It's shocking how much of medicine is just based on trust and word of mouth. Studies made decades ago that turn out completely wrong and not reproducible. We flatter ourselves that we're enlightened and based on science, but the more you dig the more you realize it's all a game of trial and error and fighting cultural wars to get your "remedy" out there and profit.
It's rather shocking to someone who's not familiar with the inner workings of the pharma industry and medicine in general.
In particular in psychiatry, we have working theories about how the various agents work to achieve anti-depressive or anti-psychotic effects, which are taken as the gospel or proven fact. And then those models turn out absolutely wrong. And we have to face the fact we're prescribing drugs to sick people we have no clue how and why they work. And whether they work at all, often.
It's especially the case when a given drug must be taken for months before any effect is seen. It's essentially impossible to control for other variables over MONTHS of someone's life. You can easily convince them they feel slightly better now because they've been months on end taking Zoloft. They may've easily been better if they hadn't taken it.
It is kind of ironic that study hints about hope/placebo. What I experienced were always side effects, no relief and then different drug, rinse and repeat. Left with original problem, worried what the next drug gonna bring as side effect with more and more diminishing hope it will ever help - despair.
Some may criticize me for saying this, but I'll explain my observations. In general I've noticed when a drug works, it immediately gets restricted in use, because it has abuse potential, or a dangerous dose.
There's no vast conspiracy here (well, sort of), but a simple principle: anything that is demonstrable to be USEful, is demonstrable to be abUSEable. No one is restricting homeopathic remedies, they don't have side-effects, or drug interactions, and that's because they don't do anything.
Many antidepressants also don't require too strict of a regime, that's because they actually have very poor therapy effects overall, but even when they do, their effect and side-effects are so stretched out in time, it's very hard to show a hard cause-effect relationship. Despite reading the list you see all sorts of conditions on a drug that may occur as a side-effect, often many of those just occurred during a study, but had little relation to a drug, while other effects were underreported (say often around sexual function as people are embarrassed, or things people can't feel, and aren't tested about, things which doctors don't expect they need to check).
So basically "long-running drugs" are a big question mark, and often turn out to be garbage.
But stimulants like Ritalin, Adderall, Vivanse, Concerta and so on are known to instantly alleviate a number of symptoms of ADHD, depression and so on. Not in months. But within AN HOUR of taking a pill. You can immediately see how it works. But of course you can abuse them, and your body craves them over time, because the body and mind adapts to everything, that's the whole point of homeostasis. So they're restricted and you're told they're not good for you because they can be abused. But this cause-effect relationship is only visible because their effect is also apparent. Not just to medicine, but also to your own body. Your mind makes the cause-effect relationship "this makes dopamine good, circuits work better, take again".
But the fact of the matter with drugs is they're all poison, and the therapeutic effect is in the right dose and application. There's no way around it. If it was nice and fun at any quantity, it's at best just sugar, or at worst some random chemical that few bad studies pushed through, which doesn't at all act like it's supposed to.
This doesn't apply just to stimulants. I have issues with my circadian rhythm so I found a brand of melatonin of Jamieson that is 10mg, slow release. I notice on the first night it works. Other smaller doses from random supplement companies did nothing, heck who knows if they even had the active ingredient.
So I'm in EU. And lo and behold, the EU notices melatonin is USEful at dose over 3mg. Therefore also abUSEable, and has side-effects in some. Very minor I might add.
But it was immediately pulled from shelves, so a long and tedious registration can begin for it as a medication rather than a supplement, and until then, EU people who need it are screwed I guess. It's absurd, but it follows the principle that if it works, it becomes controlled. So the irony in all this is that we have easiest access to garbage that doesn't help, and the drugs that do help, have high prices and restricted access due to over-regulation.
It's rather shocking to someone who's not familiar with the inner workings of the pharma industry and medicine in general.
In particular in psychiatry, we have working theories about how the various agents work to achieve anti-depressive or anti-psychotic effects, which are taken as the gospel or proven fact. And then those models turn out absolutely wrong. And we have to face the fact we're prescribing drugs to sick people we have no clue how and why they work. And whether they work at all, often.
It's especially the case when a given drug must be taken for months before any effect is seen. It's essentially impossible to control for other variables over MONTHS of someone's life. You can easily convince them they feel slightly better now because they've been months on end taking Zoloft. They may've easily been better if they hadn't taken it.