3 ms·

I don't know how you square this review with the fact that SSRIs seem to work. This feels a hell of a lot like "we can't find a good explanations for why this w

by rtpg 4y ago

I don't know how you square this review with the fact that SSRIs seem to work. This feels a hell of a lot like "we can't find a good explanations for why this work, therefore it doesn't work." This sounds reasonable, until you think that you are saying something isn't true because you can't explain it, which is also true of a 3 year old when asked how planes fly. Them not being able to explain it doesn't make the plane fall from the sky. To be fair, the title of the article and the general gist of the theory are not what is being refuted in the article, but the article is the one saying SSRIs probably aren't worth it. It seems likely there is not a good explanation for their effectiveness but sure looks effective.

e_i_pi_2 4y ago
I don't think the argument is "they don't work", moreso that they only work because the person thinks it will work and gets a placebo effect - not that the drug actually works to fix a chemical issue in the brain. Here's a couple things I found from searching "strength of placebo vs ssri": https://www.ncbi.nlm.nih.gov/books/NBK555852/table/ch4.tab29/ https://www.ncbi.nlm.nih.gov/books/NBK555852/table/ch4.tab29... https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-1173-2 https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12... https://jamanetwork.com/journals/jama/article-abstract/185157 https://jamanetwork.com/journals/jama/article-abstract/18515... The last one has a nice summary: > Antidepressant medications represent the best established treatment for major depressive disorder, but there is little evidence that they have a specific pharmacological effect relative to pill placebo for patients with less severe depression. Basically "they're the best tool we have but we don't have evidence that it actually has an effect". I remember a while ago I had a teacher that said "we laugh about rain dances today, but at the time there was a lot of evidence - you dance and you don't stop until it rains or you die, it's almost a 100% success rate". I feel like we see something similar here - we think what we're doing is helping but we don't have any causal evidence to support that. The evidence seems to suggest you could tell someone they're getting an SSRI, not give them any, and get the same outcome - suggesting the SSRI has little to no effect and what's actually causing the issue is something else, and could maybe be better addressed some other way. There's another famous story about "the anti-depressant cow" which seems very relevant here > https://antidepressantcow.org/2020/02/the-story-of-the-antidepressant-cow https://antidepressantcow.org/2020/02/the-story-of-the-antid... The TLDR is that a doctor tried to sell antidepressant meds in Cambodia and they basically told him "we don't need those - if someone is upset we get together as a community and make it better instead of trying to tell them it's their own problem to deal with"

by rtpg 4y ago

e_i_pi_2 4y ago

I don't think the argument is "they don't work", moreso that they only work because the person thinks it will work and gets a placebo effect - not that the drug actually works to fix a chemical issue in the brain. Here's a couple things I found from searching "strength of placebo vs ssri": https://www.ncbi.nlm.nih.gov/books/NBK555852/table/ch4.tab29/ https://www.ncbi.nlm.nih.gov/books/NBK555852/table/ch4.tab29... https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-1173-2 https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12... https://jamanetwork.com/journals/jama/article-abstract/185157 https://jamanetwork.com/journals/jama/article-abstract/18515... The last one has a nice summary: > Antidepressant medications represent the best established treatment for major depressive disorder, but there is little evidence that they have a specific pharmacological effect relative to pill placebo for patients with less severe depression. Basically "they're the best tool we have but we don't have evidence that it actually has an effect". I remember a while ago I had a teacher that said "we laugh about rain dances today, but at the time there was a lot of evidence - you dance and you don't stop until it rains or you die, it's almost a 100% success rate". I feel like we see something similar here - we think what we're doing is helping but we don't have any causal evidence to support that. The evidence seems to suggest you could tell someone they're getting an SSRI, not give them any, and get the same outcome - suggesting the SSRI has little to no effect and what's actually causing the issue is something else, and could maybe be better addressed some other way. There's another famous story about "the anti-depressant cow" which seems very relevant here > https://antidepressantcow.org/2020/02/the-story-of-the-antidepressant-cow https://antidepressantcow.org/2020/02/the-story-of-the-antid... The TLDR is that a doctor tried to sell antidepressant meds in Cambodia and they basically told him "we don't need those - if someone is upset we get together as a community and make it better instead of trying to tell them it's their own problem to deal with"