Posted by ItsHowdyDudyTime on November 27, 2002, at 19:55:10
In reply to Update on hard to treat depression strategies, posted by Bill L on November 27, 2002, at 13:32:31
I hope this message comes out OK. Im on an old Mac with an old version of AOL 4.0. My two previous posts didnt come out right I dont know what the problem is.
Anyway, I read the article a while back. I was unimpressed with it. It is a long, meandering article full of psychobabble. I disagree with the authors about the definition of TRD. TRD is a rather simple term in the real world and can be defined simply. Any person with severe depression and a correct diagnosis who fails three or more antidepressants each from a different class is probably TRD.
The article could have been summed up as "we dont know that much about treatment resistant depression" and "we dont know much about the neurological mechanisms underlying TRD." Instead, many psychiatrists prefer to just try one SSRI after another or do combinations of antidepressants.
The hard fact of the matter is that there are presently only two real effective treatments for severe TRD. They are ECT and old fashioned MAOIs. Thats basically all psychiatry has to offer the TRD crowd. There are experimental treatments for TRD such as rTMS, VNS implants, hormone replacement therapy for older women and testosterone replacement therapy for older men with low testosterone levels. However many of these experimental treatments dont seem to work as good as the hype surrounding them.
In the end, it always comes back to the basics. ECT and MAOIs. There is very little true neurological type research into the mechanisms of TRD. Instead many Pdocs who are frustrated with refractory and TRD patients, prefer to begin saddling TRD patients with various personality disorders and sometimes "occult," subtle, comorbid Axis I disorders such as soft bipolar, mild psychosis, OCD, etc. This is a dead end and rarely leads anywhere except to alienate the TRD patient and drive a wedge between TRD patients and their Pdocs.
Until psychiatry modernizes itself, develops real medical tests to get to the bottom of people's brain based disorders, there will continue to be very little progress on the all too common phenomenon of treatment resistant depression.
Howdy Doody.
PS I hope this post came out ok
poster:ItsHowdyDudyTime
thread:129604
URL: http://www.dr-bob.org/babble/20021127/msgs/129643.html