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> Human genome, done.

The main takeaway from the Human Genome Project was that we understand less about DNA now than we thought we did in 1999.

I read another article yesterday that even our most basic assumption, that all cells in a body share the same DNA, may not even be true: https://www.sciencedaily.com/releases/2019/02/190215135835.h...

Financial interests, publish or perish, p value abuse, reproducibility crisis...you're right to be skeptical of any soft, non experimental science.

I think the big problem is that all those fields are still very new and the thing they're studying is extremely complex and hard to directly study.

I'd argue that chemistry really began with Lavoisier in the late 1700s. Physics? Late 1600s with Galileo and Newton. What about psychiatry? I'd argue that it really got going in the latter half of the 20th century. Freud and lobotomies? They were the equivalent of alchemy. Other fields have been around in a recognizably modern fashion for hundreds of years. The same cannot be said of psychiatry and psychology.

And that's not surprising. The brain and mind are incredibly difficult to study directly. Until the advent of EEC, fMRI, and other modern tools, the only real way to do it was by studying behavior. Similarly, the brain is very complex. We didn't have, what could be considered, a modern picture of the atom until the early 1900s and that was after several major discoveries spread over a few decades. It's not surprising that we're still struggling with the brain.

>Back in highschool we had a massively depressed friend. They tried it all with her: cognitive behavioral therapy, drugs (ALL OF THEM), weed, religion. Tough love. Exercise. Diet. Nothing cured her and her depression killed her via suicide. What's the psych tell me after? Sometimes there's nothing we can do? That sucks. Human genome, done. Prevent HIV from killing someone. Can't do shit about depression sometimes.

That's still the case for a lot of things. You have ALS? On average, you'll be dead in two to four years. 90% of people die within 10 years. Treatment is mainly supportive. Likewise, it's the 1800s and you contract a bacterial disease? Can't do anything about that, antibiotics won't be invented for decades. Drain the pus and hope that you survive.

On ADHD, it turns out that Concerta and Adderall are indistinguishable to me. I take a low dosage and the side effects are basically non-existent and it also gets rid of my anxiety and depression. But it also happens that exercise reduces the intensity of all my symptoms. I only found this out when I stopped going to the gym for two weeks and noticed that my medication doesn't seem to be as effective.

It's quite possible that, if I hadn't been in the habit of exercising regularly, I would've required a higher dosage that would give me severe side effects. It's also possible that I would be fine. How is my psychiatrist supposed to know that? Maybe exercise doesn't work for some people, maybe diet is critical, maybe it's getting enough sunlight. The entire web of interactions is extremely complex and we don't currently have the ability to examine it at a fine level.

Speaking of complex interactions, ADHD is predominantly genetic and there are a number of genes that can contribute to it. For example, a variant of the gene that codes the protein Latrophilin 3 is estimated to be responsible for roughly 10% of ADHD cases. People with this variant are also very responsive to stimulant medication. Given the way that I respond to medication, it wouldn't be surprising if that's responsible for my ADHD.

But other people might have multiple gene variants, each contributing to a portion of the severity of their ADHD. Adequately treating them might require a very specific combination of drugs. The current process is trial and error, but it's possible that you'll never hit that magic combination. Likewise, maybe there is no magic combination in existing drugs or maybe the ideal dose is 6mg, but it only comes in 5mg and 10mg doses.

The medication situation is getting better. There are services that will run a genetic analysis to determine which medications might be most effective. But it's still in its infancy and that's only a portion of the picture.

The brain is complex and our current tools for examining and treating it are still blunt. Don't get me wrong, there are definitely systemic issues in those fields that need to be corrected. But a lot of criticisms seem to boil down to the equivalent of "It's 1819, why haven't chemists invented acrylic to replace the glass in my glasses?"

Sorry to hear about your friend. I swear psychiatrists are exempt from observing the Hippocratic oath.

"I need help. My life is falling apart. I'm struggling with work and school. I might have a learning disability."

"You sound depressed. Here's a prescription for some obscure variant of an SSRI not covered by your insurance."

"These meds you put me on make me feel sick."

"Let's increase your dose."

"I want to hurt other people. I want to die."

"It takes 4-6 weeks for it to take full effect."

"This just isn't working."

"Let's add another variable to the equation. Here's a second prescription. Take both and see what happens."

The experiment must continue. It always ends the same way.

I know psychiatry helps some people (especially where sedatives are involved), but for the rest of us who slip through the cracks it's just the new Nazi science.

Would you rather: "This just isn't working." "Okay, well we tried."

Once you're in the "this isn't working" phase of your story, shit is pretty dire. Hard to blame the caregiver for trying something else.

Honestly, yes. The solution to something not working is seldom to increase its complexity and/or double or triple down on it.

Bad treatments often exacerbate or inflict the symptoms they're supposed to correct.

It's a difficult one because sometimes it _does_ help people. 50mg of sertraline does nothing (other than making me sleep less, thus aggravating the base symptoms), 200mg made me feel sick for a week, but after that I'm noticeably better (OCD).

The thing is, when there are so many people who insist it isn't working, or even makes things worse, (while nobody has much of idea why the drugs should work in the first place, and there seems to be a growing movement to try treating people with currently illicit drugs instead), maybe the drugs are actually not working and the "experts" actually have no idea what they are doing.

I can only imagine the frustration you are describing, but I still wonder if the blame is really on the doctors or the branch of medicine. Is there a better alternative?

Hard to say.

I think the branch itself is too immature to have as much clout as it does, but we'd make a lot of progress if they'd start listening to their patients more than they listen to their drug reps.

The first thing you need to ask is are we, collectively, seeing an improvement or a deterioration of aggregate mental health? And how does this compare and contrast against nations where pharmacological treatment of illness is less and, if such a thing exists, more common? In other words is what we are doing better than nothing? The answer to this question is not always yes, because it's entirely possible that in the process of trying to do something you end up going backwards.

This also cannot be answered with isolated consideration such as the effectiveness of drug 'x' since there are externalities involved. What happens to these individuals in the longrun? The treatment of ADHD with amphetamines is a great one for this question. For those who showed no response to the treatment, are their outcomes better or worse than if they had never pursued treatment? What is the false positive rate and what is the affect of medication on these individuals?

The answer to this question should be obvious, but I'm not so sure it is anymore.

I don't disagree with your basic point, but that's a huge correlation bias. Why would a country with little mental illness introduce these medications?

It's not countries introducing drugs, but companies. And companies are driven primarily by a profit motive. This is not a bad thing in and of itself since it creates a private incentive for the research and development of drugs. However, when the money starts to become prioritized more heavily than the product being made, it creates a severe conflict of interest. The recent issue with opioids being an obvious example of this. Quoting this [1] great article from the Houston Chronicle:

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"The trigger of the opioid crisis was a misrepresentation of a 1980 letter published in the New England Journal of Medicine, reporting on 11,000 hospitalized patients receiving opioids. It concluded that “despite widespread use of narcotic drugs in hospitals… addiction is rare in medical patients with no history of addiction.” This became a landmark study, cited more than 600 times, particularly after Purdue Pharma introduced OxyContin (extended-release oxycodone) in 1995.

Large opioids manufacturers began funding nonprofit groups such as the American Pain Society; and pain experts advocated for pain to become an important “fifth vital sign” to be queried in every doctor’s visit when checking blood pressure, heart rate, respiration and temperature.

Caught in the trend, the Federation of American Medical Boards encouraged punishing physicians for under-treating pain. This policy was drafted by individuals with ties to opioids manufacturers. Some were members of industry speakers’ bureaus, and later became company executives.

Purdue funded more than 20,000 educational programs between 1996 and 2002 to influence physician prescription habits nationwide, and developed a misleading advertising campaign that claimed that the risk of addiction from prescription opioids was “much less than 1%.” OxyContin sales grew from $48 million in 1996, to over $1.5 billion in 2002. With increased sales came increased abuse and addiction. By 2004, OxyContin was the leading drug of abuse in the United States.

In 2007, Purdue (and three executives) pleaded guilty to misrepresenting the risks of OxyContin addiction and paid $634 million in penalties, a fraction of the $35 billion in sales in two decades."

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It's pretty sick stuff, but extremely clear evidence that these comes have come to see profit as the sole point of their existence. And these companies have extensive reach. And opioids are obviously not the only example here. This is a typical pattern, even if a rather extreme case. For instance the nonprofit industry tool used to push medicating and diagnosing of ADD is CHADD - Children and Adults with ADD.

[1] - https://www.houstonchronicle.com/opinion/outlook/article/Opi...

>better alternative

I don't know what they're teaching at psych school but it should include a single class on "researching all the shit your ADHD and depression patients, who will be your most common patients, have to look up on their own."

So, knowledge of all the treatments to depression, from ssris (and what they do to you) through diet and exercise, meditation, mindfulness, etc. Basically Try Harder.

Maybe I was just unlucky?