4 ms·
You could say much the same about depression. As it is, we know there are lots of different conditions all labeled depression, distinguishable mainly by which m
by ncmncm 4y ago
You could say much the same about depression. As it is, we know there are lots of different conditions all labeled depression, distinguishable mainly by which medication they respond to, if any. (This, despite that symptoms vary widely; e.g. many suicidal, others just lacking affect and motivation.) At least treatments exist, somehow grandfathered in. The wastebasket diagnosis means that no new medication can be found to have any useful effect, because it only treats a small fraction of patients in a trial, and worsens others.
And, somebody always pops up self-righteously insisting Gold Standard Randomized Controlled Trials prove that none of the medications that millions of people need daily to be able function at all have any effect.
- R0b0t1 4y agoI agree mostly, but w.r.t. medication, it's not that they have no effect, it's that they seem to function by accident with the most plausible explanation (chemical deficiency?) being suspect under closer consideration.
- ncmncm 4y agoNo. It is that the med under test could perfectly treat the small number diagnosed who actually have the illness it addresses, and have nil or negative effect on everybody else given the same diagnosis who have an actually different illness. According to the RCT, it just failed. Validity of RCT results is limited absolutely by validity of diagnosis. Bad diagnostics, bad results. That doesn't stop people from running invalid RCTs, so it should stop people from citing invalid RCTs. But it doesn't.
- skissane 4y agoI agree with you about depression also being a biologically dubious category. Lynn Waterhouse's publications focus on criticising ASD (and its predecessor diagnoses) in particular, but I very much doubt she thinks the rest of the DSM-5 is all fine–it is simply that autism/ASD is one of her core areas of professional/academic specialisation, in which she's spent much of her career, so that's where she focuses her criticisms. Discontent with the DSM is very widespread, in significant subsections of both research and clinical communities – however, attempts to dethrone it in practice are met with opposition from that other current of professional opinion ("it obviously is far from perfect but we need something and nobody's convinced us there is anything better"), and that other current seems to thus far be winning in the money/power/mindshare stakes. > The wastebasket diagnosis means that no new medication can be found to have any useful effect, because it only treats a small fraction of patients in a trial, and worsens others. New pharmacotherapies for depressive disorders do get approved – in 2019, the FDA approved brexanolone for post-partum depression and esketamine for treatment-resistant depression; before that, the FDA approved vortioxetine in 2013. Agometaline was approved in the EU in 2009 and and Australia in 2010, although its manufacturer gave up trying to get it approved by the FDA. And there are further new drugs in various stages of the approval pipeline. Brexanolone is particularly interesting as a drug to treat a rather specific form of depression rather than just "vanilla depression". No denying it could be better, but depression is a much better situation than autism/ASD – although risperidone and aripiprazole are both approved to treat behavioural issues (irritability and aggression) in children with ASD, neither has any impact on core autistic traits (social cognition, obsessiveness, etc). At least for depressive disorders, we have approved pharmacotherapies to treat their core symptoms, even if they only work for some patients some of the time.
- ncmncm 4y agoYes, ASD is in much worse shape than depression. And, risperidone is a terrible choice of treatment. Anxiolytics can be very effective.