Combination antidepressant treatment outperforms monotherapy in meta-analysis
One of those things where if you read STAR*D for real you'd already know this. STAR*D clearly showed antidepressants worked about 50% but most of those "successes" were only partial improvement. Very few were in full-remission. Then it went over combinations and that (obvious now) if you tried multiple meds of the same class and they failed expect others of the same class to fail.
I noticed after STEP-BD, STAR*D, and CATIE came out our field took a huge step forward. The amount of people who prescribed on a reasoning that was quite insane such as "I like this medication" (I being the provider not the patient) or, "I prescribed Seroquel cause the color on the packaging is a very beautiful purple-pink," or "it's spiritual" went down, and up went the reasoning of "this medication shows higher efficacy in studies."
We were only just a few decades behind our colleagues in other fields.
I was still in residency and on this message forum just before these studies came out and noticed quite a shift forward in the understanding of the meds we as a field prescribe in this forum, and the amount of egoist, "I'm always right" psychiatrists using Freudian explanations without any objective proof to back them up. I remember one of them on this form was mentioning his forum of therapy is he talks to a patient, within a meeting tells them they're wrong on some level, and anytime that patient complains it's just further proof he's right and they're wrong. The guy hasn't posted here for years. If a resident ever brought up frustration with their training that same guy would reply without knowing the situation that the resident was wrong.
There was a situation I detected where some Philadelphia hospitals were found dumping their patients putting them on a bus to another city. That same bozo came onto the forum and declared such a thing would never happen. Then a few months later it was public headlines that hospitals in the west outside of California were doing it and dumping patients to California. (And yes the Philadelphia hospitals were dumping).
Just as an example the notion that "Spontaneous Remission" occurs in Schizophrenia was still being pushed while I was a resident in the early 2000s. I don't see anyone talking about that at all these days. No one yet publicly declared that this thing was a total load of hogwash as official, just that it's not mentioned anymore. I still occasionally saw someone push a schizophrenogenic mother idea while as a resident. I saw an attending, while a PGY-IV, (this was in the 2000s) who still only prescribed typicals and TCAs. I recall correctly diagnosing a case of Charles Bonnet Syndrome and the attending I was working with in consults didn't know WTF it was and thought if it was a psych consult that we weren't supposed to consider it was anything other than psych, therefore this person who recently went blind, and was having visual hallucinations must have schizophrenia (despite not being in the age bracket to get it and having no sx of psychosis other than visual hallucinations).
For a few years I said you're only a real psychiatrist if you read STAR*D, CATIE, and STEP-BD although I believe now our most current graduates entered a field where the paradigm shifted enough for them to get away with not reading these studies.
