tag:blogger.com,1999:blog-1850379426161011153.post8232080648943952777..comments2023-10-24T15:18:37.944+02:00Comments on Ionian Enchantment: Audio: The rise of therapeutic nihilism about depressionAnony Mousehttp://www.blogger.com/profile/08077107616686254136noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-1850379426161011153.post-49234655243957038422008-10-31T21:29:00.000+02:002008-10-31T21:29:00.000+02:00Hi,I'm not a medic either, although I work alongsi...Hi,<BR/>I'm not a medic either, although I work alongside a lot of psychiatrists. I'm just a humble researcher. Well, not so humble.<BR/><BR/>You're right that the state of the evidence is depressingly bad. Although there are a few hopeful spots. I'll post about that soon.<BR/><BR/>In the meantime, on a related topic I've just posted <A HREF="http://neuroskeptic.blogspot.com/2008/10/mood-is-chemistry-no-really-it-is.html" REL="nofollow">this</A> which you might find interesting...Neuroskeptichttps://www.blogger.com/profile/06647064768789308157noreply@blogger.comtag:blogger.com,1999:blog-1850379426161011153.post-56263673462767461222008-10-29T15:19:00.000+02:002008-10-29T15:19:00.000+02:00Hi Neuroskeptic - thanks for your comment. I have ...Hi Neuroskeptic - thanks for your comment. I have read only <I>bits</I> of the literature - and I have no qualification in medicine - so I certainly know less about this than you do. But, for what it's worth, overall, I think you're right. The depressing thing (spot the pun...), though, is that it seems pretty clear that it has not been <I>demonstrated</I> that antidepressants have clinically significant benefits over placebo. And, of course, the onus is on the companies selling the drugs to show that they are effective.<BR/><BR/>Oh, and do let me know if you write such a post...Anony Mousehttps://www.blogger.com/profile/08077107616686254136noreply@blogger.comtag:blogger.com,1999:blog-1850379426161011153.post-87153507952585796862008-10-29T12:15:00.000+02:002008-10-29T12:15:00.000+02:00Hey Michael,I haven't managed to listen to the Mau...Hey Michael,<BR/><BR/>I haven't managed to listen to the Maudsley debate yet - I keep putting it off - but this is a topic which I know quite a bit about.<BR/><BR/>My personal view is not therapeutic nihilism but rather therapeutic skepticism. I think we just don't know how well treatments work in depression. If you read the literature (as I do - it's my job) you quickly come to feel that although there is a huge amount of evidence, it all adds up to very little actual understanding. Hence why opinions range so widely from Moncrieff all the way to Goodwin.<BR/><BR/>The problems with studying depression are many but they include: the difficulty of diagnosing depression, and hence finding appropriate research subjects;<BR/><BR/>the difficulty in rating the severity of depression (there are various pen-and-paper ratings scales but they're all seriously flawed, as Irving Kirsch has pointed out elsewhere amongst many other people.)<BR/><BR/>and the fact that almost all trials last 6 weeks or less whereas in the real world people generally take antidepressants for months or years. Yet the placebo-controlled literature on long-term antidepressant use is very limited.<BR/><BR/>All of which means, I think, that the real world clinical effectiveness of antidepressants over and above placebo could be zero or it could be very large. From "clinical experience" I suspect it's quite large but the hard evidence doesn't really exclude any possibility.<BR/><BR/>I think I'll write a blog post about this to elaborate further - I'll let you know when I do!Neuroskeptichttps://www.blogger.com/profile/06647064768789308157noreply@blogger.com