(The truth lies somewhere in the middle, probably)
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The number of conditions #antidepressants are prescribed for literally doesn't fit on 1 full page.
H1: We don't understand working mechanisms, but lucked into a miracle drug.
H0: Questionable research practices, publication bias, small samples, COIs, broken publishing system.pic.twitter.com/9rjK6CUvBj
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H2: antidepressants can (sometimes) aleviate symptoms found in a wide range of conditions?
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I mean, these conditions overlap to some extent?
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H2 is plausible in case symptoms overlap (they do, e.g. insomnia). But I usually see antidepressants advertised as "treatments", which is very different from alleviating symptoms.
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@joannamoncrieff 's argument around the use of a "drug centred model" rather than a "disease centred model" for AD's is useful here, I think.https://joannamoncrieff.com/2013/11/21/models-of-drug-action/ … - 1 more reply
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When u say antidepressants or TCAs you are talking about a group of meds (not one medication) , each medication has a specific indication(s). We know how they work, and they have been used for years to treat the conditions you listed , and they work !
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The most recent meta analyses for treating the listed conditions via antidepressants: would you agree that they all show 1) moderate to severe publication bias, 2) severe outcome switching, and 3) higher efficacy of industry-sponsored vs independent studies?
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Can you link to the recent meta-analyses, please? I’ll put an entry in
#sky
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Ignoring published evidence from RCTs for a moment, I'd first suggest differentiating between a few things: 1) common vs pharmacological terminology: the term "antidepressant medication" is at best confusing bc reduces a broad spectrum of drugs w many medical indications to 1/n
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a single indication, which partly makes up the confusion. 2) first vs second line indication etc: TCAs are normally not prescribed first line for depression and many of these conditions! Another reason why labeling it all "antidepressant medication" isn't helpful 2/n.
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Knowing a bit about the pharmacology of TCAs and the hypothesised role of neurotransmitters in most of these conditions, I must say that I am personally at least not suprised that they are being prescribed to treat certain symptoms in these conditions. 3/n
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Most of all I'd question though the quality of your source as it does not differentiate between first/second line etc and does not refer to the symptoms being treated (e.g. depressive symptoms and anxiety in PD and smoking cessation). This being said, I have little doubt that 4/n
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the body of lit you're referring too is just as plagued by QRPs as any other field in clinical medicine, which probably also holds for most preclinical work that has characterised the pharmacology based on which working hypotheses for clinical translation had been inferred 5/5.
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PS: not saying that there wasn't (very) little evidence for efficacy of TCAs in some of these. However, nobody treats PD w a TCA, but with DA meds. Another potential area for this list is neural recovery after stroke, but again only off-label use and adjuvant to other treatments.
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I think it's maybe 1/3 [anti depressants probably work at the common denominator of these symptoms by reducing neuroticism slightly/making you care less] + 2/3[psychiatric research practices are mediocre at best?]
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