> Yet, for millions of people, the antidepressant they take makes the difference between a productive, engaged life and miserable penury or suicide.
We're begging the question here.
Millions of people who have recovered some stability after a period of profound crisis were begun on a particular treatment at the nadir of that crisis. They very reasonably assign the recovery to that treatment - because they view that treatment as an individual, rather than as a cohort who endured similar crises, responded with various or no treatments, then had various degrees of recovery or mortality.
Additionally, they can't be evaluated based on their reaction after the treatment is withdrawn, because antidepressants are generally physically addictive, and you would expect a subsequent crisis even if withdrawn from a person taking them who had never had a crisis in the first place.
The effectiveness of antidepressant medication can't be assumed through the testimonial of the survivors, then types of depression reified through sorting the survivors by treatment type.
It becomes obviously self-justifying, because people who didn't improve clearly had the wrong depression for the drug. Instead, you have to evaluate the treatment against non-treatment; you can't just assume that survival indicates success, and work to refine tools that filter for the people will be helped by that treatment without material evidence, either of physical mechanisms or by already having strongly predictive tools, that the treatment is more effective than placebo.
I wouldn't deny that defining a disease by its effective treatment could be useful, but the margin for effectiveness would have to be pretty high if there were no other criteria for that definition.
I see that you have no personal experience of the topic, and are just talking through your hat.
That is permitted here, but I am likewise permitted to point it out. Please acquire some life experience before holding forth on this topic in the future.
Likewise, please post retorts with actual substance rather than simple and useless attacks on character or knowledge. I do not indeed agree that this man has 'no knowledge of the subject' and I am inclined to agree with the one who clearly and articulately outlines his view points rather than the one who proclaims to have the only truth while providing very little in the way of evidence to that fact.
You seem very sure of yourself, like you're unwilling to listen to any opinion that doesn't immediately conform to your own. And maybe this is a very difficult topic, charge with such intense emotion that it nearly hurts to hear someone so contrary. However, the man who proclaims the one truth will never learn again.
The topic is not about opinions, it is about facts.
The epistemological difficulties around treatments for wastebasket diagnoses are very real, but it demonstrates a deep, fundamental confusion to conflate those difficulties with problems with the meds themselves. This failure of reasoning is only attractive to the inexperienced, hence my advice.
To understand the problem, consider the medieval diagnosis "ague". Numerous cases respond instantly to antibiotics. Others, viral, do not respond at all. Some can be prevented by variolation, some by refrigeration, some by hygiene, some by purifying drinking water, some with mosquito netting, some by quarantine, some apparently not at all. The only way to predict which will work for a particular outbreak is to know more details about the causative agent. Denigrating antibiotics because they fail to treat malaria is deadly foolishness.
Double-blind trials, where they work, are the cheapest way to obtain reliable information about a medication's effectiveness for a reliably identified illness. Where they do not work (for readily understood reasons) we are obliged to use more expensive, time-consuming, and idiosycratic methods to obtain the same information.
In the case of "depression", as for other similar diagnoses, such methods have been found necessary, and are used. Insistence that the so-called "gold standard" is the only arbiter of truth (because the name?) betrays ignorance of history and medicine that can be remedied only by deeper experience.
One does not always have time to explain all of the above in detail, and must distill the gist. The gist is better than nothing.
Agreeing with the person who outlines her viewpoints, just because she did so most recently, leads you to agree with falsehoods. Truth is not so easily discerned as agreeableness or articulateness, appealing as the idea may be. What matters is the facts, and to how many decimal places.
We're begging the question here.
Millions of people who have recovered some stability after a period of profound crisis were begun on a particular treatment at the nadir of that crisis. They very reasonably assign the recovery to that treatment - because they view that treatment as an individual, rather than as a cohort who endured similar crises, responded with various or no treatments, then had various degrees of recovery or mortality.
Additionally, they can't be evaluated based on their reaction after the treatment is withdrawn, because antidepressants are generally physically addictive, and you would expect a subsequent crisis even if withdrawn from a person taking them who had never had a crisis in the first place.
The effectiveness of antidepressant medication can't be assumed through the testimonial of the survivors, then types of depression reified through sorting the survivors by treatment type.
It becomes obviously self-justifying, because people who didn't improve clearly had the wrong depression for the drug. Instead, you have to evaluate the treatment against non-treatment; you can't just assume that survival indicates success, and work to refine tools that filter for the people will be helped by that treatment without material evidence, either of physical mechanisms or by already having strongly predictive tools, that the treatment is more effective than placebo.
I wouldn't deny that defining a disease by its effective treatment could be useful, but the margin for effectiveness would have to be pretty high if there were no other criteria for that definition.