Yes, and do you know how much variability exists between practitioners? Diagnosis is largely a matter of personal opinion, not science.
The reason for that, in turn, is because no on knows what causes depression -- it's not like a medical condition with an identified pathogen and clinically validated treatment.
But the vague state of depression as an illness with an unknown cause doesn't prevent psychiatry and clinical psychology from offering therapy and drugs of dubious efficacy.
Antidepression drugs have been shown to be ineffective in most cases --
Title: "Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration"
Quote: "Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance."
The story is that drug companies publish only studies that support their belief in their drugs' efficacy. But when completed but unpublished studies are included, the evidence for the efficacy of antidepression drugs evaporates.
The study's authors don't say the drug companies deliberately suppressed negative findings -- they leave that conclusion to the reader.
Other side effects I experienced were clearly under-reported by the pharmaceutical companies. E.g., negative sexual side effects for Prozac that my doctor wouldn't even believe were real and not psychosomatic, until it later turned out that 25%-50% of all patients suffered these side effects, and the pharmaceutical company had neglected to inform anyone.
On other other hand, Remeron surely saved my life. I have no doubt about this. I had been in the most miserable state you could ever possibly imagine and then some, and had been this way for months, and then within a day or two of starting Remeron, I was utterly fine. (Though ironically, it may have been another antidepressant that put me in this terrible state to begin with, as I had to go off it cold turkey due to it causing a different dangerous side effect.)
As for diagnosing depression, it may certainly be the case that many cases are difficult to diagnose correctly. And there may be cases where there is no fact of the matter as to whether the particular symptoms count as depression. On the other hand, there are certainly cases where there is no question at all as to whether it's depression. I have been there quite a few times, and it's been as cut and dried as anything can be in this world.
Yes, absolutely, but saying "it was depression" is not the same as saying "depression is a disease with a proximate cause that can be identified, diagnosed and treated."
The present debate surrounding depression is global in scope. No one knows whether depression is a disease in the way that a cold is a disease, or is an extreme case of normal emotion, not amenable to any kind of diagnosis or treatment.
None of this is meant to argue that depression isn't a disease in the way that a cold is a disease -- only to say there's no reliable science behind the claims.
But we do know this -- in controlled scientific studies, antidepression drugs don't actually work for the majority of patients:
Quote: "Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance." [Emphasis added]
Comment: Drug companies have been only publishing studies that supported their drugs, and discarding those that didn't. This study compares the outcomes for all the studies, published and unpublished, and the result is that antidepression drugs do not work for the majority of patients.
I suspect that this is because most patients don't have the patience or wherewithal to try enough different kinds, or a doctor who is willing to combine them with benzos. The patient's patience is especially relevant since when you are depressed, the last thing in the world that you need is to add extra suffering from side-effects to your list of woes. Or at least that has been my personal experience. After a few bad experiences, I was very reluctant to try additional antidepressants, and after having become dependent on Ativan once, I vowed to never allow that to happen again either.
Ultimately though, I tried just about every modern antidepressant before finding one that worked, and I know people who had to go to tricyclics, which has caused them to become fat, but happy. Each of the antidepressants I tried affected me differently. But at this point, I am very relieved to know that if I become depressed again, there is a drug that I know for sure works for me. Knowing that is a huge weight off of my shoulders. Though having to look forward to weaning off of benzos again puts some of that weight back.
More recently I tried ketamine when I was worried that I was going to become depressed due to an unfortunate life circumstance. I'm here to say that it apparently worked as well as hyped since I never became at all depressed during a situation that would typically have sent me into a downward spiral. And with no ill side effects too boot. Too bad it's not legal....
Of course, trying many different antidepressants is not without its risks, as I alluded to previously.
No, no, we're talking about controlled studies overseen by scientists, not psychologists or psychiatrists in ordinary clinical practice. Typically, such a study has an experimental and control group. The experimental group gets the drug under test and the control group gets a placebo. To minimize the possibility of bias, during the study neither the experimenters nor the subjects know which subjects are controls.
After the study, the histories of the subjects are compared, and the groups to which they belong are finally revealed. Every precaution is taken to limit bias and emotional attachments to any outcome.
As it turns out, when such studies are conducted and compared to other similarly disciplined studies, the efficacy of antidepressants evaporates. In plain English, they do not work.
That's the scientific finding. It's not an opinion, like much of psychology, it is a scientific result.
> But at this point, I am very relieved to know that if I become depressed again, there is a drug that I know for sure works for me.
Yes -- and so does astrology, but only if you sincerely believe it does.
As to your claim that "they do not work", the scientific evidence that they work may be questionable, but lack of scientific proof is not the same thing as scientific disproof. You have no proof that they do not work for many people, despite your claim, as the way the drugs are used in double-blind studies do not perfectly mirror their use in the actual world. E.g., combination with other drugs, such a benzos, and/or other antidpressants, and trials of a number of different drugs to find which one is best of that particular person's brain chemistry.
Furthermore, one doesn't need scientific evidence to know certain things. I don't need published double-blind scientific evidence to know that if I hit my toe with a hammer that it will hurt. I don't need scientific evidence to know that my wife loves me.
Another point of evidence: Paxil also cured my depression within a day or two, on a different occasion, but it also had many other effects on me that were highly undesirable. It removed all pleasurable sexual sensations. It made me hypomanic and not care about how I treated other people. I felt as if everyone else in the world was an asshole who didn't give a shit about me, and so I was free not to give a shit about them. I felt absolutely no affinity any more for the people that I loved. I only found them annoying. I.e., my normal personality was turned completely upside down.
I don't need scientific evidence to know that this is how Paxil effected me, any more than I need scientific evidence to tell me how alcohol or marijuana make me feel. These are not subtle things, and the effect of Paxil on me, and the affect of Remeron on me were anything but subtle. They were as psychoactive as any substance can be.
Now since my evidence is not scientific, I am not stating that you should be convinced. On the other hand, you have no grounds to assert that I was cured by the placebo effect. You don't know me and you don't have access to the personal experiential information I have. I, personally, have plenty of information to make an accurate and rational conclusion here. And I have.
With all respect, you cannot make this claim. The only way this claim could become scientific would be with a double-blind scientific study. Such a study would compare the drug with ... a placebo.
And, as I have pointed out, the studies that have been conducted do not support the claim that antidepressants work for the majority of people -- indeed, studies demonstrate the opposite conclusion, that they do not work.
> On the other hand, you have no grounds to assert that I was cured by the placebo effect.
Yes, which means it's a good thing that I never said that anywhere. And why would I? The claim makes no sense -- no one is ever "cured" by the placebo effect.
> I don't need scientific evidence to know that this is how Paxil effected me ...
Wow. The drug companies must love clients like you.
> I, personally, have plenty of information to make an accurate and rational conclusion here.
You are ignoring the readily available scientific findings, so no, your conclusion is neither accurate nor rational.
This is an excellent capsule summary of modern psychological research -- no electron micrographs, no useful in vitro results, no objective evidence. No known causes for diagnosed conditions, and subjective diagnostic criteria. Instead, a nearly complete reliance on the self-reporting of clients, who insist that the drugs do or do not work, or the therapy works or doesn't work.
No matter how sincerely psychologists and psychiatrists want to help people, this charade will continue until real science begins to be done, and for that, we'll probably have to completely switch away from psychology to neuroscience. As it happens, Thomas R. Insel, the sitting director of the NIMH, agrees with this view:
Quote: "In most areas of medicine, doctors have historically tried to glean something about the underlying cause of a patient's illness before figuring out a treatment that addresses the source of the problem. When it came to mental or behavioral disorders in the past, however, no physical cause was detectable so the problem was long assumed by doctors to be solely "mental," and psychological therapies followed suit. Today scientific approaches based on modern biology, neuroscience and genomics are replacing nearly a century of purely psychological theories, yielding new approaches to the treatment of mental illnesses."
Furthermore, you are misrepresenting the strength of the scientific data that supports your claims: (1) The meta-analysis did show clinical significance in severely depressed patients. (2) The meta-analysis only looked at SSRI's. Remeron is not an SSRI. And most of the people that I know who are satisfied with their antidepressants are not taking SSRI's. (3) This is a single study. Individual studies are often contradicted by further studies.
From my experience with side-effects, I would not recommend anti-depressants for anyone who was not suffering from a major depression anyway. The risk is not worth the reward for just being down in the dumps. For mild cases of depression, it's not even clear to me that accurate diagnosis is possible. How can doctors accurately differentiate between mild depression and just being sad due to unfortunate life circumstances? Until we can do brain scans or blood tests to identify depression, I don't see how they could. And without the ability to make accurate diagnoses for mild cases, it's not clear to me that the data on drug effectiveness for mild cases can mean much anyway.
With all respect, I most certainly can. I know myself well enough to know how I respond to drugs. I'm sorry if that is not the case for you. I also know that I don't suddenly pop from the depths of the worst despair imaginable to being completely normal in a day or two on a hope and a dream. If that were the case, many other things would have cured me. Such as the dozen or two medications I tried before Remeron, for instance.
> The only way this claim could become scientific would be with a double-blind scientific study. Such a study would compare the drug with ... a placebo
I specifically stated that my claim was not scientific. All knowledge does not come via science. As I already mentioned, I cannot prove scientifically that my wife loves me, and yet I know this to be true. You may have no good reason to believe me about that, but that has no bearing on what I know to be true.
> Yes, which means it's a good thing that I never said that anywhere. And why would I? The claim makes no sense -- no one is ever "cured" by the placebo effect.
The placebo affect is real, so it can certainly act as a cure for minor ailments of certain sorts. I have no desire to argue semantics with you. On the other hand, it was Remeron that cured me, and I'm as sure of that as I am that I am not conversing right now with an AI program, though I can't prove that scientifically, either.
As I also mentioned, you do have not have any particularly good reason to believe me, but for reasons I have stated, you also have no good reason not to believe me. If you were not an ideologue, you would remain agnostic.
> Wow. The drug companies must love clients like you.
Your assertion is that a drug company would love me because I am willing to testify to the fact that Paxil made me hypomanic and I would assert to anyone that it is a dangerous drug and I would advise them to stay away from it if my experience is at all representative? You have a strange notion of what drug companies might love.
I've been told by doctors that I had a phobia of antidepressants because I was so utterly resistant to trying anymore after my terrible experiences with them. You sound like them: The hypomania was all in my head. The sexual dysfunction from Prozac was all in my head! Welcome to the club of quack shrinks!
> You are ignoring the readily available scientific findings, so no, your conclusion is neither accurate nor rational.
I am ignoring nothing. If you actually read what I wrote, you would know that.
As to your claims that neuroscience research will likely be hugely beneficial to our understanding. Well, of course. That verges on tautology.
> With all respect, I most certainly can.
I recommend a refresher course in science.
I recommend that you learn to read. And how to not be a jerk.