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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk2010 on May 9, 2010, at 14:45:35
In reply to Re: Interesting article? What do you think?, posted by bulldog2 on May 9, 2010, at 14:30:25
>Diet and exercise? How do you get this depressed person to do these things?
I've got an image in my head of a row of exercise bikes lines up on a psych ward.
Seriously though, they ought to pay more attention to the food that they give to inpatients. Talk about non-nutritional.
Posted by bulldog2 on May 9, 2010, at 15:03:42
In reply to Re: Interesting article? What do you think? » bulldog2, posted by ed_uk2010 on May 9, 2010, at 14:45:35
> >Diet and exercise? How do you get this depressed person to do these things?
>
> I've got an image in my head of a row of exercise bikes lines up on a psych ward.
>
> Seriously though, they ought to pay more attention to the food that they give to inpatients. Talk about non-nutritional.I am willing to be the first in line to say that diet and exercise are a key component in our overall health. But athletes and those that follow a good lifestyle fall prey to this disease. I get so tired of those that claim they have the silver bullet to this disease.
I have a feeling that the severely depressed just lingered in their depression for years. Maybe had a remission and than went back into depression.
Back in the good old days most people were active and ate well.I personally believe that magnets are the key to curing depression. The + and - side of the brains have to be brought into harmony.
Posted by Phillipa on May 9, 2010, at 20:20:46
In reply to Re: Interesting article? What do you think? » ed_uk2010, posted by bulldog2 on May 9, 2010, at 15:03:42
I personally worked in psych and was nationally certifed in psych nursing and saw same as vidio depicts. A patient admitted maybe suicidal tiny cuts on arms. Given a med and l0 minutes later laughing with other patients. Now this doesn't happen to my knowledge with depression mild or moderate, or severe. Severe is so bad incapible to suicidal it's when coming out of depression that the energy is available to carry out the act. I feel that meds are like giving say thyroid patients thyroid medicine and the thyroid doesn't need to work as hard. But that's not really true as thyroid is a disease, illness whatever. Give a brain serotonin and the brain doesn't need to make as much so becomes dependant on the med. Med trials are just too short. Phillipa
Posted by desolationrower on May 9, 2010, at 20:38:42
In reply to Interesting article? What do you think?, posted by Laney on May 9, 2010, at 11:38:40
of course life situation, diet/exercise, etc are very important for mental health. but this doesn't make depression 'not a disease'. Do people say rickets or tennis elbow are 'not a disease'? Most things people die of are highly affected by those same factors. The reason they are 'diseases' is that doctors have modalities like drugs or brain stimulations or surguries that can help. which is to say i thing medical should proceed from practical goals, not first principles.
and a medical problem can cause people to be crippled, but they are helped if society puts in wheelchair accessible entrances. That doesn't make finding cures less useful.
I do think its good not to think of 'is it a disease' as a question of the doctor just remedying a deficiency/eleminated an excess. most doctoring is doing something unnatural to make you feel better. aspirin fixes headaches, even without aspirin deficiency.
-d/r
Posted by conundrum on May 9, 2010, at 21:14:36
In reply to Interesting article? What do you think?, posted by Laney on May 9, 2010, at 11:38:40
If you go to the bottom of the link you posted you can see that mercola recomends a whole bunch of things he sells at his site like EFT and fish oils. His site certainly isn't unbiased, most of the articles are designed to generate cash. That isn't to say fish oils and EFT aren't bad and that there aren't dangers to psych drugs, but this guys got an angle.
Posted by 49er on May 10, 2010, at 4:22:06
In reply to Re: Interesting article? What do you think? » Laney, posted by conundrum on May 9, 2010, at 21:14:36
> If you go to the bottom of the link you posted you can see that mercola recomends a whole bunch of things he sells at his site like EFT and fish oils. His site certainly isn't unbiased, most of the articles are designed to generate cash. That isn't to say fish oils and EFT aren't bad and that there aren't dangers to psych drugs, but this guys got an angle.
Hi Conundrum,
While this article is on Mercola's site (I agree with you about him by the way), 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.
Obviously, many posters on this site are going to feel differently. But that is what the focus should be on and not on Dr. Mercola in my opinion.
Back to Mercola - When I listened to him interview Whitaker, in a way, it was funny (although not really) as he tried to hawk his stuff. But he just couldn't figure out how to do it and gave up as the interview continued.
He was annoying as heck as I felt he talked too much.
49er
Posted by SLS on May 10, 2010, at 8:04:23
In reply to Re: Interesting article? What do you think? » conundrum, posted by 49er on May 10, 2010, at 4:22:06
Hi.
> 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.
Do you know whether or not he suffered from depression? Had he been personally disappointed when taking antidepressant drugs?
Claiming knowledge of statistics doesn't guarantee their validity. I have seen statistics indicating that the response rate of antidepressants is significantly greater than 15%. This is especially true when one includes those people who are allowed to try more than one drug, either sequentially or in combination. Under these conditions, I have seen the response rate reported as being between 75-85%, and remission rates of 60%. 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.
- Scott
Posted by bulldog2 on May 10, 2010, at 8:24:08
In reply to Re: Interesting article? What do you think? » Laney, posted by conundrum on May 9, 2010, at 21:14:36
> If you go to the bottom of the link you posted you can see that mercola recomends a whole bunch of things he sells at his site like EFT and fish oils. His site certainly isn't unbiased, most of the articles are designed to generate cash. That isn't to say fish oils and EFT aren't bad and that there aren't dangers to psych drugs, but this guys got an angle.
I missed the selling link. Than this is just a fancy advertisement for whatever he is selling. Once there is financial gain for a point of view the entire article has to be trashed.
The internet is literally filled with perhaps a million or more of the pseudo science/advertisements. They are designed to give you hope,take your money and put money in the owner of the web site. Often despicable as they prey on the sick and give them false hope.Yes diet,exercise and MY PRODUCTS will cure you!!!!
Posted by bulldog2 on May 10, 2010, at 8:39:16
In reply to Re: Interesting article? What do you think?, posted by SLS on May 10, 2010, at 8:04:23
> Hi.
>
> > 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.
>
> Do you know whether or not he suffered from depression? Had he been personally disappointed when taking antidepressant drugs?
>
> Claiming knowledge of statistics doesn't guarantee their validity. I have seen statistics indicating that the response rate of antidepressants is significantly greater than 15%. This is especially true when one includes those people who are allowed to try more than one drug, either sequentially or in combination. Under these conditions, I have seen the response rate reported as being between 75-85%, and remission rates of 60%. 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.
>
>
> - ScottPeople 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?
Posted by Laney on May 10, 2010, at 8:52:51
In reply to Re: Interesting article? What do you think?, posted by bulldog2 on May 10, 2010, at 8:39:16
Great discussion. I was more interested in what the journalist had to say than Mercola because of the fact that other than a book he wasn't selling a cure so to speak.
Thanks Babblers,
Laney
Posted by 49er on May 10, 2010, at 9:32:32
In reply to Re: Interesting article? What do you think?, posted by SLS on May 10, 2010, at 8:04:23
> Do you know whether or not he suffered from depression? Had he been personally disappointed when taking antidepressant drugs?Not that I am aware of. If you go to his website, you can email him and ask directly.
>
> Claiming knowledge of statistics doesn't guarantee their validity. I have seen statistics indicating that the response rate of antidepressants is significantly greater than 15%. This is especially true when one includes those people who are allowed to try more than one drug, either sequentially or in combination. Under these conditions, I have seen the response rate reported as being between 75-85%, and remission rates of 60%.Hmm, I have seen nothing like that. The Star D study was reporting 67% but that is the best I have seen.
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. But I thought I would ask anyway just in case you remembered.
<<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.
Thanks
49er
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.
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