![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 23 to 47 of 55. Go back in thread:
Posted by SLS on May 12, 2010, at 6:03:45
In reply to Re: Interesting article? What do you think? » SLS, posted by 49er on May 10, 2010, at 9:32:32
> > Interestingly, the rate of response to placebo has increased rapidly over the years. This has reduced the apparent margin of statistical superiority of drugs. My guess is that this is an artifact of the use of less rigorous screening for major depressive disorder (MDD) and the inclusion of more people who don't suffer from it. (Clinical investigators are payed based on the number of subjects enrolled). One way or another, this trend must be accounted for if statistics are to be of any value. It is significant that when working with inpatients or people with more severe depressions, the placebo response rate plunges. Another guess of mine is that this occurs because a greater percentage of subjects actually have the illness being investigated.
> I will have to look up the statistics for inpatient folks and placebo rates. I haven't seen any studies on that. If you have link, that would be appreciated.
Here is the most recent study I could find:
http://www.ncbi.nlm.nih.gov/pubmed/20051569JAMA. 2010 Jan 6;303(1):47-53.
Antidepressant drug effects and depression severity: a patient-level meta-analysis.Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, Fawcett J.
Department of Psychology, University of Pennsylvania, 3720 Walnut St, Philadelphia, PA 19104, USA. [email protected]
Abstract
CONTEXT: Antidepressant medications represent the best established treatment for major depressive disorder, but there is little evidence that they have a specific pharmacological effect relative to pill placebo for patients with less severe depression. OBJECTIVE: To estimate the relative benefit of medication vs placebo across a wide range of initial symptom severity in patients diagnosed with depression. DATA SOURCES: PubMed, PsycINFO, and the Cochrane Library databases were searched from January 1980 through March 2009, along with references from meta-analyses and reviews. STUDY SELECTION: Randomized placebo-controlled trials of antidepressants approved by the Food and Drug Administration in the treatment of major or minor depressive disorder were selected. Studies were included if their authors provided the requisite original data, they comprised adult outpatients, they included a medication vs placebo comparison for at least 6 weeks, they did not exclude patients on the basis of a placebo washout period, and they used the Hamilton Depression Rating Scale (HDRS). Data from 6 studies (718 patients) were included. DATA EXTRACTION: Individual patient-level data were obtained from study authors. RESULTS: Medication vs placebo differences varied substantially as a function of baseline severity. Among patients with HDRS scores below 23, Cohen d effect sizes for the difference between medication and placebo were estimated to be less than 0.20 (a standard definition of a small effect). Estimates of the magnitude of the superiority of medication over placebo increased with increases in baseline depression severity and crossed the threshold defined by the National Institute for Clinical Excellence for a clinically significant difference at a baseline HDRS score of 25. CONCLUSIONS: The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.
-------------------------------------------------
Also:
This is an excerpt from a reply to the Newsweek article to be found in Psychiatric Times. The whole article might be worth a look at.
http://www.psychiatrictimes.com/home/content/article/10168/1520550
"Furthermore, placebo group response rates in depression studies have been mysteriously and substantially rising in recent decades"
------------------------------------------
- Scott
Posted by linkadge on May 15, 2010, at 7:56:33
In reply to Re: Interesting article? What do you think?, posted by 49er on May 10, 2010, at 9:38:26
>Literature tells us very clearly that long-term >depression has been common throughout history - >and that mostly it did not get better but in >fact often led to disastrous results.
I don't really buy this statement.
For starters, its only in the last 25 years that depression (as a disease) has really been exposed or created. Depression has always existed within humanity, yes, but.........its only the people who have killed themselves that ever make headwaves.
Sure, Jo Blo, in 1534 had a depressive episode which lasted 2 years. He got better. Case closed. No story written about him.
There is no comprehensive history anyalsis of the incidence of depression and what rate got better vs. what rate deteriorated.
Linkadge
Posted by ed_uk2010 on May 15, 2010, at 10:12:49
In reply to Re: History of depression - um? » 49er, posted by linkadge on May 15, 2010, at 7:56:33
There is some really old psychiatry textbooks in my local library. I was looking at them a while ago and noticed that in the chapter about depression, it stated that depressive illness was quite rare. I suppose they only diagnosed people with depression if the symptoms were very severe. Nowadays, we are told that a huge proportion of the population is suffering from depression.
There are also cultural differences in diagnosis. In Japan, for example, depression was rarely diagnosed until recently. It had a lot of stigma attached to it and was only diagnosed when severe eg. if hospitalisation was needed. Anxiety disorders, on the other hand, have been widely diagnosed in Japan for many years and treated with benzodiazepines.
Posted by hansi555 on May 15, 2010, at 11:41:34
In reply to Re: History of depression - um? » linkadge, posted by ed_uk2010 on May 15, 2010, at 10:12:49
http://www.madinamerica.com/madinamerica.com/Home/Home.html
Strange how things change over time...
Posted by sigismund on May 15, 2010, at 14:44:32
In reply to Re: History of depression - um? » linkadge, posted by ed_uk2010 on May 15, 2010, at 10:12:49
Depression in 1970 meant that you could not get out of bed and were physically sick. If you were unhappy or anxious, you were neurotic.
Funny how these words acquire and then lose their meanings.
Posted by ed_uk2010 on May 15, 2010, at 16:55:11
In reply to Re: History of depression - um? » ed_uk2010, posted by sigismund on May 15, 2010, at 14:44:32
> Depression in 1970 meant that you could not get out of bed and were physically sick. If you were unhappy or anxious, you were neurotic.
> Funny how these words acquire and then lose their meanings.Yes, that's what I mean. You weren't depressed unless you were so ill that you were totally incapable of normal daily activities for a prolonged period. The concept of depression being applied to people who have low mood or lack of pleasure (and a couple of other symptoms) for two or more weeks didn't exist. It's certainly good for selling drugs though.
I quite like the idea of neurosis versus psychosis. I am neurotic. I am definitely not psychotic :)
Posted by SLS on May 15, 2010, at 17:07:58
In reply to Re: History of depression - um? » sigismund, posted by ed_uk2010 on May 15, 2010, at 16:55:11
> > Depression in 1970 meant that you could not get out of bed and were physically sick. If you were unhappy or anxious, you were neurotic.
> Yes, that's what I mean. You weren't depressed unless you were so ill that you were totally incapable of normal daily activities for a prolonged period. The concept of depression being applied to people who have low mood or lack of pleasure (and a couple of other symptoms) for two or more weeks didn't exist.
This is exactly why I think that the more recent clinical trials of antidepressants fail to show a large separation between drug and placebo when compared to older investigations. Too many of the test subjects do not have the disease being investigated.
- Scott
Posted by sigismund on May 15, 2010, at 20:15:16
In reply to Re: History of depression - um?, posted by SLS on May 15, 2010, at 17:07:58
Do people have nervous breakdowns these days?
A NB was what was between persistent misery of the normal sort and hospital and the treatments there.
I can remember my mother saying (rather amusingly, I think) 'it's not scientific', referring to nervous breakdown.
Posted by Conundrum on May 15, 2010, at 23:25:38
In reply to Re: History of depression - um?, posted by sigismund on May 15, 2010, at 20:15:16
I think nervous breakdowns was basically a major depressive episode. This is not really a currently accepted medical term. Maybe it had been at one time.
Posted by ed_uk2010 on May 16, 2010, at 2:47:10
In reply to Re: History of depression - um?, posted by sigismund on May 15, 2010, at 20:15:16
>Do people have nervous breakdowns these days?
It used to be a very popular term among the general public in Britain. I've not heard it as much recently.
I think it referred to anything which was bad enough to need a few months off work, plus or minus a hospital stay. Could be depression but also severe anxiety.
It's not a scientific term but it's no worse than most of the popular psych terminology. The worst is probably 'dysphoria', which can refer to pretty much any unpleasant emotion. Talk about vague. If someone on p-babble asks 'What should I take for dysphoria?', I really have no idea what they are talking about. Now if they said they were feeling anxious, distressed, jealous, angry, sad, agitated, bored, tired, weak, restless or frightened I would have more idea what they were talking about.
Posted by sigismund on May 16, 2010, at 16:15:03
In reply to Re: History of depression - um? » sigismund, posted by ed_uk2010 on May 16, 2010, at 2:47:10
>it's no worse than most of the popular psych terminology.
Indeed.
When duty is a more compelling social force and the possibility of rescue (FWIW) by the psych profession not a feature of the landscape, it makes sense that invalidism is marked by a more violent social rupture, which is why the term has dropped out.
Take those killings of children in China, for example.
Posted by ed_uk2010 on May 16, 2010, at 16:39:06
In reply to Re: History of depression - um? » ed_uk2010, posted by sigismund on May 16, 2010, at 16:15:03
>When duty is a more compelling social force and the possibility of rescue (FWIW) by the psych profession not a feature of the landscape, it makes sense that invalidism is marked by a more violent social rupture, which is why the term has dropped out.
Hi Sigi,
Not sure that I fully understand. Do you mean that in some cultures, depression is not diagnosed because people simply don't have the option of taking on the 'sick role' unless they are totally incapacitated?
Posted by sigismund on May 16, 2010, at 17:54:05
In reply to Re: History of depression - um? » sigismund, posted by ed_uk2010 on May 16, 2010, at 16:39:06
>Do you mean that in some cultures, depression is not diagnosed because people simply don't have the option of taking on the 'sick role' unless they are totally incapacitated?
Exactly. If being sick is not an option, you either stay as well as you can appear to be, or you crack.
The expression 'running amok', comes from Malaya, I think.
Posted by ed_uk2010 on May 17, 2010, at 13:49:27
In reply to Re: History of depression - um? » ed_uk2010, posted by sigismund on May 16, 2010, at 17:54:05
>The expression 'running amok', comes from Malaya, I think.
Isn't that when someone starts running around killing people?
Posted by sigismund on May 17, 2010, at 16:10:29
In reply to Re: History of depression - um? » sigismund, posted by ed_uk2010 on May 17, 2010, at 13:49:27
>Isn't that when someone starts running around killing people?
Yes....like those killings in China.
I wonder if mental illness manifests differently in individualistic cultures as opposed to collectivist ones.
Posted by linkadge on May 17, 2010, at 20:00:40
In reply to Re: History of depression - um? » sigismund, posted by ed_uk2010 on May 15, 2010, at 16:55:11
And - in selling an illness you need to make the prognosis (for a disease without treatment) as sounding as bad as possible.
Something like 15% of the U.S. population is on antidepressants. I don't believe that this 15% would all commit suicide if their depression happened not to be treated with drugs. Infact, depending on the data you choose to look at, suicide rates have not dropped significantly since the introduction of antidepressants.
People would suffer, but for most depressions, the disease dose remit after 8-12 months. Then, typically the patient would be better for extended periods. Even in our "family history" of depression, those who didn't treat usually had 2-3 episodes in a lifetime. Yet, they were absolutely *fine* between epsiodes.
Nowadays, we are on the meds for life. Just because we have had an epsiode or two. Most of use just can't get off the drugs or don't want to get off the drugs.
Linkadge
Posted by linkadge on May 17, 2010, at 20:05:35
In reply to Re: History of depression - um? » sigismund, posted by ed_uk2010 on May 16, 2010, at 2:47:10
Perhaps this is it. For our prediction of the disease outcome, we are relying on an old definition of the disorder.
Sure, people who had the disease in the 50's, may have had a poor outcome, but can the same thing be said for the 1 in 5 Americans diagnosed with depression sometime in their lifetime these days?
Posted by linkadge on May 17, 2010, at 20:17:28
In reply to Re: History of depression - um? » ed_uk2010, posted by sigismund on May 16, 2010, at 17:54:05
>Exactly. If being sick is not an option, you >either stay as well as you can appear to be, or >you crack
Sometimes being mentally healthy simply requires the right adaptive response for the right situation. Even the thought that one should not
"have to" suffer, opens doors which directly counteract this adaptive response.We are spoiled as a society. Rising obesity is one indicator of this. Depression can be just be another manifestation of lack of psysiological stimulii. We weren't mean to sit in front of computers all day eating little white powdered donuts.
Weren't suicide rates in Brittan at an all time low during the WWII bombings?
Linkadge
Posted by linkadge on May 17, 2010, at 20:23:24
In reply to Re: History of depression - um? » ed_uk2010, posted by sigismund on May 17, 2010, at 16:10:29
>I wonder if mental illness manifests differently >in individualistic cultures as opposed to >collectivist ones.
Well, collectivist ones likely engage in more "group therapy" so to speak.
Individualist societies also learn to seek reward for ones self. Self focused reward is shallow (like crack). Reward for pleasing others probably employes different brain regions entirely -keeps us connected. Strong social networks help maintain immune responses during stressful times. Strong social networks lower cortisol during stressful events too.
Just the idea of getting ones mind off ones self is probably an extremly powerful antidepressant.
Linkadge
Posted by sigismund on May 17, 2010, at 20:42:13
In reply to Re: History of depression - um? » sigismund, posted by linkadge on May 17, 2010, at 20:23:24
If you ask Vietnamese school kids (in Vietnam) to ask you a question, mostly they will ask you your age. This is so they know which of the numerous forms of address is the appropriate one.
One girl at the English language school didn't want to come to Australia. Her friend had told her she was very lonely here. There the life is all on the street.
When a person from a culture like that goes crazy or depressed, it must be different.
Posted by chujoe on May 18, 2010, at 7:12:51
In reply to Re: History of depression - um? » linkadge, posted by sigismund on May 17, 2010, at 20:42:13
This is absolutely true. Though I'm an American I have lived for extended periods in Vietnam. One of the things I love about the place is how much of life is lived communally. But there is great pressure to conform because failure to conform often means being excluded & lonely. It is hard for us in the west to understand how frightening the prospect of loneliness is to a Vietnamese person -- whether that loneliness is caused by immigration or mental illness.
A number of people have noted lately here on PB that "mental illness" exhibits itself differently in different cultures, a fact that might give us some clues as to what happens when someone gets sick. Personally, I think it's a combination of biological predisposition and environmental influences, including the influences of the social worlds in which an individual lives.
Posted by ed_uk2010 on May 18, 2010, at 15:25:44
In reply to Re: History of depression - um? » sigismund, posted by linkadge on May 17, 2010, at 20:23:24
>Individualist societies also learn to seek reward for ones self.
I suppose it leads to people becoming quickly disatisfied?
I guess there's a growing belief in the West that we shouldn't have to feel psychological pain. Minor/temporary psychological problems are increasingly medicalised (and treated with SSRIs).
Whether or not a person's condition should be viewed as an illness is often quite subjective.
Posted by hyperfocus on May 19, 2010, at 17:48:45
In reply to Interesting article? What do you think?, posted by Laney on May 9, 2010, at 11:38:40
I can't understand how Robert Whitaker is allowed to completely misstate the facts about how depression and drugs works. His descriptions of how psych drugs work are very naive. He says stuff like psych drugs are 'stimulating' and hence can cause bipolar mania...and that drugs can convert unipolar to bipolar depression and cause cognitive problems over time. That's not really how it works. The guy clearly has very limited knowledge about psychiatry and psychopharmology and is just cherry-picking statements and studies to support his thesis. I can easily count a dozen people on PB who could right a better book than him.
Remember in the film Sixth Sense when the wife was taking Zoloft after her husband died?
My takeaway from this article and the ones posted in this thread is that people with TRD, bipolar, psychotic depression or depression co-morbid with anxiety, dissociation, etc. must be separated from people experiencing depression after a traumatic event. It's doing a disservice to everybody and just skews the data too much to keep the two groups of people together. When you try to do an empirical study you end up with absurd conclusions like in the Mercola and Newsweek article. I'm pretty sure in many people you can treat an acute episode of depression with lifestyle changes and counselling and most of all, healing time, effectively. For these people prescribing ADs may not be the best course of treatment and can cause more problems due to side effects and hitting the wrong receptors. But people with chronic, serious depression need drugs, and all of the studies show that the right drugs can help people like us.The 2nd thing is that I don't think we've got to a point where depression and other non-psychotic mental illnesses are accepted as real diseases. When I hear doctors like Mercola talking about willpower and control I get mad because they're basically saying that all people with depression can just snap out of it.
Posted by StillHopefull on May 20, 2010, at 10:47:52
In reply to Re: Interesting article? What do you think?, posted by hyperfocus on May 19, 2010, at 17:48:45
Just my opinion - worth what you pay for it... ;-D
There are times in everyone's life when things happen to cause stress, anxiety, anger, sadness, grief. If a loved one dies, certainly it is understandable to go through a very rough time, and have difficulty dealing with day to day routines. This is part of living and NOT a disease. Time, understanding, and compassion will get people through things like this.
Time, understanding, and compassion will NOT help someone who has a disease of mental illness. This is when medication is necessary and life saving.
I think that Landy is right. The DISEASE needs to be kept separate from normal human feelings that we all have from time to time.
Posted by hansi555 on May 20, 2010, at 11:04:47
In reply to Re: Interesting article? What do you think?, posted by StillHopefull on May 20, 2010, at 10:47:52
I totally agree
And that is why I also will go off the meds.I had a single episode more than 2 years ago and if I am going to try without the meds it should be now and not in 2 or 3 years from now. Besides I have had so many upps and downs that I amwondering how much the meds are doing for me...
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
[email protected]
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.