Wikipedia:Reference desk/Archives/Science/2017 March 22

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March 22

Do mind altering medication really work?

Like anti anxiety pills, anti depressants. I've read lots of people say it does nothing. I used quite a number of anti depressants and all I feel is sleepy. I also used phenibut and it does NOTHING. I feel like they are all scam by greedy pharmaceutical companies. Has there been any investigation into the effectiveness of mind altering medicine? If you know any articles please link. Thanks. Money is tight (talk) 07:59, 22 March 2017 (UTC)

Drugs work differently in different people, but they must all be tested thoroughly before being put on the market. Their effectiveness is discussed in detail at antidepressant.--Shantavira|^{feed me} 08:08, 22 March 2017 (UTC)

• I'm sorry, but even the most casual search would turn up thousands of hits on this subject (antidepressant + effectiveness alone gives me 3851 hits on PubMed this morning), what exactly are you expecting us to give you here? You might have to narrow down your question. Let me add that, as a neurobiologist, I find your assessment that these drugs are 'all scam' somewhat of a professional insult, you may also want to rephrase your question in a less inflammatory manner if you want more answers. Fgf10 (talk) 08:15, 22 March 2017 (UTC)
• While, as for any medicine, "authorized to market" is different from "working", the idea that it is all a big scam is a conspiracy theory, for which I've read lots of people say... I feel like... is not sufficient supporting evidence. Tigraan^{Click here to contact me} 08:34, 22 March 2017 (UTC)
• If a particular medication is not doing the trick for you, it's your responsibility to inform your doctor so that he can try something else. And if he runs out of options, try another doctor. ←Baseball Bugs ^{What's up, Doc?} carrots→ 08:54, 22 March 2017 (UTC)
• "I've read lots of people say..." -- are any of those people real doctors in the relevant field? And how many of them want to sell you a "natural solution"...? And wouldn't it make sense for a medication affecting something like the mind to have as subtle an effect as possible? It kinda defeats the point of taking an antipsychotic if it's followed a booming chorus of voices in your head shouting "YOUR MEDICATION IS NOW WORKING. YOU NO LONGER HEAR ANY VOICES IN YOUR HEAD BUT YOUR OWN. ENJOY THINKING YOUR OWN THOUGHTS UNINTERRUPTED." Ian.thomson (talk) 09:37, 22 March 2017 (UTC)
• It is often recognized that other complementary services (proper followup, counselling and therapies), other than medication alone, can enhance the prospect of recovery. If the time period for readaptation is longer than a few years, there is more possibility of long-term medication. Unfortunately not everyone can get an ideal treatment, partly for economic reasons. This does not preclude that these medications have a measurable effect on the brain. See the selective serotonin reuptake inhibitor article for instance, on a specific class of drugs commonly prescribed as antidepressants and sometimes as anxiolytics. Of course, other anxiolytics like benzodiazepines, and antipsychotic drugs, are quite different, and some medications are not advised for long term or regular use. Unfortunately, nothing being perfect, and with the wide array of individual biological factors, what works well for a person may not give the same effect on another. There also are side effects, with individual variation on which are felt more or less (they can affect health and mood). Other issues are adaptation of the body after repeated regular use, and its recovery (withdrawal) when the drug is interrupted (which is why many medications must be introduced and stopped gradually). The withdrawal symptoms of some medications can be very discomforting and sometimes life-threatening (which would not be the case if they did not successfully alter brain chemistry, BTW). Drugs that are on the market have been tested carefully versus placebo (not only for subjective sensations of subjects, but using blood tests, and sometimes magnetic resonance imaging and other methods). They are a result of a number of years of scientific and technological development. When possible, newer molecules are used which are more specific than previous ones to more effectively target wanted neurotransmitters or receptors than previous drug generations could, also reducing side effects as possible. PaleoNeonate (talk) 10:54, 22 March 2017 (UTC)

In order to bring a medication to the market a pharmaceutical company must prove its effectiveness in clinical trials while comparing the medicine to placebo. The trials typically last 3 months and involve a few hundred people. They are double blind. Nobody knows individual result until the very end. The whole trial typically costs upward of a billion dollars. Before the clinical trial the company must test the medication on animals, bacteria, etc. All FDA approved medications including antidepressants are effective albeit not everyone will respond. There are treatment resistant cases. Some people sabotage their own treatment because they like to complain and project an aura of misery. --AboutFace 22 (talk) 14:14, 22 March 2017 (UTC)

Citation needed for "a billion dollars". --76.71.6.254 (talk) 14:37, 22 March 2017 (UTC)

From Forbes, $4bn to $11bn total cost for every new drug approved (counting failures), and "combined cost of manufacturing and clinical testing for some drugs has added up to $1 billion". And that was five years ago. — Lomn 15:54, 22 March 2017 (UTC)

[EC] Seconded: $1 billion is in the ballpark for the total costs of all the testing and trialling required to take a single "candidate molecule" from initial identification to the market (under the regulations of the FDA, which tend to dominate the global Pharmaceutical industry). The particular type of clinical trial described by AboutFace 22 above occurs in Phase 2 of the process, which has 4 phases (0–3: Phase 4 is post-release monitoring) and typically takes around a decade.

Mind-altering medication is by definition prescribed to patients whose cognition and/or moods are in some way impaired. The corollary is that the recipients may not recognise subsequent changes in their thoughts/feelings, because one's internal viewpoint is subjective and adapts to changes, particularly slow ones.

Finally, if mind-altering medications didn't generally have any effect, there would not be widespread use of them for non-medical purposes. {The poster formerly known as 87.81.230.185} 94.12.80.28 (talk) 16:20, 22 March 2017 (UTC)

• Think what the OP would benefit from, is a broader and independent view of the subject than that which we can ever hope to give here. Was most impressed by Robert Whitaker's book Mad in America. Recommend it. It has a detailed bibliography too. Not only I but my local medical library has it on their bookshelf. This book created such a stir that there is a website to help people separate the wheat from the chaff when it comes to psychiatric drugs. You can view it here: [1]. There are much older books. One is There's Gold in Them Thar Pills: Inquiry into the Medical Industrial Complex but that is only about the shenanigans that pharmaceutical companies get up to. To my mind the OP would be better of going to the site like MiA that offers some hope and guidance, much of which the proscriber of his medications has not been taught in Med School -because it is not on the curriculum.--Aspro (talk) 16:31, 22 March 2017 (UTC)

Approved medicines are generally believed by a lot of experts to be "safe and effective". That does not, however, imply that every drug will work for every last patient... nor that the drugs will be found entirely satisfactory at producing optimal functional health even by the majority of patients. It only means that in some studies there was a statistical benefit. Nor does it mean that there is no other way by which a patient could obtain the same benefit - even a better way that is not presently approved, for whatever reason.

It is very appropriate to be skeptical, but -- a skeptic must never forget to be skeptical of his skepticism! Nothing, pro or con, is ever above suspicion, not even oneself. Wnt (talk) 00:08, 23 March 2017 (UTC)

Verily. The efficacy of a drug is often numerated as the NNT. Yet, the guidance on psychiatric drugs often lead proscriber down the garden path. They read in their med journals and are informed by drug reps about NNT but are often oblivious to NNH. So despite the evidence before their very eyes they try to increase the dosage even when the drug for a particular patient doesn't work. Hoping for more-is-better. Something which any pharmacist (who are required to study in depth the action of drugs) will tell you is far from scientific.--Aspro (talk) 17:26, 23 March 2017 (UTC)

WHO

Regarding the election of the Director-General of the World Health Organization, there are three nominees for the position (Tedros Adhanom Ghebreyesus, David Nabarro, and Sania Nishtar). Does this mean that one of those three must be elected Director-General? In other words, are those three names the only options on the ballot or only valid choices? 147.126.10.129 (talk) 17:00, 22 March 2017 (UTC)

Very likely. The WHO is part of the United Nations, so any UN-Member can propose a fitting person to fill a position. In case of the WHO its the World Health Assembly then, where every Member can send some delegate to vote. Ofcourse there is certainly some diplomathy behind closed doors between Members and/or Blocks of Members to determine infront who is proposed and what votes that person will get. --Kharon (talk) 19:34, 22 March 2017 (UTC)

Is Diplomathy where they come to an agreement on the numbers? {The poster formerly known as 87.81.230.195} 94.12.80.28 (talk) 06:27, 23 March 2017 (UTC)

No, diplomathy is not teething people who lithp. StuRat (talk) 06:34, 23 March 2017 (UTC)

I have another question—what is the date and time of the vote for Director-General? Many sources indicate it is in May, but I have yet to see any specific date or time. 147.126.10.158 (talk) 22:37, 23 March 2017 (UTC)

Trauma biochemistry

Why is sharp trauma such as a stabbing even to places like the hand so traumatic and deadly? Is it to do with shock more than blood loss? Or are there other biochemical factors involved? 2A02:C7D:B96A:200:44AE:39E3:1F2E:DE5 (talk) 19:59, 22 March 2017 (UTC)

First of all, is it? Andy Dingley (talk) 20:11, 22 March 2017 (UTC)

Getting stabbed in the heart is a lot more likely to be traumatic and deadly than being stabbed in the hand. ←Baseball Bugs ^{What's up, Doc?} carrots→ 20:58, 22 March 2017 (UTC)

Isn't that obvious? --Hofhof (talk) 21:47, 22 March 2017 (UTC)

To you and me, but maybe not to the OP. ←Baseball Bugs ^{What's up, Doc?} carrots→ 21:59, 22 March 2017 (UTC)

Maybe he takes some expressions too literally. Hofhof (talk) 22:09, 22 March 2017 (UTC)

I don't know what you mean by "so traumatic and deadly." A stabbing to a hand probably won't kill you, if treated properly. But yes, you can die from any wound that gets infected. A deep wound can inject bacteria deep into a tissue, but that does not make a stab to the hand especially deadly.

Stab wound, ballistic trauma and major trauma can get you further on the topic. --Hofhof (talk) 21:47, 22 March 2017 (UTC)

And of course hemorrage, in cases where this is serious enough and not rapidly managed. PaleoNeonate (talk) 22:40, 22 March 2017 (UTC)

But the same thing also happens in the case of blunt trauma to somewhere like the hand with no bleeding. I think I heard that trauma of any kind can release deadly chemicals into the body °or something? 82.132.242.69 (talk) 13:03, 23 March 2017 (UTC)

Rhabdomyolysis. First noted medically after the San Francisco earthquake of 1906, treatments for it were improved massively during the London Blitz.

We hear so much utter nonsense about "alkalinising" the body these days to "detox" it, but this is one condition where it can be (amongst other things) a relevant treatment. Andy Dingley (talk) 13:13, 23 March 2017 (UTC)

Calories

What tastes good is a matter of opinion. The Reference Desk is not for opinions.
The following discussion has been closed. Please do not modify it.
What is the lowest calorie "junk" food that actually tastes good? — Preceding unsigned comment added by 64.183.94.45 (talk) 20:51, 22 March 2017 (UTC) Define "junk" food. ←Baseball Bugs What's up, Doc? carrots→ 20:57, 22 March 2017 (UTC) Junk food: is a pejorative term for cheap food containing high levels of calories from sugar or fat with little fiber, protein, vitamins or minerals.--Hofhof (talk) 22:01, 22 March 2017 (UTC) Or, perhaps even harder, define "tastes good" (de gustibus non est disputandum, after all). This seems like something where WP:OR at your local food market is the only real solution. — Lomn 21:39, 22 March 2017 (UTC) Indeed. I recall a song called "The Junk Food Junkie" in which the Hostess Twinkie was the archetype of junk food. Yet I'm sure there are some (or many) who don't like the taste of them. ←Baseball Bugs What's up, Doc? carrots→ 22:03, 22 March 2017 (UTC) I'd say chewing gum + diet Coke, McDonald's McNuggets and chicken is said to have less calories than others. The Ultimate Chicken Grill Sandwich or Grilled Chicken Go Wrap of Wendy's might be less caloric than other options. --Hofhof (talk) 22:07, 22 March 2017 (UTC) I wouldn't consider a grilled chicken sandwich to be junk food, and they also have a fair amount of calories. But sugar-free items with artificial sweeteners are unhealthy, and may have zero calories, so I'd say you are right on track with those. StuRat (talk) 22:15, 22 March 2017 (UTC)