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Comment by OldSchool | Hacker News Reader

As a young engineer-type with no exposure to the psych field, I had about the same opinion when I was in my early 20's.

However, a few decades of real life later I've seen first-hand, successes and turnarounds for people who either found themselves in bad situations or were just plain genetically vulnerable. In fact, I'll go as far as saying that counseling or therapy are nothing compared to the difference that the right medication(s) can make in a life. Finding it is hit-or-miss, and there are still people who ultimately can't be helped but there are countless success stories - they just aren't worth reporting, like every time antibiotics work as expected.

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I agree with you for the most part. There are people with severe, debilitating conditions that may require medical intervention.

There are many, many more that have been labeled due to loose diagnosing guidelines to have a psychiatric disorder. A psychiatrist might just notice that your affect is slightly off, and label you with schizoaffective disorder, which is pretty well known as the diagnosis you give when you can't really put your finger on what's wrong, and yet they still treat medically.

How many people diagnosed with MDD or hypomania, do you think, genuinely deserve treatment with muddy medications? How many of them do you think may have other rectifiable issues that are leading to their disposition? Psychiatrists tend to overlook identifying those issues, and jump to asking the questions needed to diagnose a disease as per the DSM-IV.

As a programmer and former EEG tech, all I can do is nod quietly. They could be way more scientific about their medication selection if they wanted to be [1][2] but most psychiatrists are overconfident in their own judgement.

[1] http://www.ncneurocenter.com/eeg/eeg_reference.html

[2] http://en.wikipedia.org/wiki/Quantitative_electroencephalogr...

There's a difference between "how about we approach it more appropriately" and kyro's "we shouldn't use this at all until we have a near-complete understanding".

I never advocated discontinuing the use of medications. In fact, I acknowledged their efficacy. I'm all for treating the people that cannot function otherwise -- they may have no other choice. I think for millions of others, there are other choices that are not being adequately pursued or encouraged.

The same is true of most parts of medicine. Evidence based practice is quite rare unfortunately.

At least the pills are -- at worst -- mostly harmless, the surgeons who cut at the drop of hat (viz. almost all of them) do far more damage.

Exactly right. Missing from the article is a sense of just how far these drugs have allowed us to come as a society. Researching the history of mental illness treatments is almost as horrifying as reading about slavery. For serious illnesses it could be horrific.

Today, many powerful mental illnesses can be brought under control by medication. For example, the brother of a close friend suffers from schizophrenia. His drugs work so well that the biggest risk he faces is deciding that he feels so normal that he's cured, and can stop taking the drugs (which would result in a relapse).

Homeopaths and faith healers say exactly the same thing. Personal anecdotes are not data.

Most mental health disorders are inherently self-limiting and will disappear without any treatment, which makes psychiatry look far more effective than it really is. If you're depressed, you're statistically likely to not be depressed in six months time, regardless of whether you seek treatment or not. In these circumstances, it's easy for a completely ineffective treatment to look like a miracle cure. The key outcome measures for most psychiatric drug trials are episode duration and likelihood of relapse, which speaks volumes.

> Most mental health disorders are inherently self-limiting and will disappear without any treatment

Source?

Most health disorders are self-limiting. By and large, the body heals itself, except when it doesn't.

From Wiki http://en.wikipedia.org/wiki/Major_depressive_episode:

If left untreated, a typical major depressive episode may last for about six months, while about 20% of these episodes can last two years or more, with 50% of depressive episodes ending spontaneously.

I can probably find you an article reference if you want. But I have learned this kind of research findings in psychology class.

There's also a such thing as chronic depression, and reason to think that major depression follows a relapsing-remitting course, at least in some people, and may turn into or be a warning sign of developing chronic depression.

Which says nothing about the effectiveness of psychiatric treatments. But it does argue for aggressive early treatment, whatever that might mean, in the hope of halting the progression before it could become chronic.

Mental illness is fundamentally hard to study scientifically, and I'm not convinced that any of the treatments we have actually work. But it's humane to make the attempt.

>Personal anecdotes are not data.

Um, yes they are. Are they reliable data? I'm not convinced they're not.

>If you're depressed, you're statistically likely to not be depressed in six months time, regardless of whether you seek treatment or not. In these circumstances, it's easy for a completely ineffective treatment to look like a miracle cure.

Because never in the history of medicine has a treatment for depression had an immediate effect?

No depression treatment is claimed to have an immediate effect. If you start taking SSRIs and immediately feel better, it's pure placebo - the marketers of those drugs say that SSRIs take weeks to show any noticeable effect.

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