« Docs and Charity | Main | Reinhardt responds to Salgo »

March 24, 2006

Comments

Stephen

We think that depression is caused by problems with the levels and/or reabsorbtion of either serotonin, dopamine or norepinephrine, or some combination of them. But we're not really sure. Depressive symptoms can also come from thyroid problems and low levels of testosterone, and I'm sure there's other conditions that can produce symptoms eerily similar to depression.

There are some with Bipolar disorder who are misdiagnosed with depression.

Then there's the drugs used in the study. Effexor, in particular, is interesting, since it is an SSRI at low doses and an SN/SRI at higher doses (150mg and above). What dosage was given to the patients? Wellbutrin is an SDRI, and is often used in conjunction with another drug, particularly Effexor. Was this done?

As you mentioned, talk therapy seems to be absent from the study, but is pretty much, at some level, essential to the treatment of depression. If no members of the study went through any therapy, then I am shocked that so many of them were able to report such positive results.

Then there's the whole idea of a "cure." While that is probably just a word the journalist used, it is problematic. There is no "cure" for depression. There is no "cure" for the symptoms of depression. We can treat it, can work with it, maybe we can reduce the symptoms to the point where they seem to have gone. But depression is always there, always waiting, watching for a missed pill, a bad night's sleep, a stressful period in life to come back and try to regain dominance.

What the pills really do is help us to connect with the strength we have always had, help us to stand and fight the bastard every damn day, and make sure that it never owns us again.

spike

Studies have been showing for years that anti-depressents on their own only act as a cover-up of the problem and don't resolve the underlying causes of depression. In other words, as soon as you get off the meds, most people go back to being depressed.

As Stephen said, therapy combined with medication is the best treatment for depression. A lot of times, people are so bad off that without drugs any attempts at therapy are minimally effective. But drugs can act as a jumpstart to enhance the effectiveness of the therapy and allow more healthy and constructive thought patterns to take hold with the patient before drugs are discontinued. Studies I've seen show the relapse rate at only 20% when drugs are combined with therapy. Drugs alone have an 80% relapse rate. The only problem is therapy is really expensive, so many people try to get by with only drugs.

Stephen

Spike,

I'm not sure it's fair to say that medication only covers up the symptoms. Depression is, right now, a chronic and incurable disease. Treating the symptoms is the only option we have. Asthma is the same way, but we don't criticize Advair, etc. because symptoms come back if you stop taking it.

Therapy can be very expensive, plus there are still many people for whom it has a negative connotation. But it is so necessary. If I could stretch the asthma metaphor a bit more, therapy is to depression what exercise is to asthma. Asthma drugs make it possible to exercise without having an attack, they don't do the exercise for us or automatically strengthen our hearts and lungs. Antidepressants make it possible to live outside the tyranny of depression, but they don't automatically teach us how to do that.

spike

Well, considering that most anti-depressant have pretty bad side effects like decreased sexual appetite, problems with sleep, flattened affect, etc., I think it is a problem that without therapy you must stay on them for eternity to keep symptoms away. Especially since therapy so often eliminates the need for drugs entirely.

I would also dispute the claim that depression is incurable. Unless we're actually debating what depression is. If you define it narrowly enough, it can be considered incurable, but you haven't added much to the discussion at that point. But if you're just talking about a constellation of symptoms, many people have had suicidality, decreased energy and motivation, etc., for at least 6 weeks and recovered never again to have that specific group of symptoms for an extended period of time.

But whatever, it seems like we're mostly on the same side here. I believe that psychotropics do good things, generally, but they are no replacement for therapy and understanding how to develop constructive thought patterns etc.

Stephen

But whatever, it seems like we're mostly on the same side here.

Yeah. I think of depression physiologically, resulting from a problem with one or more neurotransmitters. So to me, it must be treated with both talk therapy and medicine. But that is a bit narrow, I realize.

Lauren

I didn't really find this article depressing. That one half of patients show marked improvement after taking anti-depressants is wonderful news for those in the right half. Of course that doesn't do anything for the other folks, but in the aggregate we're because of the existence of SSRI's. Of coures it would be better if the drugs worked more often but most drugs only work some of the time for some of the people; I'm not sure if a 50% success rate is even lower than average.

But the one question that the article didn't answer for me was how long patients were kept on the drugs. I am troubled by the word "round" in this statement from the article:

About one in three patients had seen their depression symptoms go away after an initial round of treatment, a result known as remission. About half achieved that goal after a new round of treatment involving either a new medication or an additional drug, the research found.

Does this mean that patients were put on drugs for a given period of time -- say, 6 months or 2 years -- and then taken off? Because if that's the case, it's no wonder that 1/2 fell into remission. The drugs don't work when you stop taking them!

That aside, I find it encouraging to see research that's asking the questions that indrustry isn't equipped to, even if the results aren't terribly surprising or groundbreaking.

James Kronefield

When I read an article like that I can't help but wonder, is it possible all these "government studies" to be just a huge commercial, payed by pharmaceutical companies, so they can sell their depression medications?

The comments to this entry are closed.