The Final Nail in Psychiatry's Antidepressant Coffin | Hacker News Reader

The Final Nail in Psychiatry's Antidepressant Coffin

counterpunch.org

20 pointsipunchghosts17 comments

This is a lot of bluster and citing academic sources like The Daily Mail. But the underlying criticism of Star*D may be valid, and you can read a much better criticism of it here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314062/

There is a very little bluster, this is a thorough summary of the main studies that should cause you to be skeptical of the efficacy of anti-depressants. He cites a Daily Mail article by Dr. Irving Kirsch himself, but he could have just as easily cited Irving Kirsch's actual studies which is what the article is about, but it shouldn't matter that much since it's the same author. There are many other citations to legitimate journals, it's odd that you would focus on this as your main criticism.

Even if an antidepressant would not work better than a placebo in treating depression, I experienced a case where its usage could be worthwile: if the side effects are beneficial. Someone I knew needed better sleep and more appetite and they got an antidepressant with two side effects: weight gain and sleepiness, to take just before going to bed.

So they got better because of placebo effects and better sleep and weight gain.

That's fine with me.

I don’t understand why the 931 people should have been excluded? They started treatment and entered remission in the first stage. And I couldn’t find it the paper that’s linked, though admittedly I skimmed.

This is a crank article. SSRIs were very effective for me, and it was 100% not placebo.

Not sure how tens of millions of people are all operating under a collective placebo delusion, yet this author totally figured it out.

I have also had good results with SSRIs.

Maybe you'd have had better luck with placebos. No side effects?

Placebos can sometimes have more harmful side effects than actual drugs: https://www.ox.ac.uk/news/science-blog/harmful-placebos

I had to try five different SSRI/SNRI’s before I found one that worked. I bet I could determine my SNRI vs a placebo in a double blind trial.

Similarly, I'd been on 6 different Tricyclics, SSRI and SNRI until I met my current meds. These ones (venlafaxine) work for me.

> SSRIs were very effective for me, and it was 100% not placebo.

You may have had extreme depression. That's the cohort that anti-depressents actually work for. But they are next to a scam for people with mild depression (or I should say, they do the same thing as placebo according to RCTs), which is where the majority of prescriptions go to. See Irving Kirsch's research on this question.

I'd add that, even if you didn't have extreme depression, I don't doubt that you experienced something that wasn't placebo, because you did take a substance that causes side effects. It is impossible to blind you to the consequences of a side-effect causing drug.

Is "extreme depression" a clinical term? I've heard of Major Depression, Chronic Depression, Clinical Depression.

I had depression, generalized anxiety, OCD, panic attacks, and myriad issues related to that. I tried years of meditation, diet changes, vitamins and supplements, and exercise routines.

When I finally agreed to try SSRIs after years of resistance, I was essentially cured within 3 weeks after 5 years of debilitating issues.

> debilitating issues.

Could it be that you had severe depression, if the issues were debilitating? Irving Kirsch's studies have shown that anti-depressents are indeed effective for such cases. Or perhaps it just happened to work for you. RCTs only look at mean effects so they dilute exceptions and outliers.

Anyways, this is a more pro-anti-depressants/pro-psychiatry analysis of Irving Kirsch's research:

https://slatestarcodex.com/2014/07/07/ssris-much-more-than-y...

The primary issue was anxiety and OCD. The drug worked, I know it’s hard for you to believe if you didn’t experience it yourself. But it is a night and day difference.

It's not a crank article. It exaggerates but does include specific criticism of a certain influential study.

I'm fairly skeptical of SSRIs. Most psychiatrists still parrot the "your brain needs more serotonin" line which is not backed by substantial evidence. I think SSRIs probably "work" as active placebos (with side effects) but are vastly overprescribed.

Also, it's very hard to know if an antidepressant worked for you because we can't test the counterfactual.

SSRIs are not placebo. They are very powerful drugs. Increasing the dosage has more extreme effects. To call it placebo is a misunderstanding of statistics.

If a drug doesn’t work for 80% of people but works for 20% very well, it might be indistinguishable statistically from placebo. That doesn’t mean it isn’t working.

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