3 ms·

It's shocking to me how few people realize that anti depressants very rarely outperform placebo. I've been arguing with people about this for years, because the

It's shocking to me how few people realize that anti depressants very rarely outperform placebo. I've been arguing with people about this for years, because the evidence from RCTs really has been convincingly bad for a while now. I'm starting to feel like psychopharmacology is a lot like academia, where the real force of change is a generation taught X dying off.

gruez 4y ago
>It's shocking to me how few people realize that anti depressants very rarely outperform placebo very rarely? >Findings >We identified 28 552 citations and of these included 522 trials comprising 116 477 participants. In terms of efficacy, all antidepressants were more effective than placebo ... https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
- engineeringwoke 4y ago
  > All antidepressants were more efficacious than placebo in adults with major depressive disorder 1 in 4 American adult women take anti-depressant drugs. Do they all have major depressive disorder?
  - mschuster91 4y ago
    > Do they all have major depressive disorder? Given that women have to bear an utter majority of the workload summarized as "care work", anything from raising children over household chores to caring for elderly relatives, on top of female-specific health issues like painful periods or endometriosis (10% of women [1], and that is before under-diagnosis or late diagnosis comes into play [2]), it makes sense that a lot of women end up with depression-related symptoms. Other societal factors that increase load on women (like the drug crisis, absent fathers, rampant sexism and misogyny in society, the recent barrage of threats to womens' lives and reproductive health) also come as an additional risk factor. Additionally, as women have entered the work force over the last decades for a number of reasons, it also makes sense they now have rising rates of work-related mental health issues like burnout and depression. And what also must not be forgotten is a severe under-diagnosis for mental health in men. Barely half the men that self-report symptoms of depression or other mental health issues actually seek out help [3], my personal guess is that this is to a large degree because the historic image of "male-ness" outright ignores mental health issues and labels men that seek help for these as "weak", which has been shown for PTSD in var veterans. Women have it "easier" from social expectations, which may help to hide the fact that, were men equally invested in their mental health, they'd end up at the same ratio of depression! [1] https://www.who.int/news-room/fact-sheets/detail/endometriosis https://www.who.int/news-room/fact-sheets/detail/endometrios... [2] https://www.forbes.com/sites/alicebroster/2020/08/27/why-it-takes-so-long-to-be-diagnosed-with-endometriosis-according-to-a-expert/?sh=1f6bf4c86967 https://www.forbes.com/sites/alicebroster/2020/08/27/why-it-... [3] https://jamanetwork.com/journals/jama/article-abstract/2434694 https://jamanetwork.com/journals/jama/article-abstract/24346...
  - mtlmtlmtlmtl 4y ago
    Are you being intentionally dense? Antidepressants are also used to treat most anxiety disorders, including GAD, OCD and PTSD. As well as depressive disorders other than MDD.
  - WastingMyTime89 4y ago
    Antidepressants being overprescribed is an issue entirely unrelated to antidepressants working better than placebo. What's your argument here exactly?
- nostrebored 4y ago
  Right, a metastudy where one of the stipulations is: "We excluded ... trials that ... included 20% or more of participants with ... treatment-resistant depression" And still the result is: "46 (9%) of 522 trials were rated as high risk of bias, 380 (73%) trials as moderate, and 96 (18%) as low; and the certainty of evidence was moderate to very low." And the cognitive bias is towards efficacy. We've raised and taught two generation of people who believe in a thoroughly defunct theory of 'chemical imbalance'. SSRIs are conceived from this idea and presented as evidence of this idea, but it simply does not hold up under scrutiny [1]. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/
  - gruez 4y ago
    > Right, a metastudy where one of the stipulations is: >"We excluded ... trials that ... included 20% or more of participants with ... treatment-resistant depression" That seems reasonable, as long as 20% isn't the baseline level of "treatment-resistant depression". If you're going to do a search for all anti-depressants studies, you're bound to turn up some studies that are researching-treatment resistant depression. If you're trying to study how anti-depressants behave typically, it makes sense to exclude the extreme examples, just like if you're trying to study whether an anti-cancer medication works you want to exclude the cases where the patient was on his deathbed.

gruez 4y ago

>It's shocking to me how few people realize that anti depressants very rarely outperform placebo very rarely? >Findings >We identified 28 552 citations and of these included 522 trials comprising 116 477 participants. In terms of efficacy, all antidepressants were more effective than placebo ... https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

engineeringwoke 4y ago
> All antidepressants were more efficacious than placebo in adults with major depressive disorder 1 in 4 American adult women take anti-depressant drugs. Do they all have major depressive disorder?
- mschuster91 4y ago
  > Do they all have major depressive disorder? Given that women have to bear an utter majority of the workload summarized as "care work", anything from raising children over household chores to caring for elderly relatives, on top of female-specific health issues like painful periods or endometriosis (10% of women [1], and that is before under-diagnosis or late diagnosis comes into play [2]), it makes sense that a lot of women end up with depression-related symptoms. Other societal factors that increase load on women (like the drug crisis, absent fathers, rampant sexism and misogyny in society, the recent barrage of threats to womens' lives and reproductive health) also come as an additional risk factor. Additionally, as women have entered the work force over the last decades for a number of reasons, it also makes sense they now have rising rates of work-related mental health issues like burnout and depression. And what also must not be forgotten is a severe under-diagnosis for mental health in men. Barely half the men that self-report symptoms of depression or other mental health issues actually seek out help [3], my personal guess is that this is to a large degree because the historic image of "male-ness" outright ignores mental health issues and labels men that seek help for these as "weak", which has been shown for PTSD in var veterans. Women have it "easier" from social expectations, which may help to hide the fact that, were men equally invested in their mental health, they'd end up at the same ratio of depression! [1] https://www.who.int/news-room/fact-sheets/detail/endometriosis https://www.who.int/news-room/fact-sheets/detail/endometrios... [2] https://www.forbes.com/sites/alicebroster/2020/08/27/why-it-takes-so-long-to-be-diagnosed-with-endometriosis-according-to-a-expert/?sh=1f6bf4c86967 https://www.forbes.com/sites/alicebroster/2020/08/27/why-it-... [3] https://jamanetwork.com/journals/jama/article-abstract/2434694 https://jamanetwork.com/journals/jama/article-abstract/24346...
- mtlmtlmtlmtl 4y ago
  Are you being intentionally dense? Antidepressants are also used to treat most anxiety disorders, including GAD, OCD and PTSD. As well as depressive disorders other than MDD.
- WastingMyTime89 4y ago
  Antidepressants being overprescribed is an issue entirely unrelated to antidepressants working better than placebo. What's your argument here exactly?
nostrebored 4y ago
Right, a metastudy where one of the stipulations is: "We excluded ... trials that ... included 20% or more of participants with ... treatment-resistant depression" And still the result is: "46 (9%) of 522 trials were rated as high risk of bias, 380 (73%) trials as moderate, and 96 (18%) as low; and the certainty of evidence was moderate to very low." And the cognitive bias is towards efficacy. We've raised and taught two generation of people who believe in a thoroughly defunct theory of 'chemical imbalance'. SSRIs are conceived from this idea and presented as evidence of this idea, but it simply does not hold up under scrutiny [1]. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/
- gruez 4y ago
  > Right, a metastudy where one of the stipulations is: >"We excluded ... trials that ... included 20% or more of participants with ... treatment-resistant depression" That seems reasonable, as long as 20% isn't the baseline level of "treatment-resistant depression". If you're going to do a search for all anti-depressants studies, you're bound to turn up some studies that are researching-treatment resistant depression. If you're trying to study how anti-depressants behave typically, it makes sense to exclude the extreme examples, just like if you're trying to study whether an anti-cancer medication works you want to exclude the cases where the patient was on his deathbed.