4 ms·

I'd like to think that medical professionals and academics in the mental health field have probably been thorough enough in their research to have looked at the

I'd like to think that medical professionals and academics in the mental health field have probably been thorough enough in their research to have looked at these finding over the years. I somehow doubt a person whose graduated in Social and Political Science and has no medical or scientific background might actually know what they're talking about in relation to this. Interesting thing about the author. He was a rising journalistic star in the UK. He'd won awards was regularly on TV and radio, until it was discovered he had been plagiarising others for a lot of his articles. It was also found that he had been editing wikipedia articles to attack people who critisised him. An interestingly tragic character. https://en.wikipedia.org/wiki/Johann_Hari https://en.wikipedia.org/wiki/Johann_Hari

wu-ikkyu 9y ago
>I'd like to think that medical professionals and academics in the mental health field have probably been thorough enough in their research to have looked at these finding over the years. You might like to read up on the short history of modern psychiatry. You'll find a great deal of mistakes, pseudoscience, and human rights atrocities.
- jdietrich 9y ago
  The same could be said of all of medicine, albeit over a longer timespan. Semmelweis was vilified for suggesting that doctors should wash their hands. Chemie Grünenthal covered up the devastating effects of thalidomide. American manufacturers spent much of the 1980s selling HIV-contaminated blood products to the rest of the world. Less than 20 years ago, rofecoxib (Vioxx) killed about 100,000 people. A lot of surgeries that are routinely performed today are completely unsupported by clinical evidence. It's largely a good thing that recent history looks hopelessly primitive and barbaric to us, because it means that we're making progress. Psychiatry still has a long way to come, but we need to be careful to not throw the baby out with the bathwater. Access to psychiatric care has a hugely positive impact on the overall disease burden; mediocre treatment is better than no treatment at all. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61611-6/fulltext http://www.thelancet.com/journals/lancet/article/PIIS0140-67...
- dsego 9y ago
  No need to go back in history. Visit a psychiatric hospital, see those poor souls on first generation antipsychotics still in use. They walk around like zombies, slowly, with a parkinsonian gait. Staring vacantly or grimacing, some have their mouths constantly open and drooling (look up tardive dyskinesia). But hey, as long as they are docile, right?
aalleavitch 9y ago
I feel like the more I learn about psychiatry, the less faith I have in psychiatrists. It is astounding what we don't know, and how wrong we've been in the past. (B.S. in Biology and Psychology, studied neuroscience in school)
- jdietrich 9y ago
  There's a bit of a paradox at play. We know that placebo effect is incredibly important in the treatment of depression and other psychiatric disorders. We know that there are still huge areas of uncertainty and ignorance and that our best treatments just aren't very effective. If we publicly admitted those facts, then our already not-very-effective treatments would get less effective, because the placebo effect would diminish. If we admit that psychiatry still has lots of glaring deficiencies, then a lot of people will end up getting sicker. If we don't admit it, then we might not invest enough in fixing those deficiencies. Nobody has a clear answer to this quandry. Is it worth sacrificing some patients now for the benefit of patients in the future? Would admitting the deficiencies in psychiatry dissuade people from seeking treatments that are actually effective? Is it possible to maintain a public facade of effectiveness, while privately accepting that we don't know what the hell we're doing? Would that be ethical? Does the risk of believing your own bullshit outweigh the benefits to patients of getting a good placebo?
  - duncan_bayne 9y ago
    I may be wrong, but I thought the placebo effect didn't diminish if the subject was aware of, or even anticipating, the effect?
rukuu_001 9y ago
The author makes some specific claims, including that there is no landmark, replicated study showing depression is caused by low serotonin. The author and his claims can be discredited if someone here can cite such a study.
- greenyoda 9y ago
  - Do we even have a way of measuring serotonin levels in a live human (as opposed to a dead lab rat[1])? Remember, we're trying to measure serotonin levels in the synapses between neurons in the brain (serotonin is a neurotransmitter, so its levels anywhere else in the body probably wouldn't matter), so you can't just draw someone's blood and test it. If the measurement involves drilling a hole through someone's skull, you can be sure it hasn't been done on lots of people (no ethics board would allow that experiment, even if you could find non-depressed people to volunteer for it). If it requires injecting people with radioactively tagged serotonin precursors and scanning their brains, it probably hasn't been done on a lot of asymptomatic people (risky and expensive). - Assuming we can measure serotonin levels in humans, how do we determine whether someone's level is "low"? Does "low" mean "low compared to the average of non-depressed people"? Does it mean "low compared to the level the patient had before they became depressed" (if so, how would we know their baseline levels)? Levels of many chemicals (hormones, glucose, sodium, etc.) vary significantly between "normal" individuals. [1] We can't talk to a rat to determine whether it's depressed. We can only observe certain aspects of its behavior, like appetite and activity levels, which we assume are proxies for depression, but could be due to unknown factors. We don't really know if rats have evolved to become depressed the way people do.
- ufo 9y ago
  IIRC, the current consensus among the psychiatric community is that SSRIs do work but no one actually knows what mechanism could explain their effectiveness. The one thing that is known for sure is that it doesn't come down to simply high vs low levels of serotonin because while SSRI treatment immediately raise serotonin levels the therapeutic effect takes some time to "kick in". I also recall reading that SSRIs have been found to be more helpful against anxiety than depression.
dboreham 9y ago
Try reading this : https://books.google.com/books?id=qreACUdDAc0C https://books.google.com/books?id=qreACUdDAc0C (the title is somewhat misleading because it is more of a history of experimental work done in the 60's and 70's in this field than it is self-help text).
ekwelio399 9y ago
Tenured professor of psychiatry here. I'll give you the summary of research on depression: 1. Emotional state is like blood pressure. It's a continuously varying thing. There is no discrete depressive disease state, just an extreme end of a continuum. 2. Just like blood pressure, though, very high blood pressure (or low) represents an illness state, a potentially very serious one. The etiology is a different matter. It may be due to sociocultural processes, or existential threat, or genetics, or neurological insults, or all of the above, each in some measure. 3. When we talk about "depression," it's usually a shorthand for a broader set of problems, related to lack of well-being, malaise, despair, sadness, anxiety, fear, and so forth. 4. The particular cocktail of emotions for each person is different though. 5. The best meta-analytic evidence suggests that antidepressants work, but not nearly as well for people as we were led to believe, and there's huge publication biases. Some drugs might not work at all. Some drugs work for some people; those same drugs might not work for other people at all. 6. Serotonin per se probably has nothing to do with the effect of antidepressants. 7. Psychotherapy works as well or as poorly as drugs on average, with some of the same publication biases. This is considered against many different types of controls, including placebo controls and various types of behavioral controls. Being wait-listed is the worst intervention of all, though. 8. Different psychotherapies do not differ in efficacy on average. The superiority of cognitive-behavioral therapy, etc. is a myth. Different therapies might differ for particular individuals, though, and there are some basic ingredients that seem to be necessary for efficacious therapy. The effect of therapist dwarfs the type of therapy (that is, some therapists are really really good, and others are less good, and that is much more important to outcome than type of therapy per se). 9. The best outcomes are generally therapy and drugs in combination, and if one thing doesn't work, trying different things will often work eventually. The recent history ("recent" being the last 30-40 years) of psychiatry and clinical psychology is dominated by economically and politically-driven reductionism and oversimplification, within the realms of therapy as well as pharmacology. A lot of these dynamics are driven by a desire to present as rigorously scientific, wrapping ones' selves in banners of other disciplines. The problem with this is behavioral science is its own thing; it resembles other disciplines in some ways, but not in others (much like every other domain of science).
- SubiculumCode 9y ago

wu-ikkyu 9y ago

>I'd like to think that medical professionals and academics in the mental health field have probably been thorough enough in their research to have looked at these finding over the years. You might like to read up on the short history of modern psychiatry. You'll find a great deal of mistakes, pseudoscience, and human rights atrocities.

jdietrich 9y ago
The same could be said of all of medicine, albeit over a longer timespan. Semmelweis was vilified for suggesting that doctors should wash their hands. Chemie Grünenthal covered up the devastating effects of thalidomide. American manufacturers spent much of the 1980s selling HIV-contaminated blood products to the rest of the world. Less than 20 years ago, rofecoxib (Vioxx) killed about 100,000 people. A lot of surgeries that are routinely performed today are completely unsupported by clinical evidence. It's largely a good thing that recent history looks hopelessly primitive and barbaric to us, because it means that we're making progress. Psychiatry still has a long way to come, but we need to be careful to not throw the baby out with the bathwater. Access to psychiatric care has a hugely positive impact on the overall disease burden; mediocre treatment is better than no treatment at all. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61611-6/fulltext http://www.thelancet.com/journals/lancet/article/PIIS0140-67...
dsego 9y ago
No need to go back in history. Visit a psychiatric hospital, see those poor souls on first generation antipsychotics still in use. They walk around like zombies, slowly, with a parkinsonian gait. Staring vacantly or grimacing, some have their mouths constantly open and drooling (look up tardive dyskinesia). But hey, as long as they are docile, right?

aalleavitch 9y ago

I feel like the more I learn about psychiatry, the less faith I have in psychiatrists. It is astounding what we don't know, and how wrong we've been in the past. (B.S. in Biology and Psychology, studied neuroscience in school)

jdietrich 9y ago
There's a bit of a paradox at play. We know that placebo effect is incredibly important in the treatment of depression and other psychiatric disorders. We know that there are still huge areas of uncertainty and ignorance and that our best treatments just aren't very effective. If we publicly admitted those facts, then our already not-very-effective treatments would get less effective, because the placebo effect would diminish. If we admit that psychiatry still has lots of glaring deficiencies, then a lot of people will end up getting sicker. If we don't admit it, then we might not invest enough in fixing those deficiencies. Nobody has a clear answer to this quandry. Is it worth sacrificing some patients now for the benefit of patients in the future? Would admitting the deficiencies in psychiatry dissuade people from seeking treatments that are actually effective? Is it possible to maintain a public facade of effectiveness, while privately accepting that we don't know what the hell we're doing? Would that be ethical? Does the risk of believing your own bullshit outweigh the benefits to patients of getting a good placebo?
- duncan_bayne 9y ago
  I may be wrong, but I thought the placebo effect didn't diminish if the subject was aware of, or even anticipating, the effect?

rukuu_001 9y ago

The author makes some specific claims, including that there is no landmark, replicated study showing depression is caused by low serotonin. The author and his claims can be discredited if someone here can cite such a study.

greenyoda 9y ago
- Do we even have a way of measuring serotonin levels in a live human (as opposed to a dead lab rat[1])? Remember, we're trying to measure serotonin levels in the synapses between neurons in the brain (serotonin is a neurotransmitter, so its levels anywhere else in the body probably wouldn't matter), so you can't just draw someone's blood and test it. If the measurement involves drilling a hole through someone's skull, you can be sure it hasn't been done on lots of people (no ethics board would allow that experiment, even if you could find non-depressed people to volunteer for it). If it requires injecting people with radioactively tagged serotonin precursors and scanning their brains, it probably hasn't been done on a lot of asymptomatic people (risky and expensive). - Assuming we can measure serotonin levels in humans, how do we determine whether someone's level is "low"? Does "low" mean "low compared to the average of non-depressed people"? Does it mean "low compared to the level the patient had before they became depressed" (if so, how would we know their baseline levels)? Levels of many chemicals (hormones, glucose, sodium, etc.) vary significantly between "normal" individuals. [1] We can't talk to a rat to determine whether it's depressed. We can only observe certain aspects of its behavior, like appetite and activity levels, which we assume are proxies for depression, but could be due to unknown factors. We don't really know if rats have evolved to become depressed the way people do.
ufo 9y ago
IIRC, the current consensus among the psychiatric community is that SSRIs do work but no one actually knows what mechanism could explain their effectiveness. The one thing that is known for sure is that it doesn't come down to simply high vs low levels of serotonin because while SSRI treatment immediately raise serotonin levels the therapeutic effect takes some time to "kick in". I also recall reading that SSRIs have been found to be more helpful against anxiety than depression.

dboreham 9y ago

Try reading this : https://books.google.com/books?id=qreACUdDAc0C https://books.google.com/books?id=qreACUdDAc0C (the title is somewhat misleading because it is more of a history of experimental work done in the 60's and 70's in this field than it is self-help text).

ekwelio399 9y ago

Tenured professor of psychiatry here. I'll give you the summary of research on depression: 1. Emotional state is like blood pressure. It's a continuously varying thing. There is no discrete depressive disease state, just an extreme end of a continuum. 2. Just like blood pressure, though, very high blood pressure (or low) represents an illness state, a potentially very serious one. The etiology is a different matter. It may be due to sociocultural processes, or existential threat, or genetics, or neurological insults, or all of the above, each in some measure. 3. When we talk about "depression," it's usually a shorthand for a broader set of problems, related to lack of well-being, malaise, despair, sadness, anxiety, fear, and so forth. 4. The particular cocktail of emotions for each person is different though. 5. The best meta-analytic evidence suggests that antidepressants work, but not nearly as well for people as we were led to believe, and there's huge publication biases. Some drugs might not work at all. Some drugs work for some people; those same drugs might not work for other people at all. 6. Serotonin per se probably has nothing to do with the effect of antidepressants. 7. Psychotherapy works as well or as poorly as drugs on average, with some of the same publication biases. This is considered against many different types of controls, including placebo controls and various types of behavioral controls. Being wait-listed is the worst intervention of all, though. 8. Different psychotherapies do not differ in efficacy on average. The superiority of cognitive-behavioral therapy, etc. is a myth. Different therapies might differ for particular individuals, though, and there are some basic ingredients that seem to be necessary for efficacious therapy. The effect of therapist dwarfs the type of therapy (that is, some therapists are really really good, and others are less good, and that is much more important to outcome than type of therapy per se). 9. The best outcomes are generally therapy and drugs in combination, and if one thing doesn't work, trying different things will often work eventually. The recent history ("recent" being the last 30-40 years) of psychiatry and clinical psychology is dominated by economically and politically-driven reductionism and oversimplification, within the realms of therapy as well as pharmacology. A lot of these dynamics are driven by a desire to present as rigorously scientific, wrapping ones' selves in banners of other disciplines. The problem with this is behavioral science is its own thing; it resembles other disciplines in some ways, but not in others (much like every other domain of science).

SubiculumCode 9y ago