Mental Health

[Byrthnoth]

Disclaimer: This is going to be a bad thread to read if you're on medication for a mental disorder. Seriously, please don't read it.

Spoiler: show

http://www.latimes.com/health/sns-he...,2744988.story

Now, I'm going to take a different view of this article's statistics, so bear with me.

~95% of students who go in for free counseling at colleges are diagnosed with a mental health disorder. Statistic didn't really change from '98 to '09.

There are two ways I see to interpret that:
1) "Wow, there's such a social stigma against seeking aid for mental problems that nearly all the students who seek assistance have mental health disorders."
2) "Wow, the counselors diagnose nearly everyone who comes to them for help with a mental disorder. Mental disorders must be really poorly defined if almost everyone qualifies."


So, does almost everyone qualify for a mental disorder via DSM-IV, and is the primary quality of someone with a mental disorder that they seek help?

My hypothesis is: Yes, and the treatments for some of these disorders are potentially harmful. Less harmful than turning the person away when they seek help, but unnecessarily harmful considering their lack of effectiveness relative to placebos.

Popular press: http://www.newsweek.com/2010/01/28/t...pressants.html
One of the better articles on the subject, should be free to view I think: http://www.plosmedicine.org/article/...l.pmed.0050045

We're messing with what we don't understand, but in some ways that's just the name of the game. Understanding of mechanism is inversely proportional to effectiveness in this field.
Famous example: Lithium salts. They even out people with bipolar disorder, been working since the 1870s, and we still have not got a fucking clue how.

We've done tests on these and older antidepressants and know for certain that they have a lasting effect on brain chemistry and connectivity. If the change in brain chemistry is not contributing to the alleviation of depression, are anti-depressants just a 20th century chemical version of a lobotomy? We're fucking with and changing what we don't understand, not unlike when they hypothesized that the frontal cortex didn't have a function and weren't afraid to wipe it out to alleviate what would now be termed depression and ADHD.

[Weiing]

I'm not so sure exactly how college counseling centers work. But I assume they are tied to some sort of insurance company? If that's the case, then insurance companies really enjoy DSM-IV-TR diagnoses...especially Axis I diagnoses. They'll pay for that stuff in a heartbeat. They also like paying for the cheapest fix: medication. However, I'm only saying this out of the assumption that college counseling centers work with insurance companies...as I really don't know.

The DSM-IV-TR has strict guidelines to diagnose someone. Yes, everyone qualifies under some diagnosis in there because mental health is on a continuum. However, not everyone is at the extreme end and is able to meet all the criteria for a diagnosis. In addition to meeting at least X amount of symptoms, they must also show a decrease in functioning in one or more areas: living, working, social, etc.

I believe it is true that many psychiatrists indiscriminately prescribe medication, as usually it's cheaper to keep refilling meds than it is to go in for therapy--any kind of therapy. (No, not just traditional psychoanalytical, as that's even falling to the wayside) I think at least for more of the serious, typically includes psychosis, Axis I diagnosis, it's been shown that people really need medication and therapy to be effective. It's true that there are risks/negative side effects for antipsychotic meds...especially with regards to Tardive dyskinesia. In such cases, one really has to see if the pros outweigh such cons. I mean, some extremely depressed individuals still go through intensive ECT and then maintenance ECT every 10 years or so. We don't know why it works, but it does. It's true there are some negative side effects of it too, such as some temporary short term memory loss, but again... it's about what they believe will help them function in society again. It's true we don't know much still, but I am optimistic we'll understand it better with more research in the future.

It more begs the question of if younger generations are developing more serious symptoms and psychopathologies or if people are overdiagnosing in general? Or perhaps, people are getting better at diagnosing? Or, to be more grim, college kids want quick drugs and will pretend they have all these symptoms to meet the criteria for a diagnosis.

[Zhais]

Just goes to show that it really is all in your head.

Doesn't mean it's not a real problem, but the cures are all psychological instead of chemical.

[Weeks]

Yes, psychiatry and psychology are still little more than pseudosciences at this point and are even worse than other fields of medicine in practitioners ignoring the harm they do. The entire mental health field needs to wake up, throw out the DSM (Which is nothing more than flimsy shorthand to give people some rough idea what pathologies they're talking about), and get on board with evidence-based medicine.

[BerenTebogo]

Just goes to show that it really is all in your head.

Doesn't mean it's not a real problem, but the cures are all psychological instead of chemical.

No, it doesn't go to show that at all. In fact, nowhere in anything written above did anything even remotely close to that get asserted as fact.

The treatments for any of these, even "self-treatment" involve balancing the chemicals in your brain.

Hurr fucking durr.

On topic: been going on forever. Cast a wide net, etc. When I was ultra young a doctor tried to put me on Lithium and I refused to take it because of how it made my heart feel. None of the adults in my life listened to me so I learned to fake taking it and throw it away. Glad I did because later on in life I met some people who were seriously fucked up because of being prescribed lithium without actually needing it.

Most doctors are good about monitoring what is good and what is bad for every person but a lot of it comes down to the patient. If you don't keep track of your mood / energy levels etc thoroughly and only walk in with anecdotal evidence about how you "don't feel like this works for you" you'll be cycled through drugs like a merry-go-round and still be a fucking nut.

Being crazy is a two-way street and what little we understand about individual brain chemistry stretches the definition of "understand". It's a good field and it's saved / helped a lot of people that I know including people in my family. Doesn't mean that about 60% or more of the kids on ritalin/adderal/stratera/etc shouldn't fucking be on it. Hell, adderrall is so highly regulated now that the extended release has become so expensive that even with my insurance I can't afford to be on it anymore. I had to switch to ritalin xr, and really, if you've had more than one conversation with me off of BG you can tell I reeeeeeeally need ADHD meds, but I'm getting priced out of the market because some 5 year old wants to draw instead of take time to do his homework. No fucking shit? He's a fucking 5 year old.

Fucking hate people.

Edit: I used the kids on adderall analogy but really, easily 50% of people on mental health drugs shouldn't be on them. It's hard to come down hard with a verdict though because I've seen some good meds literally turn a life around.

Part of me wonders if it isn't entirely the fault of the DSM, but partly pharma wanting their drugs to have as many "uses" as possible and using less than rigorous clinical studies to toss on extra uses to an otherwise good med. No evidence for this, just pondering.

[Weiing]

The DSM is pretty lame, though a very handy way to communicate with other professionals. I really hate labeling people for the most part, which the DSM typically encourages people to do.

However, they have been doing evidence based research, just need more of it. It's not just medication that psychiatry/psychology focuses on, but therapy too: CBT, solution-focused, DBT, motivational, etc.

edit in response to Sath: I think it's mainly greedy pharma, insurance companies, and psychiatrists....

[Byrthnoth]

Just goes to show that it really is all in your head.

Doesn't mean it's not a real problem, but the cures are all psychological instead of chemical.

Despite what the Newsweek article implies towards the end, consensus seems to be that that psychotherapy is not more effective than medication. If medication is not much more effective than placebo and psychotherapy is no more effective than medication, could anything work to "cure" depression?

We don't understand anything about brain chemistry, but we change it with drugs and call it "balancing." If something that cannot cross the blood-brain barrier or change brain chemistry is almost equally effective, how do we justify this?

[Zhais]

No, it doesn't go to show that at all. In fact, nowhere in anything written above did anything even remotely close to that get asserted as fact.

The treatments for any of these, even "self-treatment" involve balancing the chemicals in your brain.

Hurr fucking durr.

?

The studies' results stated that the non-placebo pill only slightly improved the results of the patients (and for that matter, included the possibility that side effects led to the expectation of better results) over the actual placebo.

It also mentions in the newsweek article I believe, that originally the drugs were intended to increase seratonin levels in the brain, whereas some recent ones /decrease/ it. Same effects.

It's not about introducing new chemicals, rather shifting what the brain actually produces/doesn't produce to fix it through psychological manipulation (ie: placebo effect).

Edit:

Aaaand, I'm not saying that psychotherapy is the absolute answer, nor am I saying that individuals with depression can 'just get over it' before any of that shit starts. I entirely agree with Sath/Byrthnoth, I just had a less-winded way of saying it. We need better ways to deal with it, better understanding.

I do for the most part think that altering how someone perceives their environment can go a long way to solving some of these problems (opinion, based on personal experiences). Partially psychotherapy, partially self-control and manipulation. Good/supportive friends and family can help a lot.

[BerenTebogo]

I didn't read any of the previous discussion or any part of the OP discussing how a vast majority of the people on these medications / participating in these studies should not be prescribed the medication they are being prescribed and am therefore completely surprised that they responded to placebo

Seriously. You have no idea what you're talking about and are trying to turn one-liners into arguments instead of reading multiple studies on the subject over the past decade (as I have).

No actual mental disorder can be cured with a placebo, just like being fucking stupid as fuck can't be cured by being presented factually correct information.

Prove me wrong.

Edit to your edit: You said that it can all be fixed by your own brain. Shut the fuck up.

[Weiing]

@Psychotherapy - Maybe I was just quickly skimming it but that Newsweek article doesn't really define what they mean by "psychotherapy". If it's traditional psychotherapy then yeah, I can see how it may not be as effective. However, there are other forms of therapy nowadays that are gaining more recognition due to EBP (evidence-based practice) research. Correct me if they do define exactly what they mean by psychotherapy.

Mental health issues are not the same as health issues where things are either "cure-able" or not. Especially if it's a severe MH issue, it's more about moderating it so that the individual can function at "normal" levels in society. Then again, people will argue what "normal" functioning means in society...etc etc.

[BerenTebogo]

Despite what the Newsweek article implies towards the end, consensus seems to be that that psychotherapy is not more effective than medication. If medication is not much more effective than placebo and psychotherapy is no more effective than medication, could anything work to "cure" depression?

We don't understand anything about brain chemistry, but we change it with drugs and call it "balancing." If something that cannot cross the blood-brain barrier or change brain chemistry is almost equally effective, how do we justify this?

Touched on this in response to the other guy, but the standards regarding the placebo tests are as flawed as the tests designed to determine who will or will not be prescribed medication.

When people who fit a "diagnosis" without being ill are admitted into a test it's a 50/50 shot of receiving the placebo or not. If the placebo works for them, bam, self-explanatory.

The layout of the data suggests that this may be a large part of the problem. There would be more indicative trends when comparing different medicines that require different diagnoses. The "cast a wide net" on all of the studies looked at for the purpose of this topic fit the loose model of 50/50 ill/healthy being split 50/50 on drug and placebo.

[BerenTebogo]

@Psychotherapy - Maybe I was just quickly skimming it but that Newsweek article doesn't really define what they mean by "psychotherapy". If it's traditional psychotherapy then yeah, I can see how it may not be as effective. However, there are other forms of therapy nowadays that are gaining more recognition due to EBP (evidence-based practice) research. Correct me if they do define exactly what they mean by psychotherapy.

Mental health issues are not the same as health issues where things are either "cure-able" or not. Especially if it's a severe MH issue, it's more about moderating it so that the individual can function at "normal" levels in society. Then again, people will argue what "normal" functioning means in society...etc etc.

These are some good points. Even ADHD, to use a very well-known disorder, cannot be "cured" or "treated" exclusively with medication. Don't care who you are, it's fucking speed, you can't be on it 24/7 or you won't sleep and you won't eat. There will always be times of day when you're medicated and when you aren't. If you aren't working to develop different habits or "warning signs" of your own behavior for the times when you're not medicated you won't be any more well-off on average than if you were just unmedicated.

As you scale up the problem, depression -> bpd -> mpd -> schizophrenia etc the balance shifts greatly from medication to constant reinforcement and treatment. 100% medication based treatments for some of the higher end of the scale are basically just treatment by coma.

Again, no question that the standards need to be re-written and there needs to be a tightening of the chains around the FDA and Pharm, but when the studies are conducted in bad faith, the results shouldn't be used to start a witch hunt (not saying you are Byrn) against an entire field.

Hell, I don't consider Psychology a real science, but it's the closest thing we've got for now and it's doing a better job than ye olde "kid acting up? beat him!" or "brother gone crazy? drop him off at the ward and never visit!"

[Zhais]

I know it's not that simple. It's not a simple matter of "Well hell, I'm gonna sit down and fix this all by myself." I wish our brains would let us do that, but it's not.

Yes, there are true chemical imbalances in the brain that aren't a product of your environment. There are also imbalances caused by environmental factors that can lead to depression and other mental problems. Obviously one treatment will not always work for both situations.


While I don't have the time to go back and look up all the crap I've read over my life, I also have a keen interest in the field.

It's..... ugh. I'm trying to agree with you here, with a bit of my own deal.

Being crazy is a two-way street and what little we understand about individual brain chemistry stretches the definition of "understand".

Due to our little understanding, we don't know exactly /what/ makes this all work. Is it the chemicals in the drugs (that change over time and from company to company), or is it the placebo effect, or is it something else? Fuck if I know, and it isn't my field.



I used to be on Ritalin. Did it help? Yes. I hated the side effects. I weaned myself off of it, and took a /long/ time to try to control my ADHD. Got friends to help too. I still have it, no doubt about it. If there's ever a magic pill that can actually control it w/o side effects, I'd be all over it. But part of the (more mild) disorders is mental (obviously imo, and in my experience).

Take any very serious disorder, and none of that works.



edit: catching up on your other two posts

[Zhais]

Instead of editing...

I basically completely agree with you >.> I just apparently have a bad way of saying it.

[Jotaru]

Sath, do you even read what people are posting before you fly off the handle in order to hold up your self-image?

This entire thread hurts my brain.

[BerenTebogo]

Instead of editing...

I basically completely agree with you >.> I just apparently have a bad way of saying it.

I get that you do, it's just the snap "oh it's all in your head" response is never going to go un-brutalized if I'm around, whether you intended it to be taken literally or not. I'd rather yell at you first and then come to an agreement instead of letting, for one second, anyone think that the above position is a valid way to think about mental health.

Sath, do you even read what people are posting before you fly off the handle in order to hold up your self-image?

This entire thread hurts my brain.

Lol.

[Zhais]

Yea, I figured that comment. Partially intentional, but should've actually said more in that post afterwards.

I guess I want to look at the more recent studies more, in how they picked the participants. You'd think that the pharma companies would have picked patients that were quite verifiably ill (skew the patients in order to show better results than less severe patients normally wouldn't). If the study has all very moderate or less severe symptom patients, then the results /should/ get closer to matching the placebo if the drug works as intended.

[Byrthnoth]

Touched on this in response to the other guy, but the standards regarding the placebo tests are as flawed as the tests designed to determine who will or will not be prescribed medication.

When people who fit a "diagnosis" without being ill are admitted into a test it's a 50/50 shot of receiving the placebo or not. If the placebo works for them, bam, self-explanatory.

The layout of the data suggests that this may be a large part of the problem. There would be more indicative trends when comparing different medicines that require different diagnoses. The "cast a wide net" on all of the studies looked at for the purpose of this topic fit the loose model of 50/50 ill/healthy being split 50/50 on drug and placebo.

So, I think what you're saying is:
300 people are admitted to the trial for an anti-depressant medication on the basis of the DSM-IV-TR criteria, which is what the medicine will be prescribed by. They're split 50/50 between "Drug" and "Placebo." It's double-blind, so no one involved in the study knows who is getting what. Of those admitted, 100 are not depressed, but happened to meet the criteria at the start of the study because they were having a bad month.
By the end of the four month study, the people that were not "really" depressed have recovered. Because they were split between the Placebo and the Drug groups randomly, 33% of each group are seen as having recovered, but in fact they were never ill.

Basically, that's why we use Placebos or Controls in the first place, and why it makes sense to check for a difference between Placebo and Drug. I'm not sure how it makes the study less valid.

[BerenTebogo]

Yea, I figured that comment. Partially intentional, but should've actually said more in that post afterwards.

I guess I want to look at the more recent studies more, in how they picked the participants. You'd think that the pharma companies would have picked patients that were quite verifiably ill (skew the patients in order to show better results than less severe patients normally wouldn't). If the study has all very moderate or less severe symptom patients, then the results /should/ get closer to matching the placebo if the drug works as intended.

Undefined standards for studies are actually better when it comes to renewing a patent on a drug. Now, please, if any of you are in the industry and what I'm about to say is incorrect, correct me.

When a drug hits the market it retains a patent for all initial treatments listed under the patent and the company who put it out retains exclusive rights for X years before a cheaper generic can be made.

Howwwwwwever, if the company, in the span of X years, can find other suitable uses for the drug that is already making them assloads of cash, they will get to renew their patent for another X years. This means that once a drug is released for Y, Z, and B disorders, the next X years it undergoes an extremely wide amount of clinical trials for everything from quitting smoking to curing back ache. Anything that can be done to extend the patent will be done.

This is when loose standards and bad science meet with multi-billion dollar a year industries and fear-based media networks.

It sounds conspiracy-theoryish but it really is just that silly.

Afraid your kid isn't getting along with others? Ritalin
Kid doesn't want to do the chores? Ritalin
Kid getting fat? Ritalin

Kid a bit sad about not forming social bonds because he has ADHD and is unmedicated and everyone in his class thinks he's a spazz? Welbutrin! He's clearly got a severe case of depression. Kids aren't sad and if they are it's because of the brain!

Again, can demonize as much or as little of the process as you want, but I don't believe anyone has any disorder unless they're both medicated AND receiving some form of talk therapy or counseling for it - even if that comes from just discussing stressors and warning signs with a spouse.

If you wake up in the morning, take a pill, and expect to be sane and then hold that as the standard for what all mental health medications should do it's pretty obvious that a near-infinite amount of studies can be conducted on the many fallacies that went into that standard.

So, I think what you're saying is:
300 people are admitted to the trial for an anti-depressant medication on the basis of the DSM-IV-TR criteria, which is what the medicine will be prescribed by. They're split 50/50 between "Drug" and "Placebo." It's double-blind, so no one involved in the study knows who is getting what. Of those admitted, 100 are not depressed, but happened to meet the criteria at the start of the study because they were having a bad month.
By the end of the four month study, the people that were not "really" depressed have recovered. Because they were split between the Placebo and the Drug groups randomly, 33% of each group are seen as having recovered, but in fact they were never ill.

Basically, that's why we use Placebos or Controls in the first place, and why it makes sense to check for a difference between Placebo and Drug. I'm not sure how it makes the study less valid.

I'm saying that if the criteria that the study is based off of is incorrect the findings aren't valid. If the people who fit into your study are comprised of people who have disease 1a, people who think they have disease 1a but don't, people who have disease 1b which shares major symptoms with 1a but responds completely differently to treatment, people who have disease 2a which shares a differ...

Blah blah, you get what I'm saying. You're trying to use scientific studies to show the negligible effect of drug over placebo when we both know that labeling these as scientific studies is a complete misnomer in the first place. The "controls" aren't good enough to be called controls in an 8th grade science fair, the guidelines for admittance fit tens to hundreds of disorders when applied loosely, etc. There's nothing scientific about it since clinical psychology isn't a real science.

Holding the studies you know to be bad science to the same standard you'd hold a physics review is disingenuous. We already know that these are the reasons needed for reform and a fuckton more oversight into the clinical process. The studies themselves and the studies of studies are at best, "shit I made up while I was cooking dinner". It doesn't help solve the real problem and it creates an easy scapegoat to turn attention to and lends itself to another grand media "Science controversy!"

I appreciate your position and it's certainly worthy of discussion but I think you know what I'm getting at here.

[Tellahh]

Lots of flaming going on in here...

To contribute, I have pretty heavy OCD and it's affected me since I was a child. I have really annoying ticks that I have to work really hard to stop myself from doing, not gonna get in-depth but if you know what OCD is you know how ticks can consume you. Marijuana helps to alleviate my thoughts and lets me relax, it's not some bs placebo prescribed by the government and it 100% does help me. Marijuana can be used for medicinal purposes? No way...

I had "ADD" as a child but my mom saw through that bs the doctors tried to feed her and refused to give me ritalin, I was just a hyper kid. I really despise that people will throw any over-the-counter med at a problem and think it'll be perfectly fine. I mean, fuck, if you watch commercials for prescribed meds all the side-effects sound nearly (if not worse) as bad as the symptom itself...