Nicely done, Awais! The points you make dovetail very neatly with the piece I did for Psychiatric Times, in which I discuss the nature of the placebo condition; what the "15%" figure in the Stone et al study really means for clinicians; and why a narrow fixation on numbers can obscure the main reason psychiatric medications are worthwhil…
Nicely done, Awais! The points you make dovetail very neatly with the piece I did for Psychiatric Times, in which I discuss the nature of the placebo condition; what the "15%" figure in the Stone et al study really means for clinicians; and why a narrow fixation on numbers can obscure the main reason psychiatric medications are worthwhile; i.e., because they reduce, even if modestly, the suffering and incapacity of extremely debilitating and sometimes lethal illnesses.
Thank you Ron! Appreciate your input. Your piece indeed complements mine quite nicely. I worry about the "weaponization" of evidence-based strategies, where a narrow fixation on numbers becomes disconnected from clinical experience and clinical wisdom.
Indeed, Awais. In my view, anti-psychiatry voices have consistently used "numbers" to attack the clinical foundations of psychiatric treatment--including especially their criticism of antidepressant treatment. This is not to say that these medications are terrifically and powerfully effective, though they appear to be very effective in the subset of patients Stone et al studied.
But then, clinical experience and expertise have also been undermined by psychiatry's critics, relegated to nothing more than "observer bias" or "confirmation bias." To be sure, these are real, epistemic problems that arise whenever one invokes one's "clinical experience." But I am old enough--and close enough to retirement!--to say without hesitation: in my more than 25 years of experience as a mood disorder specialist; and having treated hundreds of seriously depressed patients, I have no doubt that antidepressants can be extremely effective agents, when correctly prescribed (not for bipolar disorder); carefully monitored; and sequentially used and augmented. And, yes: there is over-prescription in some settings, but there is also under-prescription in, for example, some minority communities. [1]
It's also important to place these agents in the proper perspective of treatment as a whole, which ought to include some form of "talk therapy" for most seriously depressed patients. I always used to tell my patients, "Medication is a bridge between feeling terrible and feeling better. You still have to walk across that bridge."
Kind regards,
Ron
1. González HM, Tarraf W, West BT, Croghan TW, Bowen ME, Cao Z, Alegría M. Antidepressant use in a nationally representative sample of community-dwelling US Latinos with and without depressive and anxiety disorders. Depress Anxiety. 2009;26(7):674-81. doi: 10.1002/da.20561. PMID: 19306305; PMCID: PMC2882071.
Nicely done, Awais! The points you make dovetail very neatly with the piece I did for Psychiatric Times, in which I discuss the nature of the placebo condition; what the "15%" figure in the Stone et al study really means for clinicians; and why a narrow fixation on numbers can obscure the main reason psychiatric medications are worthwhile; i.e., because they reduce, even if modestly, the suffering and incapacity of extremely debilitating and sometimes lethal illnesses.
https://www.psychiatrictimes.com/view/antidepressants-placebos-and-lithium-some-parting-thoughts
All the best,
Ron
Ronald W. Pies, MD
Professor Emeritus of Psychiatry
SUNY Upstate Medical University
Thank you Ron! Appreciate your input. Your piece indeed complements mine quite nicely. I worry about the "weaponization" of evidence-based strategies, where a narrow fixation on numbers becomes disconnected from clinical experience and clinical wisdom.
Indeed, Awais. In my view, anti-psychiatry voices have consistently used "numbers" to attack the clinical foundations of psychiatric treatment--including especially their criticism of antidepressant treatment. This is not to say that these medications are terrifically and powerfully effective, though they appear to be very effective in the subset of patients Stone et al studied.
But then, clinical experience and expertise have also been undermined by psychiatry's critics, relegated to nothing more than "observer bias" or "confirmation bias." To be sure, these are real, epistemic problems that arise whenever one invokes one's "clinical experience." But I am old enough--and close enough to retirement!--to say without hesitation: in my more than 25 years of experience as a mood disorder specialist; and having treated hundreds of seriously depressed patients, I have no doubt that antidepressants can be extremely effective agents, when correctly prescribed (not for bipolar disorder); carefully monitored; and sequentially used and augmented. And, yes: there is over-prescription in some settings, but there is also under-prescription in, for example, some minority communities. [1]
It's also important to place these agents in the proper perspective of treatment as a whole, which ought to include some form of "talk therapy" for most seriously depressed patients. I always used to tell my patients, "Medication is a bridge between feeling terrible and feeling better. You still have to walk across that bridge."
Kind regards,
Ron
1. González HM, Tarraf W, West BT, Croghan TW, Bowen ME, Cao Z, Alegría M. Antidepressant use in a nationally representative sample of community-dwelling US Latinos with and without depressive and anxiety disorders. Depress Anxiety. 2009;26(7):674-81. doi: 10.1002/da.20561. PMID: 19306305; PMCID: PMC2882071.
Regards,
Ron