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Until recently, few pharmaceutical companies pre-registered antidepressant trials, which allowed them to selectively publish. This means that antidepressants ma

Until recently, few pharmaceutical companies pre-registered antidepressant trials, which allowed them to selectively publish. This means that antidepressants may be nowhere near as effective as commonly believed, and so doctors are overweighting the benefits compared to the costs of side effects. . “While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. "Negative" trials were either left unpublished or were distorted to present "positive" results.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2412901/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2412901/ If this is true, then many people who currently take antidepressants may actually be better, not worse, without them, since at least they’d avoid the side effects. Further, the “chemical imbalance” theory that is propagated through paid advertising has no applicability to a doctor prescribing an antidepressant, since the doctor has no way of measuring and monitoring that imbalance should one exist.

JudgeWapner 7y ago
> the “chemical imbalance” theory that is propagated through paid advertising I've never seen a pharmaceutical ad that used that term. The only thing I recall from the ads is them distinguishing clinical depression from feeling blue.
- doitLP 7y ago
  It’s pervasive, especially in the early days of marketing antidepressants to the general public. Example, probably the most the most recognizable anti-depressant ad ever (at least in the US): https://m.youtube.com/watch?v=twhvtzd6gXA https://m.youtube.com/watch?v=twhvtzd6gXA @ 0:20
  - JudgeWapner 7y ago
    ok, I concede that one. They used the term "imbalance of chemicals". To be fair, though, that was a "vintage commercial" and undated. And everything else is not disputed: how to recognize the symptoms of depression. However, I don't fault Big Pharma for not figuring out how to explain the neurochemistry of SSRI's in a 30 second TV ad.
    - doitLP 7y ago
      Well that’s kind of the point. The name SSRI is itself a marketing term. For every such drug, the mechanism of action is still unknown.
      - JudgeWapner 7y ago
        the mechanism that many drugs use, such as nitrous oxide aren't fully known. the wikipedia page for SSRI doesn't seem to look like marketing. a drug doesn't have to be fully understood in order for it to be effective.
      - hcknwscommenter 7y ago
        That's quite a statement. I mean, sure, the entirety of why selectively inhibiting serotonin reuptake might affect psychological outcomes may be a bit fuzzy at the end, but there is a pretty solid theory here isn't there? The drugs work by selectively inhibiting serotonin reuptake. This leads to more serotonin signaling. Sure it gets a little fuzzy from there to how this mechanism affects mood disorders with various competing theories, but "unknown" is quite a stretch here.
wayoutthere 7y ago
It’s become increasingly clear that genetics play a huge role in which psychiatric drugs are effective and which ones are not. Genetic testing for psych med effectiveness should become standard practice given how in some people, SSRIs (often the first line of defense in psych meds) can cause extended periods of psychosis. Funny thing about psychosis — when you’re psychotic, your erratic and extreme behavior doesn’t feel abnormal. You don’t feel like anything has changed. This happened to me on Prozac — the most commonly prescribed antidepressant — and it took me 3 years to put my life back together after all the damage I did to my personal relationships during that period. The anxiety I was dealing with was crippling, but it didn’t dismantle my life the way the side effects of that drug did. The treatment was absolutely worse than the disease. If they had done a genetic test first, they would have seen a red flag and avoided SSRIs all together. This testing exists today, but it’s only used in patients who show strong resistance to pharmacological intervention. It should be standard.
- SmokeGS 7y ago
  I feel like we are so close to wirelessly monitoring all brain waves (next 50 years) we will probably be able to, in real time, recognize and diagnose abnormal brain patterns. I think it would be promising if we get this sensor tech up and then perhaps deploy nanotech to interfere with maladaptive brain patterns. The ethics of such a device is considerably sticky. TED talk by Jack Gallant https://www.youtube.com/watch?v=Ecvv-EvOj8M https://www.youtube.com/watch?v=Ecvv-EvOj8M recreating vision: https://www.youtube.com/watch?v=nsjDnYxJ0bo https://www.youtube.com/watch?v=nsjDnYxJ0bo another ted talk by John-Dylan Haynes https://www.youtube.com/watch?v=mMDuakmEEV4 https://www.youtube.com/watch?v=mMDuakmEEV4 paraphrased: "wireless non-contact mind reading tech may be cheap and mass producible within the next 50 years." the only rate limiting step with his method of decoding thoughts is that it takes time under a high energy device to pair associations in the brain. Think of how much screen time we currently use. If we could pair a wireless 'headset' like headphones while looking at pictures on a screen it would be possible to build a brain bank of children->tenenagers. Currently we just need a lot of processing power and reserved bandwidth on the internet to do some cool stuff.
  - 7y ago
hcknwscommenter 7y ago
That is a very odd way of looking at the issue. The scientific literature certainly has a bias in favor of publishing positive results rather than failures. However, the scientific literature in no way affects FDA/regulatory approval. Drug/treatment candidates that fail regulatory approval are not on the market. As far as negative results being "distorted" to present "positive results" is concerned, yes it is quite common to take a patient population that overall fails to show statistically significant benefit and see if there is a subset that does in fact show a statistically significant benefit. One could call that p-hunting, but as long as it is followed up and confirmed, it doesn't seem like a nefarious thing to do.

JudgeWapner 7y ago

> the “chemical imbalance” theory that is propagated through paid advertising I've never seen a pharmaceutical ad that used that term. The only thing I recall from the ads is them distinguishing clinical depression from feeling blue.

doitLP 7y ago
It’s pervasive, especially in the early days of marketing antidepressants to the general public. Example, probably the most the most recognizable anti-depressant ad ever (at least in the US): https://m.youtube.com/watch?v=twhvtzd6gXA https://m.youtube.com/watch?v=twhvtzd6gXA @ 0:20
- JudgeWapner 7y ago
  ok, I concede that one. They used the term "imbalance of chemicals". To be fair, though, that was a "vintage commercial" and undated. And everything else is not disputed: how to recognize the symptoms of depression. However, I don't fault Big Pharma for not figuring out how to explain the neurochemistry of SSRI's in a 30 second TV ad.
  - doitLP 7y ago
    Well that’s kind of the point. The name SSRI is itself a marketing term. For every such drug, the mechanism of action is still unknown.
    - JudgeWapner 7y ago
      the mechanism that many drugs use, such as nitrous oxide aren't fully known. the wikipedia page for SSRI doesn't seem to look like marketing. a drug doesn't have to be fully understood in order for it to be effective.
    - hcknwscommenter 7y ago
      That's quite a statement. I mean, sure, the entirety of why selectively inhibiting serotonin reuptake might affect psychological outcomes may be a bit fuzzy at the end, but there is a pretty solid theory here isn't there? The drugs work by selectively inhibiting serotonin reuptake. This leads to more serotonin signaling. Sure it gets a little fuzzy from there to how this mechanism affects mood disorders with various competing theories, but "unknown" is quite a stretch here.

wayoutthere 7y ago

It’s become increasingly clear that genetics play a huge role in which psychiatric drugs are effective and which ones are not. Genetic testing for psych med effectiveness should become standard practice given how in some people, SSRIs (often the first line of defense in psych meds) can cause extended periods of psychosis. Funny thing about psychosis — when you’re psychotic, your erratic and extreme behavior doesn’t feel abnormal. You don’t feel like anything has changed. This happened to me on Prozac — the most commonly prescribed antidepressant — and it took me 3 years to put my life back together after all the damage I did to my personal relationships during that period. The anxiety I was dealing with was crippling, but it didn’t dismantle my life the way the side effects of that drug did. The treatment was absolutely worse than the disease. If they had done a genetic test first, they would have seen a red flag and avoided SSRIs all together. This testing exists today, but it’s only used in patients who show strong resistance to pharmacological intervention. It should be standard.

SmokeGS 7y ago
I feel like we are so close to wirelessly monitoring all brain waves (next 50 years) we will probably be able to, in real time, recognize and diagnose abnormal brain patterns. I think it would be promising if we get this sensor tech up and then perhaps deploy nanotech to interfere with maladaptive brain patterns. The ethics of such a device is considerably sticky. TED talk by Jack Gallant https://www.youtube.com/watch?v=Ecvv-EvOj8M https://www.youtube.com/watch?v=Ecvv-EvOj8M recreating vision: https://www.youtube.com/watch?v=nsjDnYxJ0bo https://www.youtube.com/watch?v=nsjDnYxJ0bo another ted talk by John-Dylan Haynes https://www.youtube.com/watch?v=mMDuakmEEV4 https://www.youtube.com/watch?v=mMDuakmEEV4 paraphrased: "wireless non-contact mind reading tech may be cheap and mass producible within the next 50 years." the only rate limiting step with his method of decoding thoughts is that it takes time under a high energy device to pair associations in the brain. Think of how much screen time we currently use. If we could pair a wireless 'headset' like headphones while looking at pictures on a screen it would be possible to build a brain bank of children->tenenagers. Currently we just need a lot of processing power and reserved bandwidth on the internet to do some cool stuff.
- 7y ago

hcknwscommenter 7y ago

That is a very odd way of looking at the issue. The scientific literature certainly has a bias in favor of publishing positive results rather than failures. However, the scientific literature in no way affects FDA/regulatory approval. Drug/treatment candidates that fail regulatory approval are not on the market. As far as negative results being "distorted" to present "positive results" is concerned, yes it is quite common to take a patient population that overall fails to show statistically significant benefit and see if there is a subset that does in fact show a statistically significant benefit. One could call that p-hunting, but as long as it is followed up and confirmed, it doesn't seem like a nefarious thing to do.