5 ms·

> although that could entirely be due to placebo effect If the drugs had no effect, then why are people (ab)using drugs like Adderall to improve cognition, etc

by pyre 13y ago

> although that could entirely be due to placebo effect If the drugs had no effect, then why are people (ab)using drugs like Adderall to improve cognition, etc? A big problem with trying to make a science out of the brain, is that it can be very unique to the person. For example, in people that are blind since birth, the pathways in the brain that are normally used for visual processing can get re-purposed over a lifetime to be used for other things. I'd almost say that the brain is sort of like an evolutionary algorithm. Given similar parameters, the results largely resemble each other, but alter things enough and the results can be way off.

freyr 13y ago
>If the drugs had no effect, then why are people (ab)using drugs like Adderall to improve cognition, etc? Placebo effect is certainly an effect. But the claim is not that the drugs don't have an effect (though it's true, some work no more effective than a placebo), but that we have no sound explanation for their effects.
- pyre 13y ago
  > though it's true, some work no more effective than a placebo Do you have a citation for this? What drugs on the market today are "no more effective than placebo?"
  - freyr 13y ago
    There are many studies. Here's one: http://jama.jamanetwork.com/article.aspx?articleid=185157 http://jama.jamanetwork.com/article.aspx?articleid=185157 This study found that SSRIs provided little to no benefit over placebo for patients suffering from mild to moderate depression. SSRIs did provide a benefit to patients suffering from severe depression. This raises the question, how many of the 30+ million Americans currently prescribed anti-depressants actually suffer from severe depression and benefit from the drugs? How many are taking it unnecessarily, subjecting themselves to unintended side effects and eventual withdrawal symptoms.
    - phren0logy 13y ago
      You ignore people who take it for anxiety, where SSRI are uncontrovertibly effective.
WildUtah 13y ago
Amphetamine is certainly effective and fairly well understood in its clinical effects. There is no doubt about its effectiveness and principal uses and side effects. (Adderall(^tm) is a brand name for amphetamine.) Serotonin reuptake inhibitors used for mood management are just a matter of trying them and seeing if you like the way they feel. It's exactly as scientific as drinking liquor or smoking marijuana to see if it makes you more mellow. But doctors are going around collecting rent on their prescription pads by writing scrips for Paxil and Prozac and the like as if they were technical and carefully calibrated professional tools that required twelve years of college and med school and internships and apprenticeships to master and administer. They're doing all that training and then providing the same service as witch doctors -- but for a lot more money.
- jotm 13y ago
  You say the same thing that doctors say about SSRIs: is certainly effective and fairly well understood in its clinical effects. Yeah, of course we see the effects, but we still don't really know how exactly it works. For example, no one can tell for sure why Dextroamphetamine and levoamphetamine have different effects (the former is a brain stimulant, while the latter affects mostly the body). Adderall is mostly dextroamphetamine, by the way.
lutusp 13y ago
> If the drugs had no effect, then why are people (ab)using drugs like Adderall to improve cognition, etc? You're making an assumption here -- that people's trust in, and use of, drugs argues that it's not a mere placebo effect. But there are any number of accounts of people persuading themselves that a drug is reliable, for a drug that is in fact a placebo. In fact, that's how the placebo effect is defined. The only way to sort out these issues is with a double-blind prospective trial. Unfortunately, such trials are nearly nonexistent for this class of drugs, and those trials that have been conducted, are often run badly or published in very selective ways, creating the impression that the drugs are more effective than they really are. Reference (PDF warning): http://alphachoices.com/repository/assets/pdf/EmperorsNewDrugs.pdf http://alphachoices.com/repository/assets/pdf/EmperorsNewDru...
- refurb 13y ago
  Whoa, wait a second here. Your reference article is arguing that there isn't any difference between these drugs and placebos, so by definition it was a "placebo controlled trial". To say that "double-blind prospective trials are nearly non-existent" is very wrong. Unless you are referring to very old psychiatric drugs, most of them have gone through such trials. There was a lot of disagreement about the paper you referenced. CNS drug are notoriously hard to get positive clinical trial data for. The reasons are: (1) placebo effect is notoriously difficult to control for in psychiatric trials, (2) the clinical trial endpoints are very blunt measures of efficacy. But you know what? That's the best we have right now. There certainly is a strong requirement for efficacy in psychiatric drugs as evidenced by how many have failed to get approved by the FDA. The sad thing is that most big drug companies have completely pulled out of doing R&D for new CNS drugs. They are just too hard to get approved. The end result is that patients with psychiatric illnesses will end up with fewer treatments options unless this changes.
  - lutusp 13y ago
    > To say that "double-blind prospective trials are nearly non-existent" is very wrong. You need to read each word and think about it. In a prospective trial, subjects are chosen in advance, they aren't drawn from an existing population of people who have already decided to seek psychological help. A "double-blind, prospective trial" would have to sign people up from a cross-section of the population who have no interest in, or association with, psychological treatments. Then they would be divided into two groups. One group would receive the drug under test, the other would receive a placebo. And the trial would have to be designed so that the two groups wold not be able to tell to which group they belonged. Unfortunately, about the drugs under test, most of them have side effects, which means the subjects aren't blinded (the placebo group have no problem realizing who they are). Even will all its defects and shortcomings, what I have just described is unheard of in psychological testing. > Unless you are referring to very old psychiatric drugs, most of them have gone through such trials. Absolutely false. The kind of design I am describing is simply unheard of. Most trials are of self-selected psychological treatment clients, and it's not uncommon for the "control group" to be what are euphemistically called "no-treatment controls". Guess what that means -- it means the experimental group is compared to people who are told to go home with no treatment and no sham treatment. > There was a lot of disagreement about the paper you referenced. Yes, of course -- and that's the way it should be. But there have been enough similar studies and meta-analyses that the outcome is not in question. > But you know what? That's the best we have right now. Different topic. > There certainly is a strong requirement for efficacy in psychiatric drugs as evidenced by how many have failed to get approved by the FDA. Most of the drugs that just were proven ineffective were not ever tested for efficacy as psychological drugs, they were prescribed off-label -- they were originally approved for some other purpose. > The end result is that patients with psychiatric illnesses will end up with fewer treatments options unless this changes. If the treatments were effective, that would be a shame. But they aren't, so it isn't.

by pyre 13y ago

freyr 13y ago

>If the drugs had no effect, then why are people (ab)using drugs like Adderall to improve cognition, etc? Placebo effect is certainly an effect. But the claim is not that the drugs don't have an effect (though it's true, some work no more effective than a placebo), but that we have no sound explanation for their effects.

pyre 13y ago
> though it's true, some work no more effective than a placebo Do you have a citation for this? What drugs on the market today are "no more effective than placebo?"
- freyr 13y ago
  There are many studies. Here's one: http://jama.jamanetwork.com/article.aspx?articleid=185157 http://jama.jamanetwork.com/article.aspx?articleid=185157 This study found that SSRIs provided little to no benefit over placebo for patients suffering from mild to moderate depression. SSRIs did provide a benefit to patients suffering from severe depression. This raises the question, how many of the 30+ million Americans currently prescribed anti-depressants actually suffer from severe depression and benefit from the drugs? How many are taking it unnecessarily, subjecting themselves to unintended side effects and eventual withdrawal symptoms.
  - phren0logy 13y ago
    You ignore people who take it for anxiety, where SSRI are uncontrovertibly effective.

WildUtah 13y ago

Amphetamine is certainly effective and fairly well understood in its clinical effects. There is no doubt about its effectiveness and principal uses and side effects. (Adderall(^tm) is a brand name for amphetamine.) Serotonin reuptake inhibitors used for mood management are just a matter of trying them and seeing if you like the way they feel. It's exactly as scientific as drinking liquor or smoking marijuana to see if it makes you more mellow. But doctors are going around collecting rent on their prescription pads by writing scrips for Paxil and Prozac and the like as if they were technical and carefully calibrated professional tools that required twelve years of college and med school and internships and apprenticeships to master and administer. They're doing all that training and then providing the same service as witch doctors -- but for a lot more money.

jotm 13y ago
You say the same thing that doctors say about SSRIs: is certainly effective and fairly well understood in its clinical effects. Yeah, of course we see the effects, but we still don't really know how exactly it works. For example, no one can tell for sure why Dextroamphetamine and levoamphetamine have different effects (the former is a brain stimulant, while the latter affects mostly the body). Adderall is mostly dextroamphetamine, by the way.

lutusp 13y ago

> If the drugs had no effect, then why are people (ab)using drugs like Adderall to improve cognition, etc? You're making an assumption here -- that people's trust in, and use of, drugs argues that it's not a mere placebo effect. But there are any number of accounts of people persuading themselves that a drug is reliable, for a drug that is in fact a placebo. In fact, that's how the placebo effect is defined. The only way to sort out these issues is with a double-blind prospective trial. Unfortunately, such trials are nearly nonexistent for this class of drugs, and those trials that have been conducted, are often run badly or published in very selective ways, creating the impression that the drugs are more effective than they really are. Reference (PDF warning): http://alphachoices.com/repository/assets/pdf/EmperorsNewDrugs.pdf http://alphachoices.com/repository/assets/pdf/EmperorsNewDru...

refurb 13y ago
Whoa, wait a second here. Your reference article is arguing that there isn't any difference between these drugs and placebos, so by definition it was a "placebo controlled trial". To say that "double-blind prospective trials are nearly non-existent" is very wrong. Unless you are referring to very old psychiatric drugs, most of them have gone through such trials. There was a lot of disagreement about the paper you referenced. CNS drug are notoriously hard to get positive clinical trial data for. The reasons are: (1) placebo effect is notoriously difficult to control for in psychiatric trials, (2) the clinical trial endpoints are very blunt measures of efficacy. But you know what? That's the best we have right now. There certainly is a strong requirement for efficacy in psychiatric drugs as evidenced by how many have failed to get approved by the FDA. The sad thing is that most big drug companies have completely pulled out of doing R&D for new CNS drugs. They are just too hard to get approved. The end result is that patients with psychiatric illnesses will end up with fewer treatments options unless this changes.
- lutusp 13y ago
  > To say that "double-blind prospective trials are nearly non-existent" is very wrong. You need to read each word and think about it. In a prospective trial, subjects are chosen in advance, they aren't drawn from an existing population of people who have already decided to seek psychological help. A "double-blind, prospective trial" would have to sign people up from a cross-section of the population who have no interest in, or association with, psychological treatments. Then they would be divided into two groups. One group would receive the drug under test, the other would receive a placebo. And the trial would have to be designed so that the two groups wold not be able to tell to which group they belonged. Unfortunately, about the drugs under test, most of them have side effects, which means the subjects aren't blinded (the placebo group have no problem realizing who they are). Even will all its defects and shortcomings, what I have just described is unheard of in psychological testing. > Unless you are referring to very old psychiatric drugs, most of them have gone through such trials. Absolutely false. The kind of design I am describing is simply unheard of. Most trials are of self-selected psychological treatment clients, and it's not uncommon for the "control group" to be what are euphemistically called "no-treatment controls". Guess what that means -- it means the experimental group is compared to people who are told to go home with no treatment and no sham treatment. > There was a lot of disagreement about the paper you referenced. Yes, of course -- and that's the way it should be. But there have been enough similar studies and meta-analyses that the outcome is not in question. > But you know what? That's the best we have right now. Different topic. > There certainly is a strong requirement for efficacy in psychiatric drugs as evidenced by how many have failed to get approved by the FDA. Most of the drugs that just were proven ineffective were not ever tested for efficacy as psychological drugs, they were prescribed off-label -- they were originally approved for some other purpose. > The end result is that patients with psychiatric illnesses will end up with fewer treatments options unless this changes. If the treatments were effective, that would be a shame. But they aren't, so it isn't.