Bending the Third Rail
Because We Should, We Can, We Do
Thursday, March 23, 2006
This Is Depressing
There have been a few news reports out regarding a study done of the effectiveness of anti-depressant medication over the last day or so. One of them is this WaPo article. Excerpt:
Antidepressants fail to cure the symptoms of major depression in half of all patients with the disease even if they receive the best possible care, according to a definitive government study released yesterday.

Significant numbers of patients continue to experience symptoms such as sadness, low energy and hopelessness after intensive treatment, even as about an equal number report an end to such problems -- a result that quickly lent itself to interpretations that the glass was either half empty or half full.

The $35 million taxpayer-funded study was the largest trial of its kind ever conducted. It provided what industry-sponsored trials have rarely captured: Rather than merely ask whether patients are getting better, the study asked what patients most care about -- whether depression can be made to disappear altogether.
I have a couple of points to make about this report and the way the media is covering it.

1) The WaPo article is extremely negative. ABC News did a report last night that was far more positive. Why did WaPo focus on only the negative? In a rare turnaround, the print article was a much more cursory look at the study as compared to the ABC New TV piece.

2) None of the news reports put the results in context. As little as twenty to thirty years ago, the available medications were often not as effective and had terrible side-effects. Medication for depression was an iffy possiblity at best during these times. The new medications have far fewer and less severe side-effects than the precurors.

3) The study highlights a very important consideration in looking at drug therapy for depression. Each of us is slightly different chemically. The anti-depressants are all somewhat different. It's important for depressed patients to get on the best medications for them as an individual. As most anti-depressants take anywhere from one to three weeks to become effective, it's a timely process requiring diligence to find the right drug for you.

4) The study showed that many individuals respond well to a combination of drugs. The media is highlighting the results of those who took a single drug. Again, it takes patience and skill to find that combination.

5) Most people go to a general practictioner for anti-depressants. Unfortunately, few G.P.'s are really qualified to treat those who do not respond (50% according to the study) to a single, initial anti-depressant. Yet, most patients are reluctant to take the next step of seeking a psychiatrists. Unless controlled for in the study, this fact would greatly lower the efficacy rates.

Board Certified Psychiatrists are specialists in understanding the panoply of medication options available. I emphasize "board certified", because any M.D. can call themselves a "psychiatrist" despite having no specialized training. Most psychiatrists no longer practice therapy, but rather work with patients on their very specialized medication management needs. As an example, it was found that the anti-convulsive drug Depakote was quite effective in the treatment of some cases of bipolar disorder. On the other hand, the anti-depressant Trazadone has been found to be a very effective sleep aid. This is the kind of specialized information not available to most G.P.'s.

6) Study after study after study has shown that medication, alone, is not nearly as effective in treating depression as medication combined with psychotherapy. These results are clear, and it's only a very small portion of the population that needs only medication. None of the media reports the number of study participants who were in psychotherapy.

7) For those with intractable depression, electro-convulsive therapy may help. Yes, good old shock therapy is still around. The procedure is done under anesthesia with much lower electrical impulses. But for some individuals who have responded to nothing else, it can be a life saver.

As with most medical care these days, the key is persistence. If an individual is experiencing depression that does not seem to respond to treatment, they need to persist in the pursuit of relief using specialists and a willingness to try alternatives. It's only a very very few individuals who cannot receive relief from their depression if treatment is pursued.

And above all, resist getting your information about treatment .... ah ... well about anything .... from the media alone.
2 Comments:
Blogger Lynne said...
I wonder if depression isn't a normal response to the state of the nation and world!

Blogger Debra said...
Clinical depression is overlooked and treated as is just a little more effort is needed. As an acupuncturist I used to see px in different states of stress. Some I sent straight to their therapist or had them call while in my office, some aren't depressed, they just hate the decisions theyv'e made in their lives. Like all of mine were perfect. Sheesh! GP's shouldn't be prescribing antidepressants any more than an opthamolgist prescribing an antidiuretic in the hope that your BP will go down.


didn't bother to read the article, having a difficult time following the same train of thought since anasthesia.

trust your analyis though.