Authors Lyman Stone 石來民

7 days 30 days All time Recent Popular
Ulysses S. Grant would like a WORD


Or Teddy Roosevelt. Or Dwight Eisenhower. Or Andrew Jackson. Or Abraham Lincoln. Or George Washington. Or Zachary Taylor. Or any of numerous presidents who were honest-to-goodness battle-hardened warriors.

James Monroe fought the Hessians at Trenton and nearly died of wounds sustained there, then wintered in Valley Forge, then fought until Monmouth, then repeatedly tried to raise new regiments for the war until he went bankrupt doing it.

James Monroe, of the Era of Good Feelings, longest serving president of all time.... was in the boats crossing the icy Delaware.

Andrew Jackson was in a duel. He was shot in the chest right by his heart.

But he didn't go down. He stood there and, while bleeding out, steadily took aim and killed the dude who shot him.

Stone cold.
So a few days back I was tweeting about SSRIs. The big question with these drugs is: why do controlled trials routinely show such small effects when practitioners and patients report life-changingly-large effects?

So first off, at this point the evidence is pretty clear that SSRIs and other anti-anxiety/anti-depression drugs truly don't do very much. Their average effects are beneath clinical significance, as I tweeted about here:


Basically, the problem these drugs face is that while they actually see relatively LARGE effects.... but that placebos in those trials ALSO see large effects (and most untreated depression improves within a year anyways).

So basically you have this problem where:
1. The condition tends to improve on its own in a majority of cases
2. Placebo effects for the condition are unusually large

Which means the large crude effects of SSRIs get swamped.

So that raises two new questions.
1. (Not my focus here) Are we treating these conditions appropriately given their untreated prognosis is usually (though certainly not always!!) "goes away in a few months"?

2. Why are placebo effects so unusually large?