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I think people should be allowed to share their opinions, even if they're controversial. Just because you disagree doesn't mean he's wrong (nor am I saying he'

I think people should be allowed to share their opinions, even if they're controversial. Just because you disagree doesn't mean he's wrong (nor am I saying he's right). I have no dog in this fight, but you don't have to Google much to find studies that cast doubt on the efficacy of anti-depressants. https://www.medicalnewstoday.com/articles/325767 https://www.medicalnewstoday.com/articles/325767

jlangemeier 7y ago
Ehhhhhhh... And google swings... and it misses... There are two somewhat competing studies involved in what you linked. The original meta-analysis is stating that "[a]ll antidepressants were more efficacious than placebo in adults with major depressive disorder." And if you dig into that study, the level of effectiveness varies, but is consistently above a placebo. The other, states that the original meta-analysis missed some points within their study; specifically that under the standardized criterion, there is an unknown level of bias in the results (73% showing unknown bias, and 26% showing high risk of bias - essentially confirming that most studies couldn't be done in a full blind or double-blind manner); and that while the sample size was high, the effect size was less known due to drop-out rates of the studies. This isn't necessarily contrary to the initial meta-analysis, but brings to light that they may need to be taken with a level of caution; it doesn't make the claim that anti-depressants are no better than placebos, but that when doing the meta-analysis Cipriani et. al. needed to make more apparent exigencies with their results. All this being said, the puff piece draws a more black and white tone with the meta-analysis and the meta-meta-analysis results; which tends to be the problem with these types of pieces. Sure, do your own research, but you'll need to dig into what's actually behind the journalistic fluff to get at the real meat and potatoes of the subject, if you don't you may come away with the idea that anti-depressants have 0 efficacy instead of "some efficacy, with the caveat that studies are somewhat mixed on individual results due to the nature of how the studies are conducted."
- MegaButts 7y ago
  I agree with everything you said, and was merely pointing out the evidence is far from overwhelming (or even conclusive, in my opinion). If we're going to talk about making dangerous statements, mentioning that antidepressants are effective while ignoring the fact they increase suicide for some people seems a lot more reckless to me. Of course, you don't know if they will do that until after you are already taking them. https://www.bmj.com/content/358/bmj.j3697/rr-4 https://www.bmj.com/content/358/bmj.j3697/rr-4 Since at this point it seems unlikely I really "have no dog in this fight," for what it's worth I think antidepressants likely help more people than they harm, but I do think their positive effects are exaggerated by health professionals.
  - jlangemeier 7y ago
    I really like the article you linked; I also found it interesting at the end of it: "It is absurd to use drugs for depression that increase the risk of suicide and homicide when we know that cognitive behavioural therapy can halve the risk of suicide in patients who have been admitted after a suicide attempt and when psychotherapy does not increase the risk of murder." And I think it really speaks to the need to have professionals that aren't just throwing folks on drugs and sending them off. A whole form approach to mental health is needed, where a combination of various forms of therapy may be the best way to help an individual; since pretty much every study can agree that the efficacy essentially comes down to the individual level. For my ADHD, anxiety, and depression I don't take anything (currently), but I do regularly see a therapist with whom I work through issues I'm having and how to combat them, as well as how to reinforce my successes. This isn't to say that at specific times I haven't tried different pharmacology to combat one or all of these issues; but at this time, the most effective thing __for_me__ has been basic therapy. This isn't to say that what has worked for me will work for others, but at its most basic, finding a professional that is willing to really dig into what's going on is extremely important, as they will be able to work with the individual to figure out not only what's going on, but even what the goals are and whether they are even achievable goals (elimination of symptoms, management, setting new normal habits, etc. etc. etc). And that's why I get frustrated with fluff journalism around much deeper studies, they can convince people that an entire system and industry is a bunch of quacks that shouldn't be taken seriously; is the person that's doing self-study going to dig into what it means for a study to show bias or the effect size or the sample size; or whether it's a direct study or a meta-analysis; or what the type of statistical analysis was used (were they using teeming or densification methods for gaps in data, was it a regression analysis, if so was it linear, bilinear, quadratic, etc); I could keep going on... or are they going to just read a couple of journalism pieces and call it a day. This isn't to say I don't love medium-science (not hard, not soft) journalism; I love Quanta and the pieces they put out about science and math concepts, but if I want to dig deeper I will look up the pub or pre-pub information from the details they're covering; I would hope that someone that's doing self-study would do the same with medium-science medical journalism, but I can't ever guarantee that.

jlangemeier 7y ago

Ehhhhhhh... And google swings... and it misses... There are two somewhat competing studies involved in what you linked. The original meta-analysis is stating that "[a]ll antidepressants were more efficacious than placebo in adults with major depressive disorder." And if you dig into that study, the level of effectiveness varies, but is consistently above a placebo. The other, states that the original meta-analysis missed some points within their study; specifically that under the standardized criterion, there is an unknown level of bias in the results (73% showing unknown bias, and 26% showing high risk of bias - essentially confirming that most studies couldn't be done in a full blind or double-blind manner); and that while the sample size was high, the effect size was less known due to drop-out rates of the studies. This isn't necessarily contrary to the initial meta-analysis, but brings to light that they may need to be taken with a level of caution; it doesn't make the claim that anti-depressants are no better than placebos, but that when doing the meta-analysis Cipriani et. al. needed to make more apparent exigencies with their results. All this being said, the puff piece draws a more black and white tone with the meta-analysis and the meta-meta-analysis results; which tends to be the problem with these types of pieces. Sure, do your own research, but you'll need to dig into what's actually behind the journalistic fluff to get at the real meat and potatoes of the subject, if you don't you may come away with the idea that anti-depressants have 0 efficacy instead of "some efficacy, with the caveat that studies are somewhat mixed on individual results due to the nature of how the studies are conducted."

MegaButts 7y ago
I agree with everything you said, and was merely pointing out the evidence is far from overwhelming (or even conclusive, in my opinion). If we're going to talk about making dangerous statements, mentioning that antidepressants are effective while ignoring the fact they increase suicide for some people seems a lot more reckless to me. Of course, you don't know if they will do that until after you are already taking them. https://www.bmj.com/content/358/bmj.j3697/rr-4 https://www.bmj.com/content/358/bmj.j3697/rr-4 Since at this point it seems unlikely I really "have no dog in this fight," for what it's worth I think antidepressants likely help more people than they harm, but I do think their positive effects are exaggerated by health professionals.
- jlangemeier 7y ago
  I really like the article you linked; I also found it interesting at the end of it: "It is absurd to use drugs for depression that increase the risk of suicide and homicide when we know that cognitive behavioural therapy can halve the risk of suicide in patients who have been admitted after a suicide attempt and when psychotherapy does not increase the risk of murder." And I think it really speaks to the need to have professionals that aren't just throwing folks on drugs and sending them off. A whole form approach to mental health is needed, where a combination of various forms of therapy may be the best way to help an individual; since pretty much every study can agree that the efficacy essentially comes down to the individual level. For my ADHD, anxiety, and depression I don't take anything (currently), but I do regularly see a therapist with whom I work through issues I'm having and how to combat them, as well as how to reinforce my successes. This isn't to say that at specific times I haven't tried different pharmacology to combat one or all of these issues; but at this time, the most effective thing __for_me__ has been basic therapy. This isn't to say that what has worked for me will work for others, but at its most basic, finding a professional that is willing to really dig into what's going on is extremely important, as they will be able to work with the individual to figure out not only what's going on, but even what the goals are and whether they are even achievable goals (elimination of symptoms, management, setting new normal habits, etc. etc. etc). And that's why I get frustrated with fluff journalism around much deeper studies, they can convince people that an entire system and industry is a bunch of quacks that shouldn't be taken seriously; is the person that's doing self-study going to dig into what it means for a study to show bias or the effect size or the sample size; or whether it's a direct study or a meta-analysis; or what the type of statistical analysis was used (were they using teeming or densification methods for gaps in data, was it a regression analysis, if so was it linear, bilinear, quadratic, etc); I could keep going on... or are they going to just read a couple of journalism pieces and call it a day. This isn't to say I don't love medium-science (not hard, not soft) journalism; I love Quanta and the pieces they put out about science and math concepts, but if I want to dig deeper I will look up the pub or pre-pub information from the details they're covering; I would hope that someone that's doing self-study would do the same with medium-science medical journalism, but I can't ever guarantee that.