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Re: Starting Parnate after 15 yrs treatment-resistance

Posted by Robert_Burton_1621 on February 5, 2015, at 4:01:30

In reply to Re: Starting Parnate after 15 yrs treatment-resistance, posted by ed_uk2010 on February 4, 2015, at 4:29:13

> Welcome to p-babble and do keep us up-to-date with your Parnate experience.

Thanks, indeed. Very early stages now, but would definitely like to post periodically on how I'm faring on it.

> Psychiatry might like society to think that the number/proportion of treatment-refractory patients is small, but in reality it is (unfortunately) huge.

I had not thought of putting the issue this way. Your observation identifies, perceptively, a plausible cause of the general lack of awareness of the actual extent of treatment-resistance. It does not appear to be much acknowledged outside of specialist studies. Outfits here, in Australia, like Beyond Blue, while they do some good work, also peddle to the public, quite misleadingly (in my view), the idea that "depression" is a more or less easily treatable condition. Such an assertion relies, of course, on an equivocation as to the precise meaning which is intended by use of the term "depression". My suspicion is that its usage in this way evacuates it of much clinically significant content; which therefore makes it unsurprising that - if "depression" is defined to include sub-clinical syndromes - it is transformed into an essentially transient condition which is claimed to be easily treatable according to the recognised modalities of conventional (which is not synonymous with scientifically-informed and critical) psychiatry.

I have become rather sceptical of the merits of mental health lobby groups like Beyond Blue. Their work tends rather to confirm the paradoxical truth of Byron's dictum that "this is the patent age of new inventions / For killing bodies, and for saving souls, / All propagated with the best intentions."

That description is of course a bit hyperbolic; but I am persuaded by personal experience that the high-minded intentions of mental health lobby groups can, on occassion, result in real damage to the interests of patients for whom the "new inventions" simply do not work. An example might make this a little clearer.

The disability offices of universities, mostly under the influence of the essentially upbeat message of organisations like Beyond Blue, have in recent years undertaken "awareness campaigns" about the supposed life-time incidence of "depressive" illnesses. The intent is to assist students who are suffering and cannot always comply with conditions on their candidature. But such "campaigns" seem always to go along with the assumption, often expressed without any qualification, that no-one should be hesitant to disclose his or her "depression" because treatment is essentially straightforward and in the majority of cases successful. The consequence, frequently, is this: departments become over-burdened by claims for consideration by students with "depression". Academics, who are not in any case well known for their empathy, become sceptical about the grounds of these proliferating claims. To accept them unsceptically would necessitate accepting the implied premise that the prevalence of clinically-serious depressive conditions has sky-rocketed in a matter of years, a premise that warrants explicit epidemiological justification, not mere unreflective assent. The result of such scepticism is two-fold: first, it leads academics to attribute the rise in claims not to genuine medical conditions but to student laziness, incapacity for tertiary study, preciousness, malingering, etc.; secondly, the fate of that small number of students who are, according to a rational and robust clinical definition, suffering terribly, is assimilated to that of everyone else, and the failure of their treatment to reflect the rosy prognostications of the "awareness" industry is attributed to their own failure to seek adequate treatment, a cruel and paradoxical conclusion that all too often has the effect of ruining the futures of these students.

Anyway, that's one (rather long!) example of the real-life implications of psychiatry's omission to acknowledge the extent of treatment-resistance.

> There is plenty of information about tranylcypromine here, so I hope you get some helpful replies.

So I have discovered! It is encouraging and I will make a point of looking through the archives.




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