8 ms·

Because the problem's not a "neurochemistry issue" (that theory's been debunked and the "chemicals" in play have never been known), and the solution is "no bett

Because the problem's not a "neurochemistry issue" (that theory's been debunked and the "chemicals" in play have never been known), and the solution is "no better than placebo."

dekhn 11mo ago
[flagged]
- hintklb 11mo ago
  Not that I agree or disagree with the underlying claim but a call to "credentialism" to dismiss someone's opinion is not as strong in 2025 as you think it is. The last few years have been a proof that even the "experts" are following strong political or personal ideology. Also we don't live in the 18th century anymore. A lot of knowledge (especially around medicine) is open to the world. People can read papers, understand research etc.
  - dekhn 11mo ago
    In this area, having credentials makes a difference. Experts matter. Few if any non-medical people can read medical papers and make sense of what they say. There is simply far too much context to evaluate such papers, especially in the cases of complex medical conditions.
    - hintklb 11mo ago
      Sorry but strong disagree here. I have had a lot of Spinal and sleep issues. I have read almost all new literature on this niche subject and I have brought to my spine doctor some new therapy and treatments they had literally no idea about. Those treatments have changed my life. As an engineer I read a lot of deep technical paper as my day job. Medical papers are comparatively relatively simple. The most complex part being usually the statistical data analysis. We have pushed to a whole generation of people that only the "experts" can have opinion on some fields. I encourage everyone to read papers and have opinions on some of those subjects. We are in 2025. That type of gatekeeping needs to go away. AI if anything, is going to really help with this as well.
      - tjohns 11mo ago
        I think it's good to read papers and be curious. It's also good to work with your doctors (as you seem to have done), have a discussion, and mutually agree on a plan of treatment. Experts don't know everything. But they probably know some things you don't, and can think of questions you might not to have even thought to ask. As the saying goes, "you don't know what you don't know". Experience matters. There's also a lot of people out there without an academic background that don't know how to properly read journal papers. It's common to see folks do a quick search on PubMed, cherry-pick a single paper they agree with, and treat it as gospel - even if there's no evidence of repeatability. These skills are not something that many people outside STEM are exposed to.
        dekhn 11mo ago
        Cherrypicking is bad, but worse is reading a paper and thinking you understand what it says, when you don't actually understand what it says. Or thinking that a paper and its data can be observed neutrally as a factual and accurate statement for what work was actually done. My experience in journal club- basically, a group of grad students who all read a paper and then discuss it in person- taught me that most papers are just outright wrong for technical reasons. I'd say about 1 in 5 to 1 in 10 papers passes all the basic tests, and even the ones that do pass can have significant problems. For example, there is an increasing recognition that many papers in biology and medicine have fake data, or manipulated data, or corrupted data, or incorrectly labelled data. I know folks who've read papers and convinced themselvs the paper is good, when later the paper was retracted because the authors copied a few gels into the wrong columns...
        hintklb 11mo ago
        By extending your statement you are essentially saying that the credentialed experts have a monopoly on knowledge in their fields? As anyone else reading a paper probably think he understands but actually doesn't? What a weird take. The knowledge is out there. Yes there are a ton of bogus papers and a ton of bad research. Not everyone got the critical knowledge to figure this out but I also don't think this is only reserved to the "experts". They are also subject to groupthink and other political pressure to think a specific way. At the end of the day, do your best own research and work with your "expert" to agree on a solution. Pushing back on people reading paper is an anti-intellectual take (to use the same wording as another poster below).
    - deleted 11mo ago
      [deleted]
    - throaway19852 11mo ago
      Ya, well i was diagnosed with a serious genetic condition by my doctor. I found out i was misdiagnosed based on information from the support group for the condition. If I hadn't, I would have had unnecessary surgery. The excuse from my doctor? "I didn't know!"
  - rfrey 11mo ago
    > People can read papers, understand research etc. Then he should cite the papers, point out the research, etc. Rather than dismissing the entire discipline and all its practitioners with a wave of the "common-sense mental illness isn't real" wand.
- tremon 11mo ago
  I hope you do realize that this comment thread is linked to an article that includes the words "Prozac no better than placebo" in its headline?
  - dekhn 11mo ago
    Yes, I do. I don't consider articles in the regular press to be even remotely worth looking at due to their high rate of inaccuracy. Here's the paper that the article refers to: https://www.jclinepi.com/article/S0895-4356%2825%2900349-X/fulltext https://www.jclinepi.com/article/S0895-4356%2825%2900349-X/f...
  - malfist 11mo ago
    These types of studies are published all the time and can easily be dismissed. Antidepressants are _only_ for major depression. Not mild or moderate. These studies that find no significance compared to a placebo are always tried in patients with all types of depression. Not just major. It's so common it's a trope. "Antidepressants don't work" says the scientists testing antidepressants on things they're not supposed to work on. Studies repeated with just major depression all conclude antidepressants are better than a placebo. Click through the article to the study and you'll find they did not limit their study to must major
robertakarobin 11mo ago
Can you provide a source for that theory having been debunked? I agree that data has been found that is at odds with the various neurochemical theories but am not aware of the neurochemistry link as a whole having been definitely debunked.
- GOD_Over_Djinn 11mo ago
  [flagged]
  - robertakarobin 11mo ago
    Ah, well-put! I think we may be reacting differently to the same articles. My understanding is that while various neurochemical theories have not been proven as the general public seems to think, they have also not necessarily been disproven or debunked. Certainly it has not been proven that neurochemistry has no role at all.
  - ToucanLoucan 11mo ago
    Probably because the commenter is not a medical professional and isn't qualified to judge the veracity of anything they find. "Do your own research" is a fucking plague on our modern world and is why the internet is like wall to wall grifters now. By all means, Google whatever you like, but if you show up to a doctors office waving WebMD sheets in a medical professionals face, you are going to be mocked and you deserve it.
    - ckw 11mo ago
      I witnessed a pair of doctors prescribe a family member an incredibly dangerous drug for an off label use. The company had been fined $500 million dollars for various illegal schemes to convince doctors to write such prescriptions, but I’m sure the doctors in question were unaware of this. When this family member began to exhibit textbook symptoms of an extremely dangerous (life threatening) condition which could only be caused by the drug in question, the doctors failed to notice, and in fact repeatedly increased the dosage, and added more drugs on top to treat the symptoms caused by the initial drug. It was not until I accompanied my relative to a doctor’s appointment and delivered a carefully designed incantation that they made the correct diagnosis and halted the prescriptions. So should I not have done my own research?
amanaplanacanal 11mo ago
I don't think we know if it's a neurochemistry issue. From what I understand what was debunked was the idea that they worked by blocking the reuptake of serotonin specifically.
amluto 11mo ago
…so what? There’s an interesting theory lately [0] that the antidepressant effect of SSRIs is actually unrelated to its effect on serotonin. Suppose, for the sake of argument, that this is completely true: serotonin has nothing to do with depression, increasing serotonin levels is useless for treating depression, and everything everyone has ever claimed about chemical imbalances causing depression is flat-out wrong. If so, pharma companies should probably try to develop different drugs instead of new SSRIs. But it does not follow that a patient with depression ought not to take an SSRI. That would be like saying that taking aspirin for aches has been completely debunked because there is no connection between aches and aspirin’s anticoagulant effect. [0] See, for example, https://www.science.org/content/blog-post/trkb-bdnf-and-depression https://www.science.org/content/blog-post/trkb-bdnf-and-depr...
crowbahr 11mo ago
> Because the problem's not a "neurochemistry issue" (that theory's been debunked and the "chemicals" in play have never been known), and the solution is "no better than placebo." It most certainly has not been debunked and mind altering chemicals most certainly do work. SSRIs have _questionable_ efficacy but that's not the same as proven to have none, which is an exceptionally high bar. This is close minded dogma no better a religion.
- hajile 11mo ago
  If you don't have a serious model for what you are treating, then you are experimenting on your patients and hoping it works for unknown reasons. Not too different from folk remedies. Even worse, patients are essentially never informed that the doctor is throwing things at the wall hoping something sticks.
  - johnisgood 11mo ago
    You just described what psychiatrists do. (I have many first-hand and second-hand experiences.)
nuancebydefault 11mo ago
"neurochemistry issue debunked" is a very weak argument about the (in)effectiveness of proper drugs for treatment of mental illness. It's not exactly known how they work but I am 100 percent sure SSRIs often have a very positive, even life changing effect. Moreover, every approved drug is tested 'double blind' exactly because the placebo effect has such a big biasing effect on subjectively appreciated outcomes. Only when ruling out pure placebo effect, a drug can be approved.
- jacobgkau 11mo ago
  > Moreover, every approved drug is tested 'double blind' exactly because the placebo effect has such a big biasing effect on subjectively appreciated outcomes. Only when ruling out pure placebo effect, a drug can be approved. Pretty weird the article we're commenting on about Prozac being no better than placebo for children is just now coming out when it was already approved for use in children, then.

Because the problem's not a "neurochemistry issue" (that theory's been debunked and the "chemicals" in play have never been known), and the solution is "no better than placebo."

dekhn 11mo ago

[flagged]

hintklb 11mo ago
Not that I agree or disagree with the underlying claim but a call to "credentialism" to dismiss someone's opinion is not as strong in 2025 as you think it is. The last few years have been a proof that even the "experts" are following strong political or personal ideology. Also we don't live in the 18th century anymore. A lot of knowledge (especially around medicine) is open to the world. People can read papers, understand research etc.
- dekhn 11mo ago
  In this area, having credentials makes a difference. Experts matter. Few if any non-medical people can read medical papers and make sense of what they say. There is simply far too much context to evaluate such papers, especially in the cases of complex medical conditions.
  - hintklb 11mo ago
    Sorry but strong disagree here. I have had a lot of Spinal and sleep issues. I have read almost all new literature on this niche subject and I have brought to my spine doctor some new therapy and treatments they had literally no idea about. Those treatments have changed my life. As an engineer I read a lot of deep technical paper as my day job. Medical papers are comparatively relatively simple. The most complex part being usually the statistical data analysis. We have pushed to a whole generation of people that only the "experts" can have opinion on some fields. I encourage everyone to read papers and have opinions on some of those subjects. We are in 2025. That type of gatekeeping needs to go away. AI if anything, is going to really help with this as well.
    - tjohns 11mo ago
      I think it's good to read papers and be curious. It's also good to work with your doctors (as you seem to have done), have a discussion, and mutually agree on a plan of treatment. Experts don't know everything. But they probably know some things you don't, and can think of questions you might not to have even thought to ask. As the saying goes, "you don't know what you don't know". Experience matters. There's also a lot of people out there without an academic background that don't know how to properly read journal papers. It's common to see folks do a quick search on PubMed, cherry-pick a single paper they agree with, and treat it as gospel - even if there's no evidence of repeatability. These skills are not something that many people outside STEM are exposed to.
      - dekhn 11mo ago
        Cherrypicking is bad, but worse is reading a paper and thinking you understand what it says, when you don't actually understand what it says. Or thinking that a paper and its data can be observed neutrally as a factual and accurate statement for what work was actually done. My experience in journal club- basically, a group of grad students who all read a paper and then discuss it in person- taught me that most papers are just outright wrong for technical reasons. I'd say about 1 in 5 to 1 in 10 papers passes all the basic tests, and even the ones that do pass can have significant problems. For example, there is an increasing recognition that many papers in biology and medicine have fake data, or manipulated data, or corrupted data, or incorrectly labelled data. I know folks who've read papers and convinced themselvs the paper is good, when later the paper was retracted because the authors copied a few gels into the wrong columns...
        hintklb 11mo ago
        By extending your statement you are essentially saying that the credentialed experts have a monopoly on knowledge in their fields? As anyone else reading a paper probably think he understands but actually doesn't? What a weird take. The knowledge is out there. Yes there are a ton of bogus papers and a ton of bad research. Not everyone got the critical knowledge to figure this out but I also don't think this is only reserved to the "experts". They are also subject to groupthink and other political pressure to think a specific way. At the end of the day, do your best own research and work with your "expert" to agree on a solution. Pushing back on people reading paper is an anti-intellectual take (to use the same wording as another poster below).
  - deleted 11mo ago
    [deleted]
  - throaway19852 11mo ago
    Ya, well i was diagnosed with a serious genetic condition by my doctor. I found out i was misdiagnosed based on information from the support group for the condition. If I hadn't, I would have had unnecessary surgery. The excuse from my doctor? "I didn't know!"
- rfrey 11mo ago
  > People can read papers, understand research etc. Then he should cite the papers, point out the research, etc. Rather than dismissing the entire discipline and all its practitioners with a wave of the "common-sense mental illness isn't real" wand.
tremon 11mo ago
I hope you do realize that this comment thread is linked to an article that includes the words "Prozac no better than placebo" in its headline?
- dekhn 11mo ago
  Yes, I do. I don't consider articles in the regular press to be even remotely worth looking at due to their high rate of inaccuracy. Here's the paper that the article refers to: https://www.jclinepi.com/article/S0895-4356%2825%2900349-X/fulltext https://www.jclinepi.com/article/S0895-4356%2825%2900349-X/f...
- malfist 11mo ago
  These types of studies are published all the time and can easily be dismissed. Antidepressants are _only_ for major depression. Not mild or moderate. These studies that find no significance compared to a placebo are always tried in patients with all types of depression. Not just major. It's so common it's a trope. "Antidepressants don't work" says the scientists testing antidepressants on things they're not supposed to work on. Studies repeated with just major depression all conclude antidepressants are better than a placebo. Click through the article to the study and you'll find they did not limit their study to must major

robertakarobin 11mo ago

Can you provide a source for that theory having been debunked? I agree that data has been found that is at odds with the various neurochemical theories but am not aware of the neurochemistry link as a whole having been definitely debunked.

GOD_Over_Djinn 11mo ago
[flagged]
- robertakarobin 11mo ago
  Ah, well-put! I think we may be reacting differently to the same articles. My understanding is that while various neurochemical theories have not been proven as the general public seems to think, they have also not necessarily been disproven or debunked. Certainly it has not been proven that neurochemistry has no role at all.
- ToucanLoucan 11mo ago
  Probably because the commenter is not a medical professional and isn't qualified to judge the veracity of anything they find. "Do your own research" is a fucking plague on our modern world and is why the internet is like wall to wall grifters now. By all means, Google whatever you like, but if you show up to a doctors office waving WebMD sheets in a medical professionals face, you are going to be mocked and you deserve it.
  - ckw 11mo ago
    I witnessed a pair of doctors prescribe a family member an incredibly dangerous drug for an off label use. The company had been fined $500 million dollars for various illegal schemes to convince doctors to write such prescriptions, but I’m sure the doctors in question were unaware of this. When this family member began to exhibit textbook symptoms of an extremely dangerous (life threatening) condition which could only be caused by the drug in question, the doctors failed to notice, and in fact repeatedly increased the dosage, and added more drugs on top to treat the symptoms caused by the initial drug. It was not until I accompanied my relative to a doctor’s appointment and delivered a carefully designed incantation that they made the correct diagnosis and halted the prescriptions. So should I not have done my own research?

amanaplanacanal 11mo ago

I don't think we know if it's a neurochemistry issue. From what I understand what was debunked was the idea that they worked by blocking the reuptake of serotonin specifically.

amluto 11mo ago

…so what? There’s an interesting theory lately [0] that the antidepressant effect of SSRIs is actually unrelated to its effect on serotonin. Suppose, for the sake of argument, that this is completely true: serotonin has nothing to do with depression, increasing serotonin levels is useless for treating depression, and everything everyone has ever claimed about chemical imbalances causing depression is flat-out wrong. If so, pharma companies should probably try to develop different drugs instead of new SSRIs. But it does not follow that a patient with depression ought not to take an SSRI. That would be like saying that taking aspirin for aches has been completely debunked because there is no connection between aches and aspirin’s anticoagulant effect. [0] See, for example, https://www.science.org/content/blog-post/trkb-bdnf-and-depression https://www.science.org/content/blog-post/trkb-bdnf-and-depr...

crowbahr 11mo ago

> Because the problem's not a "neurochemistry issue" (that theory's been debunked and the "chemicals" in play have never been known), and the solution is "no better than placebo." It most certainly has not been debunked and mind altering chemicals most certainly do work. SSRIs have _questionable_ efficacy but that's not the same as proven to have none, which is an exceptionally high bar. This is close minded dogma no better a religion.

hajile 11mo ago
If you don't have a serious model for what you are treating, then you are experimenting on your patients and hoping it works for unknown reasons. Not too different from folk remedies. Even worse, patients are essentially never informed that the doctor is throwing things at the wall hoping something sticks.
- johnisgood 11mo ago
  You just described what psychiatrists do. (I have many first-hand and second-hand experiences.)

nuancebydefault 11mo ago

"neurochemistry issue debunked" is a very weak argument about the (in)effectiveness of proper drugs for treatment of mental illness. It's not exactly known how they work but I am 100 percent sure SSRIs often have a very positive, even life changing effect. Moreover, every approved drug is tested 'double blind' exactly because the placebo effect has such a big biasing effect on subjectively appreciated outcomes. Only when ruling out pure placebo effect, a drug can be approved.

jacobgkau 11mo ago
> Moreover, every approved drug is tested 'double blind' exactly because the placebo effect has such a big biasing effect on subjectively appreciated outcomes. Only when ruling out pure placebo effect, a drug can be approved. Pretty weird the article we're commenting on about Prozac being no better than placebo for children is just now coming out when it was already approved for use in children, then.