Antidepressants and Placebo Controversies
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- čas přidán 30. 07. 2024
- A number of studies in recent years seemed to conclude that antidepressants were little more effective than placebos for the treatment of clinical depression. The media attention surrounding these studies created controversy among practitioners and confusion in the public. Karen L. Swartz, M.D. explains the source of the controversy, the important details in the study designs, and places the findings in context of clinical practice. This lecture was delivered at the Johns Hopkins 25th Annual Mood Disorders Research/Education Symposium on April 5, 2011.
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The Johns Hopkins Mood Disorders Center
www.hopkinsmedicine.org/psychi...
Karen L. Swartz, M.D. Faculty Profile
www.hopkinsmedicine.org/psychi... - Věda a technologie
Dr. Kirsch as I have understood him does not state that the placebo effect is nothing. This premise of Dr. Swartz's argument appears false and consequently many of her subsequent conclusions appear dubious. Additionally, she refers to what she believes occurs with optimal treatment (citing a couple of studies to support her perspective). Even if we grant that what these studies exemplify as optimal treatment works to the degree stated, this does not account for the fact that virtually no one in the real world receives this so-called optimal treatment.
From personal experience, it seems like the objective reality of any person's pain is difficult to assess. Even people who have gone to school for decades before being able to prescribe medicine use a pain scale based on smiley or frowny faces, which is subjective and arbitrary. It may be that modern medicine just isn't at a level where brain chemistry or neurological connectivity can be manipulated to produce a desired outcome when it comes to chemical intervention, or perhaps the placebo effect yields more results at this point than what humans can produce and introduce into our bodies artificially. Or there is a third option that seems to suggest that happiness or fulfillment are not something that comes in pill form. Is the human condition really meant to be some kind of perpetual sublime state all of the time or was Thomas Hobbes correct in saying that the human condition in it's natural state is "poor, nasty, brutish, and short"?
Very good talk, and a very good speaker. I remain concerned about the "breaking blind" effect Kirsch discussed in his book, "The Emperor's New Drugs..." This speaker does not address the issue, but if it were a valid concern, it would seem to throw doubt on the apparent difference in efficacy between the drugs and the placebo.
I've been on just about all of them. SSRIs have never helped with my depression at all.
SSRI is basically taking a placebo. Numerous studies have proven this yet pharmaceutical companies still make billions of dollars of profit from these drugs. CBT is much more helpful.
In you're opinion.
@@bs8825 It's 'your' BS
@@devkhajuria Yes your right.
@@bs8825 It's you're BS
Shut up, and stop spreading misinformation.
Who has depression which feels 'mild to moderate?' The Hamilton Scale is completely subjective. Manualised or forced therapy is not therapy.
So, I came to this video because I'm truly interested in the role that SSRI-type antidepressants could have in mass shootings. I think our "leaders" are spending WAY too much time and propaganda using these public shootings to push their anti-gun agendas, and not nearly enough time finding out what truly causes people to suddenly go off the deep end--and take others out with them. It's been anecdotally documented now that probably 80 to 90% of shooters are on or recently stopped taking psychiatric drugs/SSRIs. This based on looking at arrest records, autopsies, any public records available on the shooters.
What I'm taking so far from this video is that, for a percentage of severely depressed individuals, drugs are effective. In the less depressed groups, placebos plus counseling are just as effective as drug treatment. So why isn't placebo+counseling the FIRST method of choice for mildly to moderately depressed patients? Why impose a chemical solution to a problem that has a good alternative that doesn't include chemicals that may change things inside our brains, since we don't truly know how these drugs work?
Then, there's the issue of HOW the treatment of the more depressed patients is accomplished. If it's apparent that drugs+intense counseling and maybe inpatient treatment is beneficial, then doesn't that mean that treatment SETTING is important to the outcome? So I would think that the prescribing of SSRIs by GPs and "counselors" needs to stop, because they cannot provide the intense treatment necessary to make the drug treatment work as intended. GPs/counselors should stop handing out these prescriptions like candy, because they are not trained to monitor/analyse the progress like a trained professional should. They are not trained for/experienced in spotting personality disorders, detecting negative side effects, and don't generally have time to do the detailed personality testing that a professional psychiatrist has. I'm not dissing GPs, nurse practioners or counselors, I just think this is setting a dangerous precedent. And advertising directly to the patient needs to stop as well.
Apologies for the short-story, but I'm truly concerned about the burgeoning number of Americans--especially school age children--that are consuming these potentially dangerous drugs. I come from a place of having a close relative that is from childhood paranoid schizophrenic, and we had to learn to recognize the symptoms and help him manage his drugs and treatment--we in fact have to manage his entire life for him, as he's incapable of fully functioning on his own. So, I see how necessary these drugs can be for people who are truly disturbed. But the MISUSE of these drugs is also deeply disturbing to me, and our whole society is being affected by it.
Even if everything you said is true, that still does not mean that we shouldn't push anti-gun agenda. The fact that depressed people have access to guns is a much bigger problem.
@@voodooros that fact that there is a large portion of society who need happy happy brain juice to function everyday is the problem
@@0fficerpimp You need happy happy brain juice to function. Without happy happy brain juice we wouldn't be able to function at all.
@@voodooros but youre not fixing the cause of your unhappiness. No you are just fixing the symptoms, that is superficial. Even after you take these drugs you are still left empty inside and the reason for your happiness hasn't been fixed
I wish doctors could prescribe placebos. The problem is that placebos only work when patients think they're taking medicine with an active ingredient. This creates either an ethical issue if drs lie to patients or an effectiveness issue if drs are honest about giving placebos.
As for controlling the set and setting of severe depression, Swartz notes that efficacy trials are what happens if everything is perfect. Effectiveness trials are what happens in the real world. And efficiency trials are running the cost benefit analysis of what happens in the real world. That means in theory they try to account for these differences.
Too unskilled to choose the right medication YET they prescribe them. Psychiatric medications will never be as good as psychotherapy, exercise, meditation, self discipline and philosophy.
Sorry mate but I had melancholic depression with suicide attempts and tried 5 different antidepressants (paxil, celexa, cipralex, effexor, zoloft) and nothing worked. So the effectiveness is effectively zero. Now, who will give me my money back.
Same
well you just happened to be one of those people for which antidepressants unfortunately don't work. ; )
at least, that's always going to be there reasoning, despite this probably happening for the overwhelming majority of people lol
@baby pink youngjae agenda agreed
Same
OMG 🤫this has opened my eyes to understanding of how this (science) actually works 👍
The book "30 Days to Reduce Depression" by Harper Daniels is recommended. Gives good daily mindfulness exercises. Worth a try.