Posted on 02/21/2003 11:36:37 PM PST by FairOpinion
LONDON (Reuters Health) - Use of antidepressants for one year or more, in addition to the four to six months standard treatment, cuts the relapse rate in half for people with depression, according to a new report.
"Many patients remain at appreciable risk of recurrence after four to six months of treatment," said Professor Guy Goodwin, co-author of the study. "Another two years of antidepressant therapy will approximately half their risk of experiencing another episode."
In the study, Dr. John R. Geddes from the University of Oxford and colleagues in Japan and the US looked at 31 different trials involving more than 4,400 participants who had responded to treatment with antidepressants. The participants were then assigned to continued treatment or to placebo.
According to the report, further treatment for one to two years with antidepressants reduced the odds of relapse by 70%, with an average relapse rate of 18% for continued treatment and 40% for placebo. The findings are published this week in the British medical journal, The Lancet.
"The major fear for patients is of relapsing," said Goodwin. "We hope that our findings will offer them some reassurance."
The researchers suggest that further trials are needed in patients with milder illness, who may have a lower risk of relapse.
Goodwin noted that funding for the study came from the UK-based Wellcome Trust biomedical charity, and was independent of the pharmaceutical industry.
The researchers are now attempting to determine why patients choose not to take medications for extended periods of time.
"There is almost certainly a folk belief that long-term use of medication can cause harm or lead to addiction," he said. This belief may be common in doctors as well as patients, Goodwin said.
"We need to match the evidence with people's beliefs," he said.
Dr. Deenesh Khoosal from the Royal College of Psychiatrists said the paper was "an important contribution to the on-going debate on antidepressants." He also supported the need for further research.
According to the World Health Organization, depression is the leading cause of disability and the fourth leading contributor to the global burden of disease in 2000.
SOURCE: The Lancet 2003:361;653-661.
They cover quite a bit about how psychiatric studies are carried out and why the studies should be viewed with scientific skepticism.
From the very limited information presented in the article, I can already spot a few things that would skew the results.
1) Due to side-effects (or lack of side-effects with placebo), the patients and doctors can easily figure out who is taking the actual medicines and who is taking the placebos. Those on the antidepressants "know" they are getting "strong" medicine because they are experiencing side-effects, which can create a placebo effect on it's own. And the inverse is true. Those on placebos don't experience the side effects that they had while on the drugs so they "know" they aren't on the antidepressants, causing a reverse placebo effect. The doctors "monitoring" the patients are not "blind" to the side-effects either. Their own biases can also affect the research "such and such is obviously on an antidepressant therefore he must be doing better". The nonblind nature of this study alone makes the entire study an uncontrolled experiment.
2) Withdrawing from antidepressants is known to cause depression. By taking someone that has been on antidepressants for an extended time and switching them to a placebo, you are almost guaranteed to have "relapses" into depression. Unfortunately, this gets blamed on the patient, and not on the withdrawal effects of the drug. This factor is also enough to invalidate the study.
Patient: "Gee, and doctors wonder why the public considers them quacks."
Explain why this scenario of yours applies to treatments for clinical depression - a physical problem - and doesn't apply to, say, chemotherapy for cancer or protease inhibitors for HIV+ patients. (Note: An uninformed personal opinion on the meaning of "mental" illness is not an explanation. Facts only, please.)
Unfortunately, Dr. Breggin is a flat-out tinfoil kook on this issue. His arguments basically consist of conspiracy theories and Paleofreudian arguments about "frigid mothers." There's no doubt a lot of kids are misdiagnosed as ADHD, but that doesn't mean ADHD doesn't exist, or that the medications don't work for those with the disorder.
Depression is a chicken and egg problem that science has not solved. Does the root cause of depression result in serotonin hyperabsorption in the brain, or is depression caused by serotonin hyperabsorption? Or maybe depression is so tricky that it can be either, or a cascading cycle of both. You see, if depression results in serotonin hyperabsorption, then an SSRI only treats the symptoms, but in the alternative, the SSRI is actually treating the disease. Studies are ongoing.
I think a lot of depression is the lifestyles we live, the competition, societal pressures. I know people who said changing lifestyle or changing jobs made all the difference.
All of this is true, and very encouraging news for the mild cases. The more severe the case (including longterm chronic dysthymia or debilitating major depression), the more likely that rigorous cognitive therapy AND/OR medication will be necessary.
Oh yes, absolutely. Nobody with depression should simply be tossed pills and be told "these'll make ya feel better." They should be prescribed medication and therapy for a period of time; it's well-proven that providing both medication and therapy greatly increases each other's effectiveness and shortens the length of time most people need either. And, of course there's a difference between dysthymia (general low-grade depression that just keeps you kind of down, unable to fully enjoy life or function at 100%) and major clinical depression (the severe kind where you can barely function at all, don't even want to get out of bed, may be contemplating suicide, etc). The latter almost always requires the use of medications for some period of time, though again it shouldn't be prescribed without therapy.
The real problem is that most insurance companies do not provide mental health coverage that is anywhere near equivalent to so-called "physical" coverage (a term that is a lie, as mental health problems are as physical as a broken leg). Your doctor can prescribe you a $1500 medication to treat athlete's foot and your insurance company will happily pay up, but if he says "Go see a therapist for a few weeks," the insurance company will screech and stall and pretty much absolutely refuse to cover even a single session. And those that do usually only allow a limited number of sessions (like 10, or less) with barely-qualified, just-out-of-college "therapists" (read: someone that just got their BA in Social Work) not actual psychiatrists. And those 10 or fewer sessions may be PER LIFETIME, not per year. And then the world wonders why so many of these people never get any better.
I worked in a mill and we had a policy that said "If you come in drunk, you go to rehab". The day before hunting season began, a pile of men came in drunk. We wrote them out for two weeks of rehab with a "therapist" who opened in a trailer just across the highway from the plant.
People with suicidal depression tend to have a sudden burst of extreme happiness the last few days before their suicide attempt, because they've finally made their decision to "do it" and are thus ecstatic that their psychic pain will soon be over.
If you have a friend or coworker that's long had a depressive personality who suddenly shows up one day acting like the happiest person alive, starts offering you their possessions ("Oh, I don't want that 40-inch projection TV any more. Why don't you bring your minivan over and pick it up this evening? I want you to have it!"), or just generally acting 180 degrees from their usual mopey self, you should absolutely put normal etiquette aside, drag that person into a private room and *demand* they tell you what's up. There's a very high probability you may end up saving their life.
I like to compare dysthymia and major depression with a rain analogy. Normal human moods are like the weather: sometimes rain sometimes sun. Major clinical depression is like Indochina, sometimes it's the dry season, but sometimes it is monsoon season. Dysthymia is like living in Seattle: There are sunny days, but they are rare, and most of the time, it is raining...either a little or a lot.
Damn right. In fact, in a lot of states you don't even need a license. You can just rent an office, hang out your shingle reading "John Duh, THERAPIST", and start taking patients. Nobody should EVER go to a "therapist," IMHO, unless they're dealing with an emotional issue that needs arbitration more than treatment.
Other "psychotropic medications" that can cause sexual dysfunction: Monopril and Norvasc (for high blood pressure), Zoladex (prostate cancer), Roferon-A (hepatits C), Viracept (HIV) ... should I go on?
they don't produce melotonin like they used to
1) The creation/destruction of melatonin in the body, and the effects of such, are much more complicated than your simple statement would lead people to believe. 2) You can buy melatonin supplements at any Wal-Mart for around $6 if you're that worried.
And you also didn't note that for the vast majority of people that suffer antidepressant side effects, they go away after the first couple of weeks.
and they're just not interested in much of anything. You aren't depressed anymore you're just flatlined.
The medical term for this is "malpractice," not "brain damage." If the treatment is turning the patient into a zombie, it's time to try another treatment.
Oh, and according to the Feds you're not responsible enough to own a firearm if you've been on anti-depressants.
I'd like to see a cite for this. I know PLENTY of people who have been on ADs for years that have gun permits. I've heard anecdotal evidence of some people that have been committed to mental hospitals against their will who have had trouble getting firearms, but that's about it.
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