Wednesday, December 20, 2023

Shameless exploitation of antidepressant placebo effect

I wasn’t going to blog about Carmine Pariante’s recent New Humanist article, as it just repeats what he has already published. But he has been promoting it as a balanced view on antidepressants (see eg. his tweet), which it isn’t.

I’ve questioned Carmine’s scientific credibility before (see previous post). I think the Royal College of Psychiatrists may even have appreciated that he overstates his case (see another previous post). For example, he wrongly sees critical/relational psychiatry, which has produced the critique of antidepressants he rebuffs, as dualist (see yet another previous post).

Carmine does need to take the critique of antidepressant efficacy more seriously (see previous post). I told him this several years ago (see another previous post). No one’s disputing what he says that many people report benefit with antidepressants. But the question is whether that means that antidepressants work (see yet another previous post), which he says it does. Actually, people’s experience of antidepressants is more complex than mere benefit (see even another previous post). 

Carmine will not like my sceptical argument about the overstatement of psychiatric medication efficacy because of biased clinical trial methodology (see previous post). He worries people are being shamed for taking antidepressants (see another previous post). But he seems to fail to realise that doctors have always exploited the placebo effect. Why he’s being so overdefensive could be because he fears that antidepressants may be another example. The overmedicalisation of society has created too much antidepressant prescribing (see yet another previous post). If psychiatry carries on in the way Carmine wants it to then I anticipate there are going to be serious problems (see last post).


Adam said...

Interesting. Is it your view that all antidepressant therapeutic effects are placebo? I take the view that these can’t be ruled out, but not sure they can be ruled in either.

DBDouble said...

I am very sceptical about antidepressants, Adam, and agree I can’t prove they are mere placebo, although suspect they are. If true, this would have very serious consequences for modern psychiatric practice, which of course is why people do not want to contemplate it. Certainly, it’s wrong to say that the academic debate has been resolved, as does Carmine Pariante.

Adam said...

I take your point. Seems to me that we should allow a little room for a specific effect as it unlikely that a psychoactive substance should have no effect on a neuro/psychological state. Of course that doesn’t mean we need to accept that they are targeting a pathology; and neither does it presuppose that those effects will be safe or positive ones. Regards.

DBDouble said...

Yes, Adam, I’m not disputing antidepressants have side effects. And not just immediate side effects. For example, many people say that over the longer term, there’s often a sense that antidepressants have masked the real problem or altered one’s experience of oneself and others. Also, people commonly feel stuck in a vicious cycle of having to continue medication because of discontinuation problems.