Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Sunday, July 10, 2011
No Better Than a Sugar Pill?
We're only a few minutes in to "today" but here's a link to an article in the New York Times by Peter Kramer-- In Defense of Antidepressants. Kramer writes:
Could this be true? Could drugs that are ingested by one in 10 Americans each year, drugs that have changed the way that mental illness is treated, really be a hoax, a mistake or a concept gone wrong?
This supposition is worrisome. Antidepressants work — ordinarily well, on a par with other medications doctors prescribe. Yes, certain researchers have questioned their efficacy in particular areas — sometimes, I believe, on the basis of shaky data. And yet, the notion that they aren’t effective in general is influencing treatment.
Kramer goes on to discuss issues in the research that may have biased studies that deem anti-depressants to be no better than placebo. Do read it if you get the chance.
Posted by Dinah on Sunday, July 10, 2011
Labels: antidepressants, research
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Is there a possibility that their lack of efficacy is related to their overuse?
That is, they are efficacious in people with 'clinical depression' and whatever neurological changes that implies.
And they are of little use to people 'depressed' due to circumstances, or in other examples where there would not be a biological/neurological change?
Has anyone tried to ascertain the differences in efficacy based on suppositions of biological/neurological causes? Or genetic differences?
Also has anyone noted different coding for the 5-HTR in depression?
Oh, and another question. I know that different SSRIs act on different receptors with different affinities. And I know that each of the receptors have different actions and locations.
But I was also wondering in people with psychosis, depression, mania etc. Is there any evidence that their brain 'pathways' are either different to start with, or altered due to some form of pathology? Similarly changes in their receptor location, concentration and activity?
Differences in their neurotransmitters, release, storage, concentration etc?
How much is known about any physical and chemical changes that occur in the brains of those with mental illness? Both while they are 'suffering' and in remission?
They are worse than a sugar pill. Taking something which causes brain damage is not wise. A sugar pill, on the other hand, will not damage your brain.
And psych dope does cause brain damage. As far as the data being shaky for the claim that they are no better than a sugar pill, I suggest you google chapter 7 "Tricks of the Trade" from Dr. Timothy Scott's book "America Fooled" and see how they have a different set of rules for psych drugs than drugs like antibiotics. Note also that they allow tranquilizers to be given alongside of the antidepressants so it is impossible to tell what the antidepressant is doing.
Try also "Mad in America" by Robert Whitaker; he reveals the corruption of the drug companies - doctors that don't see their study subjects, etc. They have also known for years that there is no chemical imbalance - the bell curve is the same in depressed and non-depressed people alike.
Let's assume for argument sake that the are no more eefective than placebo. What accounts for the fact that anti-depressants can tip a bipolar patient into mania? Is that also a placebo effect? Would it be considered as such if this was the first episode of mania and the individual did not yet carry a bipolar diagnosis and therefore would not be assuming any such effect were possible?
Also, why is that articles on psychiatry and meds take up so much space in the paper--huge picture that was. Article was a bore to read but that may have been the early hour.
Just as Dinah recommends reading Kramer's opinion piece, I recommend that y'all read Kirsch's book "The Emperor's New Drugs", that Kramer references. The weight of the argument goes to Kirsch. You can toss anecdote in this comment section all you want. The data are the data, and the data do not support the conclusion that anti-depressants are better than placebos.
Speaking of anecdote, Kramer tosses us a howler and a screamer: the story of his friend whose paralysis from a stroke was "helped" by Prozac. You need to look no farther to locate the desperate pass that these drugs, and their defenders, have come to.
wv = morse. code, or metaphor, like mental illness?
p.s. enjoying Dan Carlat's book immensely. It's gratifying to read the story of a man struggling with the Received Wisdom. We all should try it.
Does chronic stress show any neurobiological changes?
Chronic drug use?
Lack of sleep?
Why is thinking about this so much more interesting than job applications?
Any way you dice it, no matter how many books are quoted about how these meds don't work, on a day by day basis I am faced with patient after patient who say "I feel better on this medicine." Given the choice of being on or off, people insist they want them. I am happy to treat people who don't want to be on medicine, it's rare that I 'push' people to take meds, and then only because their suffering is so painful to watch and they invariably have someone in the background who has convinced them that meds are bad. Maybe there is reason that so many people want these medicines beside bad pharma research?
Those who write in presume they hurt people in the long run.
Is that true?
There was the the Study in Finland that followed thousands of people who were discharged from the hospital on antidepressants and found a lower death rate (mostly cardiovascular) in those taking antidepressants. I blogged about that here:
In his article, Kramer failed to deal with the active placebo problem, that a placebo with side effects has a much stronger placebo effect than a sugar pill.
Also, he confuses withdrawal effects when meds are cold turkeyed versus the depression coming back. There is no way to know, is there?
How can an individual psychiatrist know if a patient is getting better due to placebo effect or because the drug is working? There is NO WAY TO KNOW. Only a study can determine this. Same thing with the patient, no way to know.
I suspect the truth is more complicated, which Kirsch acknowledged in his book. I think there are some people who are helped, but there are also some who are harmed by the meds, due to agitation, sexual dysfunction causing relationship difficulties, etc. There was not enough detail in the studies examined by Kirsch for him to determine what was happening exactly.
The fact that the blind is broken in most studies is also a serious problem. Most doctors and patients in studies know who is getting the sugar pill and who isn't if the medication has noticeable side effects that are unique, such as the weird sexual dysfunction problem.
Again I ask, how can a doctor know if a patient got better due to placebo effect or if the med was working?
Part One - Long Term Antidepressant Use
Did the researchers study other variables that might have been responsible for a lower cardiovascular death rate? I am also asking because of this exert:
"The average age of their population was just under 39. The protective factor for cardiovascular mortality was huge: 30-40% reduction in deaths."
I wasn't aware that people under 39 have major cardiac issues. I thought that effected people more who were around 45.
Unfortunately, my googling skills are impaired this morning so my apologies if I am wrong.
Also, in the study, did people have cardiac issues to begin with?
Speaking of studies, after people read the Kramer article, they might want to read this one on Robert Whitaker's blog, http://www.madinamerica.com/madinamerica.com/Whitaker.html which he refers to about studies re: antidepressants possibly worsening the long-term course of depression.
As an FYI, Whitaker is not anti meds and does realize they work for some people. He just doesn't feel they are in the majority.
Dinah, do you keep any type of clinical tracking in your practice that notes treatment responses for your patient population? It would be interesting to note what the % of depression remitters are who use non-pharm treatments vs the folks who use meds. And of course, those who use both.
There are known inflammatory and immune markers in depression, and antidepressants are known to have an anti-inflammatory effect. That might account for the cardiovascular mortality rates in the Finnish study.
My concern is that by treating mood symptoms without the underlying causes, you're essentially playing whack-a-mole, and treatment will never lead to cure.
What about addressing the depressogenic factors, such as environment, food, sleep/rest, safe shelter/transportation, meaningful work, meaningful relationships, physical and psychologic comfort, health and well-being perceptions, et al as first line therapies instead of as adjuncts, if they are considered at all? How about looking at which cultures/societies have the lowest rates of clinical depression and highest rates of well-being to try to ascertain what factors might be protective?
As for permanent brain changes as a result of antidepressants, I believe the research is demonstrating that the down and upregulated neurotransmitter states caused by them is more or less permanently dysregulated.
Part Two - Strokes and Antidepressants
Blog readers might be interested in this old entry by a neuropsychologist who has a different take on the effectiveness of antidepressants in stroke recovery:
"However, look at the post-treatment final scores for both groups: total score: 89.8 (escitalopram) versus 91 (placebo); delayed memory 96.6 (escitalopram) versus 94.2 (placebo); and immediate memory 95.1 (escitalopram) versus 98.5 (placebo). Essentially, both groups post-treatment performance was nearly identical. The reason why the escitalopram group showed a larger magnitude in change was because that group had lower baseline scores."
The authors did point out that there was not statistical different between any of the baseline scores; however, that's irrelevant. Neuropsychological test performance scores are classified as either average, low average, mild deficit, moderate deficit, or severe deficit. Many of the escitalopram group baseline scores where in the mild-deficit range while the placebo group scores were in the low-average range. Functionally, that kind of difference is significant*."
The author concludes by stating that most stroke recovery takes place in the first 6 months so if the folks on Celexa had lower baseline scores, it stands to reason that the results of the Celexa are going to look impressive.
Robb, as one who is hungry for pro football even with a sorry local team, I loved your desperate pass analogy.
Part III - Response to Dinah's comments about patients wanting ADs.
In talking to many people in the antidepressant withdrawal community, many people said they felt great on antidepressants like your patients are reporting. It was only when they started realizing they didn't give a darn about anything and had other horrific side effects that maybe these drugs weren't all they were cracked up to be.
By the way, I am not stating that your patients are wrong but just trying to point out another side to the story.
I was also one of those folks who wanted meds. Unfortunately, I didn't feel better immediately and got alot worse.
The best I felt on meds during the 11 years I took them was for about a year and a half before they turned on me. By the way, that was happening during one of the most stable periods of my life.
I now realize I should have been taken off of the meds but I felt spellbound by them and my psychiatrist never talked about reducing them.
I gave in to the prevailing philosophy that there was a med out there for me but I just had to stick with it. Well, it was an exercise in futility.
I wish to god I had listened to my mother when she was alive. She begged me to get off of meds and felt they were ruining me. Unfortunately, I blew her off as clueless about mental health issues.
I greatly cringe as I write this and not listening to her is one of the biggest regrets of my life.
Anyway, since I had alot of points to make, I broke up my posts into sections. For now, this it although of course, I don't want to say I am definitely done.
I am going to reiterate, even though nobody has had a chance to respond yet, why do psychiatrists think they can tell that a patient got better from the medication, and that it is not placebo effect? I think it is impossible for someone to determine this without doing an experiment, which a treating doctor isn't going to be able to do ethically. There have been many, many medical procedures that have been abandoned over the years, and I am sure that most docs thought they were good effective treatments until studies showed otherwise.
you know what? i've been on all the SSRIs at one time or another and if i'd gotten a placebo affect (even with the shaky hands, dry mouth, and lack of appetite side effects) on any of them I'd have gladly stayed on it for the rest of my life. A nice low dose of paxil placebo would have been awesome compared to both the years and years of med trials and then ultimate good result from heavy dose TCAs and mood stabilizers.
A placebo effect is not a bad thing, folks. It is the results that matter. Too bad it doesn't work for people with severe, biologically-based disorders.
Given that antidepressants have side effects that can be serious, it is not ethical to leave them on the market if they are working entirely thru placebo effect. In a large population (10% of the US public? Really?) the adverse effects add up.
I think more emphasis on psychodynamics might help pinpoint treatment outcomes.
Glen Gabbard, MD discusses the need to integrate brain and mind:
To everyone who hates these drugs, and psychiatrists and apparently, society as a whole.
STOP BEING SO SELFISH!
YOU may have had a bad reaction to psych meds.
YOU may hate big pharma.
But YOU are not the only person in the world.
There are a hell of a lot of people out there that have been helped by these meds.
There are some people out there that NEED these meds.
I would much prefer to take fibre supplements every day (my ONLY side effect) than to not be able to sleep, eat, think, feel, hear people who are not in the room yelling at me.
How can one little pill make such a big difference?
And has it ever occurred to you that mental illness has many physiological effects on the body too. It's not just being in a 'bad' mood.
Either collect some unbiased data or recognise that your opinions are exactly that, YOUR opinions and they do not necessarily reflect anyone else's opinion.
When I stated that it wouldn't be ethical to leave antidepressants on the market if they were working entirely thru placebe effect, that was in response to the person who said basically "who cares if the drugs are working thru placebo effect?" Obviously more study is needed. I am the anon who stated that I think there are people who are helped, and people who are harmed, and the results are cancelling each other out, but you can't tell from the data.
I really have never seen an answer from psychiatrists about this placebo issue except for "I just can't believe it! That isn't what I see in my practice."
This is similar to what creationists say. They say about evolution, "I simply can't believe it! Look at how complicated life is!I mean, look at the EYE for example, how could THAT evolve?" And that is their primary rebuttal to evolution. They just don't believe it(In recent years, there have been more sophisticated arguments, but this in not where it started).
Anyway, it seems like pyschiatry's reponse has been pretty unscientfic.
Or some defenders of antidepressants will say the studies Kirsch looked at are flawed. Well, hell, EVERY study has flaws. There are the studies that were used to APPROVE these drugs. If these studies show no benefit, the drugs should't have been approved in the first place.
Finally, I am a patient, I got severe mania on antidepressants, I think they are crap, but until this research came out, I didn't generalize onto OTHER patients. Really, 90% of the time, psychiatrists' (those who "defend" the meds) response is "I just don't believe it." I rarely hear the more reasoned response "this requires more research, let's be very careful about this going forward and try to use other options first, when possible."
Psychiatrists don't believe this data because
1) Patients report getting on the medications in a way that does not necessarily follow the usual pattern of response to placebo
2) The research is not representative of how we practice clinical psychiatry.
I will elaborate.
Placebo responses are transient improvements in response to inert pills. They are powerful and frequent, but they are transient, and usually we think of them as being limited to two weeks. So a person swallows a pill and reports a response and then has full relapse 2 weeks later. The more usual course for antidepressants is to have a response 10days to 6 weeks after initiating treatment. Some people find the meds "poop out" around 6 months and dosages need to be tweaked. Some people do have a much quicker response to medications, but if the response persists much longer than 2 weeks, we do not believe it to be a placebo response (we could be wrong).
People do stop-start experiments all the time and many simply say they feel better on the medications.
It's not our general rule in psychiatry to say "You feel better but you're wrong and you have to stop this medication." Instead, we present the risks and the benefits and let the patient decide. Many people say they are willing to accept considerable risks. If we forced people to stop medications, we'd be paternalistic creeps. We can't win here. Plus, we let members of our society smoke cigarettes, pipes, and cigars and we let them drink alcohol. Why wouldn't we let them take antidepressants.
Flaws with the research,next comment
Flaws with the research:
The research shows that 30-40% of patients respond to an SSRI with mild to moderate depression, same rate as placebo.
That sounds right to me.
The problem is it's a one shot deal. In psychiatry, we treat the over 60-70% of people. The first SSRI failed, we try another, we then change classes of meds, we augment them, we come up with 'cocktails' (what a dirty word). A lot of those people who initially didn't respond then do get better. Why would a person have a placebo response to the third medication, but not the first two? or to a combo, but not to the individual meds? It doesn't make sense.
And to say "the response rate is the same as placebo" is misleading. The response rate for the first shot is the same as placebo, the overall response rate is a lot better. Oh, they didn't do that experiment. This is why psychiatrists prescribe the medications even though the so-called 'evidence-based research' says they are like sugar pills.
Did I say it better than Dr. Kramer?
It's not that we don't care that the research says the pills are only as good as placebo, it's that the research is limited and seemingly purposely biased.
Rob: my yiddish is pretty much limited to "meshugah" and "kvetch"
As an FYI, blog readers might be interested in this response by Robert Whitaker on his Psychology Today Blog regarding Dr. Kramer's NY Time article:
This exert might be of particular interest to people who have asked about long term studies of antidepressants:
"Dr. Kramer might also have discussed the findings from the STAR*D trial funded by the National Institute of Mental Health. This was the "largest antidepressant trial" ever conducted, and the one-year results are now known. Only 108 of the 4,041 patients who entered the trial remitted and then stayed well and in the trial throughout the follow-up period. The remaining patients -- 97% of the total - either failed to remit, relapsed or dropped out of the trial."
The owner of the 1 Boring Old Man blog, a retired psychiatrist, elaborates further on Whitaker's points about STAR*D and concludes that it is dishonest science.
"In her article, Medscape Medical News writer Deborah Brauser asked STAR*D investigator Maurizio Fava, who is a prominent psychiatrist from Massachusets General Hospital, whether the published analysis by Pigott and his collaborators was correct. "I think their analysis is reasonable and not incompatible with what we had reported," he said.
His answer is revealing for two reasons. First, he is acknowledging that the low remission and stay-well rates reported by the Pigott group are accurate. Those are indeed the real results. Second, he is acknowledging that the STAR*D investigators knew this all along, and that, in fact, this information was in their published reports. And in a sense, that is true. If you dug through all of the published articles, and spent weeks and months reading the text carefully and intently studying all the data charts, then maybe, at long last, you could — like Pigott’s group — ferret out the real results.
But that is not the way that honest science is supposed to work.
There’s another way to say that. STAR*D is grossly dishonest science! And dishonest science at its worst because it carries the seal of approval from some of our most prestigious institutions, misinforms practicing physicians, and affects the lives of a very large cohort of our patients."
Bec, this last statement in my opinion speaks to your post. This is isn't about invalidating your experience as Mr. Whitaker recognizes that they definitely help some people.
It is about having an honest discussion as to how effective these meds really are so everyone can make the best possible decision for themselves.
When situations like what happened with the STAR D occur, everyone loses.
"The first SSRI failed, we try another, we then change classes of meds, we augment them, we come up with 'cocktails' (what a dirty word). A lot of those people who initially didn't respond then do get better. Why would a person have a placebo response to the third medication, but not the first two? or to a combo, but not to the individual meds? It doesn't make sense."
You're essentially describing the design of STAR*D. All drugs and placebos "worked" equally well (or badly, depending on your perspective) regardless of the order in which they were introduced.
The fact that these results and your personal experience both don't make sense should tell you something. We don't know what these drugs actually do, so why should it make sense that one "works" and another "doesn't"?
Finally, your description of the placebo response is not accurate. Irving Kirsch, whose area of expertise is the placebo response, cited numerous studies demonstrating that the placebo response is often sustained for years.
You may be interested in reading the latest blog post by Robert Whitaker, in which he critiques Kramer's article in-depth.
In it he does what Kramer has not: he provides a close reading of Kirsch's research and tries to set the record straight about the FDA trials and what they could mean for antidepressant use.
Whitaker also cites two long-term studies looking at antidepressants that speaks to your concerns about delayed therapeutic onset of antidepressants and how that may skew response rates in very short six-week trials.
In addition to placebo effect, there are also the people who naturally got better, but the pill gets the credit. They would have gotten better had they done nothing. This probably includes a lot of those mild to moderately depressed people who seemed to respond to medication.
And I'm not knocking the placebo effect either - many people who get better for awhile because of placebo probably modify their behavior and get out and socialize more, are more productive, so they feel better about themselves (I mean, really, a filthy home gets on a person after awhile) etc. So in this sense, the placebo effect fixed the patient even after it was all done with, because of the behavior changes that became possible.
Psychiatrists are also biased observers because they really WANT people to get better. So there is probably some selective bias going on (I have forgotten the term for this) where the doctor's beliefs and desire for the meds to work well is reinforced by the patients who get better, but then the psychiatrist inadvertently discards the information about the patients who didn't get better because it doesn't fit with their idea. Everybody does this. This kind of bias is partly why experiments are supposed to be double blinded (which as I stated before, the blind is usually broken due to side effects).
I also noticed in my case, when I got better in the spring, the doc credited the medicine, and in fact, what happened was the sun came out. My docs did this for YEARS and damn, I had to graph my symptoms over many years to figure it out. Even though various doctors have said this pattern is common, they never saw it. So I think docs don't see patterns as well as they think they do. It's difficult to do that if you don't take data and analyze it.
I see the same problem with various mental health organizations that take 6 month outcome data. They take data in the spring, then again in the fall. When I called one of these groups to mention they might have a problem doing their research in this way, they had not thought of the seasonal effects.
Some outcome data came out here in MN (Whitaker referenced it, I believe) and almost NOBODY is getting better from depression in these data. A couple years ago, there was another study done that I read about in the StarTrib, and the health organization (HealthPartners, I think??not sure) found that nobody was getting better. Virtually ZERO. They just couldn't believe it!
The folks who respond to these antidepressant studies often give a cursory "I just don't believe it, that's not what I see in my clinical practice," which that is probably true, because an individual practitioner is limited in what they can observe, and they are not a neutral party, either.
It is great that you (and other blogging pyschiatrists) present risks to your patients. I was never ever told risks of meds that I took, not in 15 years of treatment with numerous psychiatrists and many at prestigious facilities. Never, ever. Not warned about weight gain, tardive dyskenesia, constipation, NOTHING. Oh wait, I was warned about needing blood tests for lithium (but not warned to make sure I drink enough water and don't get too hot) and that I need to let the doc know if I got a rash on lamictal. Otherwise, the only way I knew anything was what was on the printout from the pharmacy, which doesn't give the patient any idea about which side effects are common or which are rare, it is just a list.
I just don't get it - Have I been living on Pluto? Why have my experiences been so different from what doctors SAY that they do?
Finally, prescribing antidepressants is not the same as someone smoking a pipe. Smoking is not medical treatment. Medical treatment is supposed to be safe and effective (which of course the information is imperfect and there are a lot of medical treatments in other branches of medicine that have not been proven safe and effective). There are lots of treatments that turn out to be ineffective, but there also is always a parade of patients saying that the treatment helped them.
I will also point out that I have known many people who got amazing results with magnets or crystals or other alternative remedies, results that are seemingly impossible to dispute. And they also had tried many things, and these therapies were what worked.
I think most of the psychiatrists who I've had thru the years were trying very hard to help me, and believed in the treatments etc. I also think that docs who prescribed Phen-fen (sp? were trying to help their patients, and were very upset to find out that wasn't a good treatment.
So many issues - I'm glad to see that Whitaker's response to the oped has been mentioned, as well as 1 boring old man's analysis, along with the Fava quote. It's worth noting that Fava, of MGH, is a big $ research earner through the depression and mood disorders CRO there. MGH psychiatry is BIG bidness, and the parent organization, Partners Healthcare, is headed by a psychiatrist, Gary Gottlieb, and whose wife, Derri Shtasel, is a MGH psychiatrist who directs the community psychiatry (smiley faced marketing to the have-nots and potential research subjects) program there.
But onto the blog topic and bias:
There are a myriad of problems in assessing whether any class of psychotropic medication is safe, effective and useful.
1. There are no clinical standards of care and practice in assessing patients - everything is subjectively based, and most psychiatrists and primary care docs don't consistently use reliable and valid patient screening tools for initial diagnosis and routine/scheduled reeavluations.
2. Getting better translates to nothing - there is no operational definition for it. In fact, a recent study demonstrated that when patients who were deemed to have remitted from depression were assessed, they all had residual symptoms of neuroveg. signs, sleep disorders, and impairments in quality of life indicators. A new tool was developed to track these.
3. There is a growing body of evidence that demonstrates permanent perturbation of neurotransmitter regulation and uptake in the brain, and no one has determined whether this is harmful. However, there is also a growing body of evidence that demonstrates that people who have taken SSRIs have permanent cognitive impairments, brain fog, brain zaps and recurrent depression. There is also evidence that SSRIs cause fetal harm.
Underlying neuropathophysiology suggests that both inflammatory and immune components are in play. Antidepressants exhibit anti-inflammatory properties.
But much more research needs to be done - transparently and without corporate bias.
A few PubMed free text links with relevant research reviews for your entertainment:
Mechanisms of Cytokine-Induced Behavioral Changes: Psychoneuroimmunology at the Translational Interface
Elevated Inflammation Levels In Depressed Adults With A History Of Childhood Maltreatment"
From inflammation to sickness and depression: when the immune system subjugates the brain
The relationship of depression and stressors to immunological assays: a meta-analytic review
Peripheral blood and neuropsychological markers for the onset of action of antidepressant drugs in patients with Major Depressive Disorder
Pharmacogenetics of antidepressant response
No more links...I am tired of being a free advertising site for Mad in America.
I agree that the research is dirty. I also think that your 'growing body evidence' about the evils of the medicine will also prove to be flawed.
It's a pointless argument here. No matter how loudly people say they've been helped by something, the other side returns with "you only believe you've been helped" and the anti-side has crowded out the pro-side who are no longer interested in being here, because the constant drumbeat of "you wrong when you think you are helped" or "you're an idiot, Dinah, to prescribe poison that is no less effective than sugar pills" is so utterly disrespectful to those who a) have enough problems with their mental disorders and have people in their lives hammering at them that they are weak and should be able to get better without pills, and b) feel badly enough without this.
If psychotherapy or yoga or crystals or lightboxes or exercise make you better, you should do that. And sometimes these things work: I have been known to say "You need to either go up on the medicine or exercise more." I'm all in favor of what works.
If you've felt badly and have found solace with medication, and are willing to accept the trade off that their may be risks of side effects/ adverse effects/ metabolic changes/ weight gain--all or none of which may or may not happen--plus the risk of what we don't know> the you should be able to enjoy feeling better without a community of people telling you that the studies were flawed so you don't really feel better.
It's time to move on.
Vote on the sidebar poll and please leave me names of shrinky blogs.
If I wanted to read about Whitaker, I would go to HIS blog. And if you guys want to write about Whitaker, you should do it your YOUR blog, or YOUR space on HuffPo.
Dinah, you probably weren't referencing me, but just in case, I didn't refer to Whitaker except barely in that the MN study link is there and I don't remember the name of the study, and was too lazy to go find it, but it was patients in clinics, as was that healthpartners one that he didn't mention (I am not sure it was healthpartners).
By posting controversial topics like involuntary commitment and "no better than a sugar pill?" my opinions and analysis were invited. I didn't put down most psychiatrists or imply they were stupid. I do believe I never was informed of known risks.
If you had posted about keeping a regular sleep cycle, or how exercise can help depression, or how to find a good doctor etc. then I would have made comments on those topics, instead.
This idea that people only remember the information that they agree with (selective something or another) is IMPORTANT. When you know that, then you actively look for and analyze info that you DON'T agree with and test your opinions, to see if they need revision. Most times, people who don't agree with you are not idiots, they have a reason for their opinion.
A lot of the antipsychiatry people are doing this selective information retention thing too.
I made a reference to crystals and magnets because some people think they help (I don't buy into that stuff at all).
I care a lot about people with mental illness. I have it and I have relatives and many friends with serious mental illness who are not able to function well and have to have social workers, as I do. I talk all cute and flowery on here, but my life has been destroyed by mental illness.
I have been told for years how great these meds are and most anyone can live a normal life when they find the right combo of meds etc. It is true that maybe my psychiatrists didn't tell me that. It was the brochures in the waiting room. why don't I get better? Maybe because the drugs were never as effective as I was told? I took my pills as prescribed, meditated, went to therapy, got ECT, blah blah blah and it is all useless. Well, meditating helps with anxiety. and my therapist helps me with relationship issues so that reduces stress.
So this idea that maybe the drugs are not very effective for most people - to me personally, that is an appealing argument. Maybe I am not the only one.
But I keep testing the idea, keep reading other opinions. So far, the folks refuting the placebo effect thing have not been doing a good job of it. My point in refuting what was said is so that the issue will be explored further because I really want to know the other side.
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