Commentary About Study Questioning Anti-Depressants Effectiveness for Mild to Moderate Depression

An article just published in The American Journal of American Medicine (JAMA) questions the efficacy of the use of anti-depressant medications (ADM) with mild to moderate depressions. The article is not an easy read! Here is an abstract from JAMA.

It looked at six studies with randomized control groups. Three of the studies evaluated imipramine (an older anti-depressant) and three evaluated Paxil. The conclusion is that ADM may be no better than placebo for mild to moderate depression. Further, that there was greater change with ADM as the depression was more severe. The authors reported that it has been known for more than 50 years that more severe medical and psychiatric conditions respond to a greater degree than less severe conditions.

It was also reported that FDA studies of ADM study only those with severe depressions, which they correctly report are not the impressions that Pharma's advertising gives us.

One statement in the Abstract is questionable: “Antidepressant medications represent the best established treatment for major depressive disorder.” Studies comparing ADM with several brief psychotherapies show that the latter are equally effective to ADM. Other studies show regular exercise to also be very effective. Further, therapy and exercise have dramatically lower relapse rates.

So what does this mean if you are on ADM? My suggestion is that if it is working, continue it. Don't suddenly stop altogether. Direct your questions and concerns to your prescribing physician. However, be aware that much of what many physicians know about medications, especially newer ones, is given to them by drug representatives.

email reponse to feature on depression by WCPN

This morning, there was a segment on depression treatments on our local public radio station (WCPN). It was 99% about medical (brief reference to exercise at end) treatments, i.e., anti-depressants, deep brain stimulation, etc. This unbalanced and shallow report bothered me enough to email WCPN. Below is the email I sent to them. I am interested in how YOU feel about this.

Your brief report on depression was woefully lacking. One was left with the impression that the only treatments for depression depression are medical. It is clear that Ms. Cuda had little prior knowledge about depression and that her sources were MDs, medical websites, and/or drug companies.

There have been debates in the past that depression was biological OR psychological. For 25 years, most acknowledge it is BOTH. It would be more accurate to describe it as a bio-psycho-social process.

Trauma can alter one's biology. Negative thoughts can also alter one's biology. Turning the negative thoughts around can IMPROVE one's biology. Schwartz showed this about 20 yrs ago with PET scans of those treated for OCD.

I missed ANY reference to brief psychotherapies that have proven at least equally effective as the anti-depressants. There is about 35 yrs of research that prove this. The research with exercise is another 5 to 10 yrs longer.

A good place to get a more balanced understanding of depression is http://www.nimh.nih.gov/health/topics/depression/index.shtml

While a study reported this week questions the efficacy of anti-depressants for mild to moderated depression http://blogs.consumerreports.org/health/2010/01/antidepressants-most-effective-for-severe-depression-best-buy-drugs-for-treating-depression.html do NOT make the mistake that this message is an attack on medications. Rather, it is a criticism for a lack of depth and balance. I expect MUCH better from WCPN.

Mike Miller, PhD
Psychologist

http://drmikemiller.com/depression.html

Seasonal Affective Disorder for Dummies book review

While some may be put off by the “For Dummies” series title, I have found most to be excellent starting points. Seasonal Affective Disorder for Dummies by Laura Smith and Charles Elliot is where I would suggest you begin if you have questions or interest in Seasonal Affective Disorder (SAD). It references up to date research in a practical, readable manner. It is very well organized and written.

While there is a very good chapter on Light Therapy, what I appreciate most is that most of the book addresses other interventions. What is known to date, is that effective treatments for depression are effective treatments for SAD. Another thing I like is how the authors give examples of negative thoughts in various chapters, followed by healthier thinking. Many will see their own negative thoughts and then see how they can begin to change it to healthier thinking.

If SAD is an issue for you, I highly recommend Seasonal Affective Disorder for Dummies.

Happy Holidays,

Mike

http://drmikemiller.com/sad.html

Winter Blues book review

Winter Blues (Revised 2006) by Norman Rosenthal, MD is THE classic book on Seasonal Affective Disorder (SAD). Rosenthal started his psychiatric career as a research fellow at the National Institute of Mental Health (NIMH) and was one of the original researchers. In this addition, he also references his own experiences with SAD and what has been helpful to himself.

While the main thrust is on Light Therapy (LT), he also gives full and balanced discussion to other researched interventions, i.e., medications, psychotherapy (especially Cognitive Behavioral Therapy – CBT), negative ions, exercise, vitamins, etc. I appreciate that Dr. Rosenthal is not afraid to give his own opinions to questions about LT, after giving what is known through research.

Overall, it is important to know that SAD is very treatable for most people, whether with LT and/or with other interventions.

Winter Blues is well written and practical, doing an excellent job in referencing scientific studies in understandable language. Recommended for anyone with concerns about possible SAD issues.

Reducing further suicide attempts

Suicide is the fourth leading cause of death for those under 65! A study in Philadelphia showed that recent suicide attempters treated with cognitive therapy (CT) were 50 percent less likely to try to kill themselves again within 18 months than those who did not receive the therapy. People were recruited for this study in the emergency room, following a suicide attempt. One hundred and twenty people were either assigned to CT or usual community treatment.

Seventy-seven percent had major depression and 68% a substance use disorder. About half of the participants in both groups took psychotropic medications and about 13% to 16% received drug abuse treatment. About 27% of those in the usual care group received psychotherapy outside of the study, compared to 21% of those also receiving cognitive therapy.

Over the year-and-a-half follow-up period, only 24% (13) of those in the cognitive therapy group made repeat suicide attempts, compared to 42% (23) of the usual care group. Although the groups did not differ significantly in suicidal thoughts, those who received cognitive therapy scored better on measures of depression severity and hopelessness, which the researchers suggest "may be more highly associated with a reduced risk of repeat suicide attempts."

One of the researchers reported, "We were surprised by the amount of energy and resources it takes to reach out to individuals who attempt suicide. This population lacks a positive attitude toward the mental health system and often fails to show up for scheduled appointments. However, the combination of cognitive therapy plus case management services was effective in preventing suicide attempts." He suggests that cognitive therapy's short-term nature makes it a good fit for treatment of suicide attempters at community mental health centers.

If you know someone that has made a suicide attempt, some psychotherapy follow-up should be mandatory.

Best wishes,

Mike

http://drmikemiller.com/suicide.html