mike larkin wrote:
>
> I was referring specifically to the Kirsch study, but
> the others, however more rigorous, are also open to
> question.
>
I tend to trust Miles's knowledge of the data -- but this particular debate does not touch on a key point Miles makes -- the large number (25%) of patients who do not respond to ADs (SSRIs or other types). Moreover, that figure may be too small, for it is difficult to know how exactly to draw the line. I would have to flip a coin to decide whether I belonged to the class of those who respond or of those who do not respond.
But in so far as there is evidence that the drugs benefit even a substantial minority of patients, there is a basis for seeing them as rather powerful placebos in addition to whatever direct pharmaceutical effects they might have. (The placebo effect should not, incidentally, be seen as somehow purely 'mental." Stress causes substantial changes in both the immune system and the brain "chemistry," of those who are not mentally ill as well as of those who are. This discussion can be really screwed up by mechanical -- Cartesian -- separations of brain and body. Damasio's books are very good on this. All our thought and feeling is inextricably bound up with the brain's continuous sensing of body states.)
And it seems to me crucial always to keep in mind that, as tremendous as have been the advances of neuroscience in the last 20 years (even last 5 years), we are still terribly ignorant in respect to the workings of the human brain, in 'health' or disorder. People ought to be more aware of what is known -- but I think also that we should _always_ assume that social relations are more important yet (and I think we know more about social relations than we know about the brain).
A crude example. A sufferer from bipolar in a neolithic village could not go out and run up $10,000 on her credit card in one weekend. More complex examples could clearly be imagined.
Carrol