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.