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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 17 to 41 of 55. Go back in thread:
Posted by 49er on May 10, 2010, at 9:38:26
In reply to Re: Interesting article? What do you think?, posted by bulldog2 on May 10, 2010, at 8:39:16
> People with agendas can always find studies to back their claims and or put together a study that will prove their claims.
> Very interesting as by just manipulating placebo repsonse you can conventiently subtract their numbers from the AD side. Personally I am often amazed when looking at the double blind studies at how high the placebo recovery rate is. Maybe followers of Mercola's diet and exercise protocol?Bulldog, that works both ways as far as people have agendas.
49er
Posted by bulldog2 on May 10, 2010, at 10:53:14
In reply to Re: Interesting article? What do you think?, posted by 49er on May 10, 2010, at 9:38:26
>
> > People with agendas can always find studies to back their claims and or put together a study that will prove their claims.
> > Very interesting as by just manipulating placebo repsonse you can conventiently subtract their numbers from the AD side. Personally I am often amazed when looking at the double blind studies at how high the placebo recovery rate is. Maybe followers of Mercola's diet and exercise protocol?
>
> Bulldog, that works both ways as far as people have agendas.
>
> 49er
>
>
>Very true
Posted by SLS on May 10, 2010, at 15:26:45
In reply to Re: Interesting article? What do you think? » SLS, posted by 49er on May 10, 2010, at 9:32:32
I doubt that I could find an investigation that was designed to establish such statistics other than the STAR*D study.
> The Star D study was reporting 67% but that is the best I have seen.
That is pretty good when you consider that each subject was given only four treatments out of the many that are available. The 67% they reported was for remission. The rate of response (defined as a 50% reduction in depression scores) must have been substantially higher. I don't think 75% is out of the question. I guess we can't know for sure.
> Do you have a link to that study?
> I know that is an unfair question as I will see studies and then forget where I saw them at.
I appreciate your letting me off the hook here.
:-)
> > It is significant that when working with inpatients or people with more severe depressions, the placebo response rate plunges.
> 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.
It is interesting that the people who would have you believe that antidepressants are no better than placebo must concede that they seem to be effective when severely ill populations are looked at. Khan et al (2002) found that the proportion of studies favoring antidepressants over placebo increased with the severity of depression. The response to placebo declined with increasing severity whereas the response to antidepressants increased.
http://www.ncbi.nlm.nih.gov/pubmed/11799341
- Scott
Posted by Dr. Bob on May 11, 2010, at 1:59:39
In reply to Re: Interesting article? What do you think? » conundrum, posted by 49er on May 10, 2010, at 4:22:06
> the article is referring to the book, Anatomy of an Epidemic, written by Robert Whitaker, that came out in April.
>
> For those of you not familiar with, he started out believing in the miracle of psych meds as a journalist but when he started doing research, he felt the statistics didn't back up the story being told.I'd just like to plug the double double quotes feature at this site:
http://www.dr-bob.org/babble/faq.html#amazon
The first time anyone refers to a book, a movie, or music without using this option, I post this to try to make sure he or she at least knows about it. It's just an option, though.
Thanks!
Bob
Posted by Iansf on May 11, 2010, at 11:31:22
In reply to Re: Interesting article? What do you think?, posted by bulldog2 on May 9, 2010, at 14:30:25
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. Hamlet was pretty obviously a suicidal depressive - and hardly anybody remains alive at the end of that play. If Prozac had been available, Anna Karenina wouldn't have thrown herself under a train and Mme Bovary wouldn't have taken poison. So much of our common cultural heritage is based in the inability of people to control their moods; their passions, whether love or hate, and obsessions got the better of them. While artists were able to point this out and identify both emotional excess and emotional vacancy as serious issues, few were able to point to viable solutions. The notion that depression is a modern illness is pure propaganda. Novelists, poets, playwrights and lyricists wouldn't have written about (and readers wouldn't have wanted to read about) so many sad and disturbed people if depression and other mood disorders had not been widespread.
Posted by bulldog2 on May 11, 2010, at 13:49:55
In reply to Re: Interesting article? What do you think? » bulldog2, posted by Iansf on May 11, 2010, at 11:31:22
> 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. Hamlet was pretty obviously a suicidal depressive - and hardly anybody remains alive at the end of that play. If Prozac had been available, Anna Karenina wouldn't have thrown herself under a train and Mme Bovary wouldn't have taken poison. So much of our common cultural heritage is based in the inability of people to control their moods; their passions, whether love or hate, and obsessions got the better of them. While artists were able to point this out and identify both emotional excess and emotional vacancy as serious issues, few were able to point to viable solutions. The notion that depression is a modern illness is pure propaganda. Novelists, poets, playwrights and lyricists wouldn't have written about (and readers wouldn't have wanted to read about) so many sad and disturbed people if depression and other mood disorders had not been widespread.
Excellent post and could not have put my feelings about this issue better than this. Mercola I believe made a reference to most depressed people in the old days just went into remission without any intervention. Wounder who was keeping stats back than. I believe I've read that opiate products were used by doctors for depressed patients. So there apparently was intervention and I wonder if some of these depressed patients were chronically ill and kept behind doors and hidden from the world.I think depression is used to liberally these days and that muddies the waters. Tcas and maois were used for severely and chronically depressed patients who were not just going to snap out of it, as Mercola seems to imply will happen with most depressed people. I am using the word depressed for biological and/or gentically based mood disorders. This is for life and people do not snap out of it. This chronic depression disease as opposed to millions of people besieging their doctors for ssris because of a sad mood possibly because of life events.
So when the ssris were invented the pharmaceutical companies had to broaden their market so the definition of depression was also broadened to include millions of people who were unhappy about how things were going. Yes these people may not have needed meds and would eventually snap out of it. But now everyone has been lumped together and meaningless stats and assertions have been made.This diet and exercise assertion is absurd. Not that diet and exercise are bad things. But again back in the old days I would think most people worked hard and ate a very traditional and standard diet.
Today these ssris are handed out like candy and whole families are on some type of psychotropic med.
So maybe we have to go back to the pre ssri era as far as looking for the real depressed and use them for our studies.Chronic biological illness is a severe disease that probably needs some type of med intervention. Yes diet and exercise is something we all should be doing but that is at best just a
piece of the puzzle.
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. jcf@sas.upenn.edu
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
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