatment wasn't effective. Your perspective is important. (I want to reply to some of the other posts here, but then I'll think some more about what you are saying and reply later.)

 

[Dave1001]

It should also be noted that misdiagnosis works both ways: there are people whose MDs are too conservative in their diagnoses, and miss opportunities to treat patients who would benefit.

Yup, I acknowledged that in a previous post.

 

[jskowron]

Insurance companies (those I've worked with anyways) require a diagnosis to pay for continued treatment, usually including medication. School districts require a diagnosis for a student to receive special education services. Other funding agencies (in my state- MA- the Dept. of Mental Health or the Department of Mental Retardation) require specific diagnoses to fund services. This would seem to promote overdiagnosis. Once a diagnosis is given, it lasts forever on a piece of paper somewhere, at least indirectly influencing treatment decisions for a very long time.

 

[AmateurScientist]

I think it would be prudent for psychiatric medicine to have an in-built mechanism to reappraise people diagnosed as having chronic mental illnesses as actually having suffered from temporary mental illness, and to take them off medication.

It already does. The technical term for it is "actually showing up for your follow up appointments."

AS

 

[Dave1001]

It already does. The technical term for it is "actually showing up for your follow up appointments."

AS

I'm not sure about that. It's a question I always ask psychiatrists who are open to discussing this topic with me: how exactly does one get de-diagnosed from having a chronic medical illness? I haven't gotten a clear answer yet. As for as I know a specific protocol doesn't exist. A person gets diagnosed as having a chronic mental illness by a checklist, often from a single 1 hour session. And since they're then expected to stay on medication for the rest of their life, if they are authority compliant, that's it. I consider that problematic, and I'm skeptical that it's the best course of treatment for such people. Your flippant answer here doesn't cover these concerns, in my opinion.

 

[AmateurScientist]

I'm not sure about that. It's a question I always ask psychiatrists who are open to discussing this topic with me: how exactly does one get de-diagnosed from having a chronic medical illness? I haven't gotten a clear answer yet. As for as I know a specific protocol doesn't exist. A person gets diagnosed as having a chronic mental illness by a checklist, often from a single 1 hour session. And since they're then expected to stay on medication for the rest of their life, if they are authority compliant, that's it. I consider that problematic, and I'm skeptical that it's the best course of treatment for such people. Your flippant answer here doesn't cover these concerns, in my opinion.

You mentioned a "built in mechanism" for re-evaluating a patient. I felt my short response was appropriate in that it is not possible for a doctor treating a patient to re-evaluate him without seeing the patient again and getting feedback from him.

You keep calling it diagnosis by checklist. It's not that simple. They use diagnostic criteria from the DSM-IV, but in my experience, psychiatrists in general also spend plenty of time trying to rule out other possible causes of the patient's symptoms. Remember that psychiatrists are MDs. They know the body as a whole and have been through the same rigorous medical school training other MDs have. They simply have a specialty that relies heavily on subjective symptoms as reported by their patients, without the benefit of a battery of laboratory tests or technologically sophisticated equipment like MRI machines.

I think competent ones exercising ordinary care take a full history from their new patients. I think it is you who is being flip by dismissing their diagnostic process as being able to render an opinion that a given patient suffers from a chronic illness from a single one hour visit. I think it more often takes multiple visits and some treatment and feedback before such a diagnosis can be made confidently. Even then, the patient has to return at regular intervals for monitoring, and in my experience the doctor is usually asking questions and getting feedback and constantly reassessing the situation. I think that's all they can do at the moment.

AS