4 ms·

SSRI’s are no more effective than placebo or exercise in multiple studies: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/# https://www.ncbi.nlm.nih.gov/p

by fogzen 9y ago

SSRI’s are no more effective than placebo or exercise in multiple studies: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/# https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/#

cassowary37 9y ago
but when you look across 522 studies with more than 100k participants, evidence of efficacy is indisputable: https://www.ncbi.nlm.nih.gov/pubmed/29477251 https://www.ncbi.nlm.nih.gov/pubmed/29477251
- NPMaxwell 9y ago
  The Cipriani study is a nice meta-analysis: "The random-effects summary SMD for all antidepressants was 0·30" This site explains SMD: http://handbook-5-1.cochrane.org/chapter_9/9_2_3_2_the_standardized_mean_difference.htm http://handbook-5-1.cochrane.org/chapter_9/9_2_3_2_the_stand.... This site shows what 0.3 looks like (actually shows 0.2 and 0.5): http://rpsychologist.com/short-r-script-to-plot-effect-sizes-cohens-d-and-shade-overlapping-area http://rpsychologist.com/short-r-script-to-plot-effect-sizes.... Typically, when people are summarizing this line of research saying that there is no effect, they are talking about these kinds of effect sizes which look like they round to pretty much no effect. I think using SMD for reporting by itself is unfortunate: my understanding is that the drugs have large effects for a minority of patients -- rather than that they shift everyone's emotional experience over a little bit.
  - Nomentatus 9y ago
    But note that there's no attempt to control for the (extremely strong) anti-histamine effects of these drugs (particularly elavil.) You need to test them against other anti-histamines which can also improve apparent health, a lot.
    - NPMaxwell 9y ago
      Fascinating idea!
phkahler 9y ago
Exercise is harder than taking a pill - remember these are antidepressants. Also, when you're depressed anything that gives you hope is likely to actually help and that means placebos too. Having said that, I would hope actual drugs work better than a placebo.
- aaron_altamura 9y ago
  This is a dangerous opinion and can inspire guilt in folks struggling with mental disorders. Not cool.
  - phkahler 9y ago
    >> This is a dangerous opinion and can inspire guilt... Wait what? Which part? My first sentence? There are a few opinions in what I wrote. What specifically might inspire guilt? Honest question, I try to be sensitive to such things.
  - deleted 9y ago
    [deleted]
  - gabept 9y ago
    Lies and omissions are always more dangerous than the truth.
    - phkahler 9y ago
      Tell that to a therapist.
vanderZwan 9y ago
We only recently have figured out how exercise protects the brain against stress-induced depression[0]. In short: red muscle (the endurance kind) produces an enzyme that breaks down kynurenine, one of the stress hormones that is associated with triggering all kinds of mental illnesses when it stays at chronically elevated levels. But there are many more possible causes of depression than stress - one could compare it to a fever: a high fever kills, but there are many possible illnesses leading to a fever. Expecting that exercise helps with depression every time is like assuming every fever is caused by the same illness. Not to mention the fact that while having more red muscle may help with coping with chronic stress, it does not actually fix the cause of chronic stress in and of itself (although it can of course help with providing someone with the mental fortitude needed to take on that particular problem). There are all kinds of reasons to do more exercise, but touting them as a catch-all fix for depression is dangerous and ignorant. [0] https://ki.se/en/news/how-physical-exercise-protects-the-brain-from-stress-induced-depression https://ki.se/en/news/how-physical-exercise-protects-the-bra...

by fogzen 9y ago

SSRI’s are no more effective than placebo or exercise in multiple studies: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/# https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/#

cassowary37 9y ago

but when you look across 522 studies with more than 100k participants, evidence of efficacy is indisputable: https://www.ncbi.nlm.nih.gov/pubmed/29477251 https://www.ncbi.nlm.nih.gov/pubmed/29477251

NPMaxwell 9y ago
The Cipriani study is a nice meta-analysis: "The random-effects summary SMD for all antidepressants was 0·30" This site explains SMD: http://handbook-5-1.cochrane.org/chapter_9/9_2_3_2_the_standardized_mean_difference.htm http://handbook-5-1.cochrane.org/chapter_9/9_2_3_2_the_stand.... This site shows what 0.3 looks like (actually shows 0.2 and 0.5): http://rpsychologist.com/short-r-script-to-plot-effect-sizes-cohens-d-and-shade-overlapping-area http://rpsychologist.com/short-r-script-to-plot-effect-sizes.... Typically, when people are summarizing this line of research saying that there is no effect, they are talking about these kinds of effect sizes which look like they round to pretty much no effect. I think using SMD for reporting by itself is unfortunate: my understanding is that the drugs have large effects for a minority of patients -- rather than that they shift everyone's emotional experience over a little bit.
- Nomentatus 9y ago
  But note that there's no attempt to control for the (extremely strong) anti-histamine effects of these drugs (particularly elavil.) You need to test them against other anti-histamines which can also improve apparent health, a lot.
  - NPMaxwell 9y ago
    Fascinating idea!

phkahler 9y ago

Exercise is harder than taking a pill - remember these are antidepressants. Also, when you're depressed anything that gives you hope is likely to actually help and that means placebos too. Having said that, I would hope actual drugs work better than a placebo.

aaron_altamura 9y ago
This is a dangerous opinion and can inspire guilt in folks struggling with mental disorders. Not cool.
- phkahler 9y ago
  >> This is a dangerous opinion and can inspire guilt... Wait what? Which part? My first sentence? There are a few opinions in what I wrote. What specifically might inspire guilt? Honest question, I try to be sensitive to such things.
- deleted 9y ago
  [deleted]
- gabept 9y ago
  Lies and omissions are always more dangerous than the truth.
  - phkahler 9y ago
    Tell that to a therapist.

vanderZwan 9y ago

We only recently have figured out how exercise protects the brain against stress-induced depression[0]. In short: red muscle (the endurance kind) produces an enzyme that breaks down kynurenine, one of the stress hormones that is associated with triggering all kinds of mental illnesses when it stays at chronically elevated levels. But there are many more possible causes of depression than stress - one could compare it to a fever: a high fever kills, but there are many possible illnesses leading to a fever. Expecting that exercise helps with depression every time is like assuming every fever is caused by the same illness. Not to mention the fact that while having more red muscle may help with coping with chronic stress, it does not actually fix the cause of chronic stress in and of itself (although it can of course help with providing someone with the mental fortitude needed to take on that particular problem). There are all kinds of reasons to do more exercise, but touting them as a catch-all fix for depression is dangerous and ignorant. [0] https://ki.se/en/news/how-physical-exercise-protects-the-brain-from-stress-induced-depression https://ki.se/en/news/how-physical-exercise-protects-the-bra...