6/3/2013 1:50:29 PM
It is disappointing to again see the "synpatic serotonin" myth that the effect (as limited as it is increasingly being proven to be)for the SSRIs in print in a DANA publication. At the most simplistic level, how does one understand that selective serotonin reuptake enhancers also demonstrate roughly the same efficacy as the SSRIs?
Szaszian Bunkum in Comments
5/11/2013 4:35:35 AM
I too would like to repeat the sentiments of Mike Bubba and Linda Bross above. I have been on antidepressants of one class or another for around 20 years and were it not for these drugs I would have ended my life long ago. Certainly, none of the existing antidepressants are "wonder drugs", they provide me only partial relief and they do have (in my case) minor adverse effects. But that is better than nothing and there are no real alternatives. At some point in the history of medicine many diseases that now can be treated or prevented were fatal or severely debilitating (eg. Chicken Pox, Malaria, Smallpox, Diabetes). The current situation in relation to psychopharmacology is not unprecedented in the history of medicine. Inferences that the lack of progress in psychopharmacology are incontrovertible evidence of the intrinsic invalidity of biological psychiatry are unfounded. I hazard a guess that the chattering classes of 19th century Europe would have been proclaiming the invalidity of the microbiological theory of disease before microbes were conclusively demonstrated to be the cause of various diseases. Now we have members of the chattering classes opining on the foundational assumptions of biological psychiatry. "EX NIMH RESEARCHER" (sure) claims that "there is a whole non-medical research going on, proving to cure up to 70% of most of the disorders, including schizophrenia: psychotherapy". What utter nonsense! Where is this evidence? What type of psychotherapy boasts this high success rate? What is to be done with the supposed 30% that don't respond to psychotherapy? For what it's worth I have tried psychotherapy -- CBT and psychodynamic -- and obtained no relief from the symptoms of major depressive disorder. "EX NIMH RESEARCHER" adds "[a] little programming analogous to cognitive therapy would eaily do the trick". Really? At this stage there is no Cochrane Review of CBT vis-a-vis depression but other comprehensive reviews such as Hofman et al (2012) (see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/) report "CBT for depression was more effective than control conditions such as waiting list or no treatment, with a medium effect size" and "[c]ompared to pharmacological approaches, CBT and medication treatments had similar effects on chronic depressive symptoms, with effect sizes in the medium-large range". Absent is the finding of consistently large effect size for CBT that "EX NIMH RESEARCHER" claims. In that same paper the effect sizes of CBT for schizophrenia and other psychotic disorders was found to be in the range small-to-medium. "Roar Fosse" declares that the "the biomedical approach to psychiatric disorders is ready for the dust bin" despite that neurobiology and genetics, especially as they relate to mental illness, are in their infancy as was anaesthesiology, microbiology and immunology at one point. In ostensibly empathic exasperation "Roar Fosse" urges that "[t]o the best of the millions of people suffering, time now is ripe for the opinion leaders / authority figures like Hyman to discard the simplistic biomedical hypothesis of mental illness altogether and rather focus efforts in a direction that truly is informed by the evidence". But "Roar Fosse" doesn't enlighten us as to what is the alternative to biological psychiatry. Perhaps it is what Szasz offered us after 50 or so years: psychiatric disorders are "problems in living" and the treatment being "a kind of understanding between the other person and me that we were having a conversation about what he could do with his life. That obviously involves adopting different tenets of sorts--different ways of relating to his wife, his children, his job." (http://reason.com/archives/2000/07/01/curing-the-therapeutic-state-t/1) Szasz wasn't really bothered by there being people with various mental illnesses that have no discernible "problems in living" or why "problems in living" would manifest as schizophenia in one person and depression in another and no symptoms in yet another. Szasz didn't tell us how many people he relieved of their symptoms by chatting with them about different ways to relate to things of significance. These were all just irrelevant details to Szasz's endlessly repeated grand narrative about psychiatry.
Erroneous basic view
4/17/2013 3:43:40 PM
It is fascinating how it apparently does not dawn on Hyman and his like that the biomedical approach to psychiatric disorders is ready for the dust bin. First, no convincing empirical findings from molecular genetics research of marked and replicated genetic effects exist; the field still struggles with rejecting the null hypothesis. Second, the family and twin studies Hyman refer to are far from credible. Take the twin studies; they are based on the faulty assumption that identical and fraternal twins experience environments that are equally correlated. This is not true, identical twins experience far more similar environments than fraternals, a repeatedly documented finding. There is no justified basis to conclude that the higher similarity among identical than fraternal twins on a psychiatric disorder is due to genetics.
Hence, the argument that “a very large number of genes” are known to underlie psychiatric disorders is utterly unsubstantiated and nothing but disinformation and wishful thinking from the biomedical camp. Instead, there is abundant evidence on the role of environmental stress for the entire array of mental disorders, from anxiety and depression to psychosis and “schizophrenia”. The prevalence of child adversity increases in groups with psychiatric problems is very high indeed; population studies repeatedly have documented strong dose effect associations; environmental stress is known to modify and control gene expression and hence brain development; and the clear consequences of stress upon brain structure and function – with changes that match those of psychiatric disorders – have been more than sufficiently demonstrated.
To the best of the millions of people suffering, time now is ripe for the opinion leaders / authority figures like Hyman to discard the simplistic biomedical hypothesis of mental illness altogether and rather focus efforts in a direction that truly is informed by the evidence. Consider the reasonable possibility, now obvious to many that the future will consider those who did not as being very far from the label “scientists” and much closer to the label “criminals”.
4/17/2013 9:14:43 AM
I find this article misleading. The author seems to overvalue the usefulness of genetics and the biological model of mental illness (without any real breakthrough in the last 40 years) while ignoring the importance that our environment plays in psychological distress and that at best it is the interaction between our genes and our environment that contributes towards mental health or distress. He also seems to prefer psychopharmacological treatment for metal illness despite the fact that psychotherapy has been shown to be just as effective if not more effective in treating most "mental disorders" with no known side effects. Lastly he suggests that atypical anti-psychotics produce less motor syndromes yet there has been a few large meta-analysis in the last couple of years showing that this is a myth and that there is no clinical significant difference between old and new. He also conveniently leaves out that there has been numerous studies in the last 30 years indicating that anti-psychotics cause brain atrophy and suggesting that psychiatric medication causes people to develop depression/psychosis sensitivity over the long-term which leads to worse outcomes for those that have been medicated for a long period of time compared to those that have either not received medication at all or who stopped after initial remission of symptoms.
4/16/2013 3:48:33 PM
I had a psychotic break when I was 23, and I would be dead had it not been for the antipsychotics. My current psychiatrist does not push meds, he does psychotherapy mainly with me which helps me feel safe and not so alone, but I still rely on medications in stressfull times or when I fall apart. Psychologists are just jealous they can't help as much as psychiatrists. That's been my experience anyway.
Ex NIMH researcher
4/15/2013 5:14:07 PM
It is very refreshing to see that Hyman now admits that ” the underlying science remains immature”. He seems to have a strong belief in genetics though, a field that has promised breakthroughs for the last forty years. He seems to overlook completely that there is a whole non-medical research going on, proving to cure up to 70% of most of the disorders, including schizophrenia: psychotherapy.
The STAR-D research ended up with only 3% having benefit from the state of the art treatment with antidepressants. Cognitive therapy usually beats drug treatment in head to head trials, even in the first weeks, before patients withdraw from antidepressants due to intolerable side effects, when the placebo effect of taking a pill is at its strongest. And there is no problem of withdrawal from cognitive therapy, it is supposed to last for life without side effects.
I am a psychologist, and it is really very easy to cure most psychiatric disorders without drugs. The irony is that the patients we have most problems with helping using psychological techniques are the ones on medication. They suffer side effects that are very difficult to separate from psychological problems, and when they try to reduce the medication they get withdrawal effects that may be much worse than their original problem. It is really sad to see. And it is bordering on insanity that so many millions now are unable to stop useless medication, that ruins their sex life, turns them into walking fat depositories, shorten their life with up to 25 years, and bankrupt their health care systems.
A very modest investment into training more therapists could have solved the problem elegantly. Trying with all possible means to find chemical solutions to psychological problems is like flooding our computers with various chemicals because it plays videos that disturb us. This solution will stop the videos, but ruin the computer in the process. A little programming analogous to cognitive therapy would eaily do the trick , and the computer would be in better shape after the intervention. Hyman is right, the chemical understanding of our mind is indeed immature.
The Psych Survivor Perspective
4/15/2013 9:53:52 AM
Mr Hyman is more honest than the average psychiatrist when it comes to admitting the limitations of current psychiatric practice an theories. I am going a step further, the whole notion that psychiatric disorders, that are decided on DSM committee votes alone rather than on science, have a biological basis has been proven to be a complete failure despite having been given more chances to succeed than any other pseudoscientific endeavor like homeopathy or astrology. Time to call this one for what it is as well.
He says, "This withdrawal reflects a widely shared view that the underlying science remains immature and that therapeutic development in psychiatry is simply too difficult and too risky." A more plausible reason is that the manufacturers of psychiatric drugs have been put on notice by the numerous legal proceedings that have resulted in record billion dollar fines for settling both civil and criminal charges related to dubious marketing efforts to promote drugs of zero to none efficacy that in addition were dangerous for those taking the drug. Particularly illuminating were the trials and tribulations regarding how "prestigious" academics (Martin Keller) colluded with a drug manufacturer (GSK) to ghostwrite a journal article to promote the efficacy of paroxetine to treat depression in adolescents based on data from a study (so called 329) that not only didn't back the conclusion of efficacy over placebo but whose dangers (increase in suicidal though) in those taken the drugs were hidden. This were shown in painstaking detail in the DOJ material made public last year.
So far nobody has gone to jail, but the executives of these big pharma companies might have reached the conclusion that it could be only a matter of time before somebody does. It is one thing to use shareholder money to pay for fines as a way of doing business that still makes the drug profitable (as Eli Liily has publicly admitted in its annual reports) quite another to end up in jail. So this is probably the real reason why the situation is what it is.
Psychiatric Drug Development
4/12/2013 1:27:23 AM
I disagree. I would say that psychiatry has gotten more than a fair share of drug development over the last 15 years or so. Over that time we have seen massive growth in areas of psychiatric medicine, including whole new classes such as SSRIs, SNRIs, NDRIs and atypical antipsychotics. Add those up and you have probably pushing nearly 100 newly created drugs. I think the pendulum in several disorders such as depression, anxiety, PTSD, etc has swung towards Cognitive Behavioural therapies and so on and away from simply "medicating your problems away." I'd say looking back, psychiatry probably has seen the development of more drugs than almost any other specialty. It's not going to keep that kind of focus forever Perhaps not many new drugs in the last year or 2, but take a slightly longer view, a lot of work in that specialty has been done.
4/4/2013 9:19:36 AM
I have taken wellbutrin for 10 years..it has saved my life.