It's not. I have bipolar disorder and am on Seroquel, Lamictal, Welbutrin, and Paxil. They all do different things, different ways, and none of it is placebo. We know this because the doc has to tinker and tweak dosages with changes in the season, and changes in me. Placebos have "the placebo effect" or they don't.
It's about as much a "placebo" as morphine is. It directly affects the balance of neurotransmitters in someone's brain. So does sugar (placebo), but not in the same ways.
They divined their conclusions from the effects of the drug, or lack, on less depressed patients, then said their conclusions also applied to more depressed patients.
Switching around by trial and error isn't so much to find a drug that "works" in the sense of changing your brain chemistry. They change your brain chemistry alright. They do have to titrate the dose. Trial and error is to find the drug with the most effect paired with the fewest objectionable side effects. Not to mention that many of these drugs have a significant potential for allergies.
People switch SSRIs because of weight gain, anorgasmia, allergy, triggered mania, or other significant patient-specific adverse side effect. Thing is, adverse side effects don't mean the drug doesn't work for you, and it doesn't mean the side effects wouldn't lessen over time and you couldn't tolerate the drug if there weren't less objectionable choices. What happens is that when you have significant unpleasant side effects, the doctor usually goes ahead and switches you to another drug in the same class to see if it has fewer side effects for you.
In my case, the Lamictal and Seroquel are mood stabilizers. The Lamictal is my main mood stabilizer because it has fewer exec function side effects than others and may even help exec function problems a little--other drugs don't even touch them. A lot of people can't take it because a lot of people get allergic--allergies to it can be fatal like penicillin allergies. I take a small dose of seroquel at night to help me sleep--mood stabilizer with sedating side effect. Regulating sleep in bipolars is important.
Because I have type II bipolar, I can't take a mood stabilizer as a mono-therapy. I have to have anti-depressants added in. The Paxil gives a small bump to serotonin, the Welbutrin gives a bump to dopamine.
Antidepressant therapy, across all antidepressants, is extremely well studied. There used to be a large, large debate over the effectiveness of therapy versus drugs, so there were some heavy duty longitudinal studies done on people with multiple episodes of clinical depression. They knew antidepressants kick someone loose from a severe depression, but there were long term questions. A low maintenance dose of an antidepressant was the single most effective way of preventing recurring depressive episodes.
Cognitive Behavioral Therapy is also well validated as an effective treatment, but the kicker is what percentage of patients respond to each kind of treatment, and how much of their "issues" are left over.
Like treating heart disease or cancer, treatment is complicated and must be tailored to the patient. You can't just go on WebMD and say, "Hrms. Looks like I've got cancer. I need to go to pharmacy now and order a big bottle of xylophonene. It says here that if I take two of those three times a day my cancer will be gone in three months. Yippee."
Bipolar disorder has a 20% fatality rate untreated, and an 11% fatality rate treated. Most of that risk is front-loaded into the first 3 years post diagnosis. The fatality rates vary based on whose studies you look at, but those are the numbers typically quoted by the Child and Adolescent Bipolar Foundation.
Standard treatment is drugs. It's well established to be biological problem. Therapy can help, but the only people who go into treatment, and comply, who don't take drugs for it are the percentage of sad unfortunates who aren't "medication responders."
I think a 45% drop in fatalities is pretty good evidence that psychiatric drugs work, even though yes, they do have to take a couple of years on the medication merry-go-round as the doctor finds the best medication combination to stabilize a particular patient.
no subject
It's about as much a "placebo" as morphine is. It directly affects the balance of neurotransmitters in someone's brain. So does sugar (placebo), but not in the same ways.
They divined their conclusions from the effects of the drug, or lack, on less depressed patients, then said their conclusions also applied to more depressed patients.
Switching around by trial and error isn't so much to find a drug that "works" in the sense of changing your brain chemistry. They change your brain chemistry alright. They do have to titrate the dose. Trial and error is to find the drug with the most effect paired with the fewest objectionable side effects. Not to mention that many of these drugs have a significant potential for allergies.
People switch SSRIs because of weight gain, anorgasmia, allergy, triggered mania, or other significant patient-specific adverse side effect. Thing is, adverse side effects don't mean the drug doesn't work for you, and it doesn't mean the side effects wouldn't lessen over time and you couldn't tolerate the drug if there weren't less objectionable choices. What happens is that when you have significant unpleasant side effects, the doctor usually goes ahead and switches you to another drug in the same class to see if it has fewer side effects for you.
In my case, the Lamictal and Seroquel are mood stabilizers. The Lamictal is my main mood stabilizer because it has fewer exec function side effects than others and may even help exec function problems a little--other drugs don't even touch them. A lot of people can't take it because a lot of people get allergic--allergies to it can be fatal like penicillin allergies. I take a small dose of seroquel at night to help me sleep--mood stabilizer with sedating side effect. Regulating sleep in bipolars is important.
Because I have type II bipolar, I can't take a mood stabilizer as a mono-therapy. I have to have anti-depressants added in. The Paxil gives a small bump to serotonin, the Welbutrin gives a bump to dopamine.
Antidepressant therapy, across all antidepressants, is extremely well studied. There used to be a large, large debate over the effectiveness of therapy versus drugs, so there were some heavy duty longitudinal studies done on people with multiple episodes of clinical depression. They knew antidepressants kick someone loose from a severe depression, but there were long term questions. A low maintenance dose of an antidepressant was the single most effective way of preventing recurring depressive episodes.
Cognitive Behavioral Therapy is also well validated as an effective treatment, but the kicker is what percentage of patients respond to each kind of treatment, and how much of their "issues" are left over.
Like treating heart disease or cancer, treatment is complicated and must be tailored to the patient. You can't just go on WebMD and say, "Hrms. Looks like I've got cancer. I need to go to pharmacy now and order a big bottle of xylophonene. It says here that if I take two of those three times a day my cancer will be gone in three months. Yippee."
Bipolar disorder has a 20% fatality rate untreated, and an 11% fatality rate treated. Most of that risk is front-loaded into the first 3 years post diagnosis. The fatality rates vary based on whose studies you look at, but those are the numbers typically quoted by the Child and Adolescent Bipolar Foundation.
Standard treatment is drugs. It's well established to be biological problem. Therapy can help, but the only people who go into treatment, and comply, who don't take drugs for it are the percentage of sad unfortunates who aren't "medication responders."
I think a 45% drop in fatalities is pretty good evidence that psychiatric drugs work, even though yes, they do have to take a couple of years on the medication merry-go-round as the doctor finds the best medication combination to stabilize a particular patient.