3 ms·

I think the best part is the dance you do when looking for a therapist where you try to say you really need help, but you have to temper that severity by saying

by ayngg 5y ago

I think the best part is the dance you do when looking for a therapist where you try to say you really need help, but you have to temper that severity by saying that you aren't in such bad shape that you are suicidal for fear that they commit you to protocol or something. In reality mental healthcare feels like only a slight step up from antiquated methods from days long gone. Trying the medication roulette is like spending months at a time throwing darts blindfolded to see if anything helps, hurts or does nothing at all. Waiting months to see professionals who are burned out or just trying their best to not be completely overwhelmed by the demand but are unable to give meaningful care because of how overwhelmed they are. Or not even being able to see a therapist at all because it is cost prohibitive. And then consider basically having to do that on the side while you have your other obligations that you have to tend to. I wouldn't be surprised if only a fraction of people who need help get it, and of that fraction, only a fraction of them see a benefit. It basically boils down to society not caring, or barely caring at most. In the end I suspect that the efficacy of mental healthcare has its limits, after all it is like trying to fix people after they have been broken, which is way harder than supporting people before they break, but that depends on social structures and support groups that are increasingly weak and strained.

Aerroon 5y ago
And the medicine dart board assumes your psychiatrist doesn't make mistakes. Ie you will have to look up the information on the medicine roulette and the combinations yourself.
ncmncm 5y ago
The only way, still, to determine which of a mess of conditions you have, all called depression, is to see which, if any, medication seems to help. It is as if you present with a broken bone, but they have to try splinting one after another until they hit on the broken one. And, you might actually have more than one. And, some doctors have a favorite bone, and won't try the others. Try to imagine a Random Controlled Trial protocol for a new depression medication. It is miraculous that any have been approved. It is why you are always seeing articles insisting, idiotically, that RCTs prove depression medications are no better than placebo. Splinting the left shinbone helps only a small fraction of patients who have a fracture. For validity, RCTs depend utterly on reliable sortative diagnoses. RCT fetishists (which exist, and are common) are mentally unable to process that fact.
- disgruntledphd2 5y ago
  > why you are always seeing articles insisting, idiotically, that RCTs prove depression medications are no better than placebo You mean Kirsch & Kirsch 1997? Like, that particular study found a really, really small effect in the data submitted to the FDA (so the data chosen by the pharma companies). Even this went away when they used placebos with side effects. More recent work has suggested that they work for severe depression, which is great but the trouble is that the vast majority of people with a diagnosis of depression don't have MDD (major depressive disorder). I do agree that mental health is in it's leeches phase right now, and I am deeply concerned for people who end up having to engage with this system.
  - ncmncm 5y ago
    Pharma companies demonstrating that they are no better at impossible things than anybody else does not tell you anything new. Or, did you have a point?
    - disgruntledphd2 5y ago
      You said: > It is why you are always seeing articles insisting, idiotically, that RCTs prove depression medications are no better than placebo. I responded to your claim with a little more colour on that particular trial in order to perhaps start a discussion around what we mean as depression. Clearly, I didn't succeed at my aim, my apologies ;) Edit: it's particularly the framing of the trials as "idiotic" that spurred me to reply, so I'd be interested in why you believe this.
      - ncmncm 5y ago
        I am mystified that we are having this conversation. To me the central statement in my original posting was: > For validity, RCTs depend utterly on reliable sortative diagnoses So, are you saying you believe an RCT can demonstrate a fact when whichever medication is being tested addresses the actual condition of only a tiny fraction of the participants, and even exacerbates some of the others' various conditions? Such trials are not idiotic, except as a waste of money. Reporting their results as if meaningful is what I called idiotic. Or, are you saying you know how to design the protocol for an RCT when you have no idea which, if any, of the participants actually suffer the condition your medication is supposed to treat?

by ayngg 5y ago

Aerroon 5y ago

And the medicine dart board assumes your psychiatrist doesn't make mistakes. Ie you will have to look up the information on the medicine roulette and the combinations yourself.

ncmncm 5y ago

The only way, still, to determine which of a mess of conditions you have, all called depression, is to see which, if any, medication seems to help. It is as if you present with a broken bone, but they have to try splinting one after another until they hit on the broken one. And, you might actually have more than one. And, some doctors have a favorite bone, and won't try the others. Try to imagine a Random Controlled Trial protocol for a new depression medication. It is miraculous that any have been approved. It is why you are always seeing articles insisting, idiotically, that RCTs prove depression medications are no better than placebo. Splinting the left shinbone helps only a small fraction of patients who have a fracture. For validity, RCTs depend utterly on reliable sortative diagnoses. RCT fetishists (which exist, and are common) are mentally unable to process that fact.

disgruntledphd2 5y ago
> why you are always seeing articles insisting, idiotically, that RCTs prove depression medications are no better than placebo You mean Kirsch & Kirsch 1997? Like, that particular study found a really, really small effect in the data submitted to the FDA (so the data chosen by the pharma companies). Even this went away when they used placebos with side effects. More recent work has suggested that they work for severe depression, which is great but the trouble is that the vast majority of people with a diagnosis of depression don't have MDD (major depressive disorder). I do agree that mental health is in it's leeches phase right now, and I am deeply concerned for people who end up having to engage with this system.
- ncmncm 5y ago
  Pharma companies demonstrating that they are no better at impossible things than anybody else does not tell you anything new. Or, did you have a point?
  - disgruntledphd2 5y ago
    You said: > It is why you are always seeing articles insisting, idiotically, that RCTs prove depression medications are no better than placebo. I responded to your claim with a little more colour on that particular trial in order to perhaps start a discussion around what we mean as depression. Clearly, I didn't succeed at my aim, my apologies ;) Edit: it's particularly the framing of the trials as "idiotic" that spurred me to reply, so I'd be interested in why you believe this.
    - ncmncm 5y ago
      I am mystified that we are having this conversation. To me the central statement in my original posting was: > For validity, RCTs depend utterly on reliable sortative diagnoses So, are you saying you believe an RCT can demonstrate a fact when whichever medication is being tested addresses the actual condition of only a tiny fraction of the participants, and even exacerbates some of the others' various conditions? Such trials are not idiotic, except as a waste of money. Reporting their results as if meaningful is what I called idiotic. Or, are you saying you know how to design the protocol for an RCT when you have no idea which, if any, of the participants actually suffer the condition your medication is supposed to treat?