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Comments

  1. A Bad Idea (♀) says

    I have a suspicion that the entire internet trying to get him arrested will turn out to be the best thing that has ever happened to this poor guy.

  2. Crip Dyke, Right Reverend Feminist FuckToy of Death & Her Handmaiden says

    I have no sympathy for how he treated you or others, and I don’t know anything about substance abuse, but when I was a teenager, I was depressed enough to need a hospital, and I know that some of them are pretty difficult and relatively useless. I was glad to hear that he got into a relatively good one & I appreciate hearing that things are moving forward. Thanks for the update, PZ.

  3. says

    Maybe this will turn out to be a good thing for everyone involved, including Markuze. Mental illness and drug abuse are both seriously difficult things to deal with, and if this is what it takes for Markuze to get the help he needs then so be it.

  4. atomic1973 says

    So what’s everyone been doing with their newly freed-up Mabus-deleting time?

    I assume Twitter has been able to decommission at least a couple of servers.

    I know the gateways through Montreal have been a bit faster to the east coast….

  5. Brownian says

    As someone who works with sensitive and confidential health data, I’d just like to say that my job would be a lot easier if I worked in a court.

    “Hells yeah, Barry has scabies! Also, skanky fucker smokes a pack ‘n’ a half a day.”

  6. Alverant says

    At least he’s getting treatment before he killed someone. But it’s possible treatment may make him worse.

  7. satan augustine says

    How is this knowledge public domain? Medical, perhaps especially mental health, diagnoses are supposed to be confidential as a matter of law. Mentally ill menace or not this guy has a right to medical privacy.

  8. Kevin says

    @8

    Canadian law is different from US law, so don’t assume that they are the same.

    He was arrested and subjected to court-ordered evaluation. That’s a matter of public record, as would be the disposition of that evaluation. Would you rather there be a Soviet-style “disappearing”?

  9. Matt Penfold says

    How is this knowledge public domain? Medical, perhaps especially mental health, diagnoses are supposed to be confidential as a matter of law. Mentally ill menace or not this guy has a right to medical privacy.

    He has also been charged with criminal offences. If his mental state is to be considered by the court it has to become part of the court record.

  10. MoonShark says

    Whew. I was afraid the diagnosis was “GOATS ON FIRE! Oh holy spaghettimonster it’s contagious! Noooo, help us!!!”

    Er, sorry, couldn’t resist. I wish him a speedy and effective treatment.

  11. 'Tis Himself, OM says

    Brownian #6

    Hells yeah, Barry has scabies! Also, skanky fucker smokes a pack ‘n’ a half a day.

    I didn’t know Brownian was personally acquainted with Barry.

  12. A Bad Idea (♀) says

    satan augustine #8:

    This mental health information is the result of an investigation into whether or not he is guilty of threatening people’s well-being. Insanity is a valid defense, and of course it cannot be used unless it goes on the public record that he is, in fact, something less than perfectly sane.

    Do I feel like any of us have a right to know all the juicy details? Of course not. I don’t need to know what drugs, how much, etc. or anything that he has said to his doctors. But a lot of people here are victims of his threats, some to a much greater degree than others – I was a tangental target to him at best but a lot of people I care about were directly threatened. “He’s not well, and we’re getting him help” is our answer to our question of justice.

  13. Xavier says

    How is this knowledge public domain?

    Court decisions are often public domain in a democracy.
    If you don’t want your mental health to be public, don’t harass people.

  14. ..--..- says

    (If the below does not describe you or your comment, please skip).

    HOWS ABOUT WE SANE SKEPTICS SHOW A LITTLE COMPASSION for a guy who was CLEARLY ILL?

    The stigma of mental illness is obviously active even in the Atheist and Skeptic communities. The man made a cry for HELP inside of his vile attacks. He was and probably still is incapable of communicating with people in a sane and safe and legal way.

    If he were a sick, rabid dog, you’d be FAR more compassionate, most of you.

  15. says

    Interesting… that’s not what I would have expected, but then I’m not a mental health professional of any stripe. I am glad that he’s getting the sort of attention he needs, and I really hope it helps.

  16. Saurs says

    With respect, Myers, perpetuating the outdated notion that bi-polar folk (or folk “afflicted” with any mental “illness”) are “messes” or are by virtue of medical diagnoses dangerous is asinine and unfair. Dude persecuted you and others and acted, at best, a pest, and at worst, a threat. This is hardly behavior typical of bi-polar people. The behavior and the diagnosis have a tenuous connection, at best.

  17. Bethistopheles says

    Glad to hear he’s been evaluated and presumably medicated. I can only assume it’s Bipolar I (bipolar II is bad, but without the psychosis aspect). Hopefully he does well. Meds for bipolar can be worse than the condition itself. For the people who are sane, you have no idea how luck you are lol.

  18. says

    ..–..- @ 17- “HOWS ABOUT WE SANE SKEPTICS SHOW A LITTLE COMPASSION for a guy who was CLEARLY ILL?

    The stigma of mental illness is obviously active even in the Atheist and Skeptic communities. The man made a cry for HELP inside of his vile attacks. He was and probably still is incapable of communicating with people in a sane and safe and legal way.

    If he were a sick, rabid dog, you’d be FAR more compassionate, most of you.”

    WTF are you talking about? Almost all 16 comments were positive and supportive. And, actually no, I kill sick rabid dogs.

  19. swampfoot says

    #17:

    Meh, I dunno. There are definitely some animals who have a greater right to respect and compassion than some people.

  20. bethistopheles says

    I should probably clarify: Even though meds can be a pain in the ass, it is 100% worth it to try. I was not trying to steer anyone away from getting treatment, just stating the facts as they are. Some meds are quite tolerable; others are not. Everyone’s mileage varies.

  21. Bethistopheles says

    (sorry for all the posts)

    Saurs–

    Psychosis can be a part of bipolar. It’s actually required for a diagnosis of Bipolar I. Pretty much the only generic difference between schizoaffective disorder and Bipolar I is that in schiz., the delusions happen outside of a mood episode. (mood episode being mania or depression, or everyone’s favorite…mixed episodes, which are mania and depression at the same freakin’ time. Can we say yuck?)

    Bipolar would explain why he’d post profusely, then disappear periodically.

    Could be a wrong dx, but very possible it’s right.

  22. says

    Saurs @ 19 – “The behavior and the diagnosis have a tenuous connection, at best.”

    Yeah, but the alcohol and drug abuse says a lot. Which was probably about self-medicating from his mental illness.

  23. MadScientist says

    @#17: If he were a rabid dog I would have shot him through the head. What the hell are you thinking going on about the stigma of mental illness and then comparing him to a rabid dog?

  24. Jim Kursek says

    He’s a DIFFERENT mess than I expected, but still, it makes sense.

    I had/have Borderline Personality Disorder, and combined with long-term marijuana use and mild alcoholism, I could say some FUCKED UP things to people on-line, become obsessive and troll-y, and basically just be a massive loser!

    Not saying every day isn’t a battle now that I’m clean, but still… this is the right kind of treatment for him.

    I can only imagine that if I’d stayed unwell into my late 30′s like this guy I’d be a raving lunatic as well! So much time lost because he was untreated!

    I’m waiting for his public apology when he comes to his senses — I only hope that he stays in there for 3 months instead of just 28 days.

  25. sean says

    Well, as someone who has bipolar affective disorder (type II) and has had issues with substance abuse, I can certainly feel some sympathy for him. It’s not a fun condition and certainly can take its toll on family and friends.

    His behaviour though is not really typical of the condition, as someone else has pointed out. I suspect that there are other complicating issues he has to deal with.

    Whatever, I wish him all the best and hope he comes out of this a happier and more balanced person…for everyone’s sake.

  26. says

    I didn’t see ‘substance abuse’ coming. So it turns out I don’t know everything after all. I hope he has a good experience in rehab – as good as possible, anyway- and gets positive results from the experience. I think we all hope for a future in which he is healthier, happier, and spending his days in useful and pleasant pursuits.

  27. Bethistopheles says

    Yeah, Contentedreader. Mental illness and substance abuse are highly correlated. Gotta stop the pain/voices/nightmares/[insert random symptom here] somehow….

    I kinda figured that would be the case. Like, when you *have* bipolar, (not “are” bipolar), your neurotransmitters and other stuff are all screwy. Throw mind-altering drugs in the mix? The screwy stuff gets further screw-ified, even though at the moment it might feel like it’s making things better.

    Hope he can become a productive member of society.

    I remember someone on a previous post asking where he found the time to do all this posting…. many manic people are unable to sleep during that phase of the cycle. Lots to do, and lotsa time to do it…..

  28. sean says

    I used to enjoy being manic, at least for a while. I could get super-productive and recover a joie de vivre that was sadly lacking when I was in a depressive phase, but then as mania peaks you go into pan-galactic-hyperbabble and tend to do silly things, like spend all your money, or just lose the ability to see how your behaviour is affecting those around you.

    Then again, bipolar is one of those conditions that is notoriously varied in it’s presentation. Everyone is different I guess.

    Fortunately, there are some very effective treatments for many patients, often with few, if any side effects. Mood stabilisers (often anti-convulsants like Epilem, which was a serendipitous discovery) combined with antidepressants, can transform some people, without having to go on lithium, which is often horrible to take.

  29. Saurs says

    Playing doctor on the interweb with a stranger’s head using limited, second-hand information is not conclusive doctoring, and is, in fact, a species of arrogant wankery. Sorry.

  30. Crip Dyke, Right Reverend Feminist FuckToy of Death & Her Handmaiden says

    ..–..- (UX??)

    Look, “mess” certainly has some judgemental connotations, but you referred to commenters, not the OP and I’m not assuming what you said was directed toward me because of your preamble, but I can’t find a single person here to whom it would be directed.

    I’ve had mental illness – you could say I still it. And for silliness sake, I’m the last one to be quiet about civil rights issues – or to let them pass unnoticed – and this place has consistently expressed a desire for, yes, police to take breaking the law at least as seriously when it happens to atheists as when it does to other benighted groups, say, politicians, but it has always been the assumption as long as I’ve been reading about Markuze that people in the atheist community, and particularly PZ meyers, wanted the guy to get evaluated for any potential mental health problems & then treated if appropriate. That’s not anti-mental health. That’s not stigma.

    When you’re coming in here & throwing that stuff around, saying “this might not apply to YOUR comment,” ain’t enough. Whose comment is offensive & why? If you have an idea, express it. If you don’t, you’re just dumping on a community – and one that has been more ally than not on mental health issues – than you are doing anything positive.

    Why don’t you go home & get your argument straight before you embarrass yourself further.

    …….
    as for Saurs – No one here made the assumption that the diagnosis made him a mess. PZed thought he was a mess LONG before he had a diagnosis. He didn’t prejudge the guy. He judged him based on his actions. Get off your friggin’ horse before you hurt yourself!

    And, for your info, I’m quite up to date – and I’m probably not the only one here who is – on the research on correlations between mental health & violence.

    It does NOT say that people with mental health issues or diagnoses are not going to hurt anyone. It says that the likelihood of harming another is almost the same for those with nearly all mental illness diagnoses as for those in the general public.

    But that means that those among us who have been diagnosed do commit violent crime. The way to handle that is not to judge risk based on diagnosis, but based on action. And one thing that is correlated with violence is willingness to threaten violence. Again, judging based on actions, not prejudging based on diagnosis.

    NEXT – those findings were for people diagnosed with a mental illness and in treatment for it. When he was writing all those e-mails, he was not getting any treatment, and the research there is that pre-diagnosis there is a slightly elevated risk – only slightly, but it is, while about a percentage point or a little less in absolute terms, still that’s about 16-20% in relative terms. So, yeah, clamoring to get this guy noticed is something that was geared toward increasing safety and the studies say that it will increase safety – on average, of course in specific cases YMMV.

    and friggin FINALLY – there are TWO categories of diagnosis that ARE correlated with increased violence.

    1. Substance abuse – this is very highly correlated with violence.
    2. Disorders that include both a delusional and a paranoid component. Normally this is thought of as Schizophrenia, Paranoid sub-type, but it also includes clusters of cases within Bi-polar disorder when delusions co-occur.

    So if there are two cases where not [prejudice but actual research would show that Markuze is more dangerous than a member of the general public, it would be if he had trouble with addiction and with Bipolar (I) or Schizophrenia – and felt persecuted. (People with schizophrenia who are not of the paranoid subtype are actually even -dramatically- less likely to commit violent crimes than people with no diagnosis).

    We don’t know if he was delusional, but we do know he felt persecuted and we do know BiPolar (I).

    So the next time you’re about to pop off your mouth, you might wanna STFU until you have sufficient facts. And that discrimination does occur is a fact, but not sufficient to go off on specific people.

    And if you still wanna go off on general principle? STFU – a little bit harder…

    sheesh. What is with you two?

  31. Saurs says

    Perhaps not some of your comments. But do tell, since you asked, where one can find screwy as a “clinical” adjective in any DSM, ever?

  32. I'mthegenie!Icandoanything! says

    Alcohol and substance abuse???

    Didn’t his mother say he was alright?

    May all people like this be able to find sensible treatment – in other words, may they not be stuck in the USA both poor and without insurance.

  33. Otrame says

    @17
    Not one person commenting has been unkind about DM’s mental illness. Not one. That he is mentally ill was never very much in question. His behavior was not that of a garden-variey asshole. And that is actually good, because he has a chance, with treatment, to lead a life that consists of doing more than posting several k of abusive messages every day. And that is the gist of was every one has said. So what the fuck are you talking about?

    @29
    I know how difficult dealing with BPD can be (watch relatives and coworkers struggle), especially since the nature of the problem alienates potential supporters.. Glad you are doing better.

    @33
    If we were trying to play doctor you would be right. Not one person has said anything except 1. Glad he’s getting help; and 2. Some have mentioned their own mental illness and that treatment, though sometimes difficult, has made their lives better. I’ll add my own mental illness to that. Depression runs heavily in my family and I have been on meds for 25 years. I am absolutely sure I would be dead or institionalized by now without them, instead of retired from a job I loved and happily planting fall peas and hassling my grandkids.

    And I add that I hope DM is able to make a new life for himself. No one deserves to live like he did. I blame his mother for not getting him help, but she may have similar troubles himself.

  34. says

    Saur, “Perhaps not some of your comments. But do tell, since you asked, where one can find screwy as a “clinical” adjective in any DSM, ever?”

    If you want to change the goal posts, contact the NFL.
    ++++++++++++++++++++
    Crip Dyke, thanks for your post.

  35. Saurs says

    Crip Dyke, given that the patient is far removed from your armchair, that’s one giant non-sequitur. I think we’re all quite aware of what is correlative and what is, in this instance, fact. Facts: you ain’t got them.

  36. otrame says

    Saurs, sweetie, you should try to get that hair up your ass removed. The irritation is making you a little irrational.

    We are talking in a casual way about a person we have some experience with, and now that he has been placed (finally) under enough control that he might be able to get the treatment he needs, we are pleased and wish him well, even though he has harassed PZ and dozens of others FOR YEARS, threatened violence, and frankly, scared people not a little bit.

    Crip Dyke pointed out that such fears were not unfounded. This does not mean we are assuming that just because he is mentally ill that we think he might be violent. We think he might have been violent because his symptoms were consistent with the lead up to violence that has been seen in other cases.

    The fact that we are discussing it, and that many of us know quite a bit, in general or in specific, about mental health issues does not in any way mean we are “playing doctor”. In fact I have been pleased with the general attitude. The only one being an asshole right now is you (and that other guy @17).

  37. Lyra says

    I have cyclothymia (a mind form of bipolor disorder), and have at various points in my life had PTSD and severe clinical depression.

    Make no mistake: these mental illnesses have made me into “a mess” at various points in my life. Example: back when I was suicidal (due to a combination of the above), I certainly qualified as being “a mess.”

  38. Bill Door says

    Ah, the dreaded dual diagnosis: many substance abuse centers won’t/can’t handle people with mental illness, and many mental health centers don’t have experience with substance abuse. Hopefully he found the right program.

  39. Crip Dyke, Right Reverend Feminist FuckToy of Death & Her Handmaiden says

    Non-Sequitur? Are you kidding me? Look, my memory may not be the best, but I’m pretty sure that **someone** on this thread said:

    With respect, Myers, perpetuating the outdated notion that bi-polar folk (or folk “afflicted” with any mental “illness”) are “messes” or are by virtue of medical diagnoses dangerous is asinine and unfair. Dude persecuted you and others and acted, at best, a pest, and at worst, a threat. This is hardly behavior typical of bi-polar people. The behavior and the diagnosis have a tenuous connection, at best.

    I discussed whether Myers (or anyone else) was using the Mess because of a diagnosis, or if, perhaps, instead of pre-judging and making assumptions predicated on stereotypes, Myers might have made that statement based on actual frickin’ information about actual behavior of the actual person at all.

    Maybe *I’m* crazy to think that based on my flawed potentially flawed memory of someone saying the word mess had something to do with a diagnosis, that continuing that conversation might not be a non-sequitur.

    And then, I went on to talk about whether “dangerous” is something being associated with Markuze based on behavior or whether it might be associated with him based on a diagnosis.

    Finally, I discussed whether or not in would be unfounded stereotyping to associate violence with Mr. Markuze’s particular diagnosis.

    All topics that were directly related to that comment that sticks in my mind as somehow associated with this thread.

    Thus, unless you want to deny that the above comment was part of the conversation, it would seem that my comment was not at all a non-sequitur, unless by that you mean, “A continuation of the current conversation only with a fairer reading of others’ writing by not making assumptions that since a & b occur in the same post that the author assumes a causes b… and by adding a summary of what I know offhand about the research of potential violence (read: dangerousness) associated with particular diagnoses”

    If that is what you meant, by all means, please accuse me of a written non-sequitur.

  40. Mick says

    Bi Polar people aren’t messes, but when Bi Polar sufferers are afflicted by their condition it can get very messy indeed. I suffer from PTSD, depression and have anger management issues. When I wasn’t dealing with those issues I could be very scary indeed. When I got them under control I’m rather genial.

    It’s not demonizing or ostracizing those with mental illnesses to point out that they can be rather disconcerting when they are fully afflicted by their condition. It’s just reality and one of many reasons why people should seek treatment if they are afflicted.

  41. says

    For the love of fuck.

    To clarify: That wasn’t an attack on Bethistopheles, but an expression of exasperation with professionals who’ve long known this neurotransmitter stuff is wrong and failed to set the record straight. Frighteningly, a real possibility is that most “bipolar” and rapid cycling is caused by prescription psychotropic drugs. But the idea that depression or any related condition is organically caused by imbalanced neurotransmitters is contradicted by the science.

    (Of course, pointing this out will probably lead to my being accused of making dangerous internet diagnoses, as opposed to the dozens of comments on the thread that have offered the corporate line. So it goes.)

  42. Rev. BigDumbChimp says

    I don’t have time to read the whole thread, even as short as it is, but why is his diagnosis public knowledge?

    Are there no HIPPA like laws in Canada? Doesn’t he, as fucked as his actions have been, have some right to privacy?

  43. Rev. BigDumbChimp says

    I guess, if it’s in court there is some right for the public to know would be the answer.

  44. Bill Door says

    Frighteningly, a real possibility is that most “bipolar” and rapid cycling is caused by prescription psychotropic drugs.

    Any evidence for this? Seems like it would be an easy thing to test…

  45. PaulG says

    Salty Current, 47: anti-depressants (which increase availability of certain neurotransmitters) improve depressive symptoms more than placebos do. So, what evidence do you have that this is due to off-target effects? If none, I can only assume that, yes, indeed, “depression or any related condition is organically caused by imbalanced neurotransmitters”.

    Rev Big Dumb Chimp, 48: You don’t have to read far to find the answer.

    Rev Big Dumb Chimp, 49: Bingo.

  46. PaulG says

    OTRANE, 38: “Not one person commenting has been unkind about DM’s mental illness. Not one.”

    Except, if one wanted to take it this way, PZ Myers, who wrote in the OP: “It sounds like he was a bigger mess than I expected”.

    Can you imagine the same sentence applied to a person with cancer whose disease, it turned out, had metastasized? I am genuinely not being adversarial, just sticking up for a passion of mine: the treatment of mental illnesses within society and language on a par with their physical counterparts.

  47. Therrin says

    Can you imagine the same sentence applied to a person with cancer whose disease, it turned out, had metastasized?

    Yes?

  48. Rev. BigDumbChimp says

    Except, if one wanted to take it this way, PZ Myers, who wrote in the OP: “It sounds like he was a bigger mess than I expected”.

    Yes I can. Disease is messy. It’s unfortunate and it’s not pleasant. That places no blame on the “victim” of the disease. It’s just a description of the reality and consequences of having a disease.

  49. joed says

    “Bi-polar, compounded by alcohol and substance abuse”.

    often, people with mental problems try to make their life better by “self medication”. alcohol and most other depressant type drugs are preferred.
    Perhaps Mr. Markuze was well aware that he was making trouble for himself and others and did not want to continue. Hopefully the system actually helps him. bi-polar disorder is often treatable with socially acceptable outcome.
    Good luck to Mr. Marcuze.

  50. sean says

    @51

    As far as my understanding goes, the original scree that makers of SSRI type antidepressants came out with to explain their mechanism, was that sufferers of depression had insufficient serotonin in key areas of the brain and that SSRI’s restored a more normal level. Strangely though, SSRIs raise serotonin levels quite quickly, in a matter of hours, but as anyone who has taken them knows, the anti-depressive effect usually takes some weeks to appear, often after unpleasant side effects have (hopefully) worn off.

    After that explanation was criticised, they then said that the effects were on an intra-cellular level (I forget the actual mechanism they proposed) and that is why the drugs took so long to settle down and work.

    More recently I believe researchers are saying it is now down to neurogenesis, a process that was – until recently- itself dismissed as impossible in mature brains.

    Whatever, all I know is that I can’t take SSRIs and that the only anti-depressant that works for me is an older type that is ironically specifically contra-indicated for bipolar disorder, due to its likelihood of inducing mania.

  51. PaulG says

    Sean, 56: You’re right, neurogenesis is now absolutely confirmed in adult human brains. I haven’t seen anything to convince me that this is how SSRIs and others work.

    Re the time between drug and effect: there will always be a lag with any drug. In “simple” systems, such as classic cytotoxics for example, the time between drug and individual cell death is relatively small. However, a measurable effect (here, on tumor growth), is relatively large with current technologies.

    Anti-depressants are different: they are working on a hugely more complex system (the brain, with its ridiculous number of synapses, versus a tumor) and the endpoint is also subjective versus objective (self-reported “feelings” versus, eg, MRI-derived tumor size).

    I see no conflict in saying that depression is caused by imbalances in neurotransmitters, that anti-depressants work by altering these levels, and that it is expected to take some time for their effects to be noticed.

  52. PaulG says

    #54: no, I’m sorry but I don’t buy it. The word was not “messy”, as you have applied to a disease. The sentence was “It sounds like he was a bigger mess than I expected”.

    “He was…”

    “HE was…”

    The words directly call the PERSON a “mess”, not his disease.

    This is what sufferers of mental health diseases face all the time.

    “Moron, idiot, retard, schizo, madman, crazy, loopy…”

  53. Josh says

    I’m surprised that PZ didn’t expect DM to be this big a mess. It seemed obvious to me that he was, although some aspects of the particular messagnosis took me by surprise.

    And although you don’t tell a sick person to their face, “You’re a mess,” it seems to me that there’s nothing necessarily compassionless in referring to someone’s tsuris that way, depending on the context.

  54. says

    Salty Current, 47: anti-depressants (which increase availability of certain neurotransmitters) improve depressive symptoms more than placebos do. So, what evidence do you have that this is due to off-target effects? If none, I can only assume that, yes, indeed, “depression or any related condition is organically caused by imbalanced neurotransmitters”.

    Perhaps you could click on the link in my post, see the articles by Marcia Angell and the other links there (including to the statements from Thomas Insel, head of NIMH), and then read at least the book by Irving Kirsch. That’s the evidence I have, and it’s very strong. In fact, it’s not disputed by the experts.

  55. says

    I see no conflict in saying that depression is caused by imbalances in neurotransmitters,

    You can stop right there, as that’s false. It’s long been disconfirmed.

    that anti-depressants work by altering these levels,

    Nope.

  56. Rev. BigDumbChimp says

    A person with a disease can very well be a mess. My uncle who is going through chemo right now is a total fucking mess and he would tell you so. He’s not his healthy self. His entire life, routine, schedule, appearance, everything is a mess. It’s not his fault but he is a mess.

    To ignore the fact that having a disease is messy, unpleasant and can change a person (permanently or short term) is just plain ignoring reality.

    The person suffering from the disease can very well be a mess. Curing or treating the disease can alleviate or remove the symptoms causing the person to be messy. Substance abuse and mental disease are no exception and in some instances may be even messier for the person.

    Sorry but not every description of someone suffering from something outside their control is an indictment of that person.

  57. sean says

    In regards to the time taken for some antidepressants to work. The one I take, moclobemide, is a reversible monoamine inhibitor. If this one is going to work for someone, it starts to do so in a very short time; with me it’s just three days. In fact, I can predict that my mood will lift around noon on the third day. The only trouble is, the effect wears off on me after a few months for some reason, so these days I only use it when I need to. Other than that, mood stabilisers, together with being retired and avoiding stress, seems to have worked for me.

    Oh, and I must mention cannabis. Abused, it nearly always leads to bad outcomes for myself and many others, but it has been prescribed by some psychiatrists in a strict dosing regimen with good results for some bipolar patients, or so I have read. They may be mildly stoned, but at least they are happy is what I believe one Dr said.

    All I know was back in the bad old days, when all else failed and I was an inert, miserable mess under the bedclothes, a single joint could have me laughing my head off in twenty minutes. Which would then lead to excess and a worsening of my condition…

  58. PaulG says

    Salty Current, 61: You’re joking, right? I followed the link. I found a blogpost laden with internal links, and some to interviews, etc.

    I have to get Nerd on your ass here: peer reviewed scientific literature, please.

  59. Cuttlefish says

    PaulG, would you allow that headaches are caused by a lack of aspirin?

    SC, I am at the same conclusion you are, but (oddly enough) through a completely different set of research–I’ll have to send you what I have. I brought it up a year or so ago on Orac’s and was immediately called a scientologist. I asked them to actually read the papers, and that made a bit of a difference.

  60. amphiox says

    How is this knowledge public domain?

    I’m not completely familiar with the issue of medical privacy in the setting of legal proceedings, but individuals have the right to allow their medical information to become public domain (ie waive their right to privacy). It’s quite possible that Markuze (or his legal representative) did this with the intent of using this as part of his legal defense.

    Playing doctor on the interweb with a stranger’s head using limited, second-hand information is not conclusive doctoring

    It’s a foolish and rather not-nice thing to do, but then, no one here’s doing it. Saurs, you need to relearn the definition of “doctoring”.

  61. Lion IRC says

    Speaking of bi-polar.

    Can anyone spot the ethical double-think going on here…

    “…I don’t care whether he was guilty or innocent, the death penalty is barbarous and irrevocable…”

  62. amphiox says

    If my memory serves (and my memory could easily be outdated by now), no one really knows why anti-depressants work. Nor, in fact, do we have any really good ideas about the mechanisms underlying pretty much any psychiatric illness.

    The neurotransmitter imbalance hypothesis was falsified a while back, at least in its broad form.

    We do know, on clinical grounds, that the medications work. But not knowing the mechanism by which they work means that when they do fail to work in particular individual patients, we really have no idea why they fail.

  63. Nerd of Redhead, Dances OM Trolls says

    Hey Lion, have any conclusive physical evidence for your imaginary deity yet? Or, are you getting off just stupidly (you can’t do it any other way) trolling like always?

  64. PaulG says

    Cuttlefish, 65: “would you allow that headaches are caused by a lack of aspirin?”

    Is breast cancer caused by a lack of tamoxifen? I honestly have no idea what you mean.

    amphiox, 68: “The neurotransmitter imbalance hypothesis was falsified a while back, at least in its broad form.”

    Citation absolutely needed. Also, an explanation of what “in its broad form” means.

  65. amphiox says

    Can anyone spot the ethical double-think going on here…

    “…I don’t care whether he was guilty or innocent, the death penalty is barbarous and irrevocable…”

    What ethical “double-think”?

    The statement is perfectly morally clear. It is simply stating the opinion that the death penalty is never ethically justifiable – it is barbarous and wrong and should never be used under any circumstance. Thus the guilt of the accused doesn’t matter, as the death penalty is inappropriate no matter what the accused is guilty of.

  66. PaulG says

    Sean, 63: “what I believe one Dr said”

    I love your honesty in describing your experiences, but have to say that this is not scientific evidence.

  67. says

    Salty Current, 61: You’re joking, right? I followed the link. I found a blogpost laden with internal links, and some to interviews, etc.

    FFS, the links are ultimately to peer-reviewed literature. If you don’t care to investigate, fine. But you’re wrong. You’d think the fact that the head of NIMH disagrees with you might give you pause.

    ***

    SC, I am at the same conclusion you are, but (oddly enough) through a completely different set of research–I’ll have to send you what I have. I brought it up a year or so ago on Orac’s and was immediately called a scientologist. I asked them to actually read the papers, and that made a bit of a difference.

    Cuttlefish, I can’t thank you enough for weighing in. I’m interested in your line of evidence. I had a rocky time at Orac’s, too, and Jerry Coyne did on his own site. I wasn’t called a scientologist, but some of the authors I linked to were. I’m pleased you’ve been better received than I have. If just a few people investigate further I feel like I’ve made a difference, but it’s taken a toll.

  68. says

    We do know, on clinical grounds, that the medications work.

    On clinical grounds we can conclude that they work as enhanced placebos. That’s what the evidence shows. It also shows that they’re quite dangerous.

  69. PaulG says

    Salty Current, 74: “FFS, the links are ultimately to peer-reviewed literature.”

    Kevin Bacon.

    I’m not going to trawl through 15 pages of your own blog in order to find the pot of gold. Just a direct PubMed link would be useful.

  70. amphiox says

    Except, if one wanted to take it this way, PZ Myers, who wrote in the OP: “It sounds like he was a bigger mess than I expected”.

    Unkind? That was a statement of sympathy. The context is blatantly obvious from the very next sentence.

  71. PaulG says

    Salty Current, 75: “On clinical grounds we can conclude that they work as enhanced placebos. That’s what the evidence shows. It also shows that they’re quite dangerous.”

    With ongoing basic, preclinical and early clinical research, how do you suggest we treat depression today?

  72. amphiox says

    On clinical grounds we can conclude that they work as enhanced placebos.

    I do recall encountering an article that made that argument a while back, though I can’t remember exactly where. But there are also a number of other trial results that show a better efficacy than placebo, though all the studies have their own particular flaws.

  73. amphiox says

    Just to clarify, when I said “on clinical grounds”, I meant “placebo-controlled clinical trials”, wherein a statistically significant effect was seen in the medication group superior to the placebo group.

    Such results are much stronger and more credible if a reasonable mechanism of action is known. In the absence of a reasonable mechanism, there is always the possibility that the significant result was due to a methodological error, or statistical fluke.

    And of course, a lot of these placebo controlled drug trials were still funded by the pharmaceutical companies, and there have been a few known cases of the results having to be retracted do to bias related shenaningans (and we have no choice but to assume that it happens more often than it is caught and revealed).

  74. PaulG says

    Amphiox, 80: “I do recall encountering an article that made that argument a while back, though I can’t remember exactly where. ”

    Your rigorous scientific argument is noted.

  75. PaulG says

    Salty Current, 79: “Sigh.”

    ?

    We know that aspirin is an inhibitor of COX (2 mostly, I think?). This is how we believe it exerts its effects.

    We know that SSRIs Selectively Inhibit Serotonin Re-uptake. This is how we believe they exert their effects.

    You’re not a scientist, are you?

    Sigh.

  76. says

    With ongoing basic, preclinical and early clinical research, how do you suggest we treat depression today?

    What do my personal, inexpert, inchoate views have to do with the fact that these drugs are extremely dangerous placebos whose alleged mechanism of action has been disproven?

    Let’s say for the sake of argument that neither I nor anyone has any understanding of depression or effective ideas about its treatment other than antidepressants, which isn’t the case. That wouldn’t make the chemical imbalance notion correct or make the drugs effective as anything other than a placebo.

  77. PaulG says

    amphiox, 81: “we have no choice but to assume that it happens more often than it is caught and revealed”

    Why? By what percentage? 10? 0.001?

  78. PaulG says

    Salty Current, 84: “these drugs are extremely dangerous placebos whose alleged mechanism of action has been disproven”

    Yawn.

    Citation, please. One which doesn’t require me to navigate your blogmaze.

  79. says

    Just to clarify, when I said “on clinical grounds”, I meant “placebo-controlled clinical trials”, wherein a statistically significant effect was seen in the medication group superior to the placebo group.

    Read the Kirsch book. Just read it. Read the literature at the links in my posts. Disagree if you do, but read.

    ***

    We know that aspirin is an inhibitor of COX (2 mostly, I think?). This is how we believe it exerts its effects.

    We know that SSRIs Selectively Inhibit Serotonin Re-uptake. This is how we believe they exert their effects.

    I’m flabbergasted. In what other area would people simply refuse to engage with what’s been written? Why is this? On one of Orac’s threads, people were talking about how important SSRIs were for children. I linked to articles from the BMJ and Lancet, which played a role in those drugs not being allowed for children or adolescents in the UK and pointed to the corporations’ lies about their efficacy and safety, in children, and received no response. It’s fucking astounding.

    “We” don’t believe this shit. The experts, as I show in my post, don’t believe it. It’s wrong. It’s been disproven. This ex juvantibus logic would be a problem even if the drugs had been shown to be more than placebo, but they haven’t.

  80. says

    One which doesn’t require me to navigate your blogmaze.

    I would think someone who cared about the question would take the time to click to a post to an article to the literature or to a post and directly to the literature. You want to be ignorant? Fine. Other people reading this won’t. Fortunately, you don’t represent the level of critical thinking and skepticism on this blog.

  81. PaulG says

    Salty Current, 88: “On one of Orac’s threads, people were talking about how important SSRIs were for children. I linked to articles from the BMJ and Lancet”

    I don’t know who Orac is (honestly). You’re making assertions on a different blog, so please provide links to those citations here. As I’ve said, you can’t expect people to wade through half of your own blog to find them.

    Re my quoted words in your post: the point is that drugs can have effects on off-target molecules/pathways. You’re still not a scientist, are you?

    Sigh.

  82. Akira MacKenzie says

    While substance abuse is not my issue, I can certainly speak on the issue of bi-polar disorder! For most of my life, I’ve dealt with emotional instability. It started Round 2nd-3rd grade, and I was dumped into the academic ghetto of ” special education” after being classified as “emotionally disabled.” It was worst when during puberty, not only did I have raging hormones to contend with, but a problem controlling my feelings and behavior on top of it. One day I wanted to kill myself, the next I was either angry or excited to the point where I would constantly talk to myself, make strange vocalizations (grunt or squeel),wring my hands violently, or rub my my face. Of course, my peers noticed my behavior and gave me he’ll for it from 4th grade to my senior year. Since then, my bizarre behaviors have deeply affected my employment as well as my relationships.

    It was only a few years ago that I was diagnosed with rapid cycle bi-polar disorder. However, I’m currently between physicians, so I’m not getting treatment right now. At least Dennis is fortunate enough to live in a country where health care isn’t considered a luxury item.

  83. amphiox says

    On one of Orac’s threads, people were talking about how important SSRIs were for children.

    Really? Children would be the group where the evidence that antidepressants are not helpful and do more harm than good is arguably the strongest!

    Why?

    Because everything that has ever been measured or observed in the universe by science occurs more frequently that it is actually measured or observed. Because that is the fundamental reality of imperfect measurement. If you see it happening, you know, automatically, that in reality it happens more often than you see, because you know you aren’t omniscient and cannot look everywhere all the time.

    We know that aspirin is an inhibitor of COX (2 mostly, I think?).

    Aspirin is a nonspecific COX inhibitor. In fact, it’s action on COX-1 is why it is useful as a prophylactic in heart disease and stroke.

    We know that SSRIs Selectively Inhibit Serotonin Re-uptake.

    But it does not necessarily follow from this that the clinical (symptomatic) effects seen from these medications must therefore result from a general increase in serotonin levels in the CNS (although it could), and then, if we can show that yes, indeed, the clinical effects really are the result of increasing serotonin levels in the brain, that does not automatically mean that the disease that is treated (in this case depression) is caused by a low serotonin level, or an “imbalance” (whatever you define that to mean) of serotonin.

    And the above is the general rule for pretty much all drugs. The drugs where the chain from chemical action to cellular action to whole-organism effect is clear and obvious are actually the minority.

    The clinical effects of drugs are complicated that way.

  84. PaulG says

    Salty Current, 90: “Give me the citation that proves evolution.”

    There is no such citation. However, I can give you many, many citations which strengthen the theory of evolution, and very, very few which weaken it.

    PS: I won’t, so don’t bother asking.

    Given your amateurish approach to science on this thread, I’m not going to engage with you any further on scientific matters. Sorry if that sounds harsh, but I really can’t waste my time on rebutting unrebuttable nonsense.

  85. amphiox says

    At least Dennis is fortunate enough to live in a country where health care isn’t considered a luxury item.

    The Canadian Mental Health system is seriously underfunded and strained in many ways. And patients who enter it through the criminal justice system have a tendency to get the short end of the stick quite a lot.

    There is still a very real danger that he will end up falling through the cracks in the system.

    (The Canadian system is, of course, still many magnitudes of effectiveness superior to the joke of a mess that some people call a “system” that is used in the US).

  86. PaulG says

    amphiox, 93: “But it does not necessarily follow from this that the clinical (symptomatic) effects seen from these medications must therefore result from a general increase in serotonin levels in the CNS”

    Wow. You really didn’t understand the post, did you? Is this my fault or yours? Current knowledge versus future knowledge. Have a think about it.

  87. says

    Really? Children would be the group where the evidence that antidepressants are not helpful and do more harm than good is arguably the strongest!

    amphiox, are you outside the US?

    The extent to which the companies have been able to keep that information out of the public discussion in the US has been incredible. Not only were the drugs approved here for children, but they’re extremely widely prescribed to them. Millions and millions of them, and the numbers keep growing.

  88. Jack Krebs says

    One hypothesis offered to us when our son was in treatment is that SSRI’s and talk therapy worked together: the SSRI’s helping make possible new nerve pathways, and then the talk therapy helping the patient learn new ways of being (internally and externally) that would improve the ability to be less affected by the depression.

  89. stacy says

    I suffered from untreated or ineffectually-treated clinical depression for many years. If SSRIs are placebos, they’re damn “good” ones, working–not perfectly, but noticeably well-enough to make life bearable–where nothing else ever did.

    My own (admittedly unscientific, gleaned from the popular press) understanding is that SSRIs work moderately well (though noone’s quite sure how) for chronically depressed adults, do little or nothing for the less-intensely afflicted, and should not be given to children.

    Bethistopheles and Crip Dyke, thank you for your posts. Interesting and informative.

    Mick:

    It’s not demonizing or ostracizing those with mental illnesses to point out that they can be rather disconcerting when they are fully afflicted by their condition. It’s just reality and one of many reasons why people should seek treatment if they are afflicted.

    QFT.

    BTW, PZ, and anyone else It May Concern–I’m moonkitty. Finally logged in to FtB and, well, no more different nyms for different blogs. Don’t want anyone to think I’m a sock-puppeteer.

  90. PaulG says

    Salty Current,94: “PaulG, you’re trolling.”

    This is so sad, it’s pathetic. And also a really nasty way to conduct an internet discussion. It seems to be: “Shit, the other person has out-argued me, I’d better throw in an unfounded accusation so that casual readers won’t read/believe what this person wrote”.

    Pretty pathetic. I thought OMs were this site’s bona fide heroes? They seem to me more like precious little cheerleaders.

    “You’re wrong. I’m wrong. Sometimes we’re all fucking worng.”

  91. andrewv69 says

    @PaulG

    Both you and Salty are being stubborn IMO. Anyway, I am a layman in this area, and following the link that Salty gave at #47 I found the following link down below (and Salty could have just posted the link instead of arguing) but whatever. It took me 1 minute to find the link.

    I skimmed the paper (took me 4 minutes), but it looks to me (bearing in mind I have no expertise in the field) as if this may be what you two are having this mini tiff over.

    Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature
    http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020392

    With direct proof of serotonin deficiency in any mental disorder lacking, the claimed efficacy of SSRIs is often cited as indirect support for the serotonin hypothesis. Yet, this ex juvantibus line of reasoning (i.e., reasoning “backwards” to make assumptions about disease causation based on the response of the disease to a treatment) is logically problematic—the fact that aspirin cures headaches does not prove that headaches are due to low levels of aspirin in the brain.

    AND

    Reasoning backwards, from SSRI efficacy to presumed serotonin deficiency, is thus highly contested. The validity of this reasoning becomes even more unlikely when one considers recent studies that even call into question the very efficacy of the SSRIs. Irving Kirsch and colleagues, using the Freedom of Information Act, gained access to all clinical trials of antidepressants submitted to the Food and Drug Administration (FDA) by the pharmaceutical companies for medication approval. When the published and unpublished trials were pooled, the placebo duplicated about 80% of the antidepressant response [13]; 57% of these pharmaceutical company–funded trials failed to show a statistically significant difference between antidepressant and inert placebo [14]. A recent Cochrane review suggests that these results are inflated as compared to trials that use an active placebo [15]. This modest efficacy and extremely high rate of placebo response are not seen in the treatment of well-studied imbalances such as insulin deficiency, and casts doubt on the serotonin hypothesis.

  92. Craig Reges says

    Why does the front page have quackery advertised?

    Secret Water Freedom Webinar

    CONFIDENTIAL: Earth’s Deepest Water Cleansing Secret Finally Made Public

    This Little Secret Turns The Dirtiest Water on The Planet Into Pristine Water, Pulls Fluoride, Heavy Metals, Lead, Mercury, and other Deadly Toxins Right Out Of Your Body..

    Are you kidding?

  93. says

    I suffered from untreated or ineffectually-treated clinical depression for many years. If SSRIs are placebos, they’re damn “good” ones, working–not perfectly, but noticeably well-enough to make life bearable–where nothing else ever did.

    Substitute any CAM/anecdotal evidence.

    My own (admittedly unscientific, gleaned from the popular press)

    There you go.

    ***

    (and Salty could have just posted the link instead of arguing)

    a) I did, in the post I linked to.

    b) That’s not a disagreement, you idiot.

    A sockpuppet? Who cares? Done with it, too.

  94. Desert Son, OM says

    Dealing with issues of depression right now, this thread struck a chord.

    Terrible way to return and say hello, so apologies, and I’ll add, Hello! Nice to see some familiar screen names. It’s been a while. I like the new digs, and I hope this post finds you all well.

    PaulG, SC, amphiox, others interested in re: research on neurotransmitters and affective/mood disorders.

    I did a quick search through my university database and here’s a couple of references I found, though I haven’t read the full articles and neuro-chemistry isn’t my field so there’s probably much I wouldn’t understand. In my search I restricted the parameters to include only peer-reviewed journals. Citations appear in APA format, as that’s the format I’m used to using. If that’s not a familiar format, or not a preferred format for citations here, I apologize but therein is one of the limits of my experience.

    Unfortunately I don’t have links. I don’t have a website and the documents are downloaded .pdf through a database search, so at present that’s the best I can do.

    Some articles found:

    Leheste, J. R., Curcio, C. C., Baldinger, L. L., Sarwar, S. S., Zakhary, S. M., Hallas, B. H., & … Torres, G. G. (2008). Glutamate-Based Drugs for the Treatment of Clinical Depression. Central Nervous System Agents in Medicinal Chemistry, 8(3), 170-176.

    Select quote from the Leheste, et al. (2008) introduction:

    “This hypothesis suspects dysregulation of central serotonin (5-HT) and norepinephrine (NE) transmission as the main factor contributing to major depression [1, 2, 3]. This implication is based upon the fact that drugs that deplete 5-HT precipitate depression (e.g., reserpine) and, conversely, drugs that replenish the synapse with 5-HT have antidepressant properties (e.g., sertraline). This rather simplistic hypothesis has shaped drug development since the 1950’s with the net-result that tricyclic antidepressants (e.g., imipramine), selective 5-HT reuptake inhibitors (e.g., fluoxetine) and monoamine oxidase inhibitors (e.g., phenelzine) all indirectly target the brain 5-HT/NE system. However, evidence in support of this hypothesis is weak at best. For instance, treatment for severe mood disorders, particularly, bipolar disorder, does not affect the synaptic transmission of 5-HT or NE [4]. Further, although drugs such as fluoxetine affect 5-HT levels within hours, all antidepressant agents have a characteristic delay of onset (weeks) in their therapeutic effects [5]. Finally, and of greater concern, most antidepressant drugs of adequate dose and treatment duration fail to elicit a therapeutic response in a high proportion (~30%) of patients [6].” (Leheste, et al., 2008, p. 170)

    The next article is one referenced in the Leheste, et al. (2008) article previously referenced:

    Coyle, J. T., & Duman, R. S. (2003). Finding the Intracellular Signaling Pathways Affected by Mood Disorder Treatments. Neuron, 38(2), 157-160.

    The Coyle and Duman (2003) article is a small review. Selected quote from the article:

    “For nearly 50 years, theories about the mechanisms of actions of drugs used to treat neuropsychiatric disorders have focused primarily on their effects on synaptic neurotransmission, such as inhibition of neurotransmitter reuptake (serotonin-specific reuptake inhibitors [SSRI], blockade of neurotransmitter receptors (anti-psychotics), or inhibition of neurotransmitter catabolism (monoamine oxidase inhibitors [MAOI]). However, several treatments for sever mood disorders, especially bipolar disorder, have no obvious effects on synaptic neurotransmission.” (Coyle & Duman, 2003, p. 157).

    Another:

    Pilc, A., Chaki, S., Nowak, G., & Witkin, J. M. (2008). Mood disorders: Regulation by metabotropic glutamate receptors. Biochemical Pharmacology, 75(5). pp. 997-1006.

    Select quote from Pilc, et al. (2008):
    “Glutamate is the primary excitatory neurotransmitter in the mammalian central nervous system. Preclinical and clinical evidence have suggested that altered glutamate neurotransmission plays a role in mood disorders (see [1,2] for an overview). The exciting finding that the NMDA receptor antagonist ketamine was effective in treating antidepressant-resistant patients [3,4] has increased the promise that improved treatments for the major depressive disorders might be possible by modulation of glutamatergic neurotransmission. Current therapies for mood disorders involve medications that increase the synaptic availability of monoamine neurotransmitters. The need for improved medicines is stressed by data emphasizing the poor remission rates and high rate of relapse in depressed patients seeking treatment [5].” (Pilc, et al., 2008, p. 997)

    I confess I have little idea what they’re discussing in that quote. This particular article is very heavy on the bio-chemistry and that’s just a field in which I have little or no knowledge whatsoever.

    Those are three that I found in a cursory search which obviously does not begin to adequately address the question, but I hope that will at least contribute something to the discussion. Again, this is not my area (though it affects me, as I have depression), so I’m terribly uninformed, and if this post has muddied the waters, I apologize. Any typing errors in the above quote are mine, not those of the respective authors.

    Sorry for an overly long post.

    Nice to see you all again.

    Still learning,

    Robert

  95. PaulG says

    Andrewv69, 106: “I am a layman in this area, and…I skimmed the paper (took me 4 minutes)”

    Alright, this should be good.

    You quoted this line: “the fact that aspirin cures headaches does not prove that headaches are due to low levels of aspirin in the brain.”

    Absolute nonsense.

    Aspirin is a drug. Anti-depressants are drugs. The headache (or depression) is not due to a lack of aspirin (or A-D), but it is cured by inhibition (or re-uptake inhibition) of COX enzyme(s) (or neurotransmitter(s)).

  96. says

    PaulG: In your previous incarnations as “Pollution”, “Jazzhands”, and “Monkey Genes” on the old site, you showed this same pattern of obnoxious obtuseness…a pattern that got you banned there. You are now very close to meeting the same fate here. You don’t get to tell other people to “fuck off” — you’re here on highly borderline sufferance yourself.

  97. andrewv69 says

    @PaulG

    YABUT… Why not skim the paper and then render an opinion? You will at least get the context. ie. Bad Pharma misleading proles.

    Should the FDA take similar action against consumer advertisements of SSRIs?

    As just one example, the prescribing information for paroxetine, which is typical of the SSRI-class drugs, states, “The efficacy of paroxetine in the treatment of major depressive disorder, social anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder (PD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD) is presumed to be linked to potentiation of serotonergic activity in the central nervous system resulting from inhibition of neuronal reuptake of serotonin. Studies at clinically relevant doses in humans have demonstrated that paroxetine blocks the uptake of serotonin into human platelets” [30].

    In other words, the mechanism of action of paroxetine has not been definitively established, and remains unconfirmed and presumptive (the prescribing information states that the efficacy of the drug “is presumed to be linked to potentiation of serotonergic activity” ([30], our italics added). Although there is evidence that paroxetine inhibits the reuptake of serotonin, the significance of this phenomenon in the amelioration of psychiatric symptoms is unknown, and continually debated [12,31]. Most importantly, the prescribing information does not mention a serotonin deficiency in those administered paroxetine, nor does it claim that paroxetine corrects an imbalance of serotonin. In contrast, the consumer advertisements for paroxetine present claims that are not found in this FDA-approved product labeling.

  98. PaulG says

    I won’t be back here for a few hours. Just a personal, though:

    1) This is not an argument about Government/private healthcare systems.

    2) This is not an argument about “what worked for me”.

    3) See # 2, but “what a guy I know who’s a doctor says”.

    4) It’s annoying/counterproductive linking to stuff through stuff. Just give it to us direct.

    5) There are many who comment here who have direct personal/professional experience with mental illness. This does not by definition mean that you understand the biology.

    6) You only have one life. It may seem shit at the moment, but death is final. Suicide is taking 100% nothingness versus 1-99% fun, happiness and satisfaction. The odds say stay alive.

  99. Nentuaby says

    Odd… I know bipolar people. I’m borderline bipolar myself. Bipolar is ”not” the disorder I would have guessed from the Mabus texts.

  100. Nentuaby says

    I have no idea why my italics in the previous post rendered as malformed Microsoft Quotes.

    Odd… I know bipolar people. I’m borderline bipolar myself. Bipolar is not the disorder I would have guessed from the Mabus texts.

  101. PaulG says

    PZ Myers, 112: Oh.

    I did not see this one coming. I was directly accused of “trolling”, which is why the “fuck off” came out. I thought such language was not out of order here?

    I have genuinely been having a heartfelt and serious discussion about a scientific matter. Not sure why my participation in this thread has attracted your attention.

    I think it is customary at this point to direct you to the swooning couch?

  102. PaulG says

    PZ Myers, #119: I don’t. Just seriously confused about when/towards whom the word “fuck” is appropriate to use.

    I’ll say no more tonight, and hope that I can continue to “contribute” tomorrow, etc.

    Final word: really confused that this thread got me nearly/banned. It’s touched on a passion of mine, and I absolutely believe I have been well behaved. Your comments here/to my email would be welcome, though aren’t expected (fuck, I wouldn’t bother with some annoying asshole if it were my blog).

  103. stacy says

    A sockpuppet? Who cares? Done with it, too

    Huh? Was that directed at me? I just want people to be clear that I’m not sockpuppeting. Sockpuppetry is fucked-up, and I don’t want to be mistaken for someone who’d do it.

  104. stacy says

    (Messed up the formatting. “Substitute any CAM/anecdotal evidence” should have been in blockquote. Sorry.)

  105. Who Cares says

    @Nentuaby(#116):
    There are different categories of Bipolar. I’m guessing Markuze is a type 1 and you are a type 2. Then there is that you know it and that either you or your surrounds respond when it gets out of hand, Markuze has not even been diagnosed until recently. Finally there is base personality.

    As someone with a borderliner in the family (made worse by the fact that said person denies having it) I seriously hope that treatment will have an effect and that Markuze will stay on it after he gets out of the clinic

  106. says

    Of course. I was not offering my personal experience as definitive or validating.

    Yes, you were.

    Nevertheless:…

    The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.

    Kirsch?

  107. theophontes , flambeau du communisme says

    @ ..- -.. #17

    She was only the telegrapher’s daughter, but she didit ’cause her daadaa didit

    /off-topic

  108. amphiox says

    Final word: really confused that this thread got me nearly/banned. It’s touched on a passion of mine, and I absolutely believe I have been well behaved.

    It’s the sockpuppetry that is the problem, and not the content of the posts. It’s like a bank robber claiming to the police that he acted appropriately because his getaway car wasn’t illegally parked.

  109. says

    stacy:

    I suffered from untreated or ineffectually-treated clinical depression for many years. If SSRIs are placebos, they’re damn “good” ones, working–not perfectly, but noticeably well-enough to make life bearable–where nothing else ever did.

    stacy, later:

    I was not offering my personal experience as definitive or validating.

    I’m so tired of this. It’s exactly the CAM line.

  110. azkyroth says

    With respect, Myers, perpetuating the outdated notion that bi-polar folk (or folk “afflicted” with any mental “illness”) are “messes” or are by virtue of medical diagnoses dangerous is asinine and unfair.

    Frankly, I’ve known at least three unmedicated people with bipolar diagnoses or symptoms, and all of them have made my life worse for it. Mental illnesses, some of them, can result in behavior that makes victims of others. It’s asinine to pretend that they’re exactly like, say, being a minority race or having diabetes, given that.

  111. stacy says

    Yes, you were

    O really? You base this on what? My experience is my experience. I didn’t claim it was definitive.

    Kirsch?

    I have no idea what this means. If you’d like to discuss it, please elaborate. If you just want to be dismissive, well, have fun by yourself.

  112. andrewv69 says

    @Desert Son, OM

    I notice the papers you cite are mostly dated 2003-2008. Do you have a better introduction to SSRI than the one I found here?

    Brain serotonin neurotransmission: An overview and update with emphasis on serotonin subsystem heterogeneity, multiple receptors, interactions with other neurotransmitter systems, and consequent implications for understanding the actions of serotonergic drugs.
    http://research.chem.psu.edu/amagroup/publications/AMA9.pdf

    The paper states, among other things that

    The existence of 15 different serotonin receptors, some of whichhave opposite effects (bolding is mine) on other neurotransmitter system neurons (including dopamine, acetylcholine, and glutamate neurons), has also been demonstrated.

    Something else that you may find interesting is a drug named tianeptine which is apparently not available in the English speaking world and is mentioned on PLOS (in a response to the paper I quoted in #106 & #113):

    Evident Exception in Clinical Practice Not Sufficient to Break Traditional Hypothesis
    http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0030120

    Tianeptine increases serotonin reuptake; therefore, it has the opposite effect on the serotonin system compared with that of SSRIs

  113. amphiox says

    Aspirin is a drug. Anti-depressants are drugs. The headache (or depression) is not due to a lack of aspirin (or A-D), but it is cured by inhibition (or re-uptake inhibition) of COX enzyme(s) (or neurotransmitter(s)).

    But, you see, that is not at all as clear as you think it is. Aspirin inhibits the COX enzymes, which are important in the biochemical pathways of prostaglandin and thromboxane synthesis, which play a part in inflammation.

    But to go from COX inhibition to resolution of headache as a clinical symptom requires several more layers of higher level explanatory mechanisms. You therefore absolutely cannot naively argue that because aspirin inhibits COX and aspirin relieves headache, then headache must be caused by an imbalance in COX activity. (Even going from COX inhibition to decreased inflammation, which is just a single mechanistic layer, requires additional evidence beyond the simple observation of aspirin’s effectiveness in relieving headache symptoms)

    Nor can you even argue that the headache is cured by COX inhibition (even if aspirin was a specific COX inhibitor, which it isn’t*). You can barely even argue that the symptoms of headache are masked as a result of COX inhibition, with only this amount of evidence.

    And the same is true for SSRIs and depression.

    (Aspirin has several other physiological effects besides COX inhibition.)

    (And don’t think it won’t be noticed how you moved the goalposts from “depression must be caused by an imbalance of neurotransmitters” to “depression is “cured” by inhibition of re-uptake of serotonin”. Though even that last one cannot be supported solely on the observation that SSRIs improve the symptoms of depression – which in and of itself is an assertion whose validity remains questionable)

  114. Sharifa says

    That’s exactly the same diagnosis given to the guy who stabbed his mother over Avril Lavigne tickets.

  115. andrewv69 says

    @stacy, Salty, amphiox

    I have been called many things in my time but a sockpuppet is new one. If you have any doubts ask PZ. It is trivial to verify.

    BTW, can someone eMail Dhorvath, OM and say AndrewV69 is back and wants a word?

  116. Akira MacKenzie says

    @amphiox

    I realize that Canada’s system is far from perfect, but at least they are trying. I’ve just ended a year-long stint of unemployment and there were moments where I had an issue (both mental and physical) that I would have like to talk to a doctor about, but I just couldn’t afford it. (Thanks Barry and the GOP!) My health insurance just kicked in earlier this month, but at the level I can afford to pay in, I don’t get much in the way of mental health coverage.

    Heh, I’m going to be 37 in a few months, I have a BA,. However, on top of my BPD, I can only find a job that pays just above minimum wage with mediocre benefits, I’m forced to live with my right-wing prick of a father because I can’t afford to pay rent, and I’m ugly too.

    Sucks to be me, huh?

  117. Desert Son, OM says

    Andrew69 at 133,

    I’m afraid I don’t. My search was cursory at best. My aim was to submit some research examples that began to approach the question because PaulG was asking for citations and was unwilling to follow SC’s links. My hope was that a couple of papers (granted, I didn’t have links, so maybe PaulG felt that was just as useless) might give PaulG something to read if uninterested in following links others had posted. I also hoped that if PaulG started reading those it might spur additional research contributions.

    I should probably bow out of this thread, now that I think more about it. I am not a biologist, biochemist, psychiatrist or neurologist or other physician, behavioral specialist, or clinical counseling psychologist. The search I conducted was through Academic Search Complete, filtering for peer reviewed journals, search terms: “depress*” “mood disorder” “treat*” “neurotrasmit*” “hypothesis”. That’s probably not a very efficient search, frankly. I read through some abstracts, looked at three .pdf files, made the citations and selected some quotes from the articles. I was hoping to find some references from 2010 +, but didn’t find them (which is certainly not to say they’re not out there).

    Still learning,

    Robert

  118. stacy says

    SC–Sorry–I see that “Kirsch” refers to a book you mentioned earlier in the thread. Looks like Kirsch pushes talk therapy–which is also of dubious efficacy.

    andrewv69–I seem to have inadvertently gotten in the middle of something. Not accusing you of anything. I don’t know you. I just mentioned that I changed my own nym ’cause I don’t want there to be any misunderstandings. Carry on.

    (Meta: *sigh* This is why I don’t comment here more often.)

  119. says

    With respect, Myers, perpetuating the outdated notion that bi-polar folk (or folk “afflicted” with any mental “illness”) are “messes”

    Oh, please. I’m talking about a specific individual, not making generalities. Markuze is a mess; his life is generally screwed up, and he’s been frantically struggling to make others miserable for over a decade. I guarantee you, I see him as someone entirely unique: I do not anticipate that everyone with bipolar disorder spends half their waking hours obsessively harassing legions of people on the internet.

  120. azkyroth says

    Any evidence for this? Seems like it would be an easy thing to test…

    Between this and the PETA threads, it appears that, award or no, at some point SC found the Well of Hippie Woo and drank deeply.

  121. andrewv69 says

    @Desert Son, OM

    OK thanks for the reply. I booked myself some time to go over the introduction I mentioned, and since it is dated 1998 I was hoping for something a little bit more current.

    @stacy, no worries at all. I knew you were not accusing me of anything. I thought it was funny actually. But I do apparently have a nonnormative sense of humor.

  122. skybluskyblue says

    I too hope for the best for Dennis Markuze.

    Anecdotally, my sister-in-law has bi-polar type I and when she is anywhere near off he meds she can be a little dangerous to her son. She gets strange ideas out of the blue and acts on them in the most intense ways. One was that someone like the FBI was after her so she drove at high speeds with her son in the car until she ran out of gas on the highway. I suppose she started to calm down while stuck on her car. A nice highway patrol person knew how to handle her wide-eyed fast talking self and made sure her family retrieved her and took her to the hospital. Despite her meds she still goes through up and down cycles and tries to do too much at once leading back to bed-ridden depression where she is useless.

    About SSRIs, I do not think they helped my depressions at all, but they really decreased my OCD-like thoughts. Disclaimer: My experience with SSRIs means nothing more than an anecdote.

    Curious though, are you saying that all psychiatric medicines are useless? And is autism a disease made up by drug companies? If you answered ‘yes’ to both questions you DO remind me of what Scientologists say. However, they may believe things that coincidentally non-religious people believe too.[Please go easy on me, I am on the autistic spectrum; so, I fully misjudge social situations all the time. Is it better for me to not post at all (i.e. keep my mouth shut right now)? I do not know. But hey, I think I fit in here http://blogs.discovermagazine.com/gnxp/2011/09/atheism-as-mental-deviance/ "These two figures illustrate two results:
    1) Among two equivalent demographic samples differentiated by autism diagnosis state, the high functioning autistics are much more likely to be atheists.
    2) Among a sample of autistics and neurotypicals those who are atheists have the highest “autism quotient.” ]

  123. says

    Desert Son, hi!

    I’m just going to stand back and watch the fur fly. “He was quite a mess” is the kind of thing you say could about someone who has been in an accident. It isn’t necessarily insulting.

    My own anecdote is that Prozac was keeping an allergy at bay for me, then I stopped taking it for a while, and now it doesn’t seem to be working. I don’t know if that’s because the amounts haven’t built up yet (and I’m also one of those people whom it hits quickly), whether a different generic formulation has different enough absorption characteristics to make it ineffective, or it’s just because I heard it’s no better than placebo. But I find the allergy very annoying.

  124. Bruce Gorton says

    Saurs

    Mabus was the mental health equivelant to a guy who is coughing up blood. In other words it was pretty damn obvious something was wrong.

    I am pretty sure you would not criticise anybody for saying “Go see a doctor about that coughing blood thing” for saying that while not being a medical professional – so WTF is your problem with people saying “Go seek help for those threats you are making that are escalating in number, violence and incoherence”?

    We were not in a position to diagnose what was wrong, but it was an alarming situation in which it was particularly clear something was.

    He then got arrested for making thousands of death threats a day with the result that he got a court appointed mental evaluation.

    He has been diagnosed by professionals. Not by the Internet, but by professionals working for the courts.

    Hopefully the result of all of this will be that he gets treatment for his condition and can live a fully and happy life.

  125. ichthyic says

    On clinical grounds we can conclude that they work as enhanced placebos.

    I’m going on the other side of this.

    there is a LONG and well established medical lexicon of literally thousands of papers demonstrating the mechanisms of how the neuroscience of various psychological conditions work.

    these are not correlative, they are causative, and have show the exact mechanics and chemistry involved.

    Not sure what you’re on about here, but I’d love to see you in a mud wrestling match with Shelly Batts.

    maybe you can have fun with an old article regarding ADD?

    http://scienceblogs.com/retrospectacle/2007/10/repost_the_neuroscience_of_adh.php#more

  126. ichthyic says

    But to go from COX inhibition to resolution of headache as a clinical symptom requires several more layers of higher level explanatory mechanisms. You therefore absolutely cannot naively argue that because aspirin inhibits COX and aspirin relieves headache, then headache must be caused by an imbalance in COX activity

    ah, is this the level SC means then?

    that I could agree with, but there in fact are a great many mental conditions and illnesses that DO have well documented mechanisms, and thus do respond directly to manipulating the mechanisms involved chemically (or even physically).

  127. skybluskyblue says

    Markita Lynda, healthcare is a damn right, “My own anecdote is that Prozac was keeping an allergy at bay for me, then I stopped taking it for a while,”
    You may or may not know this but, it is dangerous to suddenly stop taking SSRIs [Prozac etc] –Get the input of your doctor if you do not already have it. You can read all about it here: http://en.wikipedia.org/wiki/SSRI_discontinuation_syndrome

  128. Tigger_the_Wing says

    skybluskyblue, you fit in here, in whatever sense you meant it, as do I – and we aren’t the only spectrumites here! =^_^=

  129. Tigger_the_Wing says

    Oops! Pressed ‘submit’ instead of ‘preview’.

    I am relieved that DM now has a diagnosis and, presumably, is now eligible for the help he so badly needs.

    I have a family member, probably with Bipolar disorder (certainly extreme mood swings, periodic depression and mania) who has resisted diagnosis and has been self-medicating with both legal and illegal substances. It is very hard on relatives when someone is like this even when they aren’t actively threatening others.

  130. DifferentFrogs says

    Long time lurker here, just signing in to say:

    I read this whole comment thread, and have just lost some faith in PZ, and a little bit in the community too.

    It doesn’t seem unreasonable to request direct links to references. The links SC posted to his blog were not easy to navigate; in fact none of the links I could see on his page led to anything other than more blog posts (I didn’t follow up further than that). PaulG asked politely for direct links, and SC called him a troll.

    Which I think is very unfair. Nothing PaulG did in this thread constituted trolling. While I am not an expert on psychiatry by any means, as far as I can tell Salty is arguing against the current scientific consensus regarding how these drugs work. Not that there’s anything wrong with that – it just means that the burden of proof is on HIM to come up with citations. And when instead of doing this, he simply yells FALSE (#61), I can understand why PaulG was frustrated.

    Which is why I was very confused when, instead of calling out the poster who:

    - made radical claims
    - largely failed to back them up with evidence (telling him to click random links on a blog is not evidence)
    - instigated ad hominen attacks

    he instead tells the guy who said the word “fuck” that he will be banned next time.

    Now admittedly I don’t know any of PaulG’s history. But come on PZ. I know that SC is Order of Molly, and maybe PaulG WAS being a bit obtuse, but based on the comments in this thread only, SC was out of line calling PaulG a troll. And after making such an effort in what was until that point a reasonable argument, Paul was right to tell him to fuck off. And PZ, you were very unfair to him. If anybody deserves the warning it’s SC – come on, he failed to really post evidence, something that I thought was a cardinal sin on any rational blog.

    I am a bit sad now :(

  131. skybluskyblue says

    Thank you Tigger_the_Wing for at least temporarily relieving my worry that I was totally out of order even trying to post here. ;D We nearly look like birds of feather here with our ASDs and our bi-polar relatives. For the ~Scientology-like* people we are completely living in a “Big Pharma” invented reality. [*Ol' hypertonic saline will not appreciate that(?)]

  132. John Morales says

    [meta]

    DifferentFrogs, a few things:

    That you claim to be a long-time lurker and simultaneously that you are unaware of PaulG’s history is… odd.

    While I am not an expert on psychiatry by any means, as far as I can tell Salty is arguing against the current scientific consensus regarding how these drugs work. Not that there’s anything wrong with that – it just means that the burden of proof is on HIM to come up with citations. And when instead of doing this, he simply yells FALSE (#61), I can understand why PaulG was frustrated.

    Yet you yourself apparently think you have a magical dispensation from providing evidence that SC is indeed arguing against the current scientific consensus regarding how these drugs work.

    Finally, I note that you’ve lost faith in PZ indicates you operate on the basis of faith in PZ.

    (Good luck with that!)

  133. Olav says

    Jafafa Hots says:

    SSRIs never cured my depression, but they did completely cure the intermittent swelling of my genitals.

    Hear, hear.

    That’s why I stopped taking them too. And the general dissociation and unrest they caused while I was using them.

    The intermittent swelling of the genitals has returned, but it took a while. Months, actually.

  134. skybluskyblue says

    John Morales says/DifferentFrogs,
    [Am I butting in?]
    Would a normally banal reference: Wikipdia be able to determine what the current scientific consensus is? After all, they say that they try to get just that when they write/edit an article. What would be the best way to find this current scientific consensus? [Am I butting in?]

  135. John Morales says

    [meta]

    skybluskyblue, nah, speak your mind and butt in all you want. :)

    (This is Pharyngula!)

    As far as adducing support for one’s contentions, there are no rules and no requirements.

    As far as Wikipedia goes, that very much depends on the specific article. For medical matters no less than others, evidence-based references are probably the most authoritative — the better articles will have a number of solid references.

    I doubt there’s any given “best way” to demonstrate consensus (in general), by the way; this is generally topic-dependent.

  136. says

    With respect, Myers, perpetuating the outdated notion that bi-polar folk (or folk “afflicted” with any mental “illness”) are “messes” or are by virtue of medical diagnoses dangerous is asinine and unfair.

    I agree with the second part of your statement, but I didn’t parse PZ’s “mess” comment that way… I thought he was referring to the substance abuse. I think all of us were tres unsurprised to learn that Markuze was bipolar (though my bet would have been mild schizophrenia, as things like GOATS ON FIRE! sound disturbingly like my brother-in-law’s less lucid moments, but bipolar makes a lot of sense too, especially given his, ahem, periods of prodigious output) but I wouldn’t have guessed alcohol abuse.

    As someone who struggles personally with both depression (thankfully mild) as well as problem drinking, I guess I still can understand how “mess” would be offensive… but I guess it was just surprising. I wouldn’t have taken Markuze for a fellow boozer… Not sure why not, I just wouldn’t have.

  137. louis14 says

    #154 John Morales

    That you claim to be a long-time lurker and simultaneously that you are unaware of PaulG’s history is… odd.

    Not so odd. For instance, I have been reading this blog for several years. Occasionally I’ll read the comments, but not often – I don’t have the time. I wasn’t aware of who PaulG was or his history of other profiles.

  138. Hazuki says

    SSRIs don’t work for some people. For me, they caused awful irregular heartbeats and made the depression and anxiety worse. As someone without insurance for several years, I basically defeated panic disorder, unipolar depression, and mild OCD on my own using CBT techniques, valerian, green tea (L-theanine), and a ridiculous amount of willpower.

    It wasn’t fun and I still have some bad days, but what can you do? As part of thr growing uninsured underclass, it’s that or commit suicide.

  139. maureen.brian says

    I have been trying to restrain myself. I will now explode – but mildly!

    There are too many people here telling people they know nothing about what language they may use. We seem to have moved on from the point where mental illness must never be mentioned to a new enlightenment where we may discuss it but only in clinical language and only while wearing a collar and tie. Hoo-fucking-ray!

    A little more insight into what you you have been reading, guys, would bring you to the realisation that for many of us mental illness – our own or someone else’s – is the stuff of everyday life. Everyday life gets discussed in everyday language.

    We use the words which make sense to us and the jokes which get us from one day to the next. As far as I know, no supernatural being has put you in charge of my vocabulary. Long may it remain so.

    PZ has been driven bonkers by Mabus and for years. I have seen him scream out in exasperation but I have never doubted that his wish was to persuade someone who could do something to recognise just how disturbed the man was and that his pattern of behaviour had changed, so that he could be helped.

    You have a problem with that? Read the archives.

  140. Nerd of Redhead, Dances OM Trolls says

    Is it just me, or does DifferentFrog have the smell of PaulG’s sockpuppet?

  141. John D. says

    I have a cousin who is bi-polar. For the longest time we called her the demon child – she would be very sweet and loveable some of the time, but then she would be completely unbearable and do crazy thing at other times. She would constantly throw fits, and later in life she would steal and dropped out of high-school. One time she threatened to kill herself in front of our grandmother.

    After she was diagnosed and started taking medication for her condition and a few other life events things were very different. She’s nice to be around all the time and not just half the time. She became responsible. She got her high school diploma. She works for a stock brokerage. She did get knocked up, but at least the guy she was with is a good and responsible person (unlike her previous choices in men) and they are together and now have another kid, both of whom are wonderful and well mannered. It’s like the difference between night and day. We’re actually proud to call her a member of our family now.

    I hope Mr. Markuze will get the help he needs and will take the meds he is prescribed so he can lead a healthy, productive life where he isn’t constantly making threats and harassing people.

  142. says

    O really? You base this on what? My experience is my experience. I didn’t claim it was definitive.

    You said: “If SSRIs are placebos, they’re damn “good” ones, working–not perfectly, but noticeably well-enough to make life bearable–where nothing else ever did.” This is a general suggestion (unless you’re going to deny that you meant that they work as something other than placebos) based on anecdote. It’s also true, though not in the sense you meant it. They are damn good placebos.

    SC–Sorry–I see that “Kirsch” refers to a book you mentioned earlier in the thread. Looks like Kirsch pushes talk therapy–which is also of dubious efficacy.

    First, the latter isn’t true. Second, this has zero to do with the discussion at hand. Third, I have never seen a subject about which people are more unwilling to engage with the evidence. The Kirsch paper is available online (ignore the stupid editors’ introduction), but his book* (and Whitaker’s) have hundreds of references, and Angell provides some as well. Note: the people responding to Angell are not defending the chemical imbalance idea. They’re saying it’s a straw man for her to bring it up because everyone knows it’s false.

    ***

    in fact none of the links I could see on his page led to anything other than more blog posts (I didn’t follow up further than that).

    That is wrong. And I’m female.

    ***

    there is a LONG and well established medical lexicon of literally thousands of papers demonstrating the mechanisms of how the neuroscience of various psychological conditions work.

    This is wrong. And in the case of depression, my posts provide evidence of the head of the NIMH saying for the past several years that the neurotransmitter imbalance notion is wrong. Read my post: when people point out that the neurotransmitter idea is discredited, the response is typically that they’re attacking a straw man because no one really believes this. But as this thread has shown, plenty of people continue to believe it. It’s wrong. The scientific consensus has been that it’s wrong for some time, but there’s a powerful industry that isn’t keen on that word getting out.

    Not sure what you’re on about here, but I’d love to see you in a mud wrestling match with Shelly Batts.

    maybe you can have fun with an old article regarding ADD?

    Batts doesn’t provide citations, really. ADD wasn’t the topic here, but it’s discussed in depth in the Whitaker book, with numerous references. Doesn’t mean you have to find his argument convincing, but is it too much to ask that people become a little more familiar with the subject?

    *The book goes well beyond the paper in making the placebo case.

  143. bananacat says

    I’m really not trying to concern-troll, but even horrible people should have the right to medical privacy. Did he release this information himself, and would he be ok with everyone knowing about it?

  144. Nerd of Redhead, Dances OM Trolls says

    I’m really not trying to concern-troll, but even horrible people should have the right to medical privacy.

    This was the results of a court ordered evaluation. The court documents are public records.

  145. says

    I’m really not trying to concern-troll, but even horrible people should have the right to medical privacy. Did he release this information himself, and would he be ok with everyone knowing about it?

    It’s a fair question.

    However, the whole incident was hardly private. He sent out personal death threats to hundreds of people, and general death threats to a significant fraction of the general population. In my opinion this gives the general public the right to know.

    That said, I partially agree with you, in that the precise details of his treatment should be subject to medical confidentiality.

  146. ChasCPeterson says

    there in fact are a great many mental conditions and illnesses that DO have well documented mechanisms, and thus do respond directly to manipulating the mechanisms involved chemically (or even physically).

    No, please: don’t bother mentioning even a single specific example. Your bald assertion alone is plenty good enough around here.

  147. otrame says

    Guys

    SSRIs don’t work for everybody. For those they do work for, they work. The fact that we do not know exactly how they work does not mean they are placebos. If they were placebos, they would only work briefly, if at all. It is more likely to be that what we call depression is actually several different disorders with similar symptoms, one (or several) of which respond well to SSRIs.

    And there is no question that SSRIs can be downright dangerous for many, especially those with undiagnosed bipolar issues. There is no question that they can seriously cause failure-to-swell in some genitals. For some that is a deal-breaker, which I can understand.

    For those of you who are symptomatic and cannot tolerate meds, for what ever reason, can I mention the anecdotal evidence that exercise can help maintain some emotional balance? I mean LOTS of exercise, as much as a couple hours a day.

    I can also mention that some (not all) of us will respond well to a form of folic acid that is sort of “predigested”, allowing it to get more easily past the blood-brain barrier. Sorry, I am on my iPad this morning, and citing URLs is a bitch, but if you are interested you can check it out.

  148. says

    Guys

    SSRIs don’t work for everybody. For those they do work for, they work. The fact that we do not know exactly how they work does not mean they are placebos. If they were placebos, they would only work briefly, if at all. It is more likely to be that what we call depression is actually several different disorders with similar symptoms, one (or several) of which respond well to SSRIs.

    Incredible.

  149. Horse-Pheathers says

    @165, SC: Yeah, I too caught a distinct whiff of dirty sock when DifferentFrogs decided to “de-lurk”.

    10 to 1 it spent all this time “lurking” in PaulG’s sock drawer.

  150. Hairy Chris says

    I’ll join the chorus (minus singing) and say that I’m glad that he’s getting help. Also add me to the list of people who didn’t entirely expect bipolar as a diagnosis, although I’m not entirely surprised. A good friend is type 2, but doesn’t have the paranoia.
    As for SSRIs, well been on them since end of 05 after starting to suffer from depression in around 03. They certainly aren’t placebos – or at least lexapro and prozac aren’t. In my personal experience I handle the 2nd better then the first but it still has some side affects. @skybluskyblue, you got the OCD thing with depression too? I went through a period of having to check that my apartment door was dead-locked 3 times – once after pulling key out the first time, 2nd from end of hall, 3rd from 1/2 way across car park. Going out took a little more time than it should have done!
    I can also see exactly where the self-medication comes from. I can still remember before I had a breakdown that forced me to have treatment… I spent months drinking myself to sleep because of the rats in the walls* and general noise like an untuned radio in my head.
    * There weren’t rats in the walls but it sounded like it when I was tired. The more tired, the worse it got. Bloody infuriating.

  151. says

    I don’t stay up on the psychopharmacological literature and my studies in psychology are hopelessly out of date (BA, 1985) but I’d imagine that there are some street drugs that could really exacerbate problems like bipolar disorder. While I also doubt the “chemical imbalance” theory is going to survive, if some forms of depression do have anything to do with serotonin levels, for example, then taking ecstacy would be a pretty bad move. Other street drugs like LSD appear to make it easy to very deeply establish memories very quickly, which would be really bad news if you caught the wrong train of thought during a mood-swing. I remember studies when I was an undergrad regarding memory and amphetamine use and it was very clear that some amphetamines improve short-term memory and degrade our ability to form long-term memories. Anyhow…

    I really feel for Markuze, because I lived for 2 years with someone who was severely bipolar, was on SSRIs and was taking recreational street drugs on top of that. Express elevator to hell.

  152. Bethistopheles says

    Wow. Way too many posts to read through, but I got through about half.

    I wonder, for those that say “SSRIs are placebos and dangerous and we’re all going to die aaaaahhhhhhhhhhhhhh”
    (ok, so maybe that’s a little hyperbolic, sorry lol)

    What about NDRIs? i.e. Wellbutrin?

    I personally hate SSRIs. I can’t even handle freakin’ Tramadol (a synthetic opioid); it affects serotonin.

    I very much think there is something that is tied in with Dopamine/endorphins. Not for everyone….we’re all quite varied in our brain wiring, but it just always made sense to me as far as my condition goes. Does it stimulate dopamine or inhibit reuptake? Then BAM! I don’t want to kill myself anymore.

    Seriously, without Wellbutrin and the occasional augmenting drug, I’d be long gone. So I’m glad to say thank goodness for psychiatric medication, even though some would have us believe we’re crazy just for the fact that we take medication period.

    I am interested to see how the SSRI thing plays out. I doubt it’s the key we’re looking for. I wouldn’t be surprised if it did work well for some people, but I’m leaning toward it really doesn’t to a lot for the majority of the people who have been prescribed it. And even then, there’s SO many SSRIs on the market and they all have a slightly different effect. In the end, for all we know, we know so very little about the neurobiology of our brains.
    Mmmm………braaaaaaaaaaaiiiiiiiiiinnnnnnnnnssssssssss….(are very interesting!)

  153. Bethistopheles says

    Damnit. Need. Edit. Function.

    I meant to say that as far as SSRIs not being the key, it’s obviously tied into something that IS the key, as it does work for some people.

    I so cannot wait until we figure this stuff out. I will have a total nerdgasm, haha

  154. says

    I wonder, for those that say “SSRIs are placebos and dangerous and we’re all going to die aaaaahhhhhhhhhhhhhh”
    (ok, so maybe that’s a little hyperbolic, sorry lol)

    What about NDRIs? i.e. Wellbutrin?

    Kirsch’s work isn’t limited to SSRIs.

  155. says

    I meant to say that as far as SSRIs not being the key, it’s obviously tied into something that IS the key, as it does work for some people.

    So does homeopathy.

    I so cannot wait until we figure this stuff out. I will have a total nerdgasm, haha

    The scientific consensus is that the neurotransmitter-imbalance hypothesis for depression is wrong. That has been figured out.

  156. R2 says

    Yeah, yeah, we all should know that the neurotransmitter-imbalance hypothesis sucks. Pharmaceutical companies just love it because it is easy to make an ad out of it.

    Anyway, I can’t get Kirsch’s book. I am also not a fan of books on controversial subjects as you can write anything in them.

    Is he arguing that ADM=placebo in severe depression? That the placebo effect is what does most of the work in a disease like depression?

    Antidepressants have also been shown to work in mild, moderate, and severe dysthymia, which as a chronic disease is less affected by the placebo effect.

    We don’t know how, but antidepressants work. Yeah, they might not work for everything they’re being used for now. Yeah, they are not as magical as they seem.

    But are you claiming they are really just placebos all the time?

    As an aside… aren’t we lucky that a sucky disease like depression is so affected by the placebo effect?

  157. Bethistopheles says

    I see your point, Salty, but homeopathy? Really? Not really the same thing. We don’t have FDA-approved homeopathy over and over and over and over and over and over and over and over and over and over and over again….and still finding new ones to add and be approved by the FDA? In other words, how exactly is it that the market is flooded with SSRIs if every single one of them is nothing more than placebo? And that’s not a rhetorical answer; I’m interested in what you have to say.

    Also, you misinterpreted that second phrase I put that you quoted. I mean the ENTIRE brain. Everything. Not just serotonin or why anti-depressants work. I wasn’t exactly clear I guess, oops.

    But yeah….I so hope I live to see the day when we can treat a brain just like we can treat a heart because we actually know wtf we’re doing.

    What is your take on NDRIs?

    Also, can you explain why you say neurotransmitters are totally bunk? Why do recreational drugs cause psychosis in susceptible people? Do we have any idea what changes in the brain occur on a very small scale? *Something* is obviously changing. But what?

  158. Bethistopheles says

    forget the redundant NDRI question, sorry. Didn’t refresh the page in time to see your answer.

  159. Hairy Chris says

    @R2

    It’s also important to note that some SSRIs are more equal than others. I think escitalopram has been shown in quite a few meta-analysis to be the best one at the moment.

    It’s horses for courses, truth be told, as the different formulas affect people in different ways. I spent 2 years fucked out of my skull on this stuff and came off it when I was together enough to want to string coherent sentences together!

  160. otrame says

    SC,

    You keep going on about one book and a few papers. You know perfectly well that that is not enough to overturn a consensus. The consensus is not that neurotransmitter-imbalances cause depression. We get that. The consensus is that, for many people, SSRIs work to alleviate the symptoms of depression.

    The “why” may still be up in the air or only partly understood, but to claim that all the research and all the personal experience amounts to “placebo” because two or three scientists think so is not going to impress me.

    When they can come up with a replacement that isn’t a placebo and isn’t “dangerous” and “really works” I will try it, and if it works for me, the SSRIs will be gone. Until then I will continue taking mine, because I know what my life (if you want to call it that) was like without them.

    I’m sorry they didn’t work for you.

  161. R2 says

    Hairy Chris: Yeah, by best I meant “works for most people”.

    Also, Bethistopheles, I think SC is NOT arguing that neurotransmitters play NO role. SC is saying that the neurotransmitter imbalance hypothesis of depression is false. At the very least, I’d say it is unproven.

  162. Dan L. says

    @differentfrog:

    It doesn’t seem unreasonable to request direct links to references. The links SC posted to his blog were not easy to navigate; in fact none of the links I could see on his page led to anything other than more blog posts (I didn’t follow up further than that). PaulG asked politely for direct links, and SC called him a troll.

    My goodness, you poor child, you mean you had to click a hyperlink and navigate a new webpage just to assess SC’s evidence for her assertion? That sort of thing simply shouldn’t be allowed on the internet.

    Before I feel too sorry for you, though, could you do a quick count of all the links (direct or otherwise) that PaulG offered to support his position?

    Seems to me like Paul G:
    1. Disagreed with SC but did not provide any evidence to support his own position.
    2. Demanded that, although SC offered evidence and he didn’t, that SC did not make this evidence convenient enough for him. Apparently, opening links in new tabs to do 30 minutes of internet research is beyond his scientific acumen (note his “I guess you’re not a scientist…” barb above).

    So in short, PaulG was acting kind of like a troll. There’s a few obvious reasons why you would act otherwise. The most obvious one is a banning offense.

    Which is why I was very confused when, instead of calling out the poster who:

    - made radical claims
    - largely failed to back them up with evidence (telling him to click random links on a blog is not evidence)
    - instigated ad hominen attacks

    he instead tells the guy who said the word “fuck” that he will be banned next time.

    SC offered evidence for her “radical claims” (evidence that suggests that they’re not actually too radical), did back them up with evidence (that you…oops, I mean PaulG find the evidence somehow inconvenient to browse does not mean that it wasn’t offered), and it’s not ad hom to accuse PaulG of trolling given points (1) and (2) above — refusing to offer evidence for your own position and objecting to the other person’s evidence purely because of the format in which it is presented are indeed behaviors I would call “trolling.” It’s got more than a sniff of Glen Beck about it, really.

    @Occam’s Blunt Instrument:

    Other street drugs like LSD appear to make it easy to very deeply establish memories very quickly, which would be really bad news if you caught the wrong train of thought during a mood-swing.

    Maybe PTSD-style memories, but LSD seems to very effectively suppress conscious memories. Often extremely difficult to remember anything of a trip except for a few fleeting, dream-like, incoherent impressions (actually, I usually remember them a little better than that, but I get the impression from friends that I’m unusual in that respect). Other possibilities: LSD induces delusions in neurotypical folk, so it’s probably really bad for people with pre-existing delusional affects. (The delusions are not the same as hallucinations, even if there’s no hallucination you’ll be making weird, random, free-flowing associations that will often be nearly impossible to follow if you try to write them down and read them after coming down.) Also, there is a common side effect that when coming up, people get the sense that their minds are now “stuck like this” for the rest of their lives. For inexperienced users with anxiety disorders or paranoid affects, I would think this could be disastrous.

  163. says

    Yeah, yeah, we all should know that the neurotransmitter-imbalance hypothesis sucks.

    It doesn’t “suck.” It’s wrong.

    Anyway, I can’t get Kirsch’s book.

    You can’t go to Amazon and download it? Why not?

    I am also not a fan of books on controversial subjects as you can write anything in them.

    What an odd thing to say. You can also support your contentions with logic and references to the peer-reviewed literature (including your own articles), which Kirsch does.

    ***

    I see your point, Salty, but homeopathy? Really? Not really the same thing. We don’t have FDA-approved homeopathy over and over and over and over and over and over and over and over and over and over and over again….and still finding new ones to add and be approved by the FDA? In other words, how exactly is it that the market is flooded with SSRIs if every single one of them is nothing more than placebo? And that’s not a rhetorical answer; I’m interested in what you have to say.

    I link to the Marcia Angell articles in my post, but here’s the second one (her first reference links to the first). She summarizes the story which is told in detail by Kirsch and Whitaker. The short answer is as I said above: there’s a powerful industry with reputations and billions of dollars in profits riding on these beliefs; there are also many people who want them to be true.

    Also, you misinterpreted that second phrase I put that you quoted. I mean the ENTIRE brain. Everything. Not just serotonin or why anti-depressants work. I wasn’t exactly clear I guess, oops.

    What I’m confused about is how someone who expresses such interest in a subject doesn’t seem interested in reading articles and books about it.

  164. says

    Thank you, Dan L.!

    You keep going on about one book and a few papers. You know perfectly well that that is not enough to overturn a consensus.

    You’re suggesting a consensus that doesn’t exist.

    The consensus is not that neurotransmitter-imbalances cause depression. We get that.

    No, I don’t think some people do get that. And in fact, the consensus is that they do not.

    The consensus is that, for many people, SSRIs work to alleviate the symptoms of depression.

    So does St. John’s Wort. So do placebos. The question is whether antidepressants work as placebos or not, and this is what Kirsch seeks to answer in his book.

    The “why” may still be up in the air or only partly understood, but to claim that all the research and all the personal experience amounts to “placebo” because two or three scientists think so is not going to impress me.

    So, another person who can’t be bothered to read something before dismissing it. Good luck with that.

    When they can come up with a replacement that isn’t a placebo and isn’t “dangerous” and “really works” I will try it, and if it works for me, the SSRIs will be gone. Until then I will continue taking mine, because I know what my life (if you want to call it that) was like without them.

    If you wish to choose to remain ignorant, be my guest. But that is not a scientific or skeptical attitude.

    I’m sorry they didn’t work for you.

    WTF? I didn’t say anything about myself or anyone of my acquaintance. In any case, I wouldn’t base my beliefs about treatments on anecdotal evidence.

  165. says

    Deja vu !

    Well, it’s not really a coincidence. Coyne saw my post about the Angell articles and then posted about it himself (and got the same response as I and apparently Cuttlefish did). Then he read the Kirsch book and posted about that. As far as I know, he and I are the only ones in these discussions who have. Why others who profess interest in the subject and make numerous assertions about it are so adamant about not reading at least that one book, I don’t know. It seems a reasonable thing to do if you’re going to argue with something.

  166. ChasCPeterson says

    They certainly aren’t placebos – or at least lexapro and prozac aren’t. In my personal experience I handle the 2nd better then the first but it still has some side affects.

    You’re claiming they aren’t placebos because they have easily perceived side effects?
    You might look into the phrase ‘active placebo’.

    can you explain why you say neurotransmitters are totally bunk?

    Nobody has said anything like that.

  167. Tuválkin says

    I’m thinking that DM, even once/if all his psychiatric issues are gone, will still be an unsavoury asshole. (Pardon the pun.)

    (Maybe I should add that I had a sibling diagnosed as bipolar a few years back, aged 37, who after tretment started become more balanced than ever before.)

  168. Mattir says

    Amazingly enough, I will continue to be guided in my medical care by the opinions of my NIH-researcher psychiatrist rather than by Salty Current’s polemics against psychiatric medications. And yes, I have actually read many, although not all, of the works SC has cited.

  169. says

    Amazingly enough, I will continue to be guided in my medical care by the opinions of my NIH-researcher psychiatrist rather than by Salty Current’s polemics against psychiatric medications.

    How ridiculous. I’m not asking anyone to be guided by my “polemics.” I’m suggesting that they critically review the existing evidence, and not make assertions on the basis of anecdote, authority, etc.

    And yes, I have actually read many, although not all, of the works SC has cited.

    Amazingly enough, you haven’t actually engaged with, for example, the Kirsch book anywhere I’ve seen.

    ***

    Skybluesky, thanks for the info. I will try to keep taking it steadily. I think I’m on just about the lowest prescribed dose so I can’t really taper.

    I assume tapering in this circumstance would involve a gradual reduction in frequency. It’s of course possible to do, and you could talk to your doctor about how.

    I’m glad you’re on a low dose. Kirsch writes:

    The difficulty of finding dose-related therapeutic effects of antidepressants is yet another reason for suspecting that those effects may be independent of their chemical action. The equivalence of high and low doses of antidepressants is well known, yet doctors often increase the dose of the antidepressant when their patients do not improve. Why do they do this? The official Summary of Product Characteristics for Prozac provides a clue. It notes that ‘in the fixed dose studies of patients with major depression there is a flat dose response curve, providing no suggestion of advantage in terms of efficacy for using higher than the recommended doses’. Nevertheless, despite the absence of evidence that higher doses produce better effects, the very same document advises physicians as follows:

    The recommended dose is 20mg daily. Dosage should be reviewed and adjusted if necessary, within 3 to 4 weeks of initiation of therapy and thereafter as judged clinically appropriate. Although there may be an increased potential for undesirable effects at higher doses, in some patients, with insufficient response to 20mg, the dose may be increased gradually up to a maximum of 60mg. Dosage adjustments should be made carefully on an individual patient basis, to maintain the patients at the lowest effective dose.

    So when increasing the dose of antidepressants, doctors are merely following the manufacturer’s advice, as reported in the Summary of Product Characteristics.

    If the dose response curve is flat and higher doses produce an ‘increased potential for undesirable effects’, why does the Summary of Product Characteristics advise doctors to triple the dose if patients do not respond well enough to a lower dose? The key to understanding this contradiction is our old and trusted friend, clinical experience. The company notes that despite the negative data, ‘it is clinical experience that uptitrating [increasing the dosage] might be beneficial for some patients’.

    A study reported by Otto Benkert and his colleagues at the Department of Psychiatry at the University of Mainz shows how this works.12 Depressed patients who failed to respond to antidepressant medication were given an increased dose of the drug, following which 72 per cent of them improved significantly by showing at least a 50 per cent reduction in symptoms of depression. The catch was that the dose had only been increased for half of the subjects. The others only thought the dose had been increased; in fact it had not. Yet the response rate was the same 72 per cent in both groups. So a patient whose dose of the drug is increased may indeed show more improvement, but this effect may be due to the patient’s knowledge that the dose has been increased, rather than to the chemical effect of the medication. In other words, doctors are advised to increase the dose (and the likelihood of troubling side effects) as a means of strengthening the placebo effect (pp. 36-7; my bold).

  170. Brownian says

    I assume tapering in this circumstance would involve a gradual reduction in frequency. It’s of course possible to do, and you could talk to your doctor about how.

    That’s what I did. I still had the zaps for a couple of months.

  171. says

    Amazingly enough, I will continue to be guided in my medical care by the opinions of my NIH-researcher psychiatrist rather than by Salty Current’s polemics against psychiatric medications. And yes, I have actually read many, although not all, of the works SC has cited.

    This comment has no substance at all and consists pretty much entirely of sneering at me. I don’t know what you got out of making it, but it contributed nothing to the discussion.

  172. Matt Penfold says

    This comment has no substance at all and consists pretty much entirely of sneering at me. I don’t know what you got out of making it, but it contributed nothing to the discussion.

    Sorry SC, but please quit making stupid comments like this. I know you are not an idiot, so stop pretending to be one. It does no one any favours.

  173. Mattir says

    Amazingly enough, you haven’t actually engaged with, for example, the Kirsch book anywhere I’ve seen.

    You have zero evidence one way or the other about whether I’ve engaged with any of the literature you’ve cited. All you know is that I haven’t done so in this particular forum. I don’t engage with you in particular about this issue because you dismiss anyone who does not completely agree with you on every point as an irrational corporate dupe with the scientific integrity of a CAM enthusiast.

  174. says

    Sorry SC, but please quit making stupid comments like this. I know you are not an idiot, so stop pretending to be one. It does no one any favours.

    Perhaps you can explain what that comment’s substantive contribution to the discussion was, then, Matt. In any case, I think I’ve said what I thought was worth saying, and will be going. I’m shocked by the response to these arguments. I didn’t expect it here or at WEIT when it initially came up, it’s been a very negative experience, and I don’t see any good reason to continue to subject myself to it. I hope at least a few people might be interested enough to read some of the works, critically of course.

  175. Mattir says

    Also, my comment was meant to convey that I make my health decisions (including those concerning psychiatric medication) in consultation with competent health care providers who know me and have relevant clinical and scientific knowledge.

    I recommend that others do the same, and try not to let the “anecdata” accusations derail one’s medical care.

  176. says

    You have zero evidence one way or the other about whether I’ve engaged with any of the literature you’ve cited. All you know is that I haven’t done so in this particular forum.

    It should have been obvious that that was what I meant.

    I don’t engage with you in particular about this issue because you dismiss anyone who does not completely agree with you on every point as an irrational corporate dupe with the scientific integrity of a CAM enthusiast.

    That is bullshit. And this was another substanceless comment from you.

    Bye.

  177. stacy says

    Good work, SC. I discussed my personal experience (briefly). You assumed I was making an overarching claim for the efficacy of SSRIs and that I was further claiming that my experience must trump any and all scientific evidence.

    I have a newsflash for ya: You suck as a mind-reader. You’re no great shakes at parsing English, either.

    This is a general suggestion

    Huh? Oh, I see; you’re assuming because I presented my personal experience using a common conversational construction (“If they’re…then”) that I was proclaiming what follows must be true for everyone!

    (unless you’re going to deny that you meant that they work as something other than placebos) based on anecdote.

    “Unless you’re going to deny…” I see what you did there. I meant (wait for it) exactly what I said. I did not address the question of how they work. I included the qualifier “if they’re placebos they’re darn good ones” because I am aware that they may be. Nowhere have I made the claim that my personal experience is evidence for anything other than my personal experience.

    Despite your sneering and ungenerous reading, I did not present my anecdote as “OMG my experience is proof that SSRI’s are not placebos!” Somehow I assumed that, being obviously anecdotal, I didn’t need to attach big red neon lights screaming “PERSONAL ANECDOTE!” to my words.

    It’s also true, though not in the sense you meant it.

    Here’s a nice, decaying porcupine. You know what to do. You. Supercilious. Git.

  178. Matt Penfold says

    Perhaps you can explain what that comment’s substantive contribution to the discussion was, then, Matt.

    Well I can try, but since you seem detirmined not to see, I cannot promise I will suceed.

    Here goes: Mattir’s doctor knows more about the subject than you do.

    In any case, I think I’ve said what I thought was worth saying, and will be going. I’m shocked by the response to these arguments. I didn’t expect it here or at WEIT when it initially came up, it’s been a very negative experience, and I don’t see any good reason to continue to subject myself to it. I hope at least a few people might be interested enough to read some of the works, critically of course.

    Oh well. I will not be missing you I have to say.

  179. otrame says

    Jesus with peanut butter, Salty, you have the unmitigated gall to claim someone else is sneering at you? What the hell do you call every single comment you’ve made to me?

    And I’m sorry if I got confused about whether or not you had ever used SSRIs. I just went back over the early thread and can’t find the remark I thought I remembered you saying. I apologize. I admit that your intense emotional response on the issue would normally suggest to me that you had a dog in this fight, but in your case, well, you are a passionate person. Anyway, as I said, I was wrong and I am sorry I didn’t double check on that before saying anything about it.

  180. ichthyic says

    there is a LONG and well established medical lexicon of literally thousands of papers demonstrating the mechanisms of how the neuroscience of various psychological conditions work.

    This is wrong.

    no, it really isn’t.

    don’t know why you’re on this horse, but it’s a hobby horse at best.

    pick any specific mental illness you like, and I can do a quick pub med search and pull up all the work that has been done on mechanisms for you.

    some more detailed than others, but to utterly reject 80 years of work in this field is fucking ludicrous.

  181. ichthyic says

    I’m shocked by the response to these arguments.

    I’m shocked it appears you are trying to make the case that all attempts to treat mental illnesses by chemical means are nothing more than placebos??

  182. kristinc says

    for many of us mental illness – our own or someone else’s – is the stuff of everyday life. Everyday life gets discussed in everyday language.

    QFT. Pearl clutching nannies will never convince me to stop describing the fucked-up, insane experience of being a crazy mess with words like “fucked-up”, “insane”, “crazy” and “mess”. Said nannies need to back the fuck off and let the crazy folks talk without head patting from Nice Sane People.

  183. says

    I’m actually very interested in this discussion, though I don’t know enough about the subject (having zero background in psychology, physiology or medicine, and being completely unfamiliar with the scientific literature) to have an informed opinion. I’m a lifelong sufferer from obsessive-compulsive disorder, which has caused me serious problems in the past; since I’ve had it for my entire life (although it’s manifested in different ways over time), I’m fairly confident that it is biological in nature, rather than being caused by experiences. Although it’s under control, I’m certainly interested, from the perspective of intellectual curiosity, in knowing what, if anything, is known about the causes of these kinds of mental disorders. Apparently a number of possible explanations have been posited – neurotransmitter abnormalities being among them - but as far as I can tell, there doesn’t seem to be a clear scientific consensus as to the biological causes. (I have never been on any medication for it, but I gather that SSRIs are sometimes used in severe cases?) Please tell me if I’m talking nonsense, as I really know nothing at all about this field.

  184. says

    I admit that your intense emotional response on the issue would normally suggest to me that you had a dog in this fight, but in your case, well, you are a passionate person.

    I am a passionate person. I also have a dog in this fight. In addition to my support for truth and evidence generally, my dog is the millions of people prescribed these drugs, some of them forcibly and many of them children, with some overlap. The questions “Do these drugs work? How? Do the benefits outweigh the risks? What does this model mean in terms of our addressing pain?” are important to me, because getting this wrong causes suffering. This isn’t about me, and I think not engaging fully with these questions and the evidence about them is immoral. I’m sure I haven’t been perfect in these discussions, but I stand by what I’ve said.

  185. says

    I’m absolutely refusing to wade into the knee-deep bullshit in this thread, but I couldn’t let the following quote just sit there:

    6) You only have one life. It may seem shit at the moment, but death is final. Suicide is taking 100% nothingness versus 1-99% fun, happiness and satisfaction. The odds say stay alive.

    this is pure, unadulterated bullshit. As if depression was 99-1% “nothingness”, rather than a fuckload of pain and suffering. Truth is, once the life equation slips below 50% “fun, happiness and satisfaction” with little to no chance of recovery, 100% nothingness actually works out better. That’s why we have self-euthanasia for terminally ill people, after all: once the suffering is too much, they have the right to chose nothingness instead.

  186. First Approximation says

    Regarding the effectiveness of antidepressants, I don’t feel I know enough about the topic to comment. However, SC is right to complain about the substanceless comments here. She could very well be wrong about this. If people want to show that they should give good reasons and solid evidence.

  187. John Morales says

    Jadehawk, yes, but a salient (possibly determinative) consideration is hope — something to which you allude when you invoke chances of recovery.

    I rather think (but don’t care to attempt to substantiate) that, historically, more people overall have endured horrific conditions rather than given up and taken their own lives.

    (There’s legs in that old dictum: “where there is life there’s hope”)

  188. ichthyic says

    “Do these drugs work?

    it depends on the particular malady involved, but yes, they do.

    how?

    seriously, if you can’t already answer that question, then you shouldn’t be so passionate about dismissing all neuroscience involving chemistry, now, should you.

    Do the benefits outweigh the risks?

    again, that would entirely depend on the malady, the drugs, and the circumstances.

    If you want to make the point that we need to be careful to pay close attention to each person’s particular circumstances, then yeah.

    If you want to claim there is no role for chemistry in treating psychological maladies, then you’re doing no more or less than what anti-vaxxers do in claiming that vaccinations shouldn’t be involved in treating communicable diseases.

    I rather think this book you read has had a bit of an over-influence on you.

    I can’t even see what the point of arguing with you about it is.

    it’s like you deliberately chose to accept everything it had to say, rather than actually going to the primary lit, like you should have.

  189. PaulG says

    Salty Current, 199:

    Amazingly enough, you haven’t actually engaged with, for example, the Kirsch book anywhere I’ve seen.

    First Approximation, 219:

    I don’t feel I know enough about the topic to comment. However, SC is right to complain about the substanceless comments here. She could very well be wrong about this. If people want to show that they should give good reasons and solid evidence.

    Salty Current: why should a scientist “engage with” a book? Our battles are fought in the peer reviewed scientific literature, not vanity-feeding books. I don’t reference Dawkins’s books when writing a paper on an undescribed fossil.

    First Approximation: Maybe the “good reasons and solid evidence” would be forthcoming if SC provided links to scientific literature. Also, (s)he is not “right to complain about the substanceless comments here” when all (s)he can offer is byzantine links to self-declared original references.

  190. skybluskyblue says

    In the Youtube video called, Stanford’s Sapolsky On Depression in U.S. (Full Lecture), he seems to be saying that several neurotransmitters are responsible for the symptoms of depression but are not the only factors to consider as an ultimate “cause” to address with depression. My anecdote that the SSRIs seemed to help my OCD-like symptoms fits perfectly with what he is saying. He says that abnormalities in the serotonin system causes the obsession with grief and the perseverance of thoughts on guilt etc. I remember being depressed and thinking guilty and/or hopeless thoughts repeatedly.

    However, a few other chemicals play a role in bringing about depression symptoms. This is including hormones, especially, corticosteroids. Half of people with depression have massively elevated levels of glucocorticoids. Luckily, people can recover on their own the first few times a stress-induced depression comes on but, after more than three or four episodes like that the brain get depleted of dopamine* [*38min] thus becomes prone to prolonged production of depression symptoms.

    Then he talks about how several repeated studies conclusively prove that the whole role of genes is a strong factor in depression and in the types of depression people get. [ I will post the links that I found about these subjects in the next email to avoid this one getting hung up in moderation.]

    All of these factors thus emphasize that depression is as real and as biological as diabetes.We cannot pull ourselves out of depression via willpower any more than we can do that for diabetes etc.

    The point I am making from his lecture, though, is that there are several factors that influence whether SSRIs and other antidepressants help to relieve the symptoms of the many types depressions. He said that about only 30-40% of depressives can be treated [38 min 38sec] using this biological knowledge to prescribe antidepressants. The majority of the treatment is effective only if you address the psychological/cognitive factors* involved. [The two sound bites for those* are: "depression is aggression turned inward" and "depression is learned helplessness".--Just watch it to get a better idea about what he is saying here.]

  191. skybluskyblue says

    Here is the Stanford’s Sapolsky On Depression in U.S. (Full Lecture) video: http://www.youtube.com/watch?v=NOAgplgTxfc

    Here MAY be a reference to the genetics-based stress/depression studies I just found: http://asp.cumc.columbia.edu/psych/asktheexperts/ask_the_experts_inquiry.asp?SI=71 and http://articles.latimes.com/2003/jul/18/nation/na-depression18
    I apologize that these are not direct journal links but he did not get specific enough in the video.

  192. R2 says

    SC:

    I’m sorry. I thought it was clear that when I said “sucks” I meant it was wrong.

    I don’t know if I can d/l the book, I’d have to see if it is possible. I’m not in the US (or Europe), and I usually prefer my books in physical form. But, again, anyone can publish a book and give it any spin they want. It’s a controversial subject. I’d rather read the articles.

    I’m not stuck to the idea that SSRIs rule. I used to think so, but then I read the literature and what seems to convince me now is that, while the placebo effect is strong in depression, in certain cases (severe depression, dysthymia) they seem to be better than placebo.

    Can’t you just mention the gist about his arguments against ADM vs. severe depression? Or which studies he references?

    As an aside, I’m also finding it interesting that depression is getting compared to diabetes since they probably have a bidirectional effect on each other.

  193. Josh, Official SpokesGay says

    You want to know why people get so emotional and outraged over this, SC and others? It’s because those of us who suffer from mental illnesses that have been successfully treated with SSRIs (by whatever mechanism they work or don’t work) are fucking terrified of what would happen to us without them. Got it?

    Every time there’s another SSRI scare “OMG- it causes suicidal ideation.” “OMG, your brainz will melt,” we worry the drugs are gong to be pulled off the market. We worry for our sanity and our ability to function as human beings. I’m not kidding, and I’m not being melodramatic.

    A few things:

    1. I know the serotonin hypothesis is hotly contested, and I know it looks as though it’s bunk. It probably is.

    2. I know that we have no idea, based on empirical evidence, just how these drugs do what they do. It cries out for better research-you’ll get no argument from me.

    3. I know that regardless of my anecdotal experience, the empirical science is what it is, or what it is not. My own experience has nothing to do with whatever effects—real or placebo—the drugs do or don’t have.

    But:

    1. I’m a rational person (mostly), and I don’t take medical research lightly. I’m as interested in knowing the empirical underpinnings and possible consequences of treatment as anyone here (meaning, people who put more stock by science than by anecdote).

    2. I have suffered from mental illness so severely, and have had my life given back to me so completely by psychotropic drugs, that I cannot remain detached.

    3. I realize that I’m as prone to the placebo effect as any other person is. Yet I have a very, very, very hard time believing that the placebo effect pulled me out of a horrific cycle of obsessive-compulsive and suicidal ideation especially when I was *completely ready to kill myself and I didn’t care*. I only consented to swallowing some Prozac because I was too indifferent to fight my family and friends when they dragged me to the hospital.

    I’ve gone through the common cycles of being medicated and well, and complacent, where one forgets to take one’s medication. I’ve slipped imperceptibly into a funk, back into OCD rituals and panic, without knowing it. Because I forgot to take my meds, or because I got complacent. Friends have pulled me out of that kicking and screaming more times than I can count.

    And every time, lo and behold, the SSRIs build up in my system imperceptibly until one day a few weeks later, I “forget” to be obsessed. I “forget” to be on the verge of a panic attack.

    I know now how to recognize these patterns and stop myself from that awful cycle. And it ain’t just because I’m “withdrawing” from a drug I don’t need. Whatever it does to my brain, my brain needs it to be halfway normal.

    Yes, I want to know what the life-long consequences might be of SSRI use. I absolutely want to know the mechanism, and the potential drawbacks. But I’ll tell you right now that if I had no way to access that information and I had to make a choice to continue with the potential of long-term damage or to stop, I’d take them in a heartbeat. I got my life back—I got my personhood back—and I don’t ever want to slide into that hellish abyss I lived in before I found medicine.

    Write me off as a homeopathic devotee if you like (I’m so not), but I’m not fucking giving up my Z*loft.

  194. says

    Between this and the PETA threads, it appears that, award or no, at some point SC found the Well of Hippie Woo and drank deeply.

    I have no idea what my comments on the PETA thread have to do with woo. My claim that pharmaceutical companies have deceived people about their products with devastating effects is very well established. Ben Goldacre, Marcia Angell, and others have documented it extensively. (These are the people who’ve worked tirelessly for transparency to protect people and are having some success.) It’s been established for antidepressants specifically. Somehow, this doesn’t seem to give rise to outrage.

    Also drinking the “hippie woo” on the subject of the efficacy and safety of antidepressants are Cuttlefish, Jerry Coyne, Marcia Angell (former EiC of NEJM), NICE,…, many doctors –

    In addition to attracting media attention, the publication of the 2008 meta-analysis [I linked to it above] also had practical effects. On 23 May 2008, a scant three months after its publication, Onmedica.com published a survey of 490 doctors in the UK, in which it asked them what effect our analysis would have on their prescribing practice. Almost half (44 per cent) said that they would change their prescribing habits and consider alternative treatments rather than SSRIs for their depressed patients (pp. 54-55).*

    ***

    You want to know why people get so emotional and outraged over this, SC and others?

    No, I want to know why, on a science blog, claims about antidepressants are made repeatedly without any demands for evidence. Why assertions based on anecdote, authority, or nothing at all on the subject go unchallenged and even meet with gratitude. Why “I don’t want that to be the case so you should shut up about evidence that it might be” is an acceptable position. Why, when someone challenges these assertions, citing evidence, that evidence is ignored or dismissed with prejudice and the person citing the evidence is personally reviled, called callous, and has nefarious motives imputed to him or her. Why people don’t speak out against comments like Mattir’s and Matt Penfold’s, which are plainly ridiculous personal attacks (I’m obviously not asking anyone to make any medical decisions on the basis of my personal authority, but to recognize the evidence and consider it critically). It’s not right. It’s unkind, it’s unfair, it’s unscientific, and it’s not something this community should be comfortable with.

    * Here. (I don’t know whether this was a random sample or what the exact questions were, so I can’t speak to the quality of the survey.)

  195. KG says

    I must say that having looked at what Cochrane reviews I could find, the evidence for the efficacy of SSRIs (and tricyclics for that matter) as anything other than a placebo effect looks pretty feeble: if there is a non-placebo effect, it appears to be quite small. Here is a useful list of review studies.

    Further to Josh’s #226, I know placebos can work even if the patient knows they are given a placebo, but if this knowledge tends to weaken the effect, those who have found a given drug helpful have an incentive to protect their belief that it is not just a placebo!

  196. Matt says

    Whatever the outcome of the SSRI discussion is (I’m not qualified to evaluate the claims), I’m glad that Markuze is getting treatment. Whatever the diagnosis (which I’m also not qualified to evaluate), it was clear that his behavior was sufficient to cause reasonable people to be concerned that his rhetoric might escalate to physical violence.

    I hope he receives good treatment and finds a way to deal with whatever it is that’s causing him to do these things. It’s a long road and he may not see the need for it, but I hope he does….

  197. R2 says

    I looked at the Cochrane reviews and in general they seem to say SSRIs are more effective than placebo. They aren’t the wonderdrug that the pharmaceutical companies say they are, but through the 20-something years they have been shown to work for certain disorders.

  198. says

    I looked at the Cochrane reviews and in general they seem to say SSRIs are more effective than [inactive] placebo.

    Which Kirsch says as well. Of course, the Cochrane review of St. John’s Wort showed that it’s equally effective:

    Authors’ conclusions

    The available evidence suggests that the hypericum extracts tested in the included trials a) are superior to placebo in patients with major depression; b) are similarly effective as standard antidepressants; c) and have fewer side effects than standard antidepressants. The association of country of origin and precision with effects sizes complicates the interpretation.

  199. mythusmage says

    Speaking for myself, I happen to be one of those for whom Fluoxetine works. With the assistance of Zyprexa. Tried Abilify, but it made me anxious.

    My point is, we’re all different. That’s why why have all those different SSRIs and other antidepressants. Your version of seratonin may be slightly different than mine, leading you to require a different SSRI than what works for me.

    We also seem to be ignoring the need for therapy, to keep an eye on the patient and to watch him for self-destructive behavior. Given that immature brains don”t function like adult brains, I think it likely that anti-depressants may give a child the hope suicide is possible, before the medication has had a chance to take full effect.

    I don’t know about the controversy regarding the mechanics of clinical depression, I do suspect that we’re really talking about a family of mood disorders, some of which are actually different disorders, requiring different disorders. One thing I must caution against is lumping people into one grand assemblage.

    Finally, for SC; please stop trying to cram everybody into one particular cubbyhole. Each of us is different and what works for one is not going to work for everybody. Last I heard you make two different types of serotonin, one for the brain, the other for the digestive system. Other people make different serotonin than you do. Very small differences, but different.

    (My apologies for the disconnected thinking. Ask TI I shall expound and expand to the best of my ability.)

  200. mythusmage says

    PARA4; change a certain sentence to read, “…requiring different remedies.” (Sorry ’bout that.)

  201. Bah! says

    Yes, comment #19. I am bipolar. I’m ridiculously nice and have never been violent, don’t drink or drug or cause trouble. I’m a Teaching Assistant and a grad student, and I manage. I also don’t appreciate PZ’s facepalm statement. I’m sick of dealing with the stigma of bipolar. Dude was a menace, no need to toss around the ‘ol “bipolar” and lump the rest of us bipolar types in with this nightmare. Sigh.

  202. R2 says

    SC:

    So, to see if I understand, is your (or Kirsch’s?) argument that ACTIVE placebo are equally effective to SSRIs?

    Also, by comparing to St. John’s Wort are you criticizing spending money on SSRIs when St John’s Wort is cheaper and/or the methodology is probably wrong if St John’s Wort is shown to be effective?

    Mythusmage:

    There are many types of serotonin receptors. For example, there are serotonin recepters in platelets as well, which is why SSRIs affect clotting and why clotting might possibly be affected by mental state.

  203. julian says

    So, to see if I understand, is your (or Kirsch’s?) argument that ACTIVE placebo are equally effective to SSRIs?

    I think SC’s points have basically been 1)The popularized mechanisms by which these drugs work is in dispute 2)Drug companies have helped spread misinformation about these drugs 3)The evidence for these drugs is being overstated 4)Placebos worked about as well in trials 5)They are overprescribed.

  204. R2 says

    I agree with 1, 2, 3, and 5.

    It’s 4 what I’m not sure. From what I understand, SC’s saying that when placebos cause similar side effects to hide the fact that they are placebos (I’m supposing a better methodology than using inactive placebos), then both SSRIs and active placebos are equally effective.

    I just want to be sure we’re discussing the same thing.

  205. John Morales says

    R2, SC is quoting from material which she has previously indirectly cited @106.

    The relevant quotation (@231): The available evidence suggests that the hypericum extracts tested in the included trials [...] are similarly effective as standard antidepressants

    (Note that “equally” ≠ “similarly”)

  206. sfbooklady says

    I might not be reading this correctly, but doesn’t this:

    “When the published and unpublished trials were pooled, the placebo duplicated about 80% of the antidepressant response”

    mean that 20% of the response was probably *not* due to the placebo effect?

    So certainly this (high response to placebo and modest effect of the medication) could be evidence against the serotonin theory. But doesn’t even a modest effect mean that SSRIs will be helpful for some?

  207. ChasCPeterson says

    Mattir’s doctor knows more about the subject than you do.

    Assumes facts not in evidence.
    Physicians are people, not omniscient authorities.
    And that goes for Stanford’s Sapolsky as well.

    how [do these drugs work]?

    seriously, if you can’t already answer that question, then you shouldn’t be so passionate about dismissing all neuroscience involving chemistry, now, should you.

    Nobody knows how they work–any of them, even the ones that have been shown to ‘work’–in terms of physiological mechanism. Go ahead, Scienceman, run your pubmed search if you think that’s incorrect. (Incidentally, that goes for agents of general anesthesia as well.)

    If you want to claim there is no role for chemistry in treating psychological maladies, then you’re doing no more or less than what anti-vaxxers do in claiming that vaccinations shouldn’t be involved in treating communicable diseases.

    If you think that vaccinations are used to treat disease, you are truly confused. But even if you do know what vaccination is for, the comparison here is pretty stupid. It’s really not the same thing at all.

    why should a scientist “engage with” a book? Our battles are fought in the peer reviewed scientific literature, not vanity-feeding books. I don’t reference Dawkins’s books when writing a paper on an undescribed fossil.

    Is this parody?
    Because otherwise it’s pretty stupid.

  208. sfbooklady says

    drat, sent before I finished my thought.
    Though St. John’s Wort may be equally effective, St. John’s Wort is an MAOI – doesn’t it carry the same dangers as MAOIs?
    As a side note, the lack of clear standards for purity and amount of active ingredient in herbal supplements makes dosage tricky and that seems dangerous also.

  209. sfbooklady says

    I’m sorry, I appear to be up too late to string together words properly. That should read “as other MAOIs.”

  210. John Morales says

    [meta]

    sfbooklady, I doubt you have been up too late, given that you’ve noticed that the two phrases are semantically equivalent only if one grants that such dangers are specifically due to their being that particular type of inhibitor, and given that you felt the need to correct that ambiguity.

  211. says

    I appreciate that people are asking questions looking to clarify the positions rather than going on the attack. I also understand that for some people this is the first time having this conversation, so it’s probably frustrating that I’m not responding in detail to every question. But this is the fifth time I’ve been in this discussion online, and none of these experiences has been pleasant. I’ve provided probably a few dozen links to scientific articles and books and other relevant sources, some many times. I’ve quoted from them. I’ve summarized portions of complex arguments. I’ve cited specific book pages. The pieces by Angell summarize in very broad strokes Kirsch’s argument, and I’ve linked to them at my blog and here as well (again). It doesn’t seem worthwhile to me to keep answering questions about specific pieces of the argument as the response tends to be raising more questions or issues or studies that are addressed in detail in the book(s).

    When I repeatedly ask that people read at least the Kirsch book before dismissing the arguments, I’m not saying I think it’s flawless or that the only word on the matter. Of course there could be things that Kirsch (or I or Angell or Jerry Coyne) are missing or getting wrong, but no one can know if that’s the case unless they read the arguments and look at the evidence and engage with them as a whole.

  212. andrewv69 says

    @sfbooklady says

    So certainly this (high response to placebo and modest effect of the medication) could be evidence against the serotonin theory. But doesn’t even a modest effect mean that SSRIs will be helpful for some?

    So it would seem. If I read it correctly more than one person has commented here that SSRIs have worked for them.

    I suspect that the overall issue may be connected to the intersection of incomplete knowledge, blind spots, profit, and politics.

    This may explain the tendency to promote and market solutions that may not only be inappropriate in certain cases, but downright dangerous in others.

    In any event, going against Big Pharma is not without risk and you need to have resources to survive the event. An example is the case of Dr. Nancy Olivieri at the Hospital for Sick Kids in Toronto.

    https://secure.wikimedia.org/wikipedia/en/wiki/Nancy_Fern_Olivieri

    I remember this case because not only was I living in Toronto at the time, but I was still bemused by my own close encounter with a certain software/hardware company, where I was threatened with legal action, after informing them of certain security defects I had discovered.

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  214. says

    Thanks for the update PZ. The last I had heard was that he has a second court date last month after his 30 day psychiatric evaluation but I hadn’t been able to find out anything since then. Please keep us up to date as things develop.

    I really hope for his sake and the sake of his family that the treatment and rehab work.

    It’s been so nice over on the Randi.org blog not having to delete his posts several times a day.