[D66] JAMA Psychiatry: No Evidence that Psychiatric Treatments Produce “Successful Outcomes"

[René Oudeweg]

madinamerica.com 
<https://www.madinamerica.com/2023/03/does-psychiatry-improve-outcomes-we-dont-know-according-to-jama-psychiatry/> 



  JAMA Psychiatry: No Evidence that Psychiatric Treatments Produce
  “Successful Outcomes"

Peter Simons
5–6 minutes
------------------------------------------------------------------------

In a viewpoint piece published in /JAMA Psychiatry/, researchers write 
that there is no evidence that psychiatric interventions lead to 
“successful” outcomes. Successful outcomes, they write, include “the 
prevention of undesirable events, such as death and disability, and the 
achievement of desirable ones, such as remission.”

Psychiatry, unlike other medical specialties, has not developed efforts 
to investigate this question. They write:


          *“Despite advances in measurement-based psychiatric care,
          clinical [success rate] reporting systems do not exist for
          most psychiatric services. This applies to all psychiatric
          treatments, including pharmacotherapy, psychotherapy, and
          neuromodulation.”*

The viewpoint was written by Kenneth Freedland and Charles Zorumski at 
Washington University School of Medicine in St. Louis, Missouri.

One way to measure “successful outcomes” is to assess whether current 
treatments are more effective “for a variety of clinically important 
outcomes” than previous treatments. Other medical specialties can point 
to such progress.

Freedland and Zorumski write, “Cardiologists, oncologists, and other 
medical specialists can point to temporal trends in success rates for a 
variety of clinically important outcomes to confirm that current 
treatments are more effective than the ones that were available 20 or 30 
years ago.”

Yet, they note, “Similar data are hard to find for psychiatric disorders.”

This is the very data that the public wants to know. They want to know 
that a medical treatment leads to “successful outcomes” and that 
outcomes have improved over time.


          *“Patients with serious illnesses care about their chances of
          having successful treatment outcomes. They also expect to
          receive more effective treatments than the ones that were
          available to their parents or grandparents, and they hope that
          even more effective treatments will be available for their
          children and grandchildren,” Freedland and Zorumski write.*

If this assessment is applied to psychiatry, it raises this question: 
Are mental health outcomes today—in this era of Prozac, ECT, CBT, and so 
forth—better than they were in the era of, say, insulin coma therapy and 
lobotomy? Or even better than in the early 1800s, when Quakers 
introduced “moral therapy”?

According to Freedland and Zorumski, there is an absence of “successful 
outcomes” data that could answer that question.

The authors focus on the need for psychiatry to develop such 
measurements, focusing on the “success rate” of new psychiatric 
treatments compared to existing treatments.

They write:


          *“If psychiatric treatment success rate data systems were
          available, they would show us that it is difficult to improve
          clinical [success rates] by devising new interventions for
          patients who are potentially responsive to existing ones.”*

The two authors don’t delve into the outcomes data that do exist, which 
tell of a public health failure in psychiatric care. Instead, all the 
data today tells of worsening mental health in the United States, 
particularly among the young. For instance, new data from the CDC 
<https://www.cdc.gov/media/releases/2023/p0213-yrbs.html> found that 57% 
of teen girls feel “persistently sad and hopeless,” and 30% “seriously 
considered attempting suicide.”

And the data also shows that current interventions may contribute to 
that decline. For instance, researchers have warned 
<https://www.madinamerica.com/2023/03/mental-health-awareness-campaigns-may-actually-lead-to-global-increases-in-mental-distress/> 
that well-intentioned “mental health awareness” campaigns may be 
worsening outcomes. Antidepressants have been shown 
<https://www.madinamerica.com/2019/10/clinical-trials-show-antidepressants-not-beneficial-in-the-long-term/> 
to increase the risk that depression will run a more chronic course 
<chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https:/www.madinamerica.com/wp-content/uploads/2011/11/Can-long-term-treatment-with-antidepressant-drugs-worsen-the-course-of-depression.pdf>, 
and they increase the risk of diabetes, hypertension, and other evidence 
of poor health 
<https://www.madinamerica.com/2022/10/long-term-antidepressant-use-associated-increased-morbidity-mortality/>.

In the long term, antipsychotics 
<https://www.madinamerica.com/2020/10/greater-exposure-antipsychotics-associated-worse-long-term-outcomes/>—on 
the whole—lead to worse outcomes 
<https://pubmed.ncbi.nlm.nih.gov/25066792/> for people diagnosed with 
schizophrenia and other psychotic disorders, including worse work 
functioning 
<chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https:/www.ncbi.nlm.nih.gov/pmc/articles/PMC5661946/pdf/nihms887938.pdf>, 
even when comparing people with similar baseline symptom severity 
<chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https:/www.ncbi.nlm.nih.gov/pmc/articles/PMC5980604/pdf/WPS-17-162.pdf>.

While the authors have pointed out the absence of successful outcome 
data for psychiatric treatments, they then jump to this conclusion, 
which nevertheless presents psychiatric care in a positive light: If 
systemic measurements were created for assessing “successful outcomes,” 
they write, this could ensure that psychiatry “continues” to improve:


          *“The development of well-designed, sustainable success rate
          data systems would facilitate this kind of progress and help
          ensure that psychiatric treatment outcomes continue to improve
          in the decades ahead.”*

That sentiment suggests that psychiatric treatments have been shown in 
the past to lead to successful outcomes; yet, as they write here, there 
is no data on whether medical treatments for psychiatric disorders, past 
or present, produce that bottom-line result. As such, this paper 
highlights the fact that there is no evidence that psychiatric 
interventions do more good than harm.

****

Freedland, K. E. & Zorumski, C. F. (2023). Success rates in psychiatry. 
/JAMA Psychiatry./ Published online March 22, 2023. 
doi:10.1001/jamapsychiatry.2023.0056(Link) 
<https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2802547>
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