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As always, it is not a matter of simply saying one or the other extreme is correct, but rather one of holding two opposite views in our heads at the same time. Read More
Leaning one way
I believe with the greatest of ease that we can and millions of people do lean in favor of antidepressants. I do not take them ,for I am am not depressed,but do know more then a few who do and it's changed or saved their lives. The best observational study is asking the depressed persons loved one is there's been a change.I have no doubts you will get a ''yes'' for dramatic response. I agree with you the drug does not always help bipolar disorder but the truth is many times they do help. You can play hard to get if you like- while this drug is hard at work doing a difficult job helping millions around the world. Sincerely-David
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S. Nassir this is a timely
S. Nassir this is a timely piece. David Healey's article and the rebuttal in this month's Canadian Journal of Psychiatry left my head spinning. I like the Janusian process of your argument.
Still leaning
Were not talking about Blood letting and the past. Were talking about ostensible observations of the present. For example: depressives once cheap and greedy can become generous and enjoy spending. Once withdrawn now talkative-Once hateful now caring-once fearful now not-once paranoid now not-once having sensitivity rejection now not. I can go on with these very common observations of much improved depressed people after having taken medicine. Comparing observed blood letting of the past (witch doctors) with the dramatic observable personality change that happens and can be seen by depressed peoples loved ones is plain foolish. Antidepressants hurt almost no one, thats funny and untrue and you know it. Thanks for the reply Sincerely-David
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It appears we need to agree to disagree again. This kind of polemical debate does not clarify. We are not talking just about the past: hormone replacement therapy is another current example of overwhelming observational "proof" being disproven by randomized data. Bloodletting was not about "witchdoctors" but the average doctor, and the best doctors, as recently as 1900. It was the standard of care; it was not viewed as odd or strange. Study of the history of medicine on this issue may be worthwhile. I might suggest The Greatest Benefit to Mankind by Roy Porter. Thanks for your comments.
Thanks
They did what they could with what they had.I'm not saying it was strange then only now.We are leap years ahead and I feel it was a hypersensitive comparison.I doubt little your very good at what you do.Thanks again. Sincerely, David
I think that what Dr. Ghaemi
I think that what Dr. Ghaemi is trying to say is that whenever a physician treats their patient, and they get better, there are a variety of factors that could explain their getting better: the treatment itself, the natural course of the illness, a spontaneous improvement, regression to the mean, the Hawthorne effect, and finally, the placebo effect. The ONLY way that we can know whether a person actually improves due to the treatment and not the other factors mentioned above, is to perform a randomized controlled trial.
Now, this does not mean that if a treatment is simply placebo, then people who feel better are somehow fakers or unreal. People recover spontaneously all the time for reasons that modern science cannot understand. However, if the recovery is not due to the treatment, then that is important to know, especially when the treatments carry significant and dangerous side effects.
I mean, if you had a illness and had a 50/50 chance of getting better with or without treatment, and someone offered you a treatment with dangerous side effects that worked half of the time, then would you take it? Of course not, becuase your odds of getting well do not change with treatment, but your odds of getting WORSE due to side effects does go up.
It's the same here. :)
Cognitive Dissonance
"As always, it is not a matter of simply saying one or the other extreme is correct, but rather one of holding two opposite views in our heads at the same time"
I recognize that state of mind. It's called "Cognitive Dissonance".
Science created a law out of it: "For every action, there is an equal and opposite reaction."
For medicine this means: "For every good outcome in a drug there is a corresponding bad outcome"
How does science make progress with a law like that?
Not a magic bullet
I have to see anti-depressant medication as a help, not a magic bullet, or cure for depression. I would like to see a statistic on what percentage of depression is completely chemistry induced. I bet it's not very high. Usually there are many other factors and anti-depressants help the patient work through the other factors.
Even just having the strength to get to a doctor and say that you need help, and are willing to try medication is a step in the right direction for helping depression.
One thing that was not mentioned in the article about anti-depressants and suicide is this: when you are VERY depressed, sometimes even the thought of suicide is too much to think about. It just sounds like too much work. You don't even have the energy to do it. Sometimes anti-depressants lift you just far enough out of that state to be able to consider it and possibly even carry it out. So they work somewhat...but not enough to carry you to a place where that isn't a thought any more. A dangerous place to be.
All effective treatments for depression increase suicidality
in the short term.
That is all treatments, talk therapy included.
If you look at the rates of suicide in children, they increased after the “black box” warnings were introduced and prescription rates went down.
http://ajp.psychiatryonline.org/cgi/content/full/164/9/1356
If short term treatment causes a long term decline in the suicide rate, but a short term increase, then only long term trials will show that.
An example with made-up numbers. If untreated depression causes a suicide rate of 6% per year, but SSRI treatment causes the rate to increase by 2x for the first month and then decline to ¼ x for the remaining treatment time, how long you do the trial determines what suicide rate you measure. At one month the suicide rate is 12% per year, a gigantic increase, at 2 months it is 6.75%. at 6 months it is 3.2%, at 12 months it is 2.4%, at 24 months it is 1.9%.
All treatments have side effects. All treatments must balance the therapeutic effect with adverse side effects. Large population based studies show that suicide rates decline as more antidepressants are prescribed and that suicide rates go up when antidepressants are not prescribed.
Talk therapy increases suicidality in the short term, but because talk therapy takes a long time to work, the “short term” is many months. The increased rate of suicidality is smaller, but the total deaths due to suicide are not.
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