Stef's SSRI critic..a fallacy?

[Libertyblues]

I just listened to this tedx talk:

 

It explained how the expectation of an outcome alters the result, citing a study using morphine given by a doctor and the other group received it automatically through a drip. The effect of pain release when administered knowingly by a doctor was a lot greater.

 

If you do a placebo controlled study with antidepressions the patients expectation is changed because he is unsure if he gets the real thing. This would take away the synergy effect of the expectation that the drug will help. Therefore the placebo-controlled result isn't showing the real effect of the drug.

 

How is this bias handled in the studies?

[WasatchMan]

If the drug works, you would expect that the patients who got the drug reported better results than those who got the placebo. If the results are similar, the drug is not worth using, especially when it has real side effects.

[dsayers]

SSRI's are like applying the brake to avoid hitting a brick wall, but NOT also taking your foot off the gas. In fact, with the brake in place, the brain only tries harder by pushing down on the accelerator harder. So that once the SSRI is no longer in place, you're actually worse off than when you started. Not sure how looking at a placebo will tell you what the biochemical effects of a non-placebo will be. Placebos are used as a control for self-reporting experiential data. Which biochemical reactions are not.

[Libertyblues]

My argument here is only in regard to the fallacy that a placebo is an effective way to test efficacy of a drug. The way I understand common placebo studies is that a patient receives a drug or a placebo, to which he consents in advance, thereby changing his expectation of efficacy. The placebo might work better than it should, the real drug less. The gap between the two could hide "true" efficacy..

 

Or is my logic wrong?

[WasatchMan]

My argument here is only in regard to the fallacy that a placebo is an effective way to test efficacy of a drug. The way I understand common placebo studies is that a patient receives a drug or a placebo, to which he consents in advance, thereby changing his expectation of efficacy. The placebo might work better than it should, the real drug less. The gap between the two could hide "true" efficacy..

 

Or is my logic wrong?

 

Your logic is right, and therefore these studies will use many participants and statistical methods to help flesh out the data and what it is actually telling you.

[algernon]

My argument here is only in regard to the fallacy that a placebo is an effective way to test efficacy of a drug. The way I understand common placebo studies is that a patient receives a drug or a placebo, to which he consents in advance, thereby changing his expectation of efficacy. The placebo might work better than it should, the real drug less. The gap between the two could hide "true" efficacy..

 

Or is my logic wrong?

 

I'm not sure I understand your statement, but as I understand it most drug studies are double blind, the researcher and the patient have no idea if they are using the placebo or the actual drug. The statistical significance of the drug performing better than the placebo is what determines if the drug works or not. Everyone will give consent to be given the drug, but only half receive it.

 

SSRIs have been shown to work in a way, the problem is mental illness has never been shown to be caused by a physiological disorder - are you depressed because you have a serotonin issue? They have no idea. If you are depressed maybe alcohol, cocaine or methamphetamine will make you feel better, is that in anyway treating the cause of the depression? 

[Libertyblues]

I'm not sure I understand your statement, but as I understand it most drug studies are double blind, the researcher and the patient have no idea if they are using the placebo or the actual drug. The statistical significance of the drug performing better than the placebo is what determines if the drug works or not. Everyone will give consent to be given the drug, but only half receive it.

 

SSRIs have been shown to work in a way, the problem is mental illness has never been shown to be caused by a physiological disorder - are you depressed because you have a serotonin issue? They have no idea. If you are depressed maybe alcohol, cocaine or methamphetamine will make you feel better, is that in anyway treating the cause of the depression?

even a double blind study needs prior consent from the patient. I doubt that pacients are tricked into thinking that they really aren't part of the study anymore. that would be the only way to reverse the effect described above...from what I can tell right now..

 

I've read a couple of times that missing substances from the enzyme chain which produce serotonin can physically cause depression. for example if you miss the main building block for it which is the amino acid tryptophan..

[algernon]

even a double blind study needs prior consent from the patient. I doubt that pacients are tricked into thinking that they really aren't part of the study anymore. that would be the only way to reverse the effect described above...from what I can tell right now..

 

Yes I already stated that. I don't understand your point?

 

 

 

I've read a couple of times that missing substances from the enzyme chain which produce serotonin can physically cause depression. for example if you miss the main building block for it which is the amino acid tryptophan..

 

Do you know the process in which doctors prescribe SSRI's? What blood tests do they run again before prescribing these drugs?

[MagnumPI]

Are the results measurable or not? If so, that's it. I can't get a tooth drilled & filled and perceive the cavity is taken care of. They did it, or they didn't. And if simply thinking I don't have to worry about the cavity because the dentist is going to cure my cavity... cured the cavity, there was never a cavity.

 

The study cited, I didn't watch the whole video, you describe as being administered by a doctor and others by a drip? Was it administered the same way? Was it a single shot of 'x' dosage vs slowly adding it across time configured in a PID loop? The little cartoon I skipped to was just that. A nurse with a syringe and separately a guy lying in bed.

[jpahmad]

SSRI's are like applying the brake to avoid hitting a brick wall, but NOT also taking your foot off the gas. In fact, with the brake in place, the brain only tries harder by pushing down on the accelerator harder. So that once the SSRI is no longer in place, you're actually worse off than when you started. Not sure how looking at a placebo will tell you what the biochemical effects of a non-placebo will be. Placebos are used as a control for self-reporting experiential data. Which biochemical reactions are not.

 

I have to disagree with this analogy.  THE SSRI gives you a chance to consider what your doing, look down,  and slowly take your foot off the gas pedal.  At this point, you still have to press down the break, and you do this by changing your environment (which is causing the problem) or by changing the cognitive behavior that is feeding the neurosis.  The drug is a tool, like any other drug in the world.  It has effects, both helpful and not helpful.  

There is not much you can do when being bombarded by repeated panic attacks.

[algernon]

I have to disagree with this analogy.  THE SSRI gives you a chance to consider what your doing, look down,  and slowly take your foot off the gas pedal.  At this point, you still have to press down the break, and you do this by changing your environment (which is causing the problem) or by changing the cognitive behavior that is feeding the neurosis.  The drug is a tool, like any other drug in the world.  It has effects, both helpful and not helpful.  

There is not much you can do when being bombarded by repeated panic attacks.

 

I think you are right in an aspect, as SSRIs can be beneficial with other recovery protocols to help someone, the biggest problem is they are normally the sole method of treatment, with no plan to ever be weened off of. They are also not without side effects. Many individuals realize they aren't working and decide to quit cold turkey, that is when the psychotic breaks happen.

[jpahmad]

I think you are right in an aspect, as SSRIs can be beneficial with other recovery protocols to help someone, the biggest problem is they are normally the sole method of treatment, with no plan to ever be weened off of. They are also not without side effects. Many individuals realize they aren't working and decide to quit cold turkey, that is when the psychotic breaks happen.

 

If someone prescribes them to a patient and says "this is all you need", then that is horrible.  Though, I have never met a medical professional that has made that claim and I am around lots of them.  Everyone in the field seems to understand that these drugs are just tools to be used along with proper cognitive therapy and life management.  There are other effects or "side effects" of the drug.  But this is to be expected. What drug doesn't have them?  

 

Quitting cold turkey is terribly irresponsible and is never recommended by a professional.  As far as no plan to ween off, I think this is empirically no the case.  All patients of neurosis, once stabilized by the drug and, after a certain period of time, are encouraged to try to ween off.  However, for a certain percentage of people, they will inevitably have a relapse and will need to go back on the drug and stay on for life sometimes.  

 

The reasons for relapse vary, of course, and I'm sure in some cases it is due to the brain physically changing and adapting to the drug, but, given the circumstances in life, the severity of the issue, the tolerance of different individuals to cope, I don's see any alternatives yet.  I think the drugs are a wonderful thing when administered by someone who knows what they're doing.  

 

Fire can be your best friend or your worst enemy.  

[Matthew Ed Moran]

"There is not much you can do when being bombarded by repeated panic attacks."

 

What does this mean? Obviously you can do a lot of things. This is not any justification for SSRIs to be administered. It's like saying "I smoked weed for years to relieve my anxiety. There is not much you can do when being bombarded by anxiety." Well, actually there is a lot you can do. If you're isolated however, yea, drugs may be the only management available. But to me that could give the psychiatry industry a big excuse, because passing off drugs to isolated people rather than connecting with them is horrendously cold and sociopathic if there are other methods of treatment available which are proven to be more effective and safe.

[algernon]

If someone prescribes them to a patient and says "this is all you need", then that is horrible.  Though, I have never met a medical professional that has made that claim and I am around lots of them.  Everyone in the field seems to understand that these drugs are just tools to be used along with proper cognitive therapy and life management.  There are other effects or "side effects" of the drug.  But this is to be expected. What drug doesn't have them?  

 

Quitting cold turkey is terribly irresponsible and is never recommended by a professional.  As far as no plan to ween off, I think this is empirically no the case.  All patients of neurosis, once stabilized by the drug and, after a certain period of time, are encouraged to try to ween off.  However, for a certain percentage of people, they will inevitably have a relapse and will need to go back on the drug and stay on for life sometimes.  

 

The reasons for relapse vary, of course, and I'm sure in some cases it is due to the brain physically changing and adapting to the drug, but, given the circumstances in life, the severity of the issue, the tolerance of different individuals to cope, I don's see any alternatives yet.  I think the drugs are a wonderful thing when administered by someone who knows what they're doing.  

 

Fire can be your best friend or your worst enemy.  

 

Since you have experience from a certain side of it, I'd be curious to know, have you seen many cases of people needing these drugs, receiving the therapy they need and then successfully being weened off and not relapsing? I ask because I know many people who are on these drugs, and none of them have ever stopped taking them, and none (as far as I know) are in therapy. Of course this is just anecdotal but the statistics speak for them self - 

 

The federal government’s health statisticians figure that about one in every 10 Americans takes an antidepressant. And by their reckoning, antidepressants were the third most common prescription medication taken by Americans in 2005–2008, the latest period during which the National Health and Nutrition Examination Survey (NHANES) collected data on prescription drug use.

Here are a few other stand-out statistics from the report on antidepressants:

• 23% of women in their 40s and 50s take antidepressants, a higher percentage than any other group (by age or sex)
• Women are 2½ times more likely to be taking an antidepressant than men (click here to read a May 2011 article in the Harvard Mental Health Letter about women and depression)
• 14% of non-Hispanic white people take antidepressants compared with just 4% of non-Hispanic blacks and 3% of Mexican Americans
• Less than a third of Americans who are taking a single antidepressants (as opposed to two or more) have seen a mental health professional in the past year
• Antidepressant use does not vary by income status.

 

 

I've read some scientific studies in the past and I wish I saved them, but the basic premise was there has never been any scientific evidence of a neural chemical imbalance in depressed people, which I think is obvious because if that were the case, a simple blood/saliva test could determine if you need an SSRI, just like with insulin for diabetes or thyroid hormones for hashimoto's / thyroiditis.

 

Something else to consider, if it is a neural chemical issue, is it the cause of the effect? Are your chemically unstable because you are depressed, or are you depressed because you are chemically unstable? Someone with a high stress job or other voluntary forms of continual stress can have a very profound hormonal effect, and undoubtedly neural chemical effect as well.

 

Is it really any different than self medication through drugs or alcohol? I know of several people who manage their depression with wine (and some with wine plus SSRI.). Could the case be made that it's a proper form of treatment to become a "functioning" alcoholic? In case that term is ambiguous, these are people who drink continually throughout the day to maintain a certain level of less than sober but still functional enough to carry out most of life's tasks, some even drive, have a job etc.. 

 

Just to be clear these aren't moral questions or judgements, I would simply like to explore the validity of this form of treatment. I've read a lot of evidence for both sides of the argument, and I'm far from convinced these are a good idea.

 

Of course quitting cold turkey is irresponsible and never recommended by a professional, but professionals are giving these mind altering drugs to less than stable people, and then expecting them to follow through with compliance, which is already a problem for most people with any drug.

 

~31 million people on SSRIs, seems a bit excessive don't you think? I would say start with following the money trail, that's usually a pretty good clue.

[jpahmad]

 

"There is not much you can do when being bombarded by repeated panic attacks."

 

What does this mean? Obviously you can do a lot of things. This is not any justification for SSRIs to be administered. It's like saying "I smoked weed for years to relieve my anxiety. There is not much you can do when being bombarded by anxiety." Well, actually there is a lot you can do. If you're isolated however, yea, drugs may be the only management available. But to me that could give the psychiatry industry a big excuse, because passing off drugs to isolated people rather than connecting with them is horrendously cold and sociopathic if there are other methods of treatment available which are proven to be more effective and safe.

 

 

 

Did you read my post?  I said that the drugs must be accompanied by therapy.

[jpahmad]

Since you have experience from a certain side of it, I'd be curious to know, have you seen many cases of people needing these drugs, receiving the therapy they need and then successfully being weened off and not relapsing? I ask because I know many people who are on these drugs, and none of them have ever stopped taking them, and none (as far as I know) are in therapy. Of course this is just anecdotal but the statistics speak for them self - 

 

 

I don't know.  I have known a couple people who were on them for a very short period of time once in their lives and never went back.  It seems that your statistics are telling though.

 

 

 

 

 

Since you have experience from a certain side of it, I'd be curious to know, have you seen many cases of people needing these drugs, receiving the therapy they need and then successfully being weened off and not relapsing? I ask because I know many people who are on these drugs, and none of them have ever stopped taking them, and none (as far as I know) are in therapy. Of course this is just anecdotal but the statistics speak for them self - 

 

 

I've read some scientific studies in the past and I wish I saved them, but the basic premise was there has never been any scientific evidence of a neural chemical imbalance in depressed people, which I think is obvious because if that were the case, a simple blood/saliva test could determine if you need an SSRI, just like with insulin for diabetes or thyroid hormones for hashimoto's / thyroiditis.

 

 

 

I'll have to research myself before I can comment on that.  "Imbalance" and "balance" really don't have any meaning other than to maybe point to the fact that someone's current chemical make-up in their brains is different than what it usually is.  I'm sure this is the case.  Our brains chemical behavior changes by the hour no matter what.  I don't think it's that far fetched to imagine a state where the brain produces an unusual amount certain chemicals for some particular reason or another.  Surely this could cause a change in emotion.  The brain is just part of the body.  If other organs can "malfunciton", why can't the brain?

 

 

 

 

 

Something else to consider, if it is a neural chemical issue, is it the cause of the effect? Are your chemically unstable because you are depressed, or are you depressed because you are chemically unstable? Someone with a high stress job or other voluntary forms of continual stress can have a very profound hormonal effect, and undoubtedly neural chemical effect as well.

 

 

 

No one knows.  One can lead to the other.  A traumatic experience can lead to depression, that's for sure.  But I think once something is triggered, and it depends on the particular chemistry of each person, this can cause the descent into depression and it becomes very hard to reverse it without help.

 

 

 

 

 

Is it really any different than self medication through drugs or alcohol?

 

 

It's really not different.  You just don't get drunk

 

 

 

Just to be clear these aren't moral questions or judgements, I would simply like to explore the validity of this form of treatment. I've read a lot of evidence for both sides of the argument, and I'm far from convinced these are a good idea.

 

Of course quitting cold turkey is irresponsible and never recommended by a professional, but professionals are giving these mind altering drugs to less than stable people, and then expecting them to follow through with compliance, which is already a problem for most people with any drug.

 

~31 million people on SSRIs, seems a bit excessive don't you think? I would say start with following the money trail, that's usually a pretty good clue.

 

 

 

There are good doctors and bad doctors in the world.  Just like there are good therapists and be therapists.  I wouldn't kill the goose that laid the golden egg.  Fire can burn someone's house down, that doesn't mean fire doesn't have its wonderful applications.  

[algernon]

jpa, have you listened to this yet? - https://board.freedomainradio.com/topic/46215-youtube-myths-and-facts-about-antidepressants-robert-whitaker-and-stefan-molyneux/

[jpahmad]

jpa, have you listened to this yet? - https://board.freedomainradio.com/topic/46215-youtube-myths-and-facts-about-antidepressants-robert-whitaker-and-stefan-molyneux/

 

Yeah,  I just watched it the other day

[Matthew Ed Moran]

Did you read my post?  I said that the drugs must be accompanied by therapy.

 Ah ok sorry about that.

 

I was trying to say that there would be a lot more options if the market were not regulated by government captured government "psychiatry."

 

But yea I don't mean to discredit your experience, that makes sense to me if you are having bad panic attacks to take something which would relieve it. I'm sorry you had them

 

I also knew a guy, a friend for 8 months, that was on meds continually to manage his anxiety and he was very unhealthy psychologically in my opinion now. But he was not in therapy.

[Libertyblues]

This kinda went off topic but I don't mind!

 

Anyway, I also watched that recent rebuttal but don't agree with everything. It's known that if people are under a lot of stress for a longer time they burn off magnesium and an amino acid called tryptophan. Tryptophan is essential for Serotonin synthesis. If you don't eat enough tryptophan during that period you can have a chronic deficiency of serotonin, which can lead to chronic depression.

 

And tryptophan can be measured in the blood easily.

[Kevin Beal]

Are the results measurable or not?

That's exactly what is being debated.

 

What is the right measurement? How do we know we've successfully accounted for the variables enough to isolate the causal relationship between two things? It's an epistemic question about what constitutes knowledge of the effectiveness of SSRI's. It's part of a broader debate that's been mostly worked out over centuries. i.e. it's not simple.

 

Personally, I think it's worth trying exercise, vitamin D, and some sort of psychotherapy which helps you manage your expectations before putting yourself on a drug known to cause situationally sociopathic and violent outbursts. But that's just me.

[wblevins001]

I have been on SSRI(s) in recent past. They come with a short story of side-effects, and I got a large majority of those. It was like having 2-3 weeks of the flu. After taking them for months, I was still unsure that they had any effect. I'm sure this varies from person to person and from SSRI to SSRI. I would not take them a second time.