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Re: Starting Parnate after 15 yrs treatment-resistance

Posted by Robert_Burton_1621 on February 9, 2015, at 7:51:17

In reply to Re: Starting Parnate after 15 yrs treatment-resistance, posted by ed_uk2010 on February 5, 2015, at 7:12:32

> I suppose... psychiatry promotes the idea that 'now we have modern medications, depression can be treated easily'. In reality, I'm unsure that the proportion of patients who can be treated effectively has increased that much over the last few decades. The number of pts having to discontinue due to adverse effects may have decreased due to a greater number of tolerable options, so that could have led to an increase in response rates. A large number of those who respond do not achieve remission, however. And this is important.
> In some conditions such as bipolar disorder and particularly schizophrenia, some degree of treatment resistance is the norm, not the exception. A partial response to treatment is indeed the most common outcome.

Very good points, especially the one about the criterion for "remission". A couple of additional ones:

(1) It is difficult not to suspect that the loosening or extension of authoritative criteria (i.e. under the DSM) as to what amounts to clinically-relevant "depression" has not influenced, and distorted, the outcome of studies whose results appear on their face to support the proposition that "depression" is in the majority of cases successfully, and relatively straighforwardly, treatable. But what kind of "depression" did participants in such trials suffer from? Were sub-clinical syndromes included and categorised as "depression" as a result of expanded definitional parameters?

(2) The tendency to assume, and on the basis of such an assumption to promote the idea, that new medications invariably indicate an advance in the treatment of psychiatric illnesses is perhaps a function of two (not necessarily mutually supportive) imperatives: (a) to emphasise the character of psychiatry as a legitimate science which progresses cumulatively; and (b) to justify the financial investments made into research whose purpose is ostensibly to formulate more efficacious drugs, especially by commercial interests. In regard to (b), it is an irony that the porportion of dollars invested in narrowly targeted research projects (often structured by limited goals determined by perceived market priorities) does not always match the intrinsic importance and potential benefit of the clinical results actually achieved. Serendipity still sometimes rules. These observations do not argue against investment in research: they simply counsel scepticism in the face of puffery which leads us illicitly to infer that more investment inevitably means better and more effective treatments.




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