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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 139. This is the beginning of the thread.
Posted by SLS on April 6, 2006, at 9:43:54
All of a sudden, psychotherapy is as effective as drug therapy for treating depression!
That's right.
Just look at the medical literature.
Less than a decade ago, nearly all of the double-blind studies demonstrated a clear advantage to drug therapy over psychotherapy for treating depression.
Now, it is difficult to find such studies. Most of the current literature claims equal effectiveness between the two modes of treatment.
How can this be?
Can it be that the emergence of CBT (cognitive behavioral therapy) as the psychotherapeutic treatment of choice has drastically improved the response rate to psychotherapy?
Have current investigations defined depression in a different way than they did ten years ago?
Have the rating methods or measurement standards that define treatment success changed?
Is there a backlash against using drugs to treat depression to be found in the field of psychiatric investigation?
A little of all the above?
What's going on?
- Scott
Posted by zazenduck on April 6, 2006, at 12:03:46
In reply to Drugs versus Psychotherapy - Backlash?, posted by SLS on April 6, 2006, at 9:43:54
> All of a sudden, psychotherapy is as effective as drug therapy for treating depression!
>
> That's right.
>
> Just look at the medical literature.
>
> Less than a decade ago, nearly all of the double-blind studies demonstrated a clear advantage to drug therapy over psychotherapy for treating depression.
>
> Now, it is difficult to find such studies. Most of the current literature claims equal effectiveness between the two modes of treatment.
>
> How can this be?
>
> Can it be that the emergence of CBT (cognitive behavioral therapy) as the psychotherapeutic treatment of choice has drastically improved the response rate to psychotherapy?++yes I would think that was the most obvious reason
>
> Have current investigations defined depression in a different way than they did ten years ago?++I think depression has been defined down by the relentless advertising for ADs. The actual definition may remain exactly the same but people would be more likely to endorse the various criteria because they have conditioned to look for this kind of distress and label it depression. The actual definition may be the same but I think it is different in the mind of the potential subjects...less functionally impaired people may be seeking treatment now.
>
> Have the rating methods or measurement standards that define treatment success changed?++Most of the ratings are subjective and remain that way I think. I think more information about others who have not done well with ADs on the internet for example may have decreased the potential for positive placebo response for medications.
>
> Is there a backlash against using drugs to treat depression to be found in the field of psychiatric investigation?++Are you suggesting some bias unconscious or otherwise in the design of the studies?
>
> What's going on?++I don't know :) What do you think?
>
>
Posted by Racer on April 6, 2006, at 12:57:07
In reply to Drugs versus Psychotherapy - Backlash?, posted by SLS on April 6, 2006, at 9:43:54
Lucky for you, I don't have time to go into it right now...
Briefly, though, I think there are a couple of factors that are probably coming into play:
1. CBT probably is part of it, although I'm gonna back away from offering my opinions on that. I'd ask how long after the end of CBT treatment the assessments were done, and I'd look very, very closely at the pre-treatment baseline. Oh, and I'd do another follow up study a year or two later, to see how much LASTING benefit CBT had.
2. With SSRIs so heavily advertised to consumers, and a few changes in the world that really do affect functioning for a lot of people, I think taking a pill seemed perfectly reasonable to a lot of people for a long time. This is where my longer opinion comes in, but it's basically that a lot of the people on SSRIs in the past decade have really and truly needed non-medication interventions. They needed the things that talk therapy -- actually, more like coaching in life skills -- can provide.
3. I do think there's a wider range of what's being called depression in these studies. The studies I've read have been pretty consistent on the matter, really: for MILD depression, talk therapy can be as effective as medication. For moderate depression, talk therapy can be pretty helpful, as can medications, but both together are optimal. For severe depression, though, all the studies I've seen have consistently said that medications really are required, but talk therapy can be a very valuable adjunct.
Then again, you know I have opinions... So many, in fact, that I have to give them away to all who'll take them...
Posted by Phillipa on April 6, 2006, at 13:25:44
In reply to You just know I have an opinion, right? » SLS, posted by Racer on April 6, 2006, at 12:57:07
Racer we finally agree on something except the last part of your response. Love Phillipa and I do think too many people that don't need meds are on them and if it's true about what a lot of the people and studies say once your're on them it's for life like a diabetic.
Posted by SLS on April 6, 2006, at 15:42:48
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by zazenduck on April 6, 2006, at 12:03:46
> > What's going on?
> ++I don't know :) What do you think?I think investigative psychiatrists are failing to distinguish between people who have a biologically-driven affective disorder from those who do not. It seems that when the selection criteria for an investigation are limited to those people who have a severe and recurrent course, drugs work much better than psychotherapy.
It is unfortunate that there are not yet in use biological tests to aid in diagnosis. Psychiatry really needs to have a more precise algorithm for producing differential diagnoses. Hopefully, this will happen with the new DSM. In the meantime, I think that psychiatrists should use the existing DSM more faithfully. I know a lot of people deride it, but it really does work.
- Scott
Posted by linkadge on April 6, 2006, at 16:04:11
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 6, 2006, at 15:42:48
I think that psychotherapy has always been as effective for depression as medications. The reason we are seeing some of these results now is because of recent medication backlashes. Drug companies only wanted us to believe that depression could be fixed with drugs, but there are other factors that people are considering nowadays.
Another thing to consider is that with psychotherapy most people see only one psychotherapist and if that doesn't work they give up. But thats not the way people deal with medications. Ie, if one antidepressant fails it is customary to try a zillion others till one works.
So I don't think its really a fair comparison.
Linkadge
Posted by greywolf on April 6, 2006, at 17:09:51
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by linkadge on April 6, 2006, at 16:04:11
First, I'll second the folks who've already speculated that the depression spectrum has widened in recent years, in part due to greater public acceptance of medications. Given that, I think that the applicability of any particular study's findings to severe or treatment resistant depression depends on whether the population was overbalanced toward mild/moderate depression.
Second, I suspect that accurately evaluating effectiveness of therapy is very difficult to do, regardless of what study authors may claim. Those who have had success in therapy invariably have committed themselves to it, often over a long period of time. I'd suggest that once you've invested a significant amount of time in therapy, and have built relationships with therapists (instead of switching to a new med at will), you're probably likely to report success. To do otherwise would essentially be admitting that you've been wasting all that time in sessions.
Third, I would bet that mild depression, transient seasonal depression, event-induced depression, etc., are very susceptible to therapy simply because they're less debilitating.
Posted by linkadge on April 6, 2006, at 17:37:33
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by greywolf on April 6, 2006, at 17:09:51
"you're probably likely to report success. To do otherwise would essentially be admitting that you've been wasting all that time in sessions"
I don't know if I'd be less inclined to report therapy failure, esp when the report was not designed to make judgment on individual therapists.
One could say the same about drugs. After having spent years taking various medications, it is hard to return to the doctor and say they don't work. I tell my doctor that the drugs work when they don't.
Linkadge
Posted by SLS on April 6, 2006, at 17:38:29
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by linkadge on April 6, 2006, at 16:04:11
> I think that psychotherapy has always been as effective for depression as medications.
How do you define "depression"?
> The reason we are seeing some of these results now is because of recent medication backlashes.
It is disappointing to believe that results should depend on the popularity of a particular idea.
> Drug companies only wanted us to believe that depression could be fixed with drugs, but there are other factors that people are considering nowadays.
Probably, but not all investigations are funded by drug companies. I don't think there is a conspiracy between drug companies and people involved in pure research. Pure research demonstrates physiological differences in the brains of healthy versus depressed individuals.
> Another thing to consider is that with psychotherapy most people see only one psychotherapist and if that doesn't work they give up.
I didn't. I went from therapist to therapist without success until I properly identified myself as having an affective disorder.
> But thats not the way people deal with medications. Ie, if one antidepressant fails it is customary to try a zillion others till one works.
It was when one did work that I became convinced of the biological nature of my particular case. Actually, I was convinced prior to that because I was an ultra-rapid cycler. Once I read "Mood Swing" by Ronald Fieve, MD, I was able to observe and interpret my cycling; 3 days up, 8 days down. The switch from one state to the other took place within the time period of 30-45 minutes. It was quite dramatic and regular. I learned that I could keep a social calendar based upon the 11-day cycle.
> So I don't think its really a fair comparison.
What is fair is to be able to identify in advance who will respond to biological interventions and who will respond to psychological interventions. Of course, to combine the two offers an enhanced chance of successful treatment and prophylaxis.
Perhaps the reason we don't agree here is that we see depression from the perspectives of dissimilar illnesses. My depression is the result of bipolar disorder. Perhaps there is a bipolar spectrum affective disorder that is driven by biological perterbations, one that is most treatable using biological interventions; depressions that do not belong to this spectrum are treatable using psychotherapy. The problem would then lie in the inability to tell the difference. I think a good psychiatrist can, though.
Just a thought.
- Scott
Posted by greywolf on April 6, 2006, at 17:52:58
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 6, 2006, at 17:37:33
>
>
> "you're probably likely to report success. To do otherwise would essentially be admitting that you've been wasting all that time in sessions"
>
> I don't know if I'd be less inclined to report therapy failure, esp when the report was not designed to make judgment on individual therapists.
>
> One could say the same about drugs. After having spent years taking various medications, it is hard to return to the doctor and say they don't work. I tell my doctor that the drugs work when they don't.
>
> Linkadge
>--I agree, but I do believe that if we're talking about reports of success with therapy in cases of severe depression, it is likely that those individuals have been in therapy for years. From my personal perspective, having twice tried psychotherapy without success, you invest yourself differently, and more intimately, in psychotherapy. While we commit to a lot when working through some of the ridiculous things these drugs do to us, IMHO I am probably more likely to acknowledge that a particular med just isn't doing the trick or has become less effective than someone who has built a long-term relationship with a therapist would be to admit lack of success in that context. For instance, take a look at the countless posts mentioning love or strong feelings for therapists, people experiencing trauma ending treatment with their therapists, etc.
Not saying I'm right, but that's where my thinking is on those studies. I think I take a more negative view because there seems to have been a resurgency recently of anti-med forces (not just the Scientologists).
Posted by linkadge on April 6, 2006, at 18:17:23
In reply to Re: Drugs versus Psychotherapy - Backlash? » linkadge, posted by SLS on April 6, 2006, at 17:38:29
>Probably, but not all investigations are funded >by drug companies. I don't think there is a >conspiracy between drug companies and people >involved in pure research. Pure research >demonstrates physiological differences in the >brains of healthy versus depressed individuals.
True, we need more pure research. It is hard to know what is exactly pure research. A lot of it is tainted.
>I didn't. I went from therapist to therapist >without success until I properly identified >myself as having an affective disorder.
But have you found the right drug either?
There are others who have found the right therapist after a few trials, and some who give up right away, so results vary just like with drugs.
>It was when one did work that I became convinced >of the biological nature of my particular case. >Actually, I was convinced prior to that because >I was an ultra-rapid cycler. Once I read "Mood >Swing" by Ronald Fieve, MD, I was able to >observe and interpret my cycling; 3 days up, 8 >days down. The switch from one state to the >other took place within the time period of 30-45 >minutes. It was quite dramatic and regular. I >learned that I could keep a social calendar >based upon the 11-day cycle.
Not really trying to dismiss the biological nature of the illness. There are many different cases. I have had a bad track record with antidepressants. Little help / often make things worse. I have had more success with therapy. Thats not to say that my diseas might not be biological, it just means that current drugs don't help much. So I would say that I respond better to therapy than drugs.
>What is fair is to be able to identify in >advance who will respond to biological >interventions and who will respond to >psychological interventions. Of course, to >combine the two offers an enhanced chance of >successful treatment and prophylaxis.
Another thing to consider is exercise. It has been shown to be as effective as antidepressants in many trials, even for severe depression. Exercise actually seems to have similar downstream targets as antidepressants do. Not to say that everybody will respond. I just think that it is best to at least try alternitives first, as they can be less harsh. Not that you said it, but I don't think it would be fair to sayt that if a person responds to exercise that their illness was mild.
>Perhaps the reason we don't agree here is that >we see depression from the perspectives of >dissimilar illnesses. My depression is the >result of bipolar disorder. Perhaps there is a >bipolar spectrum affective disorder that is >driven by biological perterbations, one that is >most treatable using biological interventions; >depressions that do not belong to this spectrum >are treatable using psychotherapy. The problem >would then lie in the inability to tell the >difference. I think a good psychiatrist can, >though.
I see what you are saying. But I think that it is not really fair to restrict certain diseases to certain treatments. For instance, a new study suggests listening to mozart can increase the seizure threshold, and reduce some patient's need for anticonvulsants. Thats not to say that the disease isn't biological, it just says that biology can be altered in ways other than drugs.
Linkadge
Posted by med_empowered on April 6, 2006, at 18:23:10
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 6, 2006, at 18:17:23
I think that we're entering a point where the realization that therapy really CAN help with problems--even severe ones, like schizophrenia--is finally sinking in to the mainstream in the US. I do think shrinks have kind of started to ignore the "neurotic" depressions from the "endogenous" depressions...however, I think therapy can help disorders that seem "biologically driven," too (look at the success of CBT for schizophrenia). Plus..the meds aren't that great.
I think a lot of times we stick to the "depression is a biological illness--period" explanation b/c docs prefer biological illnesses (psychiatry does fancy itself a part of modern medicine, afterall, although many patients probably beg to differ) AND b/c patients prefer to have "biological" illnesses rather than "problems with living".
I seem to recall reading that therapy can help more severe depressions, both w/ and w/o meds (though how effective it is, I couldn't say). Plus, I think the drugs vs. therapy debate is based on an old view of the mind--that the brain is this static organ that can be changed by drugs, but not experiences or therapy. Now we know that the brain changes in response to external stimuli, not just drugs, so it becomes a question not of if treatment is affecting the brain's functioning, but **HOW**--are you just pumping up serotonin with SSRIs, or are you doing more subtle fine tuning with therapy, or a mixture of the two, or...?
Posted by linkadge on April 6, 2006, at 18:29:36
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by greywolf on April 6, 2006, at 17:52:58
I see what you are saying.
I think the problem is that people still see therapy as only helping those with "character flaws". I don't know why we try and restict the brain in such ways. Consider ECT. We still don't know how it works, and yet in some sitatuions it is more effective than drugs.
Linkadge
Posted by linkadge on April 6, 2006, at 18:34:08
In reply to reality check, posted by med_empowered on April 6, 2006, at 18:23:10
We've got SSRI's and we've got tianeptine. Both clinically effective, yet they do the opposite biologically. Every time science tries to categorize, we discover a counterexample to the rule.
I don't even think there is enough evidence to suggest that antidepressants have made a big impact on the rates of depression and suicide.
Linkadge
Posted by FredPotter on April 6, 2006, at 19:57:41
In reply to Re: reality check, posted by linkadge on April 6, 2006, at 18:34:08
What was the hypothesis behind Tianeptine? Or was it an accident?
Posted by greywolf on April 6, 2006, at 20:00:03
In reply to Re: reality check, posted by linkadge on April 6, 2006, at 18:34:08
> We've got SSRI's and we've got tianeptine. Both clinically effective, yet they do the opposite biologically. Every time science tries to categorize, we discover a counterexample to the rule.
>
> I don't even think there is enough evidence to suggest that antidepressants have made a big impact on the rates of depression and suicide.
>
> Linkadge
>--I've always wondered about the impact rates. Here we are with all of these meds, and all of these therapists, and all of these psychiatrists, and all of these research scientists, and I think all we've achieved is a limited degree of illness management.
It's tempting to look back to the early/mid 20th century, because we can probably reassure ourselves thereby that things have dramatically improved. But how about looking back over the past 15 years? From my perspective with respect to depression and BP, we seem to have reached a plateau. Lots of med refinements, new combo treatments, but not so much in the way of breakthroughs.
That's a lot of time for psychotherapy to increase its rates of success.
Posted by Caedmon on April 6, 2006, at 20:28:21
In reply to Re: reality check, posted by greywolf on April 6, 2006, at 20:00:03
I'm less confident about depression. But, I understand that long-term studies of CBT in anxiety disorders tend to include basically the same rate of relapse as med discontinuation, when treatment is stopped.
I'm guessing that it depends on the cohorts used in the study. Exogenous and endogenous depression are different animals IMO. Most people have exogenous depression, and even those who don't, typically have poor coping mechanisms or patterns of behavior that worsen the condition. God knows I sure do.
- C
Posted by Phillipa on April 6, 2006, at 20:56:24
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 6, 2006, at 17:37:33
Link l0 years and I'm worse than before meds. I did well on a benzo and beer nightly. Sometimes more or less but I divorced raised my three kids on my own, had my own business, went to nursing school, graduated magna cum laude and had scholarships the last year that paid my way. Worked as a nurse . Move to VABeach on my own with my kids bought my own house, boat, swimming pool. Never an ad. Hummmm Love Phillipa ps I told the neurosurgeon today when he said that percocet was addicting what about what happened with vioxx and zyprexa, and aren't ad's addictive too. There is a withdrawl. I told him I've wasted l0years of my life listening to pdocs. I said I would rather have l0 years of quality life and drink and have fun and be able to work again. Not be some zombie scared to leave my home.
Posted by Phillipa on April 6, 2006, at 21:04:40
In reply to Re: Drugs versus Psychotherapy - Backlash? » linkadge, posted by SLS on April 6, 2006, at 17:38:29
Scott what you say I believe but where do you find a good pdoc? l0minute appointments. And oh I found out none of the ones in NC at least do psychoanalycist at the same time . Meaning talk to you at least for 20minutes or so. Love Phillipa
Posted by FredPotter on April 6, 2006, at 23:31:02
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by Phillipa on April 6, 2006, at 21:04:40
Hi Phillipa I'm in NZ and I can't even get CBT unless I also have an alcohol or drug problem, which I don't. I had to give up drink as in the long term it made my anxiety and depression worse. It was the only thing that ever worked for anxiety though - in the short term Fondly Fred
Posted by Phillipa on April 7, 2006, at 0:18:59
In reply to Re: Drugs versus Psychotherapy - Backlash? » Phillipa, posted by FredPotter on April 6, 2006, at 23:31:02
Another one from so far away. your babblelight is off. Mine is one babblemail me and I'll send you my E-mail That way we can talk in private. Love Phillipa
Posted by SLS on April 7, 2006, at 7:42:21
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 6, 2006, at 18:17:23
> > I went from therapist to therapist >without success until I properly identified >myself as having an affective disorder.
> But have you found the right drug either?
Yes. On several occasions. Parnate + desipramine produced a dramatic remission that lasted for 6 months before mania began to emerge. Unfortunately, my doctor at the time chose to avoid this treatment upon my relapse into depression. I have also had tricyclics bring me into a state of euthymia. Unfortunately, this response lasts for less than a week. I have had similar, although less robust responses to several SSRIs, memantine, and a few other drugs that I can't now remember. I also experience partial responses to MAOI monotherapy. Unfortunately, the Parnate + TCA combination no longer works.
> There are others who have found the right therapist after a few trials, and some who give up right away, so results vary just like with drugs.
Yes. I think this is an important point.
> >It was when one did work that I became convinced >of the biological nature of my particular case. >Actually, I was convinced prior to that because >I was an ultra-rapid cycler. Once I read "Mood >Swing" by Ronald Fieve, MD, I was able to >observe and interpret my cycling; 3 days up, 8 >days down. The switch from one state to the >other took place within the time period of 30-45 >minutes. It was quite dramatic and regular. I >learned that I could keep a social calendar >based upon the 11-day cycle.
> Not really trying to dismiss the biological nature of the illness.
I am convinced that a huge number of people who complain of depression do not have a biological illness.
> >What is fair is to be able to identify in >advance who will respond to biological >interventions and who will respond to >psychological interventions. Of course, to >combine the two offers an enhanced chance of >successful treatment and prophylaxis.
> Another thing to consider is exercise.
Been there. No dice. Not for me. Not for many others either.
> >Perhaps the reason we don't agree here is that >we see depression from the perspectives of >dissimilar illnesses. My depression is the >result of bipolar disorder. Perhaps there is a >bipolar spectrum affective disorder that is >driven by biological perterbations, one that is >most treatable using biological interventions; >depressions that do not belong to this spectrum >are treatable using psychotherapy. The problem >would then lie in the inability to tell the >difference. I think a good psychiatrist can, >though.
> I see what you are saying. But I think that it is not really fair to restrict certain diseases to certain treatments.I don't think that is what I wrote. What do you mean?
> Thats not to say that the disease isn't biological, it just says that biology can be altered in ways other than drugs.
I used the term "biological interventions" on purpose. Drugs are only one type of somatic treatment.
I think you will find that when psychomotor retardation is used as a gauge of the severity of depressive illness, drugs work much better than psychotherapy. I believe that there should be more focus on improving diagnostics. Not all people complaining of depression have MDD or BD. Not all people complaining of depression should be treated with drugs.
- Scott
Posted by SLS on April 7, 2006, at 7:49:02
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 7:42:21
I though that I had posted the link to the following submission somewhere along this thread. I can't find it so...
A repost from April 2000
--------------------------------
BIOLOGY OR PSYCHOLOGY?
The best answer to this question may be “either and both”.Many of us here have been diagnosed as having a mental illness. “Mental illness” is NOT “mental weakness”. The diagnoses that we are most familiar with include:
1. Major Depression (Unipolar Depression)
2. Bipolar Disorder (Manic Depression)
3. Dysthymia (Minor Depression)
4. Seasonal Affective Disorder (SAD)
5. Schizophrenia
6. Schizo-Affective Disorder
7. Obsessive-Compulsive Disorder (OCD)
8. Post-Traumatic Stress Disorder (PTSD)All of these disorders have one thing in common. They are not our fault. Each has both biological and psychological components. We all begin our lives with a brain that is built using the blueprints contained within the genes we inherit from our parents. Later, hormones change the brain to prepare it for adulthood. The brain can be changed in negative ways by things such as drugs, alcohol, and injury. The brain is also changed by the things we experience.
How we think and feel are influenced by our environment. Probably the most important environment is the family, with the most important time being our childhood. We all have both positive and negative experiences as we travel through life. How we are as adults is in large part determined by these positive and negative experiences. They affect our psychology, our emotions, and our behaviors. All of us can be hurt by unhealthy negative experiences.
Some of us are also hurt by unhealthy brains. Medical science has long recognized that many mental illnesses are biological illnesses. Even Sigmund Freud, who we know for his development of psychoanalysis, proposed a role for biology in mental illness. The first solid evidence for this concept in modern times came with the discovery of lithium in 1947. Lithium was found to cause the symptoms of bipolar disorder (manic-depression) to disappear completely, allowing people to lead normal lives. Lithium helps to correct for the abnormal biology that is the cause of bipolar disorder. Later biological discoveries included the observations that Thorazine (an antipsychotic) successfully treated schizophrenia, and that Tofranil (an antidepressant) successfully treated depression. Again, these drugs help to correct for the abnormal biology of the brain that accompanies these illnesses.
What about psychology? This can be a two-way street. The abnormal biology that occurs with some mental illnesses affects our psychology – how we think, feel, and behave. On the other hand, our psychology can also affect our biology. Often, the emotional stresses and traumas we experience change the way our brains operate. This is especially true of things we experience during childhood. These stresses can trigger the start of major depression, bipolar disorder, schizophrenia, and other mental illnesses. In order for this to happen, however, there must be a biological weakness to begin with. Not all doctors agree with all of this, but the vast majority of our top researchers in psychiatry do.
It is important to understand that not all psychological and emotional troubles are biological in origin. Again, we are all products of our environments – family, friends, enemies, school, work, culture, climate, war, etc. Environments that are unhealthy often produce unhealthy people. This, too, is not our fault.
In conclusion, regardless of the cause of our illness, it is important that we treat both the biological and the psychological. We will all benefit if we do.
- Scott
Posted by Sobriquet Style on April 7, 2006, at 9:24:53
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 7:42:21
> Another thing to consider is exercise.
>Been there. No dice. Not for me. Not for many others either.
From what I understand, exercise acts as a biological intervention for improving mood, depression and overall general health and well being - for depression which is thought to be of a biological cause, studies have shown it can be equally and sometimes more effective than both psychotherapy and medication. Mixing the treatments, if needed medication + exercise, or psychotherapy + exercise, can produce even more positive remission outcomes, as can using all 3 depending on the individual.
On the other hand people with chronic fatigue syndrome, do not benefit from exercise and it can actually make them feel worse in the long run, including their depression.
~
Posted by naughtypuppy on April 7, 2006, at 10:02:07
In reply to Re: reality check, posted by linkadge on April 6, 2006, at 18:34:08
> We've got SSRI's and we've got tianeptine. Both clinically effective, yet they do the opposite biologically. Every time science tries to categorize, we discover a counterexample to the rule.
>It just goes to show how complex and adaptive the brain is. Two different people can exibit similar symptoms, but the problem is caused by an entirely different mechanism. I guess that's why certain meds work for some people but not others.
> I don't even think there is enough evidence to suggest that antidepressants have made a big impact on the rates of depression and suicide.
>
> Linkadge
>
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Dr. Bob is Robert Hsiung, MD,
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