<html>
<head>
<meta http-equiv="content-type" content="text/html; charset=UTF-8">
</head>
<body text="#000000" bgcolor="#f9f9fa">
<p> </p>
<div class="top-anchor"></div>
<div id="toolbar" class="toolbar-container scrolled"> </div>
<div class="container" style="--line-height: 1.6em;" dir="ltr"
lang="en-US">
<div class="header reader-header reader-show-element"> <a
class="domain reader-domain"
href="https://www.madinamerica.com/2023/03/does-psychiatry-improve-outcomes-we-dont-know-according-to-jama-psychiatry/">madinamerica.com</a>
<div class="domain-border"></div>
<h1 class="reader-title">JAMA Psychiatry: No Evidence that
Psychiatric Treatments Produce “Successful Outcomes"</h1>
<div class="credits reader-credits">Peter Simons</div>
<div class="meta-data">
<div class="reader-estimated-time"
data-l10n-id="about-reader-estimated-read-time"
data-l10n-args="{"range":"5–6","rangePlural":"other"}"
dir="ltr">5–6 minutes</div>
</div>
</div>
<hr>
<div class="content">
<div class="moz-reader-content reader-show-element">
<div id="readability-page-1" class="page">
<div>
<p>In a viewpoint piece published in <em>JAMA Psychiatry</em>,
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.”</p>
<p>Psychiatry, unlike other medical specialties, has not
developed efforts to investigate this question. They
write:</p>
<p>
</p>
<h5><strong>“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.”</strong></h5>
<p></p>
<p>The viewpoint was written by Kenneth Freedland and
Charles Zorumski at Washington University School of
Medicine in St. Louis, Missouri.</p>
<p><img
src="https://www.madinamerica.com/wp-content/uploads/2023/03/Depositphotos_137958652_S.jpg"
alt="" class="moz-reader-block-img" width="366"
height="244">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.</p>
<p>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.”</p>
<p>Yet, they note, “Similar data are hard to find for
psychiatric disorders.”</p>
<p>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.</p>
<p>
</p>
<h5><strong>“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.</strong></h5>
<p></p>
<p>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”?</p>
<p>According to Freedland and Zorumski, there is an
absence of “successful outcomes” data that could answer
that question.</p>
<p>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.</p>
<p>They write:</p>
<p>
</p>
<h5><strong> “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.”</strong></h5>
<p></p>
<p>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, <a
href="https://www.cdc.gov/media/releases/2023/p0213-yrbs.html">new
data from the CDC</a> found that 57% of teen girls
feel “persistently sad and hopeless,” and 30% “seriously
considered attempting suicide.”</p>
<p>And the data also shows that current interventions may
contribute to that decline. For instance, <a
href="https://www.madinamerica.com/2023/03/mental-health-awareness-campaigns-may-actually-lead-to-global-increases-in-mental-distress/">researchers
have warned</a> that well-intentioned “mental health
awareness” campaigns may be worsening outcomes.
Antidepressants <a
href="https://www.madinamerica.com/2019/10/clinical-trials-show-antidepressants-not-beneficial-in-the-long-term/">have
been shown</a> to increase the risk that depression
will run <a
href="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">a
more chronic course</a>, and they increase the risk of
<a
href="https://www.madinamerica.com/2022/10/long-term-antidepressant-use-associated-increased-morbidity-mortality/">diabetes,
hypertension, and other evidence of poor health</a>.</p>
<p>In the long term, <a
href="https://www.madinamerica.com/2020/10/greater-exposure-antipsychotics-associated-worse-long-term-outcomes/">antipsychotics</a>—on
the whole—lead to <a
href="https://pubmed.ncbi.nlm.nih.gov/25066792/">worse
outcomes</a> for people diagnosed with schizophrenia
and other psychotic disorders, including <a
href="chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https:/www.ncbi.nlm.nih.gov/pmc/articles/PMC5661946/pdf/nihms887938.pdf">worse
work functioning</a>, even when comparing people with
<a
href="chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https:/www.ncbi.nlm.nih.gov/pmc/articles/PMC5980604/pdf/WPS-17-162.pdf">similar
baseline symptom severity</a>.</p>
<p>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:</p>
<p>
</p>
<h5><strong>“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.”</strong></h5>
<p></p>
<p>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.</p>
<p>****</p>
<p>Freedland, K. E. & Zorumski, C. F. (2023). Success
rates in psychiatry. <em>JAMA Psychiatry.</em>
Published online March 22, 2023.
doi:10.1001/jamapsychiatry.2023.0056<a
href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2802547">
(Link)</a></p>
</div>
</div>
</div>
</div>
<div> </div>
<div aria-owns="toolbar"></div>
</div>
</body>
</html>