Posted by SLS on April 8, 2006, at 14:20:53
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 8, 2006, at 13:16:14
> Not everbody with severe depression is low in energy. Severe suicidal depression can exist completely independantly of any psychomotor retardation.
It is true that agitated depressives have psychomotor activation. These people are probably more at risk for having suicidal ideation. Others are just too anergic, psychomotor retarded, or vegetative to contemplate suicide.
One reason people develop suicidal ideations while taking antidepressants is that they regain enough mental energy to contemplate and plan. This occurs as they begin to respond favorably to treatment, but before they have responded well enough to feel substantially less depressed. It is an irony of sorts. Unfortunately, not enough psychiatrists take this into consideration when they treat people. They don't council patients to be aware of this risk, and they don't monitor patients closely enough during this critical period early in treatment. Of course, some of these drugs can also produce idiosyncratic exacerbations of depression. Just giving patients the insight that these are possible response scenarios would help keep them safe.
> If a person with severe depression was capable of exercise I would recomend trying it first.
I doubt we will agree on this point.
> Antidepressants have a degree of toxicity and potential for dependance,
As do many other types of drugs prescribed for various ailments. Prednisone?
> they can also poop out.
Yes. I know. It is obvious that our current armament of medications is lacking.
Still, you have a better chance of responding robustly to an antidepressant than you do to exercise if you are severely depressed (MDD). This is my contention. I doubt we will agree here.
> Many people with severe unipolar depression don't see results with an antidepressant for a few months anyway.
From what I have seen with the doctors I have worked with, I think this number represents a minority. I think the majority of responders will demonstrate subtle improvements during weeks 3 and 4 of treatment at a therapeutic dosage. I have yet to meet a doctor who routinely uses a rating scale to evaluate the condition of their patients (outside the arena of investigative work). I bet an improvement would become evident earlier in treatment if they were to do so.
> Remember, we must not start this argument under the assumption that antidepressants work flawlessly.Nor do the doctors who prescribe them.
Despite all of my treatment failures, I still believe that, in capable hands, over 75% of MDD people will respond well to the drugs we already have available, especially when used as part of a multimodal approach that may include psychotherapy, nutrition, and even exercise.
- Scott
poster:SLS
thread:629584
URL: http://www.dr-bob.org/babble/20060408/msgs/630599.html