4 ms·

I'm curious what you make of the claims Robert Whitaker makes in "Anatomy of an Epidemic" and elsewhere? Psychiatry comes off looking quite bad in his analysis

I'm curious what you make of the claims Robert Whitaker makes in "Anatomy of an Epidemic" and elsewhere? Psychiatry comes off looking quite bad in his analysis and he is far from the only critic of the profession. My attempts to find convincing rebuttals of his claims from Psychiatrists have so far drawn a blank. In a nutshell for those not familiar with the book, he presents convincing evidence that most psychiatric medicines have no significant short term benefits over active placebos and in fact worsen long term outcomes and that the profession has been complicit in presenting unsupported hypotheses about chemical imbalances in the brain causing conditions such as depression as established fact and in pushing drugs as the primary means of treatment without sufficient evidence of their efficacy and largely ignoring worrying evidence of long term harm. I'll admit to having a pre existing suspicion of psychiatry stemming from taking a degree in psychology in the UK but after reading this book and digging more deeply I have to say it looks far worse for psychiatry than I previously imagined.

djcjgshjjc 10y ago
It looks like meta-analyses published after that book support the efficacy of anti-depressants, are you familiar with this evidence? https://en.m.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor https://en.m.wikipedia.org/wiki/Selective_serotonin_reuptake...
- mattnewport 10y ago
  This seems to be a fairly balanced (and pretty long!) review of the evidence from Scott Alexander who is a psychiatrist (I believe) which comes down on the side that the balance of the evidence is that SSRIs do have an effect that can't be explained purely as active placebo: http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo... Here's another 2014 article leaning the other way by Irving Kirsch, one of the more prominent researchers to question the evidence for anti depressant efficacy: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ In Anatomy of an Epidemic Robert Whitaker details many of the problems around the published studies that raise real concerns how bias free the remaining positive results of these studies might be. In addition, pretty much all of the discussion above is based around short term effects and perhaps the most worrying part of Whitaker's book for me is the suggestive evidence of devastating long term effects of many psychiatric drugs, SSRIs included. Personally I think the bar should be rather higher for evidence of short term benefit for any drug than the 'optimistic' view of the evidence for SSRIs and especially in light of evidence of the drug making the condition it is supposed to treat significantly worse over the long term. Given that even proponents of SSRIs seem to accept that talk therapy is equally effective I know I'd rather take the drug and side effect free option but Scott Alexander gives a different take on that in his article, pointing out that drugs are much cheaper (and hence more profitable for both psychiatrists and drug companies as Whitaker points out in his book).
Houshalter 10y ago
I just heard a convincing criticism of our mental health system from the invisibilia podcast. They went to a European town where mentally ill people were assigned to live with regular people to take care of them. And that they had much better outcomes than in the US. The full episode is here, there's a lot of interesting observations in it: http://www.npr.org/programs/invisibilia/483855073/the-problem-with-the-solution http://www.npr.org/programs/invisibilia/483855073/the-proble...

djcjgshjjc 10y ago

It looks like meta-analyses published after that book support the efficacy of anti-depressants, are you familiar with this evidence? https://en.m.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor https://en.m.wikipedia.org/wiki/Selective_serotonin_reuptake...

mattnewport 10y ago
This seems to be a fairly balanced (and pretty long!) review of the evidence from Scott Alexander who is a psychiatrist (I believe) which comes down on the side that the balance of the evidence is that SSRIs do have an effect that can't be explained purely as active placebo: http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo... Here's another 2014 article leaning the other way by Irving Kirsch, one of the more prominent researchers to question the evidence for anti depressant efficacy: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ In Anatomy of an Epidemic Robert Whitaker details many of the problems around the published studies that raise real concerns how bias free the remaining positive results of these studies might be. In addition, pretty much all of the discussion above is based around short term effects and perhaps the most worrying part of Whitaker's book for me is the suggestive evidence of devastating long term effects of many psychiatric drugs, SSRIs included. Personally I think the bar should be rather higher for evidence of short term benefit for any drug than the 'optimistic' view of the evidence for SSRIs and especially in light of evidence of the drug making the condition it is supposed to treat significantly worse over the long term. Given that even proponents of SSRIs seem to accept that talk therapy is equally effective I know I'd rather take the drug and side effect free option but Scott Alexander gives a different take on that in his article, pointing out that drugs are much cheaper (and hence more profitable for both psychiatrists and drug companies as Whitaker points out in his book).

Houshalter 10y ago

I just heard a convincing criticism of our mental health system from the invisibilia podcast. They went to a European town where mentally ill people were assigned to live with regular people to take care of them. And that they had much better outcomes than in the US. The full episode is here, there's a lot of interesting observations in it: http://www.npr.org/programs/invisibilia/483855073/the-problem-with-the-solution http://www.npr.org/programs/invisibilia/483855073/the-proble...