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by thomasfedb 2818 days ago
> Why should the solution to a negative outlook be to mess with the chemistry alone, through drugs?

Well perhaps because it works?

> We identified 28 552 citations and of these included 522 trials comprising 116 477 participants. In terms of efficacy, all antidepressants were more effective than placebo, with ORs ranging between 2·13 (95% credible interval [CrI] 1·89–2·41) for amitriptyline and 1·37 (1·16–1·63) for reboxetine.

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Of course there's issues with publication bias, but this is the best evidence we have to work with. Psychotherapy ("talking") also works, and so the teaching I've received tells me to prescribe both in tandem, although the drugs "alone" do help. I'm a student doctor.

> I find it quite frankly disturbing that the solution to such a learned insecurity should be just drugs.

I think your implicit suggestion here is that the correct treatment is unlearning. I suggest that this is not always possible. The plausible mechanism is that damage during development might result in "built in" changes that can't be talked away.

1 comments

> all antidepressants were more effective than placebo

Comparing them to placebo isn't appropriate, you need to compare them with an active placebo and only look at studies that continue longer than two years. Of which there are all of like 2 studies.

You should remember that we do research on real humans. Sometime this means we can't have the evidence we'd like to have.

Active placebos are designed to cause detriment to the patient - to cause side effects to convince them they're not on the placebo. Getting ethics approval to do randomised trials in depressed patients is hard enough without harming your control group.

> Active placebos are designed to cause detriment to the patient

Patients on active placebos have reduced depression symptoms as compared with patients on non-active placebos.